Failed my drug test and I'm pregnant

KatieMI, BSN, MSN, RN · Feb 7, 2018

The thing is, Katie - while abruption (nobody I know who works in OB calls it "abruptio") can be a catastrophic emergency (not always, its common to have partial abruptions that aren't diagnosed until after delivery with gross examination of the placenta), abruption caused by cocaine use is no more a catastrophic emergency than an abruption caused by any other cause. Meaning, we would not change our course of treatment.
Knowledge of cocaine use has only academic value when it comes to the care and treatment of the pregnant woman. Our treatment of her would not change, knowing she has cocaine in her system.
Regarding your statement "It is tightly linked to cocaine use" - are you saying that cocaine use is a common cause of abruption? Please provide some stats for that. While cocaine use is *a possible cause* of abruption, I strongly disagree that it is "tightly linked". I've seen dozens of abruptions in my years working in OB, and I can't honestly recall one of them that was believed to be caused by cocaine use. (Frankly, I can't recall the last time I saw a pregnant woman who tested positive for cocaine - it's meth and opioids pretty much exclusively).

Cocaine is not a "cause" of abruption. It is as much etiologic factor as obesity in pathogenesis of cancer (yep, we all know that being obese increases risks of breast, colon and other cancers quite a bit but still obesity is not considered to be "cause" of these cancers simply because so far we do not know how pathophysiology really works and why some obese people got cancer but the majority of them still doesn't).

Here are a couple of academic sources re. the subject. Otherwise, it is classic content of obstetrics textbooks, USMLE, ACOG Boards and AANP, and that's only exams I know about.

https://pdfs.semanticscholar.org/d913/dd07432a2ad84a4e30946c5b558a9d559c8b.pdf

(placental abruption accounts for up to 15% of adverse effects of cocaine use during pregnancy - a bit more than "purely academic interest")

Just "incidence/prevalence" number study, but a new one and from a good peer rewieved journal. 14% of patients in sample used cocaine

Etiologies and Risk Factors of Placental Abruption and Neona... : Obstetrics & Gynecology

And, of course, my favorite emedicine, which describes the life as it is:

Abruptio Placentae Clinical Presentation: History, Physical Examination

Ob/Gyn, of course, won't change course of action if the abruption "caused" by cocaine or not. Anesthesia and Critical Care will change a lot of their actions because for them an active user of cocaine is a a MUCH more complicated thing to deal with.

Although I agree that prevalence of cocaine abuse differs from one region to another.

Guest374845 · Feb 7, 2018

How would you get a confirmatory test that predates the false positive?

A hair follicle test targeting fentanyl or its metabolites can show use as far back as 90 days, so if she had her supposed positive UDS in the last few weeks, a hair follicle test could demonstrate error in that test.

And I'm not going to say it would never or has never happened, but CPS does NOT want to take custody of anyone's infant unless the parents are grossly unfit.
In the hypothetical case of the OP, what would typically happen is the patient would be questioned further, they might check with CPS in other counties that the patient might have lived in to determine if there were any previous CPS cases. If there are no red flags, it would be dropped. If there were red flags, they might do a home visit and come up with a plan wherein the parents do regular check-ins with CPS.
No, not ideal, particularly if the parents truly are innocent of illicit drug use. But hardly the "medical kidnapping" scenario that you paint.
99% of the time, DHS just wants to find that the infant is safe, and keep him/her with her parents. If nothing else, it's a LOT less effort and paperwork than to actually take custody of the child.

Again, I'm no expert, but I live in state that has a low threshold for taking kids. Their stance in my state is that they'd rather take ANY potential case out of parent custody and reunite them later when found to be innocent, than to under-react and be so permissive as to miss a real case. And again, just my n=1 as a parent and having had my kid treated in a hospital with the highest rate of 'medical kidnapping' in the state. I defer to your experience, but the picture you paint sounds like a dream compared to some of the less thorough or intellectually developed cases I'm privy to.

klone, MSN, RN · Feb 7, 2018

Katie, I'm not ignoring this. I haven't had time to sit down long enough to really read through your response and formulate one of my own. Feel free to remind me if you don't hear back from me by the weekend (if you care enough, that is)

KatieMI, BSN, MSN, RN · Feb 7, 2018

Katie, I'm not ignoring this. I haven't had time to sit down long enough to really read through your response and formulate one of my own. Feel free to remind me if you don't hear back from me by the weekend (if you care enough, that is)

No problem, I am too insanely busy.

morte, LPN, LVN · Feb 7, 2018

Katie, this is not about coke. why was this person tested for fent? there in lies the big question. I am thinking switched specimens, purposeful or not.

KatieMI, BSN, MSN, RN · Feb 7, 2018

Katie, this is not about coke. why was this person tested for fent? there in lies the big question. I am thinking switched specimens, purposeful or not.

She was tested on standard 8 or 10 panel because she had symptoms of possible abruption or simply because her local ER tests everybody by policy. That is not a mystery and I wrote in my above posts everything possible about it. How it turned out to positive test for fentanyl, we still have no idea.

I wrote above that I too suspect the possibility of mix-up. It happens in busy ERs.

ianurse · Feb 10, 2018

Hi, everyone! Still trying to get this ironed out. I returned to my OB on Monday, to find the second test to be positive as well. We agreed to a repeat testing with a different lab. It was done but I won't find out the results until this week's appointment. I went to the hospital and requested my medical records, which is where things take a very strange turn. The first test, all urine according to record, was done before I was even admitted to the room. I had my blood drawn immediately upon entering the room, and the urine times with that draw. I did not start my 24 hour urine until around 1500, first urine tests timed around 1330. Remember I was doing a 24 hour urine from 1500 on Thursday until 1500 on Friday, I was urinating in the hat and dumping my own urine in the jug so i know that no sample was given after the jug started. Anyway the 2nd test times at 1100 on Friday, the same exact results other than a big difference in creatinine levels between samples. Now I'm not sure if the 2nd sample was just a retest of the first sample or what has happened there. The nurse also had me leave a urine sample as I was being discharged citing the Dr. wanted to make sure there was no infection present, but the records show no results for any urine sample after the 24 hour urine. i will update again after i see what the lab shows this week.

Horseshoe, BSN, RN · Feb 10, 2018

Hi, everyone! Still trying to get this ironed out. I returned to my OB on Monday, to find the second test to be positive as well. We agreed to a repeat testing with a different lab. It was done but I won't find out the results until this week's appointment. I went to the hospital and requested my medical records, which is where things take a very strange turn. The first test, all urine according to record, was done before I was even admitted to the room. I had my blood drawn immediately upon entering the room, and the urine times with that draw. I did not start my 24 hour urine until around 1500, first urine tests timed around 1330. Remember I was doing a 24 hour urine from 1500 on Thursday until 1500 on Friday, I was urinating in the hat and dumping my own urine in the jug so i know that no sample was given after the jug started. Anyway the 2nd test times at 1100 on Friday, the same exact results other than a big difference in creatinine levels between samples. Now I'm not sure if the 2nd sample was just a retest of the first sample or what has happened there. The nurse also had me leave a urine sample as I was being discharged citing the Dr. wanted to make sure there was no infection present, but the records show no results for any urine sample after the 24 hour urine. i will update again after i see what the lab shows this week.

In my opinion, you absolutely need a hair follicle test to clear your name. Why aren't you demanding one? As I said earlier, if I had to pay for it myself, I'd do it. This is a big deal.

Jory, MSN, APRN, CNM · Feb 11, 2018

I have a question for the group, an opiate screen comes back quickly (in a few hours), but can a fentanyl screen come back in 26 hours? At our hospital it takes a minimum of 48 hours for results for a specific drug.

This is the only problem I have with this story.

KatieMI, BSN, MSN, RN · Feb 11, 2018

I have a question for the group, an opiate screen comes back quickly (in a few hours), but can a fentanyl screen come back in 26 hours? At our hospital it takes a minimum of 48 hours for results for a specific drug.
This is the only problem I have with this story.

There are one-use substance-specific test systems which take less than 30 min. They are widely available and used extensively in outpatient specialty settings. They cost $$$ and, if a "breach of contract" is suspected (i.e. patient is on chronic hydromorphone but came to be positive for fentanyl as well), there must be a confirmatory test done in an outside, specifically certified lab, preferably used another speciment type (blood, saliva or hair follicles) and/or another sample taken under controlled conditions. That, plus transport, takes 12 to 48 hours. This is because systems of this particular type are highly prone to cross-reactivity with certain substances - in case of fentanyl, it is Benadryl and its multiple variants.