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• W2914581663 abstract "A 60-year-old female patient with a history of chronic pain and headache presented to the Pain Management Clinic for follow-up assessment of her prescribed medications, as well as to determine the patient's suitability for enrollment in the medical cannabis program. The patient's chronic pain and headache were secondary to traumatic brain injury sustained in a motor vehicle accident approximately 2 years before her appointment. The patient also was afflicted by chronic pain in her right arm due to nerve damage associated with surgery for de Quervain tendonitis. Following the motor vehicle accident, the patient had been evaluated at a multidisciplinary traumatic brain injury clinic and had been prescribed Tylenol #4 (acetaminophen 300 mg/codeine 60 mg) up to a maximum of 4 times daily for pain, and lorazepam (1 mg every 8 h as needed) for anxiety and insomnia.To determine the patient's suitability for the medical cannabis program, the patient was required to submit a urine sample for drugs of abuse testing. Analysis of the sample was performed by a combination of immunoassay (amphetamines, barbiturates, benzodiazepines, benzoylecgonine, carboxy-tetrahydrocannabinol, and phencyclidine) and high-resolution accurate mass spectrometry (opioids). Following review of the patient's urine test results the clinician contacted the laboratory for assistance with the interpretation of the opioid results. A review of the immunoassay screens only demonstrated presumptive positive results for the amphetamine class; however, reflexive confirmatory testing via liquid chromatography–tandem mass spectrometry for amphetamines (amphetamine, methamphetamine, phentermine, methylenedioxyamphetamine, methylenedioxymethamphetamine, pseudoephedrine/ephedrine) was negative (Table 1).View this table:Table 1 Laboratory test results.The high-resolution accurate mass spectrometry results were more complex and demonstrated the presence of codeine, codeine-6-β-glucuronide, morphine, and morphine-6-β-glucuronide, which were consistent with the use of codeine (Table 1) (1, 2). However, the analysis also unexpectedly revealed the presence of hydrocodone, norhydrocodone, dihydrocodeine, and hydromorphone-3-β-glucuronide (Table 1).### QUESTIONS TO CONSIDER1. What are the …" @default.
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• W2914581663 date "2019-02-01" @default.
• W2914581663 modified "2023-09-23" @default.
• W2914581663 title "A Question of Opioid Diversion or Compliance" @default.
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• W2914581663 doi "https://doi.org/10.1373/clinchem.2018.294140" @default.
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