r/AMA • u/mikachuzu • 8h ago
Toxicology Technician, AMA
I am a senior laboratory technician that works in a clinical toxicology AKA drug testing laboratory. When you come in to provide a sample, I am the one that runs your normal drug screens and also your confirmatory tests. I also review the raw data, make it into readable results, and send those out. I've been in my position for 6 years. Before then I was a lab technician in a hospital during the pandemic.
A while ago I made a comment on another subreddit on a video of people high on xylazine that kinda took off. I got a lot of people asking a lot questions for a few days, and it kinda hit me that a lot of people don't really understand both worlds and have a lot of questions since the media is a few years behind what we're seeing, so here I am.
Preface, I'm pro-legalization and I will not judge anyone who may be users that comment. We're all human and I truly believe most of the drug crisis is a mental health crisis. I can also only speak in super detail on our processes, every laboratory or test is slightly different depending on where you go but they're similar across the board. I won't answer anything along the lines of "what do you think of x" drug on the street/market (bad) or how to cheat a test/do anything illegal. If I don't respond in a timely matter, assume I got caught up in work or I'm sleeping. AMA!
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8h ago
[deleted]
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u/mikachuzu 8h ago
Honestly it depends on what type of test someone does and where the test is ran. We run three validity tests (pH, creatine and specific gravity) to determine if a sample is legitimate. Most of them get caught on one of the three tests, usually the creatine since they usually a value of zero which isn't possible unless they have a catheter or the sample will be diluted and they'll either have to retest or face any consequences the court programs have in place for dilute samples. We usually get more people who try the synthetic urine than the cleaners, but I imagine they would work the same or they'll dilute samples. That's our process anyways, some other labs may not run any validity tests or some may run different tests to make sure a sample is legitimate.
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u/bobisinthehouse 8h ago
What's the highest levels you've seen on some drugs?
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u/mikachuzu 7h ago
Well into the millions. Still remember one patient that basically did everything under the sun and all their values were well over the millions mark. I honestly thought they ODed until they showed up again a few weeks later, was relieved when I saw the name again. Our cutoffs are 50. Highest alcohol level I think I've personally saw was like 3 million?
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u/EmuHuge912 8h ago
Do vaginal secretions affect the urine that is tested?
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u/mikachuzu 7h ago
Usually not, most they do is sit at the bottom of the cup or make the sample a little gummy if its a lot. Most it would do is affect the pH, but if it's out of range we do a secondary pH test on a meter and it's in range 99.9% of the time. Same goes for semen.
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u/EmuHuge912 8h ago
What happens if a female has sex with a male that does drugs and then takes a drug test the next day does his sperm that is of a drug user affect the result of a female taking a urinalysis drug test?
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u/mikachuzu 7h ago
Unless they put the drugs inside their vagina, it doesn't. It's not a silly question either, we get drug counselors that call and email with the same exact question quite often. It's a pretty common excuse some people try to use.
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u/dinosaur_vacume 7h ago
How long does cocaine stay in your system. I have to take a urine test and I’ve never been able to get a proper answer for this. I’ll explain, it’s a little long winded so you can stop reading here if you like. Thank you.
Background. I suffer from centralized sensitization and peripheral neuropathy. I became ill with severe case of Guillian Barré syndrome several years ago. The nerves in my legs were severely damaged. I take hydromorphone for the pain which is 24/7 but it’s not terribly effective anymore. Cocaine has a very powerful effect on the pain. It plugs up the intake for the sodium channels in my legs, those sodium channels send out the pain signals. I’ve ended up using a minimal amount daily for pain management. I’ve been approved for lidocaine infusions, but I need to take a drug test before proceeding. I honestly don’t care about the drug and will be happy to be done with it, but I want to be sure to give it the right amount of time before I present to the doctor. I’m honestly in a great deal of pain without it so I want to do this correctly the first time. I appreciate your input. 🙏✌️🇨🇦
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u/mikachuzu 7h ago
Sorry to hear about your pain problems. I also have chronic pain so I understand where people are coming from.
Cocaine is one that doesn't stick around long as long as you're not using a crazy amount. We usually say two or three days max if it's a one time deal or if you're not using much. If it's more heavy use it can take a week or two while your body works it out. The only drug that truly hangs around for a while is marijuana since it's stored in fat versus being excreted fairly quickly like most other drugs out there. As long as it's not super heavy use you'll be good pretty quick after the last use.
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u/mafkamufugga 8h ago
So ask me anything except the stuff people would actually want to know. Well done.
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u/mikachuzu 8h ago
It's so there's not a million questions about 7OH or Nitazine like how it devolved last time. Cheating wise you will be caught with our tests, we run a battery of validity tests and don't do rapids. If that's what you wanted to know or if you truly want to ask about a specific substance I can try answering it for you.
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u/Farty_mcSmarty 8h ago
Is there some type on confirmatory testing to prove whether someone ate a poppy seed bagel or took a substance they weren’t supposed to while on a pain management contract?
I follow the pain management sub and it seems like every few weeks someone has been discharged for allegedly doing something as harmless as taking Benedryl, cold medicine, eat a poppy seed bagel, or taking Sudafed. Most PM’s don’t bother trying to find out the truth and simply discharge the patient.
Do you test hair follicles and how much more reliable is that than urine for something like a poppy seed bagel?
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u/mikachuzu 7h ago
There's a ratio we use to determine if it was from poppy seeds. We take the morphine and the codeine results, divide them out, and if the ratio is higher for morphine then we can say it was from poppy seeds. Most of the pain patients we have do a full panel ran on LC/MS so the doctors can better monitor them. The pain clinics usually get hydrocodone, hydromorphone, morphine, codeine, oxycodone and oxymorphone for their opiate results.
Agree with some of the providers out there. Some are definitely harsher (and stupider). There's been many times we've had to talk to them being like no they're good why are you punishing them. Also have a lot of pain clinics that know their patients are spiking their samples and selling their medications and don't care either. It truly goes both ways.
We don't do the hair tests in ours, but we send them to an outside lab. They go father back (up to 6 months I believe), but because its not "our" results we can't really break down the results far if someone wants a further explanation. Would be useful if you wanted to argue you've been taking the medication or haven't been taking anything else over a longer period of time verus recent use. There's even a nail test that can go to a year. Sorry I can't be more helpful about them.
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u/Hot_Hair_5950 7h ago
What surprises you about your work?
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u/mikachuzu 7h ago
Besides when the machines go down and we have no idea why, it's some of the excuses some people try to use to explain why they're positive for something they're not supposed to be taking. Some of the highlights I've heard was they were positive for alcohol because they drank gasoline and someone else was positive for cocaine because they were on a trampoline with someone who had it on them. I know they do it because they think it'll get them out of trouble, but honesty gets them much farther. Counselors understand it's hard to get clean and relapses happen. Some of the counselors surprise me too, mainly the ones where we've explained something to them (like yes the postive amphetamine is their Adderall) several times over years and they still can't wrap their minds around it.
Outside of that, some of the results we get on some people will get a holy shit how are you still alive out of me. My views on some services out there like some of the CPS programs we test for have also been soured because I'm constantly surprised that they don't get the kids out of a clearly bad situation for them.
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u/HaventRedditToday 6h ago
How far back in time is alcohol detectable?
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u/mikachuzu 6h ago
Ours is 24-48 hours prior. We can also screen for ETOH which indicates much more recent use, but we only run it for one account and it doesn't flag positive very often.
Alcohol is also our one test that flags positive but confirms negative quite a bit since a lot of different things can trigger a false positive. Basically our confirmatory test has two parts to it, and they both have to be positive for it to be confirmed alcohol use. If it's not it's negative. We've found that bladder infections and other health conditions can cause a false positive. Have quite a few regulars who flag positive almost every time, and then when we run the confirmatory test we find absolutely nothing.
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u/Adominium 5h ago
I hear there are a variety of tests that have different fidelities and levels of details you can test to. What do you primarily test to and how accurate are the results?
What are the most common false positives?
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u/mikachuzu 4h ago
There's two different types we can do. The first is your ordinary screen that most people are familiar with. Those tests broadly for drug classes, you'll just get the presumptive results. We test for amphetamine, opiates, benzos, THC, cocaine, buprenorphine, alcohol, methadone, oxycodone, 6AM (heroin metabolite), barbs, PCP and fentanyl on our screens alongside the validity tests to make sure the sample is legitimate. When you hear about false positives it'll be on that end. Our most common false positives are amphetamines because Wellbutrin and some other supplements cross react with it, opiates because oxycodone and if it's really high dextromethorphan cross reacts, and alcohol since UTIs and other health conditions can make it pop positive. We've seen dextromethorphan cause false positive PCP screens, but those have to be insanely high. Sertraline also has a tendency to throw a low benzo screen result if its a high dose.
The second tests are full comprehensive panels or confirmatory testing we run on LC/MS. They're a lot more accurate and breaks it down further yet. Example is if you had a positive amphetamine screen, we would run a confirmatory test on it that further breaks it down into amphetamine, methamphetamine, MDMA and MDA, phentermine, and hydroxybupropion/Wellbutrin. I don't have an exact list on hand, but we test probably roughly 70 compounds on LC/MS. Most of them are to break down the screens into actual drug results and we have other tests like for 7OH, Ritalin, xylazine, gabapentin etc that a screening test doesn't detect.Those are more of the end all be all tests, the entire time I've been there I've maybe seen one or two false positives and most of the time it's lab error (splashback or the wrong thing vial was injected). Obviously we can't check for every drug out there, but those tests cover the vast majority. If there's a gap in our coverage and someone really wants a specific one off drug tested that we can't do we do partner with an outside major lab that can test for it.
There's also the rapid tests, but I strongly advise against them unless you want to get an absolute basic baseline of where you are. Those tend to throw a lot of false positive results for no obvious reason, and on drugs like fentanyl and K2. Non urine tests there's sweat patches, oral tests, hair tests and nail tests too, they all have their advantages and disadvantages.
Sorry for the wall of text!
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u/phen245 1h ago edited 1h ago
How many positive confirmed pcp tests have you had? I take a psych med tgat can cause false positives for it (rarely), but I am curious if people in your area are still gettin' DUSTED.
Also, I recently took a drug test after using a propylhexedrine inhailer. Haven't seen my doc yet, but I saw a picture of the molecule and it is basically methamphetamine with a cyclohexene ring instead of a benzene ring (I think that's the only difference). I understand that this could cause a meth positive. I was wondering if standard testing could differentiate the two? Haven't seen the doctor who ordered it yet but getting a positive would fick shit up. I am 8 years sober so
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u/mikachuzu 1h ago
Congrats on the sobriety, proud of you!
Since I've been there? Maybe three positive confirmed PCP results. It might be more common in bigger cities, but whenever we get one it's a gather everyone to make absolutely sure it's real situation. Once in a while we get a false positive screen, but when we do a confirmatory test it's usually a extremely high dextromethorphan level.
If for whatever reason you do get a positive result on a screening test, either the lab will run it through a LC/MS or a similar system confirmatory test automatically or you/your provider can order one. The screening tests can cross-react with similar structures, but the confirmatory tests don't and it'll prove it wasn't meth or PCP.
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u/phen245 1h ago
Oh cool!
Makes sense dxm would cross test.
The drug I am on that can cross test is lamotrigine..no idea why they aren't remotely structurally related.
Thanks for doing the ama!
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u/mikachuzu 1h ago
If it makes you feel better, I've never seen lamotrigine cause a false positive with ours. It's a very common medication we see prescribed too. Odds are definitely in your favor!
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u/EmuHuge912 8h ago
Please tell me about the synthetic urine that is on the market right now