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Thread: Dextromethorphan/DXM may cause [+]result for opiates on EMIT tests

  1. #1
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    Default Dextromethorphan/DXM may cause [+]result for opiates on EMIT tests

    Note: I understand that this topic HAS been discussed previously, and some information is available by searching through all of the forums threads. I believe that this thread, however, provides a substantial amount of personal evidence, as well as new resources and citations for those interested in further research, to qualify creating a new thread. I hope I'm correct, but if not, please advise me and/or remove this thread or merge to a more appropriate place

    Dextromethorphan (also known as DXM), present in many over-the-counter pharmaceuticals including cough syrups and cough & cold remedies, may cause false-positives for opiates on EMIT-style urine drug screens or other similar, inexpensive dipstick or one-step sample-cup urine drug tests. The following resources/citations show that false-positive opiate results caused by dextromethorphan intake are actually quite common with preliminary, rapid-result drug tests.

    ASCP (American Society for Clinical Pathology) LabMedicine #41, p. 457-460: "Is Dextromethorphan a Concern..."
    FAQ: VitroDiagnostic.com
    LawyersAndSettlements.com: Potential Lawsuit/False Positive Drug Testing
    Legal Bulletin 6.4: Urinalysis Drug Testing; Lewisburg Prison Project, Inc.
    OregonHerald.com Workplace Drug Testing: "Drug Testing Does No Good"
    Yale LabMed: Urine Drugs of Abuse by EMIT


    I have quite a bit of personal experience regarding false-positive drug screen results caused by dextromethorphan/DXM, having had six or eight false-positive results myself in the past 6-months. As a methadone maintenance patient at a small, private clinic (operated by a single physician), I am required to submit a supervised urine sample once-per-week. And my personal experiences regarding this problem are in regards to two different styles of rapid urinalysis, a dipstick-style 7-panel test, and a one-step 5-panel sample cup. I will explain/describe these two tests in detail below.

    I do understand that my personal experiences are only anecdotal, but I feel that they may be useful to other individuals who are drug-screened on a regular basis using inexpensive, preliminary EMIT tests, and are therefore still relevant information that meets the qualifications for this forum. If not, please advise me otherwise.

    The first style of test that I am most frequently subjected to is an EMIT-style 7-panel dipstick test. This test has the following test-panels: THC (marijuana, hashish, etc.), COC (cocaine), AMP (amphetamine, methamphetamine), BZP (benzodiazepine; tests for the metabolite oxazepam), OPI (opiates incl. morphine, codeine, heroin, hydromorphone, high-doses of meperidine/demerol, and potentialy several other synthetic, morphine-related opioids), OXY (oxycodone), and MET (methdone). These tests are quite sensitive, and even if you are below the cutoff level for a certain substance, a (sometimes very) faint line will often appear, which the doctor usually (incorrectly) reads as a positive result.

    The second style of test, a one-step sample cup with the 5-panel test built right into the cup, is one that I only see infrequently. It tests for only 5 substances: COC, BZP, OPI, OXY, and MET. I have noticed personally, and have confirmed with my doctor, that these tests are extremely sensitive, much moreso than the first style of test. Even if you are well below the cutoff level, you can have a positive test result (cocaine, for example, can show up on this test for up to a week or more).

    And now, regarding dextromethorphan/DXM causing false positives on the OPI-panel of these drug-screens; in my experience, dextromethorphan can ABSOLUTELY cause a false-positive result, and depending on the type test, even therapeutic doses can sometimes cause false-positive results. At the start of my methadone treatment, I was continually receiving positive results for opiates (under the OPI-panel), even though the only opiate/opioid I was consuming was oxycodone, which shows up seperately under the OXY-panel. These tests were all of the first type I described (the 7-panel dipstick test). It took me a number of weeks before I was finally able to figure out that it was dextromethorphan that was causing these opiate-positive results. I was using dextromethorphan daily at the time to help slow the development of my tolerance to methadone, in doses that were several times larger than what is recommended therapeutically: between 60-90 mg per dose, once or twice each day. Once I made sure that I was only using therapeutic doses in the days running up to my test, I stopped getting the false-positive results for opiates.

    With the second style of test that I described, I twice tested positive for opiates (again, under the OPI-panel, when I only should have tested positive under the OXY-panel) after using only therapeutic doses (15-30 mg) of dextromethorphan in the several days prior to my drug screen. These 5-panel tests are one-step sample cups, meaning that the results appear right on the side of the sample cup, immediately following the deposit of your sample. I had one of these false-positive results sent to a lab for GC/MS testing, which verified that I was negative for opiates and that my positive result was in error.

    Some sources claim that EMIT-style drug screens are incorrect as much as 30% of the time, causing either false-positive or -negative results.

    I now ensure that I do not take dextromethorphan AT ALL, in the 2-3 days leading up to my sample dates. Since I began this, I have not once tested positive incorrectly on any of my UA's. I believe that the reason DXM has the potential to cause false-positive test results may have something to do with it's structural similarity to several opioid analgesics. Dextromethorphan is the dextrorotatory enantiomer of levomethorphan, an opioid analgesic that is the methyl ether of levorphanol, which is a more potent, pure-opioid-agonist analgesic, used in the treatment of very severe pain. Also, dextromethorphan itself is known to have some painkilling properties, and it is a cough supressant, similar to several opiates used for this same purpose.

    Please keep in mind that this is only my opinion. Your mileage may vary.
    Last edited by bradw; 04-24-2012 at 04:59 PM. Reason: Added preliminary note.
    Helpful Owlie, Katniss, H20shed65 Rated helpful
    My statements are to be considered opinions only. I am not a medical professional.


  2. #2
    Wow, thank you very much for this detailed post. I really appreciate how you combine research and clinical/legal evidence along with your own personal experience. I know that threads regularly come up here about people who have failed just such a test and have no idea why; it could definitely be for this reason. Hopefully this will be of use to many!

  3. thanks for the info!

  4. #4
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    @Owlie & @curbiechris You both are very welcome.

    I have another UA test coming up on Monday, and I'll make sure to share the results of that one once it's completed. I last used dextromethorphan (several times the recommended therapeutic dose) yesterday morning, so we shall see if 72 hours is enough for me to come out negative on the test. It may depend on the type of test I am given, but i'm sure to let you know all the details on Monday.
    My statements are to be considered opinions only. I am not a medical professional.

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    Sorry for the delay in responding, but in regards to my last urinalysis on April 30th, I am happy to report that my test came back negative on the opiate panel. This time, my urinalysis was given using a two-step dip-style test (which in my experience is less sensitive than the one-step sample-cup style tests).

    Seventy-two (72) hours had passes since my last ingestion of dextromethorphan (DXM or DM) at a dose several times greater than what is recommended therapeutically -- between 45 and 75 mg if my memory is correct.

    I sample again in two-days, so i'll report back with the results of this test as well. Since I can still leave dirty urines at this point in my program without any consequences what-so-ever, I plan on taking a therapeutic, 30 mg dose of dextromethorphan exactly 24 hours before my test. I am very curious to find out what the results will be, and I certainly hope that i'm not the only person interested in this... if I am, though, oh well, at least i'm satisfying my own curiosity .
    My statements are to be considered opinions only. I am not a medical professional.

  6. #6
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    Okay, so I just returned home from my weekly Monday morning meeting with my methadone doctor. It went well, and as promised, I'm here to report my findings.

    As usual, I was required to provide my weekly supervised urine sample. Since the clinic is rather small and the doctor and his staff/technicians know and trust me, i'm not exactly "supervised": very rarely one of the technicians may take a small peek through the small one-way glass window to make sure i'm not doing anything fishy, but beyond that, it isn't like someone is in the room with me, watching as I give my sample (I do have several anxiety-spectrum disorders though, so I still tend to have panic attacks while i'm in the clinics bathroom and leaving a sample is never easy for me).

    Today, as well as last week, I felt really good about my progress on the program, since the doctor spoke with me and wrote my prescription without even seeing the results of my urinalysis/drug-screen. He seems to have developed enough trust in me, since I always advise him of exactly what he will find in my sample (be it prescription opioids that I personally am not prescribed, the benzodiazepines which I take that I am prescribed, and in some cases the dextromethorphan which I sometimes take and which sometimes shows up as a false-positive for "opiates" on my drug screen).[/SIZE]

    Today, my sample was tested using the dip-stick method (the first style of test described in my first post in this thread). This test is an EMIT-style 7-panel test (the panels are: THC, COC, AMP, BZP, OPI, OXY, and MET; if you don't know what these mean, please refer to no. 5 in my first post). As I had mentioned, I took a 30 mg dose of dextromethorphan (DXM or DM) as close as possible to 24 hrs before today's urine-screen (which was Sunday morning). And i'm happy to report that my drug-screen was negative [-] under the OPI panel (the same panel for which I have received false-positive results before after ingesting dextromethorphan; although normally in doses higher than what is therapeutically recommended.

    Today's result helps to conform that therapeutic doses of DXM are not as likely to cause false-positive results as are doses several-times greater than the therapteutic recommendation of 30 mg per dose. I do not know, however, if I still would have tested negative (on the OPI panel) had I been given the more sensitive type of test which I described in no. 6 of my initial post (the 5-panel, one-step sample cup with the panel-strip built right into the sample-cup itself). As I receive this variety of test on a much less frequent basis than the test-style I took today, I'm not sure exactly how long it may take me to put together some amount of data regarding false-positives caused by dextromethorphan when using the more sensitive one-step 5-panel rapid-urinalysis.

    If anyone happens to have any information whatsoever regarding this matter, I would be extremely pleased to hear from you. As I (and most everyone should) know that false-positive results on the OPI-/opiate-panel of any drug test can be absolutely disasterous. Individuals like myself can lose the trust of their doctors and in certain cases may even be kicked-out of their programs; individuals on parole or probation can be subject to random testing, which if failed (by a false-positive, for instance, caused by DXM) can result in any number of negative consequences, up-to-and-including jail-time (loss of well-earned privileges, more stringent controls, et cetera; the list is endless). Even chronic pain patients (CPP's), if given a random drug screen, can lose the trust of their pain-doctors (and good ones are nearly impossible to find) or even, in extreme cases, be kicked out of their programs or pain-clinics for breaching their medication-contracts (normally a GC/MS verification test would clear patients of any wrong-doing, but not all doctors follow the rules and some seem to be on the lookout or ANY possible reason to dismiss a patient).

    Enough rambling from me though -- i'm sure you're all starting to get bored (if you managed to read this far at all, give yourself a huge pat-on-the-back and have someone give you a big bear-hug from me). I will continue to ingest a therapeutic, 30 mg dose of dextromethorphan 24 hours prior to my future sample-dates (which, for the time being, occur once each week on Monday morning). Hopefully I will be able to obtain some futher data to corroborate the evidence I had already presented.

    Best regards, and I promise to post the results of my next drug-test one-week from now (next Monday morning).
    I hope one person, at the very least, finds this thread to be interesting/enlightening/useful/beneficial/or anything really for that matter (i'm not picky at all ). I am, however, very interested in knowing if any PR members have actually have found this thread to be either informative or of interest to them. I would LOVE to hear any feedback.
    My statements are to be considered opinions only. I am not a medical professional.

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    Personal experience: 720 mg rec dose of dxm tested positive for PCP (not opiates) about 24 hours later using EMIT. A friend of mine also tested positive for PCP 12 hours after a 600 mg dose.

    We were teenagers. Cut us a break.


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