How JustAnswer Works:

  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.

Ask Andy PhD DABT Your Own Question

Andy PhD DABT
Andy PhD DABT, Toxicologist
Category: Health
Satisfied Customers: 99
Experience:  Board certified with 17 years in research or consulting
58853142
Type Your Health Question Here...
Andy PhD DABT is online now
A new question is answered every 9 seconds

For employment purposes

Customer Question

For employment purposes (with this job, 2.5 years) I am randomly screened 2-3 times a month for panel 5 (urine screens) and have never tested positive for anything. A new client requested that all project members have a hair test. Mine came back positive for amphetamine-methamphetamine, I do not use drugs. Although I am on multiple drug regime for HIV, including, Atripla, Seroqeul, albuterol inhaler (rescue) symbicort, and take generic pseudoephedrine HCL, I recently began taking Chantix for smoking cessation. I noted your post that the Methyl component of the inhaler might be the cause of the positive meth test. your post stated: The chemical name for albuterol sulfate is (alpha) 1 [(tert-butylamino) methyl]-4-hydroxy-m-xylene-(alpha), (alpha)'-diol sulfate (2:1) (salt). It may be possible that the meth part of that is showing up in your drug test. Could that also apply to the CHANTIX tablets contain varenicline (as the tartrate salt), which is a partial agonist selective for α4β2 nicotinic acetylcholine receptor subtypes. Varenicline, as the tartrate salt, is a powder which is a white to off-white to slightly yellow solid with the following chemical name: 7,8,9,10-tetrahydro- 6,10-methano-6H-pyrazino[2,3- h][3]benzazepine, (2R,3R)-2,3-dihydroxybutanedioate (1:1). I am at a lost for why I am testing positive for amphet/meth, the MRO was not responsive to any of my questions in regards XXXXX XXXXX positive test, stating that his job was only to rule out or in any known reasons based on my current drug profile I fax'd to him. I dont want to lose my position because of this positive test, he (MRO) would not inform me if the hair test indicated chronic or episodic meth/amphetamine use. thank you for any info you might be able to provide. My current meds are, Atripla, Atenolol, Celexa, Seroquel IR daily as prescribed. I usually use my inhaler at least once a day, take Pseudoephedrine HCL 30mg in the AM and PM, use Afrin nasal spray in the early am (upon inital waking), along with nasonex, I did use viagra 100mg a week prior to having the hair test. I also use a symbicort inhaler average 3-4 times a week, and I am on daily androjel application for low testosterone.
Submitted: 2 years ago via AskDocWeb.
Category: Health
Expert:  Andy PhD DABT replied 2 years ago.
Hello,

Did the MRO say if any confirmatory tests had been done yet?

The tests starts with immunoassay screening tests. This uses antibodies against the drug of interest and these antibodies can also bind to similar drugs, which can give a false positive test. However, this is just a screening test. All negative screening tests stop there, they are not tested further, unless it was adulterated. Samples that come our positive are then sent for confirmatory testing, usually with a GC/MS (gas chromatography/mass spectroscopy). The GC/MS does not have cross reaction issues and so other drugs will not give positive results in this confirmatory assay. So if it has not already been done, I would ask the MRO to order a confirmatory test by GC/MS, that should clear it all up, regardless of what other drugs might give you a positive result in the screening assay.

I hope this helps.

Take care,
Andy
Customer: replied 2 years ago.
I am not sure if he said it was confirmed by GC/MS or not, he was very rude, and only gave limited information (with a disclaimer), when I told him that my MD was interested in knowing if it was showing episodic or chronic use, so she could look into my most recent medical regime for my HIV, he just said that none of the meds I was on would indicate (a positive test/) and that was what he was reporting. what I did not mention was that the hair sample came from my armpit hair.
Customer: replied 2 years ago.
Would the fact that i take pseudoephedrine HCL (generic Walgreens Brand) show up as a positive for for amphetamine use even with the GC/MS ????
Expert:  Andy PhD DABT replied 2 years ago.
I would talk to the MRO about getting the confirmatory test done. GC/MS should be able to distinguish methamphetamine from pseudoephedrine, though the pseudoephedrine could give a positive in the screening immunoasay.

Let me know what the MRO says.

Take care,
Andy
Expert:  Andy PhD DABT replied 2 years ago.
Hello,

Have you been able to talk to the MRO? If so, what did they say?


Take care,
Andy
Customer: replied 2 years ago.
not yet, it is difficult because I work in a secure building (FDA regs) and if the MRO isnt available can only call during a quick break, as I said he was rude and told me that none of my meds would test postive for amphetamines, and he was reporting my test as positive and I should check with my employer, they have not heard anything as of today, tuesday, not sure if he ran a GS/MS/MS, quest diagnostic p/p states that if hair came from an alternative site they had to check it twice, plus the do not use the fed guideline for cut offs, they use a 300 level for both test, my chain of command does not indicate where the specimen was taken, so they may not have done the additional testing required to my an informative decision. I am randomly checked (two times a month) and have never tested (urine) positive for anything, and now this new client requested hair screening, the only difference in my meds is asthma inhalers, pseudophed, and chantix, I use to be on allegra but my insurance co. will not cover it now that it is OTC. my research on the additional meds do indicate that a screen would test positive but not sure if quest lab has done anything else, their policy say that all positives are verified by GC/MS but the MRO did not indicate if his decision is based on confirmation or only by a review of the medical profile I faxed.
Expert:  Andy PhD DABT replied 2 years ago.
Hi,

Keep trying to contact the MRO, if would be better to deal with this before it gets to your employer. If the MRO says that GC/MS was done and found to be positive, then you should see if your employer has an appeal process. Hair has many problems, you could get drugs in your hair from just being around people smoking methamphetamine. Also, different hair absorbs drugs to a different degree. Black hair absorbs more then blond hair, even if both people took the same amount of drug. Also African hair absorbs more drugs than Caucasian hair, even if they are both black hairs. So there is a good basis to appeal the finding, especially since you are tested twice a month by urine and come out negative.

If it was tested by GC/MS and there is an appeal process, then I would suggest you tell them that you would take urine tests under direct observation. That means someone will have to watch you pee, which is embarrassing, but it also means that there is no real way you could cheat on the test, so if it’s negative, it should truly be negative.

Keep me informed of what is going on, I might be able to help you if you need to file an appeal.

Take care and keep in touch,
Andy
Customer: replied 2 years ago.

My urine screens are observed already. I didnt know that you could test positive if you were exposed to someone else smoking it, I was in the presence of 2 people smoking it the Friday prior to taking the test, exposed on friday into saturday a.m. about 2am and had the test done on tuesday a.m. at 6:30am, I left the room/encounter after I requested the two people to not use it in front of me, they stopped the first time, but when I left the room to go to bathroom, upon return they were smoking again, so I got dressed and left since they were not respecting my request. Would that exposure have tested me positive, I would have only been second hand exposure, and wouldnt it have been too soon after exposure to show on a hair screen, it was only perhaps 72 to 80 hours after exposure. Thanks for you previous answer, it made me remember the event that had occurred, forgotten about it because it was so brief. And as I said earlier the specimen came from my armpit. ps. given this new info, how soon does meth show up in a hair screen, especially since I didnt partake, but was just in the room, and I am a white male BTW, I thought I would have had to use it myself for it to get into my blood stream and then into my hair, and it was only a brief, perhaps a couple of minute when I arrived and made my first request for them not to use, then maybe 4-5 minutes (when I returned to the room), and the room didnt appear to be smoky looking either time. and in light of this new information (that second hand exposure) could make a positive test, although I really dont know how, I looked it up before responding, the web site says it would take anywhere from 7/10 days to show up in head hair and longer in body hair. With this new knowledge in your experience should I be proactive and inform my employer of the event???

Expert:  replied 2 years ago.
Hi,

Alright, some more things that might help. I would still talk to the MRO and not your employer for right now, but depending on what they say, you may need to talk to your employer. First, hair can become contaminated by drugs, especially if they are smoked, without the drug going into your blood. Hair, unlike urine is on the outside of your body and is directly exposed to smoke, so the smoke can bind to the hair and adhere to it giving a positive. There are cutoff levels that the concentration of drug must exceed to be considered a positive and they are suppose to address second hand exposure, but there are studies that show kids hair being positive when parents smoke drugs, so it can give a positive. Part of the issue is that hair should be washed in the lab to remove any of these external exposures, the problem is there is no real good way to wash the hair, some methods don’t remove external contaminants well, while others work so well it strips some of the drugs that got into the hair from the blood. So washing is a balancing act to remove external contaminants, without removing internal ones. That being said, one way you can tell if a drug was taken into the body and in the blood is to look for metabolites. If external exposure to smoke is the cause of a positive, then there should not be metabolites present, since the hair is made of dead cells which can’t perform metabolism. So you could ask the MRO to test for methamphetamine metabolites. The main metabolite of methamphetamine is amphetamine, but there are also some minor ones that would show up if you had taken the drug. They include parahydroxyamphetamine and benzoic acid. So ask the MRO if they looked at not only methamphetamine, but also parahydroxyamphetamine, and benzoic acid.

Now the other issue is with the pseudoephedrine. In most cases GC/MS can distinguish it from methamphetamine, however, depending on the specific procedure for GC/MS, the pseudoephedrine or ephedrine can look very much like methamphetamine. Usually there needs to be a lot of pseudoephedrine or ephedrine present to cause this. This happens because in the GC/MS, they heat up the sample to get it into a gas. If they heat it up to over 300 degrees Celsius, then it can turn pseudoephidrine into methamphetamine. This can be dealt with also by looking at metabolites since amphetamine, the main metabolite would not be produced from pseudoephidrine. The lab can also get around this my keeping the chamber temperature at no higher than 185 degrees Celsius and pre-treating the sample with periodate. Also if they used an electron impact mass spectroscope the pseudoephedrine can also be mistaken for methamphetamine. Instead chemical ionization mass spectroscopy can distinguish the two. So depending on the method they use, pseudoephedrine might give a false positive.

So I would ask the MRO if they looked at metabolites: amphetamine, parahydroxyamphetamine, and benzoic acid. The metabolites would clear up both problems, either that it’s a false positive from pseudoephedrine, or its from external exposure to smoke. There is a slight chance that you inhaled enough smoke through second hand exposure which gave a positive, but as you said it takes some time for it to show up in your hair and the cutoff values usually make it so that type of exposure would be considered negative, so using the argument of second hand exposure when they find metabolites would probably not work for you.

If they did test for parahydroxyamphetamine and benzoic acid and they were present, then I don’t think you can fight it. If that is the case, then maybe they will let you stay if you do more frequent urine tests. Methamphetamine has a half life of 6 to 12 hours, so testing every week, especially on a Monday with directly observed collection should catch you if you are using it. So if you are negative with weekly urine tests then it should show that you are not using methamphetamine. Testing you by hair really doesn’t make much sense when they are already testing you so frequently with urine. The hair is mostly to look at a longer period of time which can catch occasional uses and not just frequent uses, but you were being tested twice a month which is pretty rigorous. So if the MRO says that you did have metabolites, then I would talk to your employer about more frequent urine tests, but to fight them finding metabolites would be a losing battle, that would be pretty solid evidence against you.

Also I would stop hanging out with the people who were smoking methamphetamine, they may be the cause of your troubles.

I hope this helps.

Take care,
Andy
Andy PhD DABT, Toxicologist
Category: Health
Satisfied Customers: 99
Experience: Board certified with 17 years in research or consulting
Andy PhD DABT and 7 other Health Specialists are ready to help you
Customer: replied 2 years ago.

Thank you for all the information you have provided. As for the last suggestion that has already taken place. They were new people I had met and didnt know that they partied and played, Thats why I left when they didnt respect my wishes and I DO NOT plan on any further contact!!! I still dont know how there can be any metabolites present, I dont use any drugs that are not part of my HIV regimen, I have partied in the past on occasion but last time was in 2005. thank you again, and I will try to keep you informed/updated. It has been a stressful time, because I know that I dont use drugs or any substance including alcohol and am very careful what I do put into my body. I do take anywhere from 120 to 150mg of pseudoephidrine a day to help with my breathing and congestion otherwise I have a constant cough, sneezing and/or nasal congestion!!!

Expert:  Andy PhD DABT replied 2 years ago.
Hi,

I have another idea for you. You might want to consider getting your hair tested again. You would have to pay for it, but if it comes back negative you have a solid base to stand on. Since they tested hair and hair shows drug exposure over a long period of time a test done now would still be valid and comparable to the one you just had. If this were urine it would not help you because what ever you may have had in your body at the time the urine was taken would be all gone by now, but for hair it stays in your hair until it is cut. I would go to a completely different lab to have it tested and just go straight for the GC/MS, making sure they consider the metabolites and pseudoephedrine. I am not sure how much it would cost, but it certainly would be cheaper then losing your job. It would be good to get this done, but not tell the MRO or your employer until you find out what the results are for the second test. If the results are positive, then you don't want them to know that, but if it is negative, then use it to counter this positive test. Hopefully the other lab has a different washing technique and will give a different result.

If you need help finding a lab, I could try to find some for you, but would need to know what city and state you live in.

Take care,
Andy
Customer: replied 2 years ago.
Thats a good idea, I live in Allentown, Pa.
Expert:  Andy PhD DABT replied 2 years ago.
Hi,

Here are some labs that have locations in Allentown PA.

http://stdlabtest.com/drug-tests-and-info/hair-follicle-drug-test/

http://www.testcountry.com/drug-testing-center-facilities/allentown-pennsylvania.htm#

Take care,
Andy

JustAnswer in the News:

 
 
 
Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.
 
 
 

What Customers are Saying:

 
 
 
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
< Last | Next >
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
  • I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well! Claudia Albuquerque, NM
  • Outstanding response time less than 6 minutes. Answered the question professionally and with a great deal of compassion. Kevin Beaverton, OR
  • Suggested diagnosis was what I hoped and will take this info to my doctor's appointment next week.
    I feel better already! Thank you.
    Elanor Tracy, CA
  • Thank you to the Physician who answered my question today. The answer was far more informative than what I got from the Physicians I saw in person for my problem. Julie Lockesburg, AR
  • You have been more help than you know. I seriously don't know what my sisters situation would be today if you had not gone above and beyond just answering my questions. John and Stefanie Tucson, AZ
  • I have been dealing with an extremely serious health crisis for over three years, and one your physicians asked me more questions, gave me more answers and encouragement than a dozen different doctors who have been treating me!! Janet V Phoenix, AZ
 
 
 

Meet The Experts:

 
 
 
  • Nurse Milli, RN

    Nurse (RN)

    Satisfied Customers:

    4043
    20 years experience in many areas of Nursing. Both Hospital and Private Practice experience.
< Last | Next >
  • http://ww2.justanswer.com/uploads/NU/nursescare4u/2013-3-31_03429_JApic.64x64.jpg Nurse Milli, RN's Avatar

    Nurse Milli, RN

    Nurse (RN)

    Satisfied Customers:

    4043
    20 years experience in many areas of Nursing. Both Hospital and Private Practice experience.
  • http://ww2.justanswer.com/uploads/agketch/2008-7-14_184046_drketchresized.jpg Dr. Ketch's Avatar

    Dr. Ketch

    Doctor

    Satisfied Customers:

    102
    Medical Degree, Former Assistant Professor at School of Medicine at Yale University
  • http://ww2.justanswer.com/uploads/FA/FamilyPhysician/2013-8-31_191624_JA550x500Photo.64x64.jpg Family Physician's Avatar

    Family Physician

    Doctor (MD)

    Satisfied Customers:

    5622
    Emergency Medicine and Family Practice for over 26 years
  • http://ww2.justanswer.com/uploads/drphophalia/2007-08-23_095626_dr._arun_phophalia.jpg Dr. Arun Phophalia's Avatar

    Dr. Arun Phophalia

    Doctor (MD)

    Satisfied Customers:

    17025
    MBBS, MS (General Surgery), Fellowship in Sports Medicine
  • http://ww2.justanswer.com/uploads/VA/VANP/2012-6-6_235535_Skye2.64x64.jpg A. Schuyler, NP's Avatar

    A. Schuyler, NP

    Nurse Practitioner

    Satisfied Customers:

    12170
    Board Certified NP, MS, RN. Private practice & hospitalist
  • http://ww2.justanswer.com/uploads/TA/tazechip/2012-6-7_135230_drpic.64x64.png Dr. Chip's Avatar

    Dr. Chip

    Doctor (MD)

    Satisfied Customers:

    10029
    Over 20 yrs of Family Practice
  • http://ww2.justanswer.com/uploads/neurosurg/2009-10-06_120923_profile.jpg Dr. Mark's Avatar

    Dr. Mark

    Doctor (MD)

    Satisfied Customers:

    6234
    U.S. Physician/Surgeon in Neurosurgery