Sunday, November 22, 2009

Morphine, hydromorphone, and urine drug testing

Clinical Chemistry has a fascinating case discussion about finding hydromorphone on a urine drug test in a hospice patient receiving high doses of morphine. It discusses hydromorphone as a minor metabolite of morphine, and one that can be found in urine drug testing in patients only taking morphine (which they argue this patient likely was - was in a sequestered environment long-term, etc.). In talking to colleagues and friends nationally who work in palliative care settings, urine drug testing is becoming a real presence in our clinical practice (perhaps used rarely, and reluctantly) as the reality of aberrant drug use in cancer patients in palliative care settings is becoming more of a palpable clinical challenge. That said, the more I read about urine toxicology screening, the less I am convinced it's good for much other than demonstrating some modicum of compliance (but any smart patient will know what to do about that) and the presence of non-opioid 'street' drugs.

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