Taking prescribed medication? What to tell us before testing

Why disclosure matters

Drug screens look for drug classes, not intentions. A prescribed medication in the same class as a drug of misuse will screen positive, and some unrelated medicines can cross-react with screening strips. A clinical review advises that presumptive positive results be interpreted in the context of a patient’s current medications (StatPearls). When your tester knows what you take before the result comes in, a positive is a conversation, not a crisis.

Medications that are expected to show up

• Prescribed opioids

  Pain medications such as codeine or morphine, and depending on the panel, other opioids.

• Stimulants for ADHD

  Amphetamine based medications screen positive for amphetamines. A peer reviewed review notes that prescribed medications such as ADHD stimulants can be detected (Hadland and Levy, 2016).

• Benzodiazepines

  Medications prescribed for anxiety, panic or sleep.

• Barbiturates

  Some seizure and headache medications.

• Medications for opioid use disorder

  Methadone and buprenorphine are usually detected only if the panel specifically includes them.

Medicines that can cause false positives

Instant screens use antibodies that can react to look-alike molecules. Documented examples include:

• Pseudoephedrine (decongestants) and phentermine (weight loss) on amphetamine screens (SAMHSA TAP 32)
• Dextromethorphan (cough medicine) on PCP screens in some assays (SAMHSA TAP 32)
• Selegiline and bupropion on amphetamine screens (StatPearls)
• Poppy seeds, which contain low levels of morphine detectable by sensitive tests (Hadland and Levy, 2016)

This is not a complete list. That is the point of disclosing everything, even items you think are harmless.

Products that matter for alcohol tests

If you are tested for alcohol with EtG, alcohol based products count too. Mayo Clinic Laboratories notes that incidental exposure from products like hand sanitizer and mouthwash may produce detectable EtG and EtS (Mayo Clinic Laboratories). Liquid medicines and tinctures can also contain alcohol. See EtG and incidental alcohol.

Medications a screen may miss

Disclosure is not only about explaining positives. Some prescribed drugs may not show on a basic panel even when taken as directed. Laboratory educators note that methadone does not cross-react with opiate immunoassays and that oxycodone triggers them only at high concentrations (ADLM). If someone in your life expects to see a prescribed medication in results, for example as part of a medication adherence plan, make sure the panel actually includes it.

A note on medications for opioid use disorder

If you take buprenorphine or methadone as part of treatment, testing can actually work in your favor. When the panel includes these medications, a positive result shows you are taking what was prescribed, and a negative one may prompt a helpful conversation with your prescriber. Tell your tester and, with your permission, your prescriber can be included in who receives results. Taking a medication for opioid use disorder is treatment, not a relapse, and a good monitoring program treats it that way.

What to tell your tester

1. Every prescription you take, including the name, dose and when you last took it.
2. Over the counter medicines from the past week, especially cold, allergy, sleep and cough products.
3. Supplements and herbal products.
4. Alcohol containing products if you are being tested for alcohol.
5. Recent foods that might matter, such as poppy seeds.
6. Any change since your last test, including a new prescriber or dose.

Keep a current list on your phone and bring your pharmacy label or bottle if a result might be questioned.

What happens if a prescribed medication screens positive

A screen cannot tell a prescribed dose from misuse. Laboratory confirmation can identify the specific substance, which helps separate a prescribed medication from something else in the same class. SAMHSA recommends confirmation when a result is disputed or could carry consequences (SAMHSA TAP 32). Questions about whether a medication is being taken as prescribed belong with the prescriber. A drug test alone cannot answer them, and NIDA notes testing should not be the sole basis for care decisions (NIDA).

Never stop or change a prescribed medication to avoid a positive test. Talk with your prescriber instead.

Privacy and who sees your medication list

Your medication information is personal. It should be used to interpret your results and shared only with people you authorize. If results go to an attorney, a program or a family member, you can decide how medication details are described in what they receive.

How Blackburn Monitoring can help

At Blackburn Monitoring, your coordinator asks about medications before you test and keeps that information private. Presumptive positives can be sent to our partner laboratories for confirmation, and results go only to the people you authorize in writing. Testing is low cost and by appointment in Los Angeles.

Use the medication disclosure checklist, read about lab confirmation, or see our FAQ. If you need help with a medication plan, our team can introduce you to psychiatric care at Blackburn Clinical Services.