Skip to main content

Advertisement

Log in

False negative result for amphetamines on the Triage® Drug of Abuse panel?

The cause of the unusual phenomenon with experimental analyses

  • Case Report
  • Published:
International Journal of Legal Medicine Aims and scope Submit manuscript

Abstract

On-site drug screening devices are widely used today for their simple test procedures and instantaneous results. Among other devices, a Triage® Drug of Abuse panel is considered to be highly reliable for its high specificity and sensitivity of abused drugs. Although it is known that a false positive amphetamine (AMP) result may be obtained from the urine samples containing putrefactive amines or ephedrine-related compounds, no clinical false negative methamphetamine results have been reported to date. However, a false negative Triage® result was obtained from the urine of a fatal methamphetamine poisoning victim taking Vegetamine® tablets. Further experimental analyses revealed that the cross-reactivity of methamphetamine and chlorpromazine metabolites, including nor-2-chlorpromazine sulfoxide, was the cause for a false negative Triage® reaction for AMP. Forensic scientists and clinicians must be aware of the limitations of on-site drug testing devices and the need for the confirmatory laboratory tests for the precise identification and quantification of drugs in suspicious intoxication cases, as also recommended by the manufacturers.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

References

  1. Moody DE, Fang WB, Andrenyak DM et al (2006) A multiple-site laboratory evaluation of the instant-view 5-panel test card with OnTrak Testcup Pro 5: comparison with gas chromatography-mass spectrometry. J Anal Toxicol 30:50–56

    PubMed  CAS  Google Scholar 

  2. Peace MR, Poklis JL, Tarnai LD, Poklis A (2002) An evaluation of the OnTrak Testcup-er on-site urine drug-testing device for drugs commonly encountered from emergency departments. J Anal Toxicol 26:500–503

    PubMed  CAS  Google Scholar 

  3. Peace MR, Tarnai LD, Poklis A (2000) Performance evaluation of four on-site drug-testing devices for detection of drugs of abuse in urine. J Anal Toxicol 24:589–594

    PubMed  CAS  Google Scholar 

  4. Amemiya M, Nagai T (2000) Studies on the Triage system for screening test of methamphetamine abuser’s urine. Nihon Kanshikikagaku Kaishi 4:95–98 (in Japanese)

    Google Scholar 

  5. Tomaszewski C, Runge J, Gibbs M, Colucciello S, Price M (2005) Evaluation of a rapid bedside toxicology screen in patients suspected of drug toxicity. J Emerg Med 28:389–394

    Article  PubMed  Google Scholar 

  6. Phillips JE, Bogema S, Fu P et al (2003) Signify ER drug screen test evaluation: comparison to Triage Drug of Abuse panel plus tricyclic antidepressants. Clin Chim Acta 328:31–38

    Article  PubMed  CAS  Google Scholar 

  7. Crouch DJ, Hersch RK, Cook RF, Frank JF, Walsh JM (2002) A field evaluation of five on-site drug-testing devices. J Anal Toxicol 26:493–499

    PubMed  CAS  Google Scholar 

  8. Nishiguchi M, Kinoshita H, Higasa K et al (2001) The false positive reaction of the Triage panel drug-of-abuse by herbal drugs ma-huang (Ephedra sinica (Ephedraceae)). Nihon Hoigaku Zasshi 55:331–338 (in Japanese)

    PubMed  CAS  Google Scholar 

  9. Ishida T, Kudo K, Naka S, Toubou K, Noguchi T, Ikeda N (2007) Rapid diagnosis of drug intoxication using Novel NAGINATA™ gas chromatography/mass spectrometry software. Rapid Commun Mass Spectrom 21:3129–3138

    Article  PubMed  CAS  Google Scholar 

  10. Kudo K, Ishida T, Hara K, Kashimura S, Tsuji A, Ikeda N (2007) Simultaneous determination of 13 amphetamine related drugs in human whole blood using an enhanced polymer column and gas chromatography-mass spectrometry. J Chromatography B 855:115–120

    Article  CAS  Google Scholar 

  11. Schulz M, Schmoldt A (2003) Therapeutic and toxic blood concentrations of more than 800 drugs and other xenobiotics. Pharmazie 58(7):447–474

    PubMed  CAS  Google Scholar 

  12. Karch SB, Stephens BG, Ho CH (1999) Methamphetamine-related deaths in San Francisco: demographic, pathologic, and toxicologic profiles. J Forensic Sci 44:359–368

    PubMed  CAS  Google Scholar 

  13. Wijetunga M, Seto T, Lindsay J, Schatz I (2003) Crystal methamphetamine-associated cardiomyopathy: tip of the iceberg? J Clin Toxicol 41:981–986

    Article  CAS  Google Scholar 

  14. Hong R, Matsuyama E, Nur K (1991) Cardiomyopathy associated with the smoking of crystal methamphetamine. JAMA 265:1152–1154

    Article  PubMed  CAS  Google Scholar 

  15. Jacobs LJ (1989) Reversible dilated cardiomyopathy induced by methamphetamine. Clin Cardiol 12:725–727

    Article  PubMed  CAS  Google Scholar 

  16. Baselt RC (2002) Chlorpromazine. In: Baselt RC (ed) Disposition of toxic drugs and chemicals in man, 7th edn. Biomedical, Foster City, pp 217–222

    Google Scholar 

  17. Smith-Kielland A, Olsen KM, Christopherson AS (1995) False-positive results with EMIT II amphetamine/methamphetamine assays in users of common psychotrophic drugs (letter). Clin Chem 41:951–952

    PubMed  CAS  Google Scholar 

  18. Olsen KM, Gulliksen M, Christopherson AS (1992) Metabolites of chlorpromazine and brompheniramine may cause false-positive urine amphetamine results with monoclonal EMIT dau immunoassay (letter). Clin Chem 38:611–612

    PubMed  CAS  Google Scholar 

  19. Melanson SE, Lee-Lewandrowski E, Griggs DA et al (2006) Reduced interference by phenothiazines in amphetamine drug of abuse immunoassays. Arch Pathol Lab Med 130:1834–1838

    PubMed  CAS  Google Scholar 

  20. Pavlic M, Libiseller K, Grubwieser P, Schubert H, Rabl W (2007) Mediolegal aspects of tetrazepam metabolism. Int J Legal Med 121:169–174

    Article  PubMed  Google Scholar 

  21. Pavlic M, Libiseller K, Grubwieser P, Rabl W (2005) Cross-reactivity of the CEDIA buprenorphine assay with opiates: an Austrian phenomenon? Int J Legal Med 119:378–381

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Noriaki Ikeda.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hikiji, W., Kudo, K., Sato, S. et al. False negative result for amphetamines on the Triage® Drug of Abuse panel?. Int J Legal Med 123, 247–252 (2009). https://doi.org/10.1007/s00414-008-0304-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00414-008-0304-9

Keywords

Navigation