Dr. Hudson

Please provide additional information: type of drug test, method and quantitative results, if applicable.

Thanks

Michael Borkowski, MD, MPH

Medical Director, F&MCW Occupational Health Services

Phone: 414-805-7997 | Fax: 414-805-7995

Cell Phone: 414-881-3762

E-mail: michael.borkowski@froedtert.com

Froedtert & the Medical College of Wisconsin

Occupational Health Services

9200 West Wisconsin Avenue

Milwaukee, WI 53226

froedtert.com

From: MCOH-EH [mailto:mcoh-eh-bounces@mylist.net] On Behalf Of Hudson, T. Warner
Sent: Friday, November 14, 2014 5:02 PM
To: Karl Auerbach; MCOH/EH
Subject: Re: [MCOH-EH] MRO question

I have a suspicion based result back on a nurse; has Rx for Dilaudid and Hydrocodone/acetaminophen:

Positive for:

Morphine

Codeine

Hydrocodone

Hydromorphone

My sources say the latter two make sense (hydromorphone and hydrocodone) but not the morphine and codeine. Any debate one that?

T. Warner Hudson, MD FACOEM, FAAFP

Medical Director, Occupational and Employee Health

UCLA Health System and Campus

Office 310.825.9146

Fax 310.206.4585

Pager 800.233.7231 ID 27132

E-mail twhudson@mednet.ucla.edu

Website www.ohs.uclahealth.org

From: MCOH-EH [mailto:mcoh-eh-bounces+twhudson=mednet.ucla.edu@mylist.net] On Behalf Of Karl Auerbach via MCOH-EH
Sent: Friday, October 10, 2014 1:03 PM
To: 'MCOH/EH'
Subject: Re: [MCOH-EH] MRO question

It is a bit suspicious but don’t forget that drug tests are done at levels which may be well below the therapeutic “half life” calculations.

I would be happy to send this on to the MRO list where you might get much more input.

Karl

From: MCOH-EH [mailto:mcoh-eh-bounces@mylist.net] On Behalf Of Holt, Claudine
Sent: Friday, October 10, 2014 1:29 PM
To: 'mcoh-eh@mylist.net'
Subject: [MCOH-EH] MRO question

Dear Colleagues,

I have an MRO question and would appreciate some feedback:

Someone came in for a pre-placement physical (in a patient care role) and the drug screen came back positive for phenobarbital. She denies use of any barbiturate and none of the medications that she is on should cause a positive barbiturate screen. However, she called me back a day later to say that she had a colonoscopy on 9/9 and her gastroenterologist told her that might have caused the positive test. The drug test was done 20 days after the colonoscopy on 9/29 and as far as I know, you don’t typically get a barbiturate during a colonoscopy.

I asked her to have the anesthesiologist’s report sent to me so I could see what was administered.

The t ½ of phenobarbital is 53-140 hours (per Up to Date). Since it takes about 5 half-lives to eliminate something, it could take from 265-700 hours. She had the procedure on 9/9 and the drug test on 9/29 which is 480 hours. So if she was given phenobarbital during the procedure, it actually might have been in her system.

Has anyone ever dealt with anything like this? What are your thoughts?

Sincerely,

Claudine Holt, MD, MPH

Staff Physician, Occupational Health Services

Temple University Hospital

Basement, Rock Pavilion

215-707-8151 (phone)

215-707-5751 (fax)

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