Find Cause Of Unexpected Hydromorphone Positive Test (gcms)

If you too are testing positive for hydromorphone but are taking only other opioid medicines (and that includes peripheral antagonists, such as Movantik or Relistor, as well as drugs such as oxycodone or oxymorphone):

Please respond with what opioid(s) you are taking, and also if you are taking any probiotics, what bacteria strains are listed on the package? (certain bacteria are known to transform some opioids to hydromorphone)

Was a GCMS test done?

I'll keep a tally and post the results, hopefully helping everyone with this problem.

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REPORT

This is just an update: I stopped taking both the probiotics and Movantik, and had another GCMS urine test, which was (finally!) negative for hydromorphone.

So, this shows that either Movantik or the probiotics were the cause of the unexpected results.

It does not tell me, however, whether the cause was A) Movantik was being reported as hydromorphone (presumably as a result of hydromorphone being the closest entry in the lab's spectral library) or B) one of the probiotic bacteria stealing an oxygen atom from some of the Oxymorphone in my gut, converting it to hydromorphone.

What had made me decide to stop taking them was the result of googling, and finding: A) The structure of naloxegol is very close to naloxone, which in turn is very close to that of hydromorphone, and B) there are medical journal articles describing how investigation into putative "false positive" results (showing the presence of ? quantities of unexpected hydromorphone in hospice patients having controlled medicinal intake) revealed that bacteria in the gut was transforming morphine to hydromorphone. The same was also found in one hospitalized pediatric patient.

Note that such transformation is not the same thing as hepatic metabolism, which would not transform an "oxy" drug to a "hydro" drug. Instead the gut bacteria removes the oxygen atom from the "OH" group that distinguishes it from hydromorphone. [Via Google, I found a number of U.S. patents describing the use of such bacterial transformations in drug manufacture. I also found an article which describes the structural differences between these and some other opiates, exceptionally clearly. The article appears to have been written by and for opiate abusers, but is nonetheless clearly and concisely written. It's a good reference for understanding how the transformation could occur.]

Source: "A Look at the Morphinan Structure Activity Relationships of Six Popular Opiates", Opiophilia.blogspot.gr. Web. December 8th, 2012

I would still like to hear from anyone who has had similar urine test reports after taking either Movantik or probiotics.

I cannot take either more Movantik or the same probiotics I had been using to determine which is the actual cause, because such an experiment would require the use of further urine tests to obtain data, and another positive test could get the doctor in trouble with his board (which audits the records), and also result in his discharging me from his practice.

However, tabulating the data from other people would be an acceptable substitute for such an experiment.

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I am prescribed oxycodone and I'm three tests they're stating that I tested positive for oxymorphone and hydromorphone which I have not taken either one of those I only take my oxycodone when I am prescribed please help me I've been discharged from my doctor's office and they don't believe me

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I am taking gabapentin oxymorphone and oxycodone for chronic back pain. I was given a swab test last month. When I went in yesterday to see my doctor she put me on probation because I tested positive for hydromorphone!!!! I have NOT taken hydromorphone EVER IN LIFE! WHY is this happening to me!?!?

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Re: Michael (# 1)

I have a definite answer to the question of why I was getting a false positive test for hydromorphone.

A minimal understanding of GC/MS (or LC/MS) is needed.

GC/MS can be very precise. But that precision is not built into the hardware, but instead is dependent upon the library loaded into the instrument containing a spectra description that matches the compound being matched.

There are many millions of possible chemicals. Millions of comparisons would be exorbitantly expensive (and time-consuming), so, in GC/MS, the list of possible candidates is pared down, by using heuristics. One such heuristic might restrict the set of potential matches to only those containing the elements indicated by the sample's spectra. Often, 7 or fewer heuristics can narrow the match possibilities to perhaps one dozen.

After obtaining a small set of possibilities, one by one comparisons against sample spectra defined in a library are performed. There can be several very, very close matches and if the compound of interest is not present in the library, the closest match that IS present will be reported.

See shimadzu.com/an/searching_libraries.html for a flash animation of such comparisons.

In the animations, a set of vertical lines represents the spectra of a compound. The position of each vertical line represents one element from the periodic table, and its height represents the relative quantity of that element in relation to the others. The red lines represent the sample under test, and the blue lines represent potential matches, from the lab's library. When the blue lines are slid left over the red lines, more congruent the lines from a library member are with the lines of the sample being tested, the closer the match.

In the case of the false positive that was plaguing me: the lab in question was Millennium Labs. After digging into heavy papers in peer-reviewed journals, I came to suspect that the problem was that the library in use by Millennium did not contain a spectra match for Movantik (naloxegol).

I stopped taking the Movantik, and my next test after doing so was negative. My doctor spoke with Millennium. At first he was stonewalled, but eventually he spoke with someone there who understood the (potential) issue.

I started taking Movantik again after the doctor told me that Millennium had added a spectra specification for Movantik to their lab's library, and I have had no further false positives for hydromorphone.

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Re: Susie (# 3)

GCMS can be very precise, but only when the test equipment has sufficient data in its library, a state which can cease being true if a new drug is introduced, and you get a prescription for it before the drug has been added to the test lab's library for their GC/MS system(s).

Are you taking Movantik?

I had been getting false positives for hydromorphone in tests that were run at a laboratory operated by "Millennium Labs", until my doctor spoke with them and had them add Movantik (naloxegol) to the library used to describe the spectra of various opioids to their LCMS/GCMS testing system.

When ionized, the main ion fragment of naloxegol has a spectrum that is quantitively very similar to the main ion fragment of hydromorphone HCL (hydromorphone). Because of that similarity and because the library used by the Millennium lab had lacked a specification for naloxegol, it was reported as hydromorphone.

It might be possible for something similar to happen with the relatively newly introduced Relistor tablet, which serves the same purpose as Movantik.

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