title: Rapid urine drug screens: diphenhydramine and methadone cross-reactivity.
abstract: BACKGROUND
  Rapid urine screens to detect drugs of abuse are often used in pediatric emergency departments (PEDs). A positive result may lead to further clinical testing, social evaluation, and increased stress/inconvenience. A PED patient with suspected diphenhydramine (DPH) ingestion had a positive methadone result on the rapid urine drug screen, One Step Multi-Drug, Multi-Line Screen Test Device (ACON Laboratories, San Diego, Calif). There was no history of methadone exposure so the patient was admitted while confirmatory testing was performed. Gas chromatography/mass spectroscopy testing of the urine failed to confirm the presence of methadone. We present this unreported false-positive methadone result and evaluation of the kit for cross-reactivity of DPH and methadone.
  
  
  METHODS
  The same One Step urine drug screen was tested at an independent laboratory for cross-reactivity between methadone and DPH including the DPH metabolites. Drug-free urine was fortified with DPH, nordiphenhydramine, or dinordiphenhydramine at 0, 10, 25, 50, and 100 μg/mL for each analyte. One hundred microliters of the solutions were added to each of the 4 wells on test cassettes. Urine was allowed to migrate according to manufacturer instructions. Each cassette was interpreted by 2 analysts to ensure consistent interpretation and accurate data recording.
  
  
  RESULTS
  In vitro laboratory testing results showed cross-reactivity between methadone and DPH but not for nordiphenhydramine or dinordiphenhydramine.
  
  
  CONCLUSIONS
  Rapid urine drug screens using immunoassays based on the principle of competitive binding may show false-positive methadone results for patients who have ingested DPH. Product information for urine drug screens may not include all cross-reacting agents and should be used with caution when interpreting drug screen results in PED patients.
authors.affiliation: Connecticut Children's Medical Center, University of Connecticut School of Medicine, 282 Washington Street,Hartford, CT 06106, USA. scrogers@ccmckids.org
authors.forename: Steven C
authors.initials: SC
authors.lastname: Rogers
authors.forename: Charles W
authors.initials: CW
authors.lastname: Pruitt
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Crouch
authors.forename: E Martin
authors.initials: EM
authors.lastname: Caravati
mesh_terms: D000701:Analgesics, Opioid / Q000652:urine; D002648:Child; D004155:Diphenhydramine / Q000652:urine*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000652:urine; D007118:Immunoassay / Q000379:methods; D008297:Male; D008691:Methadone / Q000652:urine*; D015203:Reproducibility of Results; D015813:Substance Abuse Detection / Q000379:methods*; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000652:urine*; D016482:Urinalysis / Q000379:methods
chemical_list: D000701:Analgesics, Opioid; D006993:Hypnotics and Sedatives; D004155:Diphenhydramine; D008691:Methadone