Once again, poppy seed bagels and muffins and their role in provoking positive opiate drug test results have come to the attention of the DAR Hotline. In prior editions of the MEDTOX Journal, we have provided anecdotes and actual case histories where poppy seed bakery products have caused unsuspecting consumers to come into the crosshairs of drug testing programs. Those impacted include unaware new hires being drug tested for a new job up to veteran clients of probation or parole programs that get hauled before the court. Poppy seeds are components of the opium poppy plant. The opium poppy is, of course, the organic starting line for the manufacture of narcotics such as codeine and morphine. When poppy seeds are harvested for use in the creation of foodstuffs, minute traces of opium, morphine, and codeine come along for the ride. These trace opiates are consequently ingested when a person eats a bagel or muffin that is covered over with poppy seeds. And when a person is subjected to a drug test a short time following ingestion of the poppy seed pastry, it is possible that a positive result for the presence of opiate might be rendered.

The Internet is full of stories and anecdotes involving individuals who innocently and unknowingly ate poppy seed products. These people subsequently had their lives turned upside down with a positive opiate drug test and allegations of drug abuse and addiction. And this accidental ingestion may also apply to foodstuffs that contain hemp products as well. Hemp is a fibrous element harvested from the marijuana plant. It too contains trace residue of tetrahydrocannabinol(THC), the most active ingredient in marijuana. So products such as hemp energy bars, hemp milk, etc., should be avoided by anyone who may possibly be the subject of a drug test. It is much easier to avoid eating such a food product than it is to have to explain to an employer, judge, or commission that you ate contaminated food. And as an aside, a positive opiate testing report that is a consequence of poppy seed ingestion is not a false positive result; it is a legitimate, accurate report that reflects the presence of opiates. It is only false in the sense that the opiates were not ingested as a means to get high.

The morphine and codeine that hitch rides on poppy seeds into a consumer's bloodstream do so in very small quantities, concentrations that do not always rise to a level that is high enough to trigger detection. In modern drug testing protocols, cutoff levels are calibrated in part to hedge against inadvertent, accidental ingestion of trace amounts of drugs. For opiates themselves, drug testing cutoffs span a wide range of concentrations. From some that are as high as 3,000 ng/ml to others that are sensitively dialed in at 300 ng/ml, testing systems have the potential to identify unsuspecting poppy seed consumption. Various studies have attempted to quantify the relationship between the amounts of consumed poppy seeds and the time it takes for those trace amounts of morphine and codeine to clear the system. Conventional wisdom holds that a "typical" poppy seed bagel will produce a morphine concentration of 250 ng/ml sometime between two and three hours following ingestion. These trace amounts of codeine and morphine on poppy seeds are insufficient to get a person high. It would take dozens of bagels and muffins for a person to begin to feel the analgesic and depressant action of the opiates. And even then, a trained DAR or DRE evaluator would not find any of the classic signs that are associated with opiate intoxication. And beyond that, the gastric distress caused by cramming down multiple bagels or muffins "overdose" would be frightening. Nevertheless, tying on a second poppy seed pastry may be an invitation to trouble.

Some time ago, Discovery Channel's MythBusters confronted the claim that poppy seed ingestion can cause positive opiate drug test results. In that episode, one participant ate an entire poppy seed covered loaf; the other ate several poppy seed bagels. Both of them generated positive opiate drug test results a short time later. The positive results persisted for hours. Each one had been drug tested before their poppy seed meal, each was negative. This incident adds to the controversy that surrounds poppy seeds and drug testing. But not everyone who eats poppy seed food items will test positive for opiates. Toxicologists and drug test experts fall on both sides of this issue. Some are adamant that consumption of a single poppy seed product will NOT trigger a positive test result, while others caution that even a couple of bites from a poppy seed bagel could spell trouble.

MythBusters- Poppy Seed Drug Test

The best public policy is to let the buyer beware. Many probation and parole programs now require participants to sign an acknowledgement that foodstuffs can be the cause of a positive drug test. But that the responsibility for avoiding such situations is the burden of the participant or client. And any positive drug test result will therefore include a non-rebuttable presumption that the drug involved came from a nefarious, illicit source.  

A recent study published by the Center for Disease Control and Prevention (CDC) shows a sharp increase in fatal overdoses of prescription drugs. Data that had been collected by Florida medical examiners from 2003 to 2009 also showed a similar decrease in cocaine-related deaths. Recent national data indicates an increasing number of deaths involving opioid analgesics and cocaine through 2006. The findings indicate a worsening problem in Florida with overdoses involving prescription drugs, especially oxycodone and alprazolam, and recently a decline in cocaine-related deaths.  

According to the CDC, in 2007, unintentional poisonings were the second leading cause of injury death in the United States (after motor-vehicle crashes). Drug poisoning, also known as drug overdose, caused approximately 93% of all unintentional poisoning deaths. Overall prescription drug related deaths increased 84.2%, from 7.3 to 13.4 per 100,000 population. Oxycodone (Oxycontin, Percocet, etc.) death showed the greatest increase at 264.6%, followed by alprazolam (Xanax) at 233.8%, methadone at 79.2%, hydrocodone (Vicodin, Lorcet, Norco, etc.) at 34.9%, and morphine at 26.2%. Conversely, the death rate for heroin decreased 62.2% from 2003 to 2009. By the end of 2009, the study suggests that the number of deaths involving prescription drugs was four times the number involving illicit drugs. Hidden within these details are changes in user preferences, a movement that involves heroin users shifting their efforts towards acquiring and using oxycodone. Not known in this study is whether or not the new Oxycontin"OP" formula impacted these empirical shifts. The new Oxycontin formula renders it much less susceptible to conversion into a parenteral (I.V. or smoking) administered drug. In Western U.S. locations, many veteran Oxycontin smokers have been befuddled by the new OP formula and have switched their hardcore opiate preferences back to heroin. Out west, heroin is usually cheaper and more available than Oxycontin.  

In the report, similar changes in overdose and death incidents were reported by the Office of State Medical Examiner in Kentucky. From 2007 to 2009, the number of deaths involving oxycodone in Kentucky doubled, while at the same time the number of deaths involving cocaine and methadone declined. The report, however, states the trends reported in Florida and Kentucky are not necessarily indicative nationwide. In fact, Florida and Kentucky have been spotlighted as states with exacerbated prescription drug diversion problems, places where Oxycontin, Vicodin, Soma, Xanax, and Valium are out of control. Diversion of pharmaceutical medications, often times redirected products from ubiquitous pain clinics, is the source of these drugs on the streets. 

In fact, since 2007, Florida has seen a dramatic influx in the number of pain clinics that prescribe large quantities of oxycodone products and alprazolam (Xanax), some of which is ultimately and obviously used for nonmedical purposes, the CDC reports. On the streets, oxycodone and Xanax reach the euphoric heights of what some users call "drug store heroin." Some users swear allegiance to Oxycodone, Soma, and Valium, as another pharmaceutical combination that triggers a dangerously euphoric high. Many of the customers of such clinics reside outstate, reportedly Appalachian states such as Kentucky, who travel to Florida to obtain prescription drugs and then resell them in their home state. According to the study, Florida has now passed legislation establishing standards for pain management clinics. The new legislation establishes more stringent licensure requirements, along with putting a limit on the amount that could be prescribed when patients pay with cash. The new legislation also now requires tamper-resistant prescription forms. The CDC says that the impact of such legislation has yet to be determined.

Regular readers of this column will reach one of two possible conclusions reading this essay. Readers will either deduce the identity of this month's mystery drug right away or they will be forced to read on through to the last drop of narrative. We'll endeavor to put our major clues up front this time around.

This month's drug is a benzodiazepine, a member of the family of drugs that sports prescription sedatives such as Valium and Xanax. Arguably, this month's drug may be the most elegant and most powerful of the benzodiazepine family. This drug is widely used in modern healthcare systems. But it is unlikely that this drug will be found in residential medicine cabinets. The local pharmacy would probably not be able to fill the prescription were a physician to lend his or her approval. The drug is safe, but it is powerful. Like most other benzodiazepines, this month's drug is controlled and regulated under the terms of Schedule IV. Much of the industrialized world approves and uses this drug; it is a reliable sedative and seizure-limiting drug. It is available in a variety of forms. It can be found in syrup and as a solution for intramuscular (IM) injection. In Europe, the drug is widely distributed in tablet form, via Internet markets; some of that product makes it into the United States. In some places, the drug is available as a small lozenge (buccal) designed to dissolve in the mouth; it is also available in suppository form for use in pediatric medicine. In the United States, the most common form of the drug is in a solution for intramuscular injection. This drug is unique among other benzodiazepines in that it is water-soluble. Because of its water solubility, the drug has more nimble chemical characteristics; it is widely distributed in the body following ingestion or injection.

Despite its chemical lineage as a member of the benzodiazepine family, there is some controversy surrounding this drug. In hospital settings, this drug is routinely used as an adjunct in procedural anesthesia. Although the drug is effective in the treatment of pediatric seizures, it is more widely recognized for its role in reducing anxiety and the restlessness that precedes surgical procedures in adults. Millions of patients have received this drug as a means of relaxation before routine diagnostic procedures, such as a colonoscopy. Surgery, whether it is same day or in-patient, involves some rather unpleasant hospital experiences. When used as pre-medication for surgery, this month's drug can impair memory and effectively erase bad memories from occurring. But this drug is relatively short acting; its effects can wear off quickly. Many patients have reported waking up during a procedure in a quasi-state of anesthesia unable to communicate their consciousness. Some patients have even complained that while anesthetized, this month's drug subjected them to mistreatment by healthcare workers. Lodged allegations of molestation have occurred. As such, this month's drug has a devoted group of opponents who denounce its use. The Internet is awash with the stories of activists who decry the use of the drug.

This month's drug is a valuable asset in treating terminal illness. Palliative care requires drugs with sufficient potency to reduce the pain, restlessness, and anxiety associated with end-of-life care. Particularly when agitation occurs in patients in hospice settings, this month's drug is an efficient means of controlling actions that can exacerbate conditions leading to more pain and suffering.

Abuse of this drug is relatively rare. Healthcare workers are the most susceptible. Recent media coverage of the Michael Jackson manslaughter trial has spotlighted the roll that this month's drug plays in treating severe cases of insomnia. Diazepam, temazepam, and other benzodiazepines are more efficient sleep aids over the long haul. But in treating those insomniacs who can't get to sleep by other means, this month's drug is a reliable choice. As mentioned in the Jackson case, this drug is routinely used in conjunction with the surgical anesthetic propofol. Both drugs are short acting hypnotics that, when professionally administered, are safe and reliable drugs. Like all benzodiazepine class drugs though, tolerance and dependence to this drug can develop over time. But unlike other drugs in its class such as Xanax and Valium, this month's drug is infrequently used over extended periods of time. Cops on the street are unlikely to find this drug in the pockets of substance abusers, drunk drivers, or drug dealers. Rehabilitation experts working in the impaired professional market should keep this drug in mind when dealing with physicians, nurses, and other healthcare workers who may have drug and/or alcohol problems. And although the drug is not easy to locate at your local pharmacy, doctors and nurses will have no problem finding the drug in the hospital.

Click Here for this month's mystery drug.

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This is not a rhetorical question, but what is wet? MEDTOX DAR staff, with over 250 years of collective law enforcement experience, defines wet in three different manifestations. The original version of wet found in the mid to late 80s was a PCP cigarette that had been dipped in formaldehyde, dried, and then smoked. Perhaps the most potent of any street drug ever manufactured, PCP, also known as angel dust, was a scourge. PCP abusers were not your usual weekend drug smoker. They were frequently gang members and violent criminals who controlled the production and sales of the drug. PCP ignited violent tendencies from those who abused it. Confrontations with the police were almost predestined. Electrocutions, drownings, and fatal pedestrian accidents were the order of the day for abusers. By dipping a PCP cigarette in formaldehyde, the insidious effects of the drug were exacerbated. The formaldehyde added to the anesthetic effects of PCP and heightened the dissociative experience it caused. In those days, wet was a formidable street drug. People high on wet were dangerous, uncontrollable, and incapable of feeling pain. Early wet users were mostly found on the west coast with clusters found in the gang populations of Los Angeles, San Diego, and Fresno. By the mid 90s, PCP was on the wane. Focused and determined law enforcement had forced PCP production to retreat to Mexico. But by then, the popularity of cocaine and methamphetamine had squeezed PCP out of the retail drug market. With little demand for its bizarre and alienating high, PCP all but disappeared.

Wet underwent a reincarnation in the new millennium. In 2000, word started to spread of a new wet. This product was more subdued. Rumors of the new version of the drug arose in east coast cities like Newark, Philadelphia, and Baltimore. With PCP nearly extinct, wet users had now taken to dipping marijuana cigarettes into formaldehyde, once again smoking them when the cigarettes had dried. Called shamrocks in San Diego, crickets in Miami, and wet in Los Angeles, formaldehyde-dipped, hand-rolled cigarettes were popular. When smoked, they emitted a very pungent odor that was easy to detect by police. The effects of marijuana-dipped cigarettes were noticeably different. Users of this form of wet were docile. They were out of it, but they were compliant, and for the most part, non-violent. DAR staff instructors recall many of these wet users complaining of crushing headaches and hallucinations. But unlike PCP-dipped wet cigarettes, there was little violence evidenced with the smoking of marijuana and formaldehyde.

With the emergence of designer botanical strains of marijuana, dipping marijuana cigarettes in anything has become an affront to good taste. Marijuana quality and potency has reached new heights. The drug does not need added ingredients to reach a quality high. So in this modern era, economics may be the determiner of drug trends. Consider this a recession concession. Wet is back. But in a sign of the times, tobacco is now dipped in formaldehyde. Cigarettes dipped in nail polish remover are also on the menu. Although smoked when dry, these treated cigarettes are flammable and prone to "flash" burning. Modern wet cigarettes are shared by two or three smokers. The combined effects of nicotine and inhaled formaldehyde are cited as "calming" and "mellowing." These effects last for 7 to 10 minutes. Tobacco-dipped wet cigarettes are vogue in New England and other major cities that dot the eastern Atlantic coast. Wet is most popular with teenagers and very young adults. Symptoms of intoxication are mostly depressant in their net effect, but the very short span of effects makes it difficult for evaluators to pinpoint signs and symptoms of intoxication. Calls to the DAR Hotline regarding wet make it clear that there has been resurgence of use. But there is no evidence that wet's return is accompanied by a reemergence of PCP. A silver lining perhaps.

So wet is indeed back. But wet is much less dangerous than it was just years ago. And although modern wet smokers are still putting themselves in bad situations, their plights are much less frightening than they were for the PCP and formaldehyde smokers of the prior generation. Many a physical scar, bad memory, or newspaper obituary exists today because of the insidious effects of wet's PCP and formaldehyde combination.

Recent reports on the proliferation of pain clinics have linked expanded medical utilization of narcotic analgesics with their diversion and non-medical use in the community. A recent poison control center survey reports that the national rate of pediatric drug poisonings now has exploded and that opiates and anxiolytics are at the top of the list of offending drugs. From Oxycontin to Xanax, powerful prescription medicines have experienced rapid expansions in their rates of utilization in communities where "pain clinics" have sprouted. These drugs are routinely prescribed in batches of 100 tablets or more per script. In many cases, these drugs sit unsecure in medicine cabinets, exposed to intentional and accidental access by persons other than the intended user.

In the modern effort to control pain, semi-synthetic opiates and benzodiazepine-based anxiolytics form the basis of the pharmaceutical approach to chronic pain control. But for the modern substance abuser, these drugs form the core of the cocktail that is the preferred recreational high. Adult drug use trends ultimately translate into the formula for pediatric and adolescent accidental poisonings. In particular, those drugs that mom and dad take for aches and pains are the same substances that young kids accidentally overdose on when scooped up from the family medicine cabinet.

A retrospective study published in the Journal of Pediatrics looked at the histories of 450,000 pediatric emergency room admissions between 2001 and 2008 where ingestion of a pharmaceutical product had occurred. In an assessment of the entire population, over 95% of those cases involved accidental self-ingestion of a controlled substance. Topping the list of drugs involved were opiates and sedative hypnotics. Although diabetes medicines and blood pressure control medicines were represented, far and away the most common miscreants were opiates and benzodiazepines. Expanded use of these drugs in the era of pain management has led to the poisoning and illness of innocent, unsuspecting youth. Beyond the lessons associated with medicine cabinet security are warnings to the rest of us about the dangers of powerful medications used to treat serious adult conditions.

Thank you subscribers. We appreciate your dedicated readership. At MEDTOX we are committed to providing clients with the service and solutions you need to run successful drug testing programs. Our Journal is just one way that we show that commitment. We always encourage feedback from our Journal. Please send your thoughts to medtoxjournal@medtox.com.