Dear doctor, I have been a patient at the pain clinic for 5 plus years but have been on opiate pain medication for 15 years. I have rheumatoid arthritis, degenerative disc disease, sjogren\’s syndrome, narcolepsy with cataplexy, severe hip dysplasia, torn hip labrum and now need a hip replacement. I take several medications including MS contin, alprazolam lyrica, naproxen, Adderall for narcolepsy, propranolol, miralax docusate sodium, flonase, flexeril, and Diclofenac topical gel. Oh and Zyrtec for allergies. I see the pain clinic every 3 months for injections into my spine, SI joints, trigger point injections into muscles into my back and hips. I take a drug screen once a year in the fall, which I recently had October 7th. I was called on November 1st and told that my drug screen tested positive for diazepam, or restoril. My response was that I absolutely never taken diazepam. I wouldn\’t need to as I already take alprazolam and flexeril. I was told that I need to come in and see the PA before getting any refills of my medication. I\’m absolutely terrified that I\’m going to just be cut off and my pain will be out of control again. But even more so I\’m concerned about my reputation being ruined with all of my specialists and the ortho surgeon that I need to have the hip replacement with. I was also a certified drug screen collector for many years as I was a medical assistant working in occupational health. I know that there can be a chain of custody problems and human error. But I never expected this to happen to me. Is there anything that I\’m taking or combinations of what I\’m taking that could cause the false positive result? I don\’t have the actual result to give you at this point because they won\’t release it to me until I see the PA. Thanks in advance for your help.
Healther, Thank you for your question. The answer is YES, there is a chance of a false positive for diazepam. See the metabolic pathways of benzodiazepines here. Although alprazolam is chemically different from diazepam (Valium) and temazepam (Restoril), it is similar enough, that depending on the laboratory sensitivity, methods, and/or controls, there could be a false positive. I have an article coming out on this soon, the citation of which is noted below. If you send me an email to firstname.lastname@example.org, I will send you a graph of false positive findings for diazepam. If that is falsely present, it stands to reason that temazepam will be too because it is a metabolite of diazepam. Feel free to print this out and whatever I send via email to share with your prescriber.
Rosano TG, Wood M, Hooten WM, Rumberger JM, Fudin J, Argoff CE. Application and Clinical Value of Definitive Drug Monitoring in Pain Management and Addiction Medicine. Pain Medicine. 2021 Oct 13.