About William J. Walker, Pharm.D. Expertise Homeopathic, alternative, herbal, natural, adverse drug reactions, side effects, risks, outcomes, research, medication, rational therapeutics, infectious diseases, cardiology, pain management, nutrition, psychopharmacology, oncology, pediatrics, sleep disorders, tropical diseases, HIV, drug interactions, substance abuse, illicit drugs of abuse, geriatrics
Experience
Past/Present clients State of California Department of Youth Authority
State of California Department of Mental Health
County of San Luis Obispo Public Defenders Office
County of San Luis Obispo District Attorney Office
TenetHealth Corporation
Boy Scouts of America
Better Life Institute
Campus Crusade for Christ
Volunteers in Medical Evangelism
His Healing Hands, Inc.
AskMe.com
Kiwanis International
Question Is is possible for flexaril to metabolize into either oxazepam or temazepam. We have an employee on flexaril, hydrocodone, phenergan and hydroxyzine whose drug screen is positive for the two mentioned above and I have to make a decision as to continuing her employment.
Since flexaril is 3-(5H -dibenzo a,d cyclohepten-5-yliden-N, N -dimethyl-1- propanamine HCL) I thought I should ask an expert
Please reply ASAP
SMB
Answer Your inquiry seems simple and straightforward at first glance but actually it becomes quite complicated.
It is very common these days for pre-employment screening to utilize drug testing. And it is also often a component of disciplinary action to insist upon the same. But seldom is it the case that continued employment is based on the outcome of drug testing whether or not these are done routinely. Unless there is some attendant loss in performance or some other reason to suspect a problem. It needs to be determined what is at stake in such cases. How is one's position jeopardized by the medications they are taking? Some jobs are indeed crucial in that regard. Airline pilots for example.
Lacking here is the background so I cannot tell how you came about getting this information or what transpired before hand. Such a history could be important in the decision making process you face regarding her employment status. As in the case of witholding information or providing false information.
You have presented a list of medications that she is reportedly taking. All of which are prescription medications implying that she is under medical treatment. And these medications happen to infer that apparently she has some kind of a problem that could very well lead into more serious problems. Of the sort that I am sure you wish to avoid. But the list is also such that a benzodiazepine (like oxazepam or temazepam) would very easily lend itself well to inclusion. Typically it is not a huge stretch to imagine that a patient with this profile would also have been prescribed one of these anxiolytics. So that begs the obvious question. Did she tell you otherwise? Or did she "forget" to include something? Is it not possible that she is under treatment for anxiety and/or insomnia? Because that is the most obvious explanation for the appearance of these two substances.
Yes, false positives are possible in urine drug screens. But cyclobenzaprine is chemically a tricyclic antidepressant. It would be expected to appear as such. Not as a benzodiazepine. It is anticholinergic in properties and possibly also noradrenergic. But not GABAergic.
Hydrocodone is of course an opiate. Promethazine is a phenothiazine. Similar to the neuroleptics. And hydroxyzine is an antihistamine. Which, oddly enough, has been known to appear as a false positive for corticosteroids on urine screens. But not for benzodiazepines.
Both temazepam and oxazepam are eliminated unchanged. They have no known active metabolites. In fact, some other benzodiazepines actually are eliminated as oxazepam in urine. But the appearance of these specific agents in the urine is an indication of benzo ingestion.
So I guess my concern is that you have thoroughly ruled out all less sinsiter possibilities before deciding her fate. But there is much I don't know about this case. As in what is at stake or what her position has been regarding the outcome of this test. Confusing to me still is the fact that presence of substance alone as a reason to terminate would seem to be already manifest in the list of meds she is taking. Hydrocodone for instance.
Perhaps she forgot about a sleeping pill...or neglected to tell you...or perhaps she merely needs to be confronted about it...as in the case of being ashamed or embarrassed by it. In my opinion she has taken a benzo or it would not have appeared. The other meds in her regimen seem to support that suspicion if only by comparison to others like it. Did other substances also appear in the screen? It should have revealed hydrocodone or hydromorphone. At the very least. If it did not then I would begin to question either the source of the urine or the reliability of her information.
I hope this helps you. If you need more let me know.
