An employee was tested for reasonable suspicion and the test result is positive for hydromorphone (1784 ng/ml) and oxymorphone (117 ng/ml). The employee only took 1 tab hydrocodone APAP 5/325 the day before and also tramadol 50 mg. When asked specifically about oxycodone, she said no. Her daily medications are Lexapro, Metformin, Multivitamin and Kratom (supplement with herbal ingredient she uses daily to help with pain).
From metabolism pathway, oxymorphone cannot be a metabolite of hydrocodone or tramadol. Is there a possibility of impurity in hydrocodone tab that could contain a small amount of oxycodone to give oxymorphone?
In my quick research of Kratom: Kratom can help decrease pain from compounds of mitragynine and 7-α-hydroxymitragynine. These compounds should not metabolize to oxymorphone. Is there anything in her medicine that can give oxymorphone in her urine other than she used oxycodone and didn’t revealed it? IS there any possible reason that the result is false positive? I checked with the state prescription medication surveillance program (PMP) but she did not get any prescription of oxycodone (hydrocodone prescription was Mar 2018 and tramadol was Aug 2018). I got the prescription for hydrocodone and tramadol verified but no oxycodone. What should the determination in this case? Should I call it "positive" for oxycodone?
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