drug test

For a long time, I was an avid medical show consumer– whether it be reality or scripted. The reality based ones, that highlight functioning ER’s, are tolerable. The scripted ones just started to drive me crazy and I haven’t partaken in a medical fiction series in a while. I’ll let you know about my trauma related to watching Rescue: HI-Surg in another post(and I’m not even a lifeguard).

Unfortunately, that doesn’t stop other shows from violating medical accuracy. Why does accuracy matter? It proves to the consumer of the product that you took care to present something close to reality. Our goal should also be to keep them in the story bubble. Any time a reader is pulled out of that magic snow globe, they lose pace and connection with the story.

Which brings me to Netflix’s The Perfect Couple. The basic plot is a woman from a modest background marrying into high society when her best friend, and maid of honor, shows up dead on the beach. The series delves into all the ins and out of who murdered her.

At one point, they show the victim’s toxicology report and I’m including a screen shot of said evidence.

This is hard to read so I’ll give you the details. In the victim’s urine (presumably– the report doesn’t specify) are the following drugs:
1. Zolpidem (Ambien)– sleep agent
2. Polyethylene Glycol– (Miralax)– laxative
3. Diazepam (Valium)
4. Pentobarbital (Barbiturate) Central Nervous System Depressant
5. Alcohol

This report confused me. Why would a dramatic television show reveal the victim was positive for a laxative? Which, by the way, isn’t going to show up on a drug screen.

Then it hit me. My belief is the writing staff really meant this fictitious toxicology report to read “ethylene glycol” which is very different. Ethylene glycol is a highly toxic component typically found in antifreeze. Antifreeze tastes sweet, which is why pediatric patients will continue to drink it if they find it in an open container. It has disastrous effects on the body and can cause death quickly if proper medical treatment isn’t enacted (and even then– it’s dicey).

This toxin also isn’t going to show up on a standard drug screen. The medical team is going to have to look for it specifically and such a niche test isn’t going to be available at every medical center. Also, Ambien is not part of a baseline drug screen.

Wouldn’t it have been more interesting to the plot to have antifreeze found in her system?

What strange things have you noticed on medical show toxicology reports?

I think there is a general misconception in the public that all drugs can be detected by a basic blood or urine drug screen. This is not true.

First, when is a drug screen done?

There are several instances where we would likely run a drug screen. Here are a few.

1. You are having suicidal ideation. Suicidal ideation means you are having thoughts/feelings of hurting yourself and either you have presented or someone has brought you to the ED. This is fairly standard to see what might be in your system. What also will be added will be an acetaminophen (Tylenol) and salicylate (Aspirin) level. These are blood levels.

2. You are acting crazy. Meaning– you’re hearing and seeing things that aren’t there. There are gait disturbances, a decreased level of consciousness. Perhaps even seizure activity. A common set-up for this scenario is a child or teen that begins to act funny at school. Here, there is a concern for ingestion and it will be best to sort out what we might be working with.

3. An actual ingestion in any age group. The history will be looked at very closely but if it is— toddler got into grandma’s medicine cabinet (this happens more often than you would think) and the youngster just flat out began to go through boxes/bottles swallowing everything in sight– he will get a urine drug screen.

A urine drug screen can be an effective screening tool. But it definitely does not rule out all substances. That is the most important thing to know.

So– the following drugs are on a basic drug screen. It may also be called a “drugs of abuse” of panel. Something along those lines.

1. Amphetamines— interesting thing about this is some ADHD drugs contain amphetamines so kiddos on these will show positive. If they are on an ADHD med in this drug class– it doesn’t mean that they are not also abusing other types of amphetamines.

2. Barbiturates: The Truth Serum Drugs (Amytal Sodium, Phenobarbital and Luminal). But, do these drugs really act as truth serum? Interesting article here: http://www.damninteresting.com/the-truth-about-truth-serum/

3. Benzodiazepines: Drugs like Valium, Versed and Ativan are in this drug class.

4. THC: Tetrahydrocannabinol. Cannabis. The active ingredient in marijuana.

5. Cocaine

6. Opiates: Stuff of the opium poppy seed plant. Morphine, Fentanyl, Vicodin, Lortab, Codeine

7. PCP

Notice what is not on the basic drug screen? Alcohol… we would have to test separately for this.

Is this what you thought was on a drug screen?