This episode of Mental Health Monthly we will be discussing drugs screens in the Emergency Department with Dr. Justin Romano and Eddie Carillo. Dr. Justin Romano is a current psychiatry resident and Eddie Carillo is a licensed mental health therapist. Check out their podcast Millennial Mental Health Channel on all major podcast platforms. Shout out to Dr. Dave Marshall whose grand round presentation this was based on.  Key Points:  Try not to judge your patient based on the results of their drug screen  Drug screens are used a lot; they are not always accurate  Based on one study there was no significant change in outcome, treatment, disposition or psychiatric course when a drug screen was obtained  Specific good uses for drug screens include new onset of psychiatric symptoms  Educational Pearls:  1 in 8 ED visits are due to psychiatric complaints which is up 44% since mid 2000’s  63% of new psychiatric complaints had a medical cause  Physicians use drug screens commonly in the Emergency Department, but often do not understand their limitations and are often not using them in the most clinically effective manner  Urine is by far the most commonly used in the Emergency Department  UA drug screens are notorious for having false positives and false negatives  Length of clearance from the urine:  Alcohol 12 hours  Methamphetamines/Amphetamines 48 hours  Benzodiazepines 3 days  Opiates 2-3 days  Cocaine 2-4 days  Marijuana dependent on use: 3- 15 days  Phencyclidine (PCP) 8 days  Urine drug screens have a false positive rate of 5-10 % and a false negative rate of 10-15%  False Positive; urine drug screen positive, but drug is not in their body  False positives for amphetamines: bupropion, trazodone, metformin, promethazine, pseudoephedrine, phentermine and atomoxetine  False positives for benzodiazepines: sertraline False positives for cannabis: ibuprofen, naproxen, proton pump inhibitors  False positives for opiates: poppy seeds, antibiotics, Benadryl  False positives for PCP: venlafaxine, ibuprofen and Ambien  False positives for cocaine: amoxicillin  False Negative; urine drug screen negative, but drug is in the body  Benzodiazepines: such as alprazolam, clonazepam, lorazepam or triazolam Cannabinoids: CBD, synthetic marijuana such as K2 Opiates: oxycodone, fentanyl, methadone and tramadol  If you get a test that you don’t think is accurate you can always send off for a confirmatory test References Summarized by Emily Mack OMSIII | Edited by Mason Tuttle The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at www.emergencymedicalminute.com/cme-courses/ and create an account.