Posts Tagged ‘Mate De Coca’

Red Bull Simply Cola &reg & UA Tests

Wednesday, July 15th, 2009

The beverage that started the energy drink craze in 1987, Red Bull® launched a new product line in 2008 named Red Bull Simply Cola®.1 In late May 2009, several news sources reported that food scientists at the Health Institute in the state of North Rhine Westphalia Germany had discovered traces of cocaine in Red Bull Simply Cola®. 2-6 This analysis found 0.4 micrograms per liter (μ/L) of cocaine in Red Bull Cola which works out to about of 0.13μ of cocaine contained in the 12 oz. can of the cola. An average street dose of one “line” of cocaine is usually 20 milligram (mg) of cocaine powder7 which is 153,846 times the amount of cocaine in the 12 oz can of the beverage. Note that 20 mg is equal to 20,000 micrograms (μ). Thus, news stories were quick to point out that the cocaine content of Red Bull cola was much too low to pose a health threat. Still, the German States of North Rhine-Westphalia, Hesse, Thuringia and Rhineland-Palatinate as well as the nation of Taiwan banned the drink soon after the discovery was made.6 The makers of Red Bull Simply Cola® assert that they only used de-cocainized coca leaf extract as a “natural” flavoring agent for their product, as does Coca-Cola® and other food products. The manufacturer also asserts that the trace levels of cocaine and its degradations products are miniscule residues left over from the de-cocainization process and pose no potential health risks.3

In 1920, Coca Cola® allegedly became totally cocaine-free by using only de-cocainized coca leaf extract in their product.8 Because Coke’s formula is a closely guarded secret, it is not clear whether the de-cocainized coca leaf extract used by Coca-Cola® contains residue trace amounts of cocaine or even if the company still uses it to flavor their product. In April of 1985, Coca-Cola® launched New Coke® made from a different formula to appeal to those who preferred Pepsi® and other cola drinks. Instead of increasing sales, the formula change resulted in worldwide protests driving the company to revive their original formula only 3 months after launching New Coke®. The reintroduction of their original formula was marketed as Coca-Cola Classic®.9 New Coke® was discontinued in 2002. One can’t help but wonder if the coca leaf extract flavoring didn’t play a major role in the public’s demand that Coca Cola® return to its original formula.

The question that should be asked regarding the use of coca leaf extract to flavor Red Bull Simply Cola® and Coca-Cola® is whether the trace amount of cocaine in their beverages are in sufficient concentrations to result in a false-positive drug test for cocaine. Cocaine drug tests are less susceptible to food-source, prescription/non-prescription medications, or any other forms of potential contamination that can result in false-positive tests. A fair number of those who test positive for cocaine vigorously question and protest their test results every year. Most often, such protests are summarily dismissed because it is believed that only two things can potentially cause a false-positive test of cocaine abuse: coca leaf teas and maybe by the remotest possibility, the antibiotic amoxicillin. Consumption of coca tea containing coca leaves (Mate de Coca®, Delisse®, Inka Tea®, Coca Tea Windsor®, et al) is the best documented cause of false-positive cocaine tests. An excellent study of these teas’ effect on cocaine drug testing was conducted by Jenkins, Llosa, Mantoya and Cone in 1996.10 This study helped to set some basic levels at which these and other sources of non-intentional cocaine use can result in a false-positive urine test for cocaine abuse. The research analyzed common coca tea bags produced commercially in Peru and Bolivia. They found that each tea bag contained about 1 g of plant material that yielded an average of about 5 mg of cocaine. Tea prepared from these samples averaged about 4.2 mg of cocaine per cup. Since cocaine is rapidly metabolized by the body, drug tests focus on the presence of its major metabolite benzoylecognine (BE). Peak urine concentrations of BE from these cocaine teas were generally above 4,000 ng/ml with 48 hour cumulative BE urinary excretion being about 3.0 mg. These levels of BE from drinking coca leaf tea are indeed high enough to result in a positive test for cocaine use. But, since 12 oz. of Red Bull Simply Cola® has been found to contain only 0.13μ or 0.00013 mg of cocaine, it would seem more than unlikely that its consumption would result in a false positive urine test for cocaine.

An interesting study on the potential of the antibiotic amoxicillin to produce a false-positive cocaine urine test was conducted by the University of Florida in 2008.11 The research concluded that amoxicillin is unlikely to produce a false-positive cocaine urine test when the screening BE cutoff level is set at 150 ng/ml. What is interesting about this study is that of the 33 subjects given amoxicillin, two tested positive for cocaine by all four of the urine screening methods employed in the study. These positives tests were then further confirmed by gas chromatography-mass spectrometry (GC-MS) for levels at or above the 150 ng/ml cutoff established. Three other subjects also tested positive for BE concentrations at below the cutoff levels. GC-MS analyzed these levels to be 54, 94 and 119 ng/ml. Since the study could not determine whether these 5 subjects had abused cocaine previous to their participation in the study, it concluded that amoxicillin is unlikely to result in a positive test since 31 of the 33 subject urines resulted in tests for cocaine that were indistinguishable from negative controls. However, I would still like to discover why any levels of BE appeared in 5 of the 33 subjects given amoxicillin in this study. I am also now curious to know what BE cutoff levels are generally being used to test for cocaine in urine drug screens.

I discussed cocaine test cutoff levels with Greg Elam, MD Medical Review Officer for National Toxicology Specialists, Inc. in Nashville Tennessee. Dr. Elam stated that most labs use a BE level of 150 to 300 ng/ml as their cutoff concentration for cocaine testing. This means that urine must contain at least these levels of cocaine before a lab or testing method identifies it as positive for cocaine. GC/MS quantization can identify even smaller levels of BE in urine samples but Dr. Elam cautioned that levels below 50 ng/ml would be subject to too many fluctuations and “background” contamination to be worth considering as a definitive test for the presence of cocaine. Thus, most labs will only consider 150 to 300ng/ml as definitive for presence of cocaine in a given test sample.12 In an era of “zero tolerance” for drugs and given the ability to test urine for miniscule levels of drugs, it is a bit scary that Red Bull® would include coca-leaf extract in their cola product. The U.S. Department of Defense, an ultra conservative organization with zero or no tolerance for cocaine abuse, has set an urine screening BE cutoff level at 150 ng/ml and a BE confirmation level at 100ng/ml.13 These levels may be sensitive enough for Red Bull Simply Cola® to test positive for cocaine if one poured a full 12 oz can of it into the testing cup instead of urinating into the sample vessel. But, it is still much too high of a cut off level if one had ingested even several cans of the cola and then urinated into the cup. Thus, it seems that coca leaf teas remain the only viable source of a false-positive test for cocaine.

Darryl S. Inaba, PharmD., CADC III
July 2009

References

1. Nipps E, Red Bull cola controversy stirs cocaine concerns, St. Petersburg Times, May 28, 2009 http://www.tampabay.com/news/health/article1004932.ece accessed 5/29/09

2. BBC News (2009), Germany bans cola after drug test, 5/26/09 http:// news.bbc.co.uk/2/hi/europe/8067970.stm accessed 6/4/09

3. Friedman-Rodovsky J (2009), Red Bull’s new cola: a kick from cocaine? Time CNN May 25,2009, http://www.time.com/time/world/article/0,8816,1900849,00.html?iid=tsmodule accessed 6/13/09

4. The Seattle Times (2009), Austria: traces of cocaine found in Red Bull drink, http://seattletimes.nwsource.com/html/nationworld/2009276897_apeuaustriaredbull.html accessed 6/16/09

5. Portland Me Examiner (2009), Actual cocaine found in Red Bull Cola, 5/31/09, http://www.examiner.com/x-8543-SF-Health-News-Examiner~y2009m5d31-Cocainecola-Red-Bull-saga-spreads accessed 6/16/09

6. Wall Street Journal (2009), Red Bull faces scrutiny after drug test, http://online.wsj.com/article/SB124346904511260559.html accessed 6/18/09

7. eMedicineHealth (2009), Cocaine Abuse: lethal dose, http://www.emedicinehealth.com/cocaine_abuse/article_em.htm accessed 6/18/09

8. Frederick A (1994), Secret Formula, HarperCollins, New York, NY

9. Pendergrast M (2000), For God, Country and Coca Cola, Basic Books, New York, NY

10. Jenkins AJ, Llosa T, Montoya I, and Cone EJ (1996), Identification and quantitation of alkaloids in coca tea, Forensic Science International, 77(3):179-189

11. Reisfield GM, Haddad J, Wilson GR, Johannsen LM, Voorhees KL, Chronister CW, Goldberger BA, Peele JD and Bertholf RL (2008), Failure of amoxicillin to produce false-positive urine screens for cocaine metabolites, J. of Analytical Toxicology, 32(4):315-318

12. Personal discussion with Greg Elam, MD on 6/23/09 at the University of Utah. Greg Elam, Med. Review Officer, National Toxicology Specialist, Inc., 1425 Elm Hill Pike, Nashville, TN 37210

13. DOD Urinalysis (Drug Test) Program (2009), http://usmilitary.about.com/od/theorderlyrooml/bldrugtests.htm accessed 6/13/09

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Food-Source Opiates: Therapeutic Positive UA

Friday, March 13th, 2009

Recently I reviewed two urine tests from two residential clients that were positive for opiates. The drug testing provider confirmed these opiate positive results with follow-up tests utilizing Gas Chromatography/Mass Spectrometry (GC/MS). The quantitative GC/MS test was also positive for opiates but found both urine samples to contain fairly low levels of morphine and other opiate alkaloids. One of the urine specimens contained 0.15 micrograms/milliliter (µg/ml) of morphine and the other 0.3 µg/ml. Urine toxicology is routinely ordered for residential clients when they return from off site dental appointments or lab tests. Both clients were in treatment for alcohol and marijuana dependence with no history of opiate abuse and were doing well in our residential program. Neither exhibited clinical signs of being under the influence of any drugs, and denied any use while off site.

I contacted our testing provider’s toxicologist for more information and was told that the lab attributed morphine urine levels of under 5.0 µg/ml to be food-source contamination. Studies have confirmed that foods containing poppy seeds can result in a positive urine test for opiates.1, 2 Some cakes, cupcakes and bagels can contain enough poppy seeds to produce a positive urine tests when no opiates were abused. This is known as a false-positive opiate urine test.

Prior to 1998, the US threshold level for a positive opiate urine test was a morphine concentration greater than 300 nanograms/ml (ng/ml) or 0.3µg/ml. Those levels were changed to concentrations greater than 4000 ng/ml for morphine and 2000 ng/ml for codeine in response to the recognition that poppy seed contamination could indeed result in false-positive opiate test at that level. 1 This is 13 times greater than the amount that would have resulted in a positive urine test for opiates prior to 1998! The International Olympic Committee (IOC) set their threshold for morphine at 1000 ng/ml and will re-examine any disputed positive opiate test upon request.2 A nanogram is equal to 1000 micrograms so these levels are equivalent to 4.0 µg/ml and 2.0 µg/ml in the US and 1 µg/ml for the IOC.

Our clients’ urine tested positive for morphine with concentrations of only 0.15 and 0.3 µg/ml. These levels are well below the current threshold concentrations established for identifying use of opiates and clearly seemed to have resulted from food-source contamination. On the other hand, if one of these clients did use opiates and then remained abstinent several days previous to being tested, the low levels of opiates in the urine could actually be a positive indication of that use since body metabolism of the abused opiate would result in low residue urine concentrations several days after use. In this latter scenario, attributing low concentrations of opiates in the urine tests to food-source contamination would be a false-negative test for opiates in the urine and could contribute to continued abuse resulting in an eventual relapse to addiction. Unfortunate and unwarranted consequences result from misinterpreting low opiate concentrations of a false-positive urine test as a positive indication of drug abuse when it actually resulted from food-source contamination. But, equally unfortunate consequences can result from misinterpreting low opiate urine concentrations as a negative test if a urine specimen is collected after a sufficient length of time had lapsed since abuse of an opiate drug – a false-negative test.

We rely on a process known as a Therapeutic Positive to address this and other urine drug testing dilemmas. The Therapeutic Positive process brings the primary counselor and/or our program’s medical review officer and the client together to review the results of a positive drug test without providing the detail of the low concentration of the drug. The client is asked to explain why their urine contained the substance. This process provides an opening for the client to admit to a recent slip or drug exposure. If an admission is made, it is only used therapeutically to intensify the treatment process and develop strategies to avoid future interruptions to their recovery efforts. It is never used punitively to catch a client in a lie that could result in discipline or banishment from treatment. If the client adamantly denies use, and their treatment participation/performance validates this claim, program staff then works with the testing lab’s toxicologist to explore potential causes of a potential false-positive test.

Foods ingested prescription and non-prescription medications, illnesses, cosmetics and even personal hygiene products should be considered as possible sources for a false-positive test. In the two cases presented here, both clients ate a poppy seed muffin while waiting to be seen for their medical tests which were off-site.

Several years ago, I worked with a client who had tested cocaine positive due ingestion of Mate De Coca, a tea that contains coca leaves.3,4 Hemp oil is sometimes added to foods and it will result in a false-positive THC or marijuana test.5

In addition to food-source contamination, biologic processes and medications can result in questionable urine testing results. Sequestration and subsequent release of drugs from body fat can result in a marijuana or PCP urine “spike” which is another form of a false-positive test. The urine of diabetics have fermented into ethanol resulting in false-positive tests of alcohol consumption.6-9 A person’s hydration status and some disease states can impact urine creatinine which may be misinterpreted as a purposeful attempt to dilute urine and evade detection of drug abuse. The problem of false-positive ethanol test due to urine fermentation may have been partially addressed by the recent development of ethyl glucuronide (EtG) testing. EtG is only produced by the liver when alcohol is ingested. However, ethanol can also enter the body via other products such as food cooked with wine, mouthwash, or hand sanitizers and could result in false-positive tests. EtG testing better addresses false-negative tests because ethanol remains in urine for up to 80 hours after drinking whereas an ethanol level of 0.08 (legal limit for DUI violation) will result in no measurable levels of alcohol 5.33 hours after the last drink.10

Many prescription and non-prescription medications can complicate urine drug testing. Ibuprofen (Advil®, Motrin®, et. al.) is reported to cause both false-positive and false-negative (at high doses) THC or marijuana urine tests.11 Vicks® inhaler and nasal spray have resulted in false-positive urine tests for methamphetamine and Ecstasy. Dextromethorphan, found in cough and cold medications has been misidentified as morphine or other opiates. Antibiotic medications like amoxicillin or ampicillin have been misidentified as cocaine in some tests. An ongoing, growing and referenced list of many other medications and even illnesses that have been reported to result in false-positive urine tests for abused substances can be accessed on line at:

http://www.askdocweb.com/falsepositives.html

Darryl S. Inaba, PharmD., CADC III

References

  1. Meadway C, George S and Braithwaite R (1998). Opiate concentrations following the ingestion of poppy seed products – evidence for ‘the poppy seed defense’. Forensic Science International, 96:29-38.

  2. Kaczorowski M (2008). The poppy seed defense: scientifically sound? McGill Sci Undergrad Res J, 3(1):40-41.

  3. Jenkins AJ, Llosa T, Montoya I, Cone EJ (1996). Identification and quantitation of alkaloids in coca tea. Forensic Sci Int., 77(3):179-89.

  4. elSohly MA, Stanford DF, elSohly HN (1986). Coca tea and urinalysis for cocaine metabolites, J Anal Toxicol, 10(6):256.

  5. Kwong TC (2008). Handbook of drug monitoring methods: therapeutics and drugs of abuse. Humana Press, New York, NY.

  6. Sulkowski HA, Wu AH, McCarter YS (1995). In-Vitro production of ethanol in urine by fermentation, J Forensic Sci. 40(6):990-3.

  7. Saady JJ, Poklis A, Dalton HP. Production of urinary ethanol after sample collection, J Forensic Sci, 38(6):1467-71.

  8. Logan BK, Jones AW (2000). Endogenous ethanol ‘auto-brewery syndrome’ as a drunk-driving defence challenge, Med Sci Law, 40(3):206-15

  9. Gruszecki AC, Robinson CA, Kloda S, Brissle RM (2005). High urine ethanol and negative blood and vitreous ethanol in a diabetic woman: a case report, retrospective case survey, and review of the literature, Am J Forensic Med Pathol, 26(1):96-8.

  10. Skipper GE, Weinmann W, Thierauf A, Schaefer P, Wiesbeck G, Allen JP, Miller M, Wurst FM (2004). Ethyl glucuronide: a biomarker to identify alcohol use by health professionals recovering from substance use disorders, Alcohol Alcohol, 39(5):445-9.

  11. Brunk SD (1988). False negative GC/MS assay for carboxy THC due to ibuprofen interference. J Anal Toxicol, 12(5):290-1.

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