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Re: Myocardial Infarction Associated with Adderall XR and Alcohol Use in a Young Man

Brain Health NW
Bellevue, Washington

Correspondence: drdave{at}brainhealthnw.com

To the Editor: I appreciated the information in this article,¹ as one who specializes in the diagnosis and treatment of attention deficit/hyperactivity disorder. I am curious whether the drug screen urinalysis performed in this case distinguished between amphetamines and methamphetamine; the article noted the patient's sample was positive for methamphetamine.

One patient of mine experienced legal problems when a routine urinalysis in the workplace resulted in positives for both amphetamine and methamphetamine; she was taking plain dextroamphetamine for her attention deficit disorder. The head of the testing laboratory assured me that their test distinguished between these agents and that a positive methamphetamine result suggested abuse whereas the positive result for amphetamines in her case was expected.

I believe the distinction is important to make in order to identify what may be a major complicating condition in a patient, namely substance abuse involving methamphetamine. In the case cited, substance abuse is evident for alcohol, but not for methamphetamines necessarily (though the Adderall was being misused).

I am unaware whether amphetamines metabolize to methamphetamine in the body, resulting in a "false positive" for methamphetamine solely from the use of amphetamines in an appropriate manner. With some drug monitoring systems making the distinction between the two, it seems unlikely.

I welcome any comments on the above.

Notes

The above letter was referred to the author of the article in question, who offers the following reply.

Reference

1. Jiao X, Velez S, Ringstad J, Eyma V, Miller D, Bleiberg M. Myocardial infarction associated with Adderall XR and alcohol use in a young man. J Am Board Fam Med 2009;22:197–201.[Abstract/Free Full Text]

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This Article Full Text (PDF) Rapid Responses: Submit a response Alert me when this article is cited Alert me when Rapid Responses are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Pomeroy, D. PubMed PubMed Citation Articles by Pomeroy, D. Social Bookmarking                      What's this?