Rationale for need:
(1) A patient, usually with real pain, is prescribed an opiate by a physician. Thus the patient has a legitimate prescription for an opiate.
(2) The patient sells that drug on the street.
(3) The patient then uses the proceeds to buy another opiate that is cheaper to treat the pain.
profit for the patient =
= (price on the street) - (cost of getting the prescribed drug) - (cost of cheaper opiate)
If the prescribed drug is paid for by health insurance, then its cost may be negligible. For a patient with chronic pain this can give a tidy profit.
The opiate(s) or opiate metabolites causing the positive urine drug test should be identified by gas chromatography mass spectroscopy (GC-MS).
If the identified drug or metabolites can be explained by the prescribed drug, then there is no evidence of diversion.
If the identified drug or metabolites cannot be explained by the prescribed drug, then there may be evidence for diversion.
This task requires:
(1) access to the structural information about the drug and its metabolites
(2) the metabolic pathways for the drug
(3) an understanding of pharmacogenetics - for some patients a minor metabolite may be the primary metabolite.
