Residual drug in intranasally dosed recreational drugs

[coralfangs]

Previously posted in IM forum but I think you guys might know more about this

I just want to share with you guys with this questionable excuse that a patient at the methadone clinic had for his positive drug screen.
Is that even possible?
Basically he was tested positive for cocaine. He claims that his last use was over 3 months prior. He said that he probably had residual drug left in his nasal cavity causing the positive result. I called bull**** on it because nansal mucosal membrane can absorb the substance very well and chances that anything left after a few months are low unless you shove a ball of the substance up your nose.
Well I talked to the attending. He basically ridiculed me for being so naive because hes seen a case of cocaine granulomas in the sinus cavity due to chronic intranasal use and that I was careless for not considering the possibility. He wrote it in my eval.

I mean. Really?! I tried looking up but none of the studies talked about such magically long lasting residual.... I kind of want to challenge the feedback.

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[neutropeniaboy]

Hmmm.

I think the patient was jerking your chain, and your attending is suspect.

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[Pir8DeacDoc]

Hmmm.

I think the patient was jerking your chain, and your attending is suspect.

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Would agree with this.

Though I will say I see pts around here with lortab residue in their nose. But I think they are recent users. That stuff will chew up your nose/palate just like cocaine. Nasty business. Never saw it in residency but somewhat common in practice.