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Diphenhydramine is an antihistamine often used to treat allergies, insomnia, and other conditions. However, there has been an alarming rise in diphenhydramine misuse in recent years, particularly among young people. The “Benadryl Challenge” on TikTok led the FDA to put out a statement in 2020 warning about the risk of using high doses.

What is Diphenhydramine?

Diphenhydramine (also known as DPH, Dimedrol, and Benadryl) is an antihistamine commonly used to treat allergy symptoms such as itching, sneezing, and runny nose. It is also used as a sleep aid and to treat other conditions such as motion sickness and Parkinson’s disease.

What are the Risks of Diphenhydramine Misuse?

Diphenhydramine is often misused in two ways, to induce sleep and to experience euphoria. Misusing diphenhydramine can have serious consequences. When taken in large doses, it can cause hallucinations, delirium, and seizures. It can also cause rapid heartbeat, high blood pressure, and difficulty breathing. In some cases, it can even be fatal.

In addition to the physical risks, diphenhydramine misuse can also have psychological effects. People who misuse the drug may experience anxiety, paranoia, and other mental health issues.

Are There Drug Tests for Diphenhydramine?

Yes. Though diphenhydramine is a legal substance, like alcohol, misuse can become a larger problem for some individuals, especially if they are in legal programs to get on the road to recovery. In these circumstances, drug testing for any mind-altering drug might be a consideration regardless of its status as legal or illicit. 

USDTL offers diphenhydramine testing in hair and nail specimens to organizations that administer drug testing. Diphenhydramine can build up and remain in hair and nail specimens for up to approximately three months. 

If your organization would benefit from offering this type of detection, please get in touch with us at 1-800-235-2367 or fill out our contact us form. Please note we are a business-to-business forensic laboratory only, and we do not offer toxicology testing to the general public. Due to confidentiality obligations, we cannot answer questions from parties not explicitly authorized by our business-to-business clients.

References:

1. U.S. Food and Drug Administration. (2019). Diphenhydramine (Benadryl): Drug Safety Communication – Serious Problems with High Doses from Over-the-Counter (OTC) Use. Retrieved from https://www.fda.gov/safety/medwatch-safety-alerts-human-medical-products/diphenhydramine-benadryl-drug-safety-communication-serious-problems-high-doses-over-counter-otc-use

2. National Institute on Drug Abuse. (2021). Misuse of Prescription Drugs. Retrieved from https://www.drugabuse.gov/publications/drugfacts/prescription-cns-depressants

3. Substance Abuse and Mental Health Services Administration. (2020). Key Substance Use and Mental Health Indicators in the United States: Results from the 2019 National Survey on Drug Use and Health. Retrieved from https://www.samhsa.gov/data/sites/default/files/reports/rpt29393/2019NSDUHFFRPDFWHTML/2019NSDUHFFR1PDFW090120.pdf

4. American Academy of Pediatrics. (2019). Diphenhydramine (Benadryl). In: Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Red Book: 2018 Report of the Committee on Infectious Diseases. 31st ed. Elk Grove Village, IL: American Academy of Pediatrics; 2019:364-365.

5. Drug Enforcement Administration. (2021). Drugs of Abuse: A DEA Resource Guide. Retrieved from https://www.dea.gov/sites/default/files/2021-01/Drugs%20of%20Abuse%202020%20Edition%20Digital%20Download.pdf

6. https://www.fda.gov/drugs/drug-safety-and-availability/fda-warns-about-serious-problems-high-doses-allergy-medicine-diphenhydramine-benadryl

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What is Buprenorphine?

Buprenorphine is a derivative of thebaine, an extract of opium. Buprenorphine is an opioid partial agonist, meaning it can activate the opioid receptors in the brain, but to a lesser degree than opioids such as heroin.

Partial agonist drugs like buprenorphine, butorphanol, and tramadol can be helpful for treating pain and can assist in treating opioid use disorder, as they can help minimize withdrawal symptoms. Buprenorphine has a ceiling effect, causing a plateau in the sedative effects, which helps protect the individual from negative respiratory and/or cardiovascular effects when taken as prescribed.

Buprenorphine has been used internationally for several years to assist people suffering from opioid dependency. Subutex, which is pure buprenorphine, is designed to be used in the initial stages of addiction treatment.¹

Buprenorphine Misuse and Diversion

As the opioid crisis started growing, treatment drugs such as buprenorphine were being looked at for misuse and diversion. In 2014, the Food and Drug Administration required new safety labeling on prescribed opioids, indicating they are a Schedule III drug and warning of “risks of addiction, abuse, and misuse, which can lead to overdose and death.”³

According to the National Drug Intelligence Center, Suboxone (buprenorphine and naloxone)–because of its ceiling effect and ability to precipitate withdrawal systems if taken in high doses– is more susceptible to misuse by individuals who are addicted to low doses of opioids or individuals in the early stages of opioid addiction.¹

Misuse may include mixing buprenorphine with other drugs, such as heroin or methamphetamine, for a more intense high. Buprenorphine misuse is extremely dangerous even though it is used in clinical settings. In those settings, buprenorphine is administered in small, specifically curated doses based on the patient’s substance use history.

Diversion of buprenorphine, or nonmedical use by people it is not prescribed for, is another potential risk for consideration. According to the Center for Disease Control’s (CDC) 2022 Clinical Practice guidelines for prescribing opioids, toxicology tests can assist clinicians in identifying when patients are not taking opioids prescribed for them, which may indicate diversion or other clinically important issues such as difficulties with adverse effects.³ Advanced specimen drug testing may be the link to identifying the misuse or diversion of buprenorphine.

USDTL Advanced Specimen Testing

As an innovative leader offering alcohol and other drug testing, we understand the importance of being able to test for drugs of concern when it is most feasible for your organization. We offer buprenorphine testing, along with testing for many other drugs of concern, in urine, nail, and hair specimens. Contact us at adultandchild@usdtl.com with any questions.

References:

1. https://www.justice.gov/archive/ndic/pubs10/10123/index.htm
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3154701/
3. https://www.cdc.gov/mmwr/volumes/71/rr/rr7103a1.htm