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PubMed1996

Alcohol and drug abuse in an urban trauma center: predictors of screening and detection.

Studies of the prevalence of alcohol and drug abuse among trauma patients have produced recommendations that all trauma patients be screened for these substances. But a national survey of trauma centers showed that just 72.0% of level 1 trauma centers routinely obtain blood alcohol levels on trauma patients and only 50.4% routinely utilize toxicology screens. Utilizing patient summary data collected on 2,246 trauma patients treated in the Emergency Department of Long Beach (CA) Memorial Medical Center over a 2.5 year period, and laboratory results for a random sample of 246 of these patients, this study sought to determine patient and presenting problem characteristics associated with screening and positive test results in centers (such as ours) where screening is done selectively. Results show that 75.4% of trauma patients are screened for blood alcohol levels, and 58.5% are given a urine toxicology, with lowest rates for 12-20 year olds and highest rates for patients over 40 who were confused or incomprehensible. Men were slightly more likely to be screened for blood alcohol than women, but their positivity rate was 2.5 times higher; by contrast, the toxicology positivity rate did not differ significantly by gender. A positive finding for either test was associated with a 40% higher rate of positivity for the other.

Adolescent↗
PubMed1993

Laboratory tests for rapid screening of drugs of abuse in the workplace: a review.

The use of rapid, on-site drug detection devices is reviewed. These tests permit the detection of various psychoactive substances in urine, and are easily used by nonskilled personnel. Saliva tests are available for detection of alcohol. These rapid tests have varying degrees of accuracy, and it is recommended that positive outcomes for all rapid tests be verified by standard laboratory procedures. The tests have potential use in the emergency room, doctor's office, drug treatment program, and the work place. When access to formal laboratory testing is limited by either time or location, an easily portable test can give critical information. A number of commercially available tests are reviewed for method, accuracy, advantages and disadvantages. Consequently, the interested practitioner should be able to find a suitable screening test from among the tests reviewed.

Humans↗
PubMed1997

Illicit use of clonidine in opiate-abusing pregnant women.

OBJECTIVE: To examine prevalence rates and psychosocial correlates of clonidine use in a sample of opiate-dependent pregnant women. METHODS: Clonidine use was assessed in 90 treatment-seeking, pregnant, opiate-abusing women using both self-report and urinalysis toxicology. Clonidine-positive and -negative subjects were compared for selected demographic, substance use, and psychosocial measures. RESULTS: One-third of the sample was clonidine-positive. Urinalysis identified 26 clonidine-positive subjects, whereas self-report detected only six cases. Logistic regression identified four predictors of clonidine use at treatment admission: recent clinical anxiety, greater severity of family or social problems, recent cocaine use, and recent drug treatment. CONCLUSION: Clonidine use is prevalent in treatment-seeking opiate abusers, particularly those with concurrent cocaine use. The abuse potential of the drug warrants further study in this high-risk population.

Adult↗
PubMed2005

Erythropoietin abuse and erythropoietin gene doping: detection strategies in the genomic era.

The administration of recombinant human erythropoietin (rhEPO) increases the maximum oxygen consumption capacity, and is therefore abused as a doping method in endurance sports. The detection of erythropoietin (EPO) abuse is based on direct pharmacological and indirect haematological approaches, both of which have several limitations. In addition, current detection methods cannot cope with the emerging doping strategies of EPO mimicry, analogues and gene doping, and thus novel detection strategies are urgently needed. Direct detection methods for EPO misuse can be either pharmacological approaches that identify exogenous substances based on their physicochemical properties, or molecular methods that recognise EPO transgenes or gene transfer vectors. Since direct detection with molecular methods requires invasive procedures, it is not appropriate for routine screening of large numbers of athletes. In contrast, novel indirect methods based on haematological and/or molecular profiling could be better suited as screening tools, and athletes who are suspect of doping would then be submitted to direct pharmacological and molecular tests. This article reviews the current state of the EPO doping field, discusses available detection methods and their shortcomings, outlines emerging pharmaceutical and genetic technologies in EPO misuse, and proposes potential directions for the development of novel detection strategies.

Doping in Sports↗
PubMed2000

A review of postmortem alcohol detection as a diagnostic test for substance abuse disorders in suicides.

To assess the role of toxicologic detection of alcohol to diagnose substance abuse disorders in suicides, the author reviewed suicide studies with both comprehensive toxicologic and diagnostic data. The sensitivity of alcohol detection to diagnose alcohol and substance abuse disorders in suicides was low in all studies (range, 39%-42%), and the specificity was 80%-95%. A higher cutoff level for alcohol did not increase diagnostic performance. The author concludes that toxicologic detection of alcohol is not a reliable indicator of alcohol and substance abuse disorders in suicides because of the high rate of false-negatives. Most of the suicides with positive alcohol detection seem to suffer from chronic substance abuse problems. The role of intoxication is difficult to assess because of methodologic problems.

Alcoholism↗
PubMed2006

Oral fluid testing: new technology enables drug testing without embarrassment.

Drug abuse is a widespread problem across society, and its negative impact on performance and safety in the workplace cannot be overstated. Even as abuse of older, illicit drugs such as heroin, cocaine, marijuana, and amphetamines persists, new mind-altering chemicals continue to emerge, contributing to an ever-changing landscape of drug abuse and its physical and psychological consequences. Abuse of multiple drugs, and the combined use of alcohol and illicit and prescription drugs, have become increasingly common. The growing and continually evolving problem of drug abuse demands novel strategies for drug testing that reliably and reproducibly detect drugs of abuse, offer an effective solution to persistent problems related to test accuracy and the potential for sample adulteration and substitution, and speak to the growing concerns over issues of individual privacy. Oral fluid testing is a reliable, new technology that overcomes many of the problems of older methods for drug detection.

Cocaine↗
PubMed2006

Controlled substance abuse and illicit drug use in chronic pain patients: An evaluation of multiple variables.

BACKGROUND: Opioids are used extensively for chronic pain management in the United States. The frequency of opioid use prior to presenting to interventional pain management settings and in interventional pain management settings has been shown to be above 90%. Opioid abuse has been demonstrated in 9% to 41% of patients receiving chronic pain management. Illicit drug use has been reported in 14% to 34% of patients in chronic pain management settings. OBJECTIVES: To evaluate and correlate multiple variables with opioid abuse and illicit drug use. DESIGN: A prospective, consecutive study. SETTING: Interventional pain management practice setting in the United States. METHODS: A total of 500 consecutive patients prescribed opioids, considered to be receiving stable doses of opioids supplemental to their interventional techniques were evaluated for opioid abuse and for illicit drug use. Abuse was defined as a patient receiving controlled substances from any source other than the prescribing physician at our center with the exception of controlled substances for acute injuries unrelated to the problem being treated, or for emergencies. Urine drug testing for illicit drugs was performed by urine rapid drug screen (Instant Technologies, iCup Norfolk, VA). Results were considered positive if one or more of the monitored illicit drugs including cocaine, marijuana (THC), phencycledane methamphetamine or amphetamines were detected. RESULTS: Opioid abuse was seen in 9% of patients, with illicit drug use in 16% of patients. Significant differences were noted in the prevalence of opioid abuse in patients who developed chronic pain following motor vehicle accident(s) and in patients presenting with pain in three regions of the body. Illicit drug use (marijuana) was more common in females. Illicit drug use was also more common in patients younger than 45, after motor vehicle injury, and in patients with involvement of three regions of the body. CONCLUSION: Opioid abuse and illicit drug use were common in chronic pain patients with a prevalence of 9% and 16%, respectively. Age, pain after motor vehicle accident, involvement of multiple regions and past history of illicit drug use were identified as risk factors.

Accidents, Traffic↗
PubMedDate not supplied

Clinical issues associated with urine testing of substances of abuse.

Several factors may affect the validity and outcome of urine testing for abused drugs such as amphetamines, barbiturates, benzodiazepines, cannabinoids, cocaine, ethanol, opiates, and phencyclidine. Urine is used for large-scale testing because acquisition of the sample is noninvasive and because most abused drugs can be detected in urine for a reasonable duration after ingestion. Urine testing for drugs of abuse is a two-step process. In the first step, screening assays are used to identify presumably positive specimens. Common screening tests are radioimmunoassays, enzyme immunoassays, fluorescence polarization immunoassay, and thin layer chromatography. Since they may be subject to cross-reactivity, once a possible positive sample has been identified by a preliminary test, a second more specific methodology, gas chromatography with mass spectrometry, is done to confirm the results. Knowledge of the pharmacology and pharmacokinetics of abused drugs affects selection and interpretation of test results.

Cross Reactions↗
PubMed1991

Accuracy of common drug screen tests.

Forty consecutive urine specimens, obtained from patients seen in the emergency center, positive for either cocaine and/or marijuana, were analyzed using five methods of analysis. A new latex agglutination inhibition assay, Abuscreen OnTrak, (Roche Diagnostic Systems, Nutley, NJ), was compared with four other drug abuse assays: mass spectrometry, (Hewlett-Packard Co, Richardson, TX); an automated homogeneous enzyme immunoassay technique, ETS System, (Syva Co, Palo Alto, CA); a manual enzyme multiplied immunoassay technique; EMIT-st, (Syva); and a fluorescence polarization immunoassay, TDx, (Abbott Laboratories, Chicago, IL). For statistical purposes, mass spectrometry was the reference point for the presence or absence of a specific substance. All instrument sensitivities, with the exception of mass spectrometry, were set with the same "cut off" point of 100 micrograms/L for marijuana and 300 micrograms/L for cocaine and its metabolites. Efficiency in the detection of cocaine and its metabolites was 95% by all methods. Efficiency for the detection of marijuana and its metabolites ranged from 70% (Roche's OnTrak) to 90% (Syva's ETS). Simple to use, assays of minimal cost are presently available for rapid, accurate drug of abuse screening.

Evaluation Studies as Topic↗
PubMed1993

Simultaneous determination of drugs of abuse (opiates, cocaine and amphetamine) in human hair by GC/MS and its application to a methadone treatment program.

A new method was developed for the simultaneous detection and quantitation of 6-acetyl-morphine (MAM), amphetamine, benzoylecgonine (BZE), cocaine, codeine, dihydrocodeine, EDDP (methadone metabolite), methadone and morphine in hair. The hair samples were washed, cut into 2-cm segments, pulverized, incubated with phosphate buffer and beta-glucuronidase/aryl-sulfatase. After solid phase extraction and derivatization with pentafluoropropionic anhydride/pentafluoropropanol, the drugs were identified and measured by gas chromatography/mass spectrometry using their deuterated analogues as internal standards. The method is reproducible with detection limits under 0.1 ng/mg hair for almost all substances tested. Fifteen hair samples from five subjects of a methadone treatment program were collected in a 6-month period. The hair samples were segmented and examined for methadone, its main metabolite EDDP, and drugs of abuse. Of the 96 segments analysed, 95% were positive for methadone (mean value, 10.9 ng/mg), 76% for the metabolite EDDP (mean value, 1.2 ng/mg), 69% for opiates (mean values, MAM, 7.3 ng/mg; morphine, 2.9 ng/mg; codeine, 1.0 ng/mg) and 43% for cocaine (mean values, cocaine, 2.6 ng/mg; BZE, 1.1 ng/mg). A correlation of 0.63 was found between administered methadone dosages and concentrations measured by hair analysis. Further investigation is needed to clarify interindividual differences.

Adult↗
PubMed2004

Multicomponent screening for drugs of abuse: direct analysis of urine by LC-MS-MS.

By allowing for direct injection of urine, liquid chromatography-tandem mass spectrometry (LC-MS-MS) with atmospheric-pressure chemical ionization has proven to be useful for analysis of drugs of abuse in human urine. The purpose of this study was to evaluate this technique by direct screening for 23 different substances (phenylethylamines, hypnotics, and N-benzylpiperazine) in urine samples. It was possible to achieve lower detection limits compared with commercial immunochemical methods. There was a linear response for all analytes with an intraday coefficient of variation of about 16%, and the gradient elution gave a variability in relative retention time of about 1%. Positive results were confirmed by reanalysis including sample preparation by solid-phase extraction. Among the 529 authentic urine samples analyzed, 35 samples were screened positive for phenylethylamines, and 20 for hypnotics. Of these, 23 (66%) samples were confirmed to be positive for phenylethylamines, and 11 (55%) for hypnotics. This study demonstrates that LC-MS-MS is a valuable complement to immunochemical screening analysis, especially for substances for which immunochemical methods are not yet available or when an increased sensitivity is needed.

Chromatography, Liquid↗