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At least 163 records · Page 9Linked to original sources
PubMed2004

Analytic performance of immunoassays for drugs of abuse below established cutoff values.

BACKGROUND: The analytic performance and accuracy of drug detection below Substance Abuse and Mental Health Services Administration (SAMHSA) cutoffs is not well known. In some patient populations, clinically significant concentrations of abused drugs in urine may not be detected when current SAMHSA cutoffs are used. Our objectives were to define the precision profiles of three immunoassay systems for drugs of abuse and to evaluate the accuracy of testing at concentrations at which the CV was <20%. METHODS: Drug-free urine was supplemented with analytes to assess the precision in three commercial drugs-of-abuse immunoassay systems below the SAMHSA-dictated cutoffs for amphetamines, opiates, benzoylecgonine, phencyclidine, and cannabinoids. Consecutive urine samples with signals associated with a CV <20% by Emit immunoassay and below SAMHSA cutoffs were then subjected to confirmatory analysis. RESULTS: The CV of all immunoassay systems tested remained <20% to drug concentrations well below SAMHSA cutoffs. The accuracy of urine drug-screening results between the SAMHSA-specified cutoffs and the precision-based cutoffs was less than accuracy for specimens above the SAMHSA cutoffs, but the use of the precision-based cutoff produced a 15.6% increase in the number of screen-positive specimens and a 7.8% increase in the detection of specimens that yielded positive results on confirmatory testing. CONCLUSION: The precision of three commercial immunoassay systems for drugs-of-abuse screening is adequate to detect drugs below SAMHSA cutoffs. Knowledge of the positive predictive values of screening immunoassays at lower cutoff concentrations could enable efficient use of confirmatory testing resources and improved detection of illicit drug use.

Cocaine↗
PubMed2003

Is oral fluid analysis as accurate as urinalysis in detecting drug use in a treatment setting?

BACKGROUND: Technology for testing oral fluid (OF) for the presence of drugs is available for treatment services and is more attractive than urinalysis: its validity is not well established. AIMS: Compare the accuracy of methods of on-site testing of OF and urine. DESIGN: Comparison of the sensitivity and specificity of on-site testing of samples of OF and urine collected on the same occasion, using subsequent blind laboratory analysis of the same urine samples as the standard. SETTING: British addiction treatment service. PARTICIPANTS: 157 drug dependent persons, 89% with evidence of opiates, 73% male, and 85% aged between 20 and 35 years. MEASUREMENTS: Assessment of presence of four drugs using SYVA ETS urinalysis and Cozart Rapiscan OF Drug Test systems. Laboratory urinalysis using microplate enzyme-immunoassay technique. RESULTS: The sensitivity of OF tests and urinalysis were, respectively, for opiates 91 and 91%, methadone 91 and 94%, and benzodiazepines 6 and 72%. The specificity of OF tests and urinalysis were, respectively, for opiates 78 and 67%, methadone 90 and 95%, and benzodiazepines 95 and 96%. Amphetamine usage was rare. CONCLUSIONS: OF testing is as accurate as urinalysis in detecting the presence of opiates and methadone, and the absence of methadone and benzodiazepines.

Adult↗
PubMed2005

Using the EDAC test to monitor abstinence and relapses during outpatient treatment.

The main objective of this study is to show the performance of the EDAC test in monitoring alcohol consumption during outpatient treatment. The EDAC is a new approach that uses routine laboratory tests to identify binge drinking as well as chronic drinking. The overall diagnostic performance of the EDAC fluctuates around 80 to 90% for both specificity and sensitivity. Close to two thousand subjects have been tested by the EDAC since the early eighties; 300 of these were patients undergoing treatment at different institutions across the U.S. This article selected five case studies to represent examples of classical drinking behaviors encountered in most outpatient clinics. The first four cases illustrate the use of the EDAC alone and the last case represents the use of the EDAC combined with CDT. These five case studies illustrate the use of the EDAC to detect relapse episodes, to monitor abstinence during outpatient treatment and to recognize a slip early enough to prevent more severe drinking. The use of biomarkers to monitor drinking behavior in alcohol dependent patients is gaining popularity because they provide objective information on a patient's drinking status when used as an adjunct to self-report.

Adult↗
PubMed2004

False-positive urine opiate screening associated with fluoroquinolone use.

OBJECTIVE: To review the literature regarding false-positive urine opiate screens associated with the use of fluoroquinolones. DATA SOURCES: Literature was identified using MEDLINE (1966-February 2004), EMBASE, and all EBM Reviews with the terms quinolones, substance abuse detection, opiates, cross-reactions, false-positive reactions, and each fluoroquinolone. Article references were also reviewed. DATA SYNTHESIS: Various settings utilize the practice of screening for drugs of abuse, such as opiates. These screening procedures can impact aspects of one's life, such as employment; therefore, accuracy is of the utmost importance. Two clinical trials were evaluated which showed that certain fluoroquinolone antibiotics cross-react with some of the commonly used urine opiate screening immunoassays. This suggests the importance of verifying positive results in instances where one's livelihood can be affected. CONCLUSIONS: Fluoroquinolones can cause false-positive urine opiate screens. Clinicians should be aware of this potential interaction and may need to verify positive results.

Cross Reactions↗
PubMed2002

A national 5-year follow-up of treatment outcomes for cocaine dependence.

BACKGROUND: Long-term (5-year) outcomes of community treatment for cocaine dependence were examined in relation to problem severity at treatment entry and treatment exposure throughout the follow-up period. METHODS: Interviews were conducted at 1 and 5 years after treatment for 708 subjects (from 45 programs in 8 cities) who met DSM-III-R criteria for cocaine dependence when admitted to treatment in 1991-1993. Primary outcome measures included cocaine use and arrests. Self-reported cocaine use showed high overall agreement with urine (79% agreement) and hair (80% agreement) toxicology analyses. RESULTS: Weekly cocaine use was reported by 25% of the sample at 5 years, slightly higher than the 21% at 1 year. Similarly, 26% had cocaine detected in urine specimens at follow-up and 18% reported having been arrested. Poorer long-term outcomes were related to higher problem severity at treatment admission and low treatment exposure. CONCLUSIONS: The large decreases in cocaine use 1 year after treatment discharge were sustained during the 5-year follow-up. Severity of drug and psychosocial problems at intake was predictive of long-term outcomes and outcomes improved in direct relation to level of treatment exposure.

Adult↗
PubMed1994

Psychotropic drug consumption and other factors associated with heroin overdose.

In clinical or forensic practice there are few studies assessing which risk factors are associated with heroin overdoses. A series of 76 consecutive non-fatal heroin overdoses were compared to 22 consecutive subjects who self-injected heroin within 1 h before admission to the emergency room. Whereas blood levels of alcohol and IgE and urinary cocaine metabolite levels were similar in both groups, higher benzodiazepine plasma levels were detected in the heroin overdose group. The assessment of methadone, dextropropoxyphene, amphetamines and cannabis in urine analysis did not show differences between both groups. The interview revealed that only 48% of subjects in the heroin overdose group self-administered the last dose of heroin before admission in the usual setting as compared to 100% of subjects in the non-overdose group. The application of a log-linear regression model identified self-injection of heroin in an unusual place and plasma concentrations of total morphine and benzodiazepines as risk factors for heroin overdose.

Adolescent↗
PubMedDate not supplied

Looking back on cocaine dependence: reasons for recovery.

Factors that contributed to long-term recovery from cocaine dependence were examined as part of a 5-year national follow-up study of 708 patients from 45 treatment programs in eight U.S. cities. Outcomes from 33% of the sample were highly favorable at follow-up, including no drugs detected in urine or hair specimens, no self-reported use of any drugs, less than daily alcohol use, and no illegal activity or arrests during the past year. Major reasons cited for these improvements were motivations to change, positive influences of family, strength from religion and spirituality, and help from drug treatment. "Recovery" was viewed as a continuous process and one that benefits from lessons learned in treatment. These retrospective attributions affirm many of the same findings from prospective outcome studies and contribute to a conceptual framework for treatment process and recovery.

Adult↗
PubMed1997

Harm reduction measures and injecting inside prison versus mandatory drugs testing: results of a cross sectional anonymous questionnaire survey. The European Commission Network on HIV Infection and Hepatitis in Prison.

OBJECTIVES: (a) To determine both the frequency of injecting inside prison and use of sterilising tablets to clean needles in the previous four weeks; (b) to assess the efficiency of random mandatory drugs testing at detecting prisoners who inject heroin inside prison; (c) to determine the percentage of prisoners who had been offered vaccination against hepatitis B. DESIGN: Cross sectional willing anonymous salivary HIV surveillance linked to a self completion risk factor questionnaire. SETTING: Lowmoss prison, Glasgow, and Aberdeen prison on 11 and 30 October 1996. SUBJECTS: 293 (94%) of all 312 inmates at Lowmoss and 146 (93%) of all 157 at Aberdeen, resulting in 286 and 143 valid questionnaires. MAIN OUTCOME MEASURES: Frequency of injecting inside prison in the previous four weeks by injector inmates who had been in prison for at least four weeks. RESULTS: 116 (41%) Lowmoss and 53 (37%) Aberdeen prisoners had a history of injecting drug use but only 4% of inmates (17/395; 95% confidence interval 2% to 6%) had ever been offered vaccination against hepatitis B. 42 Lowmoss prisoners (estimated 207 injections and 258 uses of sterilising tablets) and 31 Aberdeen prisoners (229 injections, 221 uses) had injected inside prison in the previous four weeks. The prisons together held 112 injector inmates who had been in prison for more than four weeks, of whom 57 (51%; 42% to 60%) had injected in prison in the past four weeks; their estimated mean number of injections was 6.0 (SD 5.7). Prisoners injecting heroin six times in four weeks will test positive in random mandatory drugs testing on at most 18 days out of 28. CONCLUSIONS: Sterilising tablets and hepatitis B vaccination should be offered to all prisoners. Random mandatory drugs testing seriously underestimates injector inmates' harm reduction needs.

Cross-Sectional Studies↗
PubMed1988

Advisability of substance abuse testing in parents who severely maltreat their children: the issue of drug testing before the juvenile/family courts.

The authors discuss the advisability of juvenile courts requiring urine testing for parents who severely maltreat (abuse and/or neglect) their children. While urine testing for substance abuse is not sufficient to ensure adequate treatment, it is important as part of the overall substance abuse treatment in a selected group of parents. An objective of this article is to offer specific urine testing guidelines in the context of child maltreatment cases in which the court considers removing children from parental custody to state custody. Although potentially useful, urinalysis to detect abused substances has limitations and is appropriate only in well-defined situations. Effective treatment of the substance-abusing, child-maltreating parent must be multimodal, with treatment of substance abuse as the first and most important step.

Adult↗
PubMedDate not supplied

Use of 'very low-dose phenobarbital' to investigate compliance in patients on reducing doses of methadone (detoxification).

Incorporation of very low doses of phenobarbital into a methadone linctus has enabled us to monitor the compliance of 7 patients receiving a reducing dose of methadone (detoxification) for treatment for opioid addiction. By measuring both plasma phenobarbital and methadone we detected 4 patients who consumed extra illicitly obtained methadone during the detoxification regime. Treatment outcome was poor; 11 of the original 18 patients dropped out of treatment within 14 days and of those who remained, 4 patients relapsed and reabused illicit drugs and 2 returned to a fixed dose of methadone. Laboratory measurements were successfully used to detect poor methadone compliance.

Adult↗
PubMed1995

Effects of combined fluoxetine and counseling in the outpatient treatment of cocaine abusers.

Three methods of analysis were used to determine the effects of the combination of counseling with fluoxetine (20, 40, or 60 mg) and "active" placebo (diphenhydramine, 12.5 mg) randomly assigned. Forty-five cocaine-only dependent subjects were treated as outpatients with "interpersonal" counseling, medication, and drug use monitoring three times per week for up to 12 weeks. Treatment effects were analyzed: first, by comparing the three original assignments and placebo; second, by comparing the placebo group to fluoxetine subjects with detectable fluoxetine/norfluoxetine blood levels and those with no detectable medication blood level; third, by examining relapse prevention versus use cessation through stratifying the subjects into four groups according to fluoxetine or placebo assignment and initial urine cocaine positivity or negativity. All three analyses showed improvement on some measures over time regardless of group assignment. The 60-mg fluoxetine group showed least effectiveness, the group with detectable blood levels had less cravings, and the fluoxetine subjects who were abstinent at the start of treatment were somewhat less likely to avoid relapse than those on placebo.

Adult↗
PubMedDate not supplied

[Level of autoantibodies to opiate receptors in blood of patients with opiate addiction].

The level of autoantibodies to opiate receptors was measured in serum of heroin addicts in withdrawal and in the period of long-term abstinence and in healthy volunteers as well. The level of autoantibodies was assessed with ELISA with synthetic peptide specific for subregions of mu and delta opiate receptors. The scores of the level of autoantibodies higher than 150% of the level noted in healthy volunteers was observed in 56% of heroin addicts. The dependence of autoantibodies level from duration of diseases was shown. Elevated level of opiate receptors autoantibodies were detected in the sera of 71% patients with opiate addiction who had been using heroin more then one year. High levels of opiate receptors autoantibodies were observed more frequently in patients with opiate withdrawal syndrome then in patients with long-term remission. Elevated level autoantibodies to opiate receptors were determined in the blood of 38% opiate abusers with remission for 3-8 months. The level of autoantibodies to opiate receptors may be used for diagnostics of heroin dependence and control of treatment efficiency.

Adolescent↗
PubMedDate not supplied

Cocaine use in pregnancy.

BACKGROUND: Cocaine use during pregnancy has many deleterious effects on both the mother and the fetus, including the following: preterm labor (< 37 weeks' gestation), congenital anomalies, intrauterine growth retardation (IUGR), abruptio placenta, low-birth-weight infants (< 2500 g), neonatal death, and sudden infant death syndrome (SIDS). Potentially catastrophic maternal outcomes include a pre-eclampsia-like syndrome, acute pulmonary edema, seizures, cardiac arrhythmia, and sudden death. Family physicians who practice obstetrics might encounter cocaine-abusing women as part of their primary care practice. This article reviews the current knowledge regarding the pharmacology, pathophysiology, prevalence, demographics, and methods of detecting cocaine use in pregnancy. METHODS: Material for this paper came from a MEDLINE review of the literature from 1988 to the present. RESULTS AND CONCLUSIONS: Family physicians who practice obstetrics, especially those who practice in urban minority settings, are likely to encounter pregnant women who are abusing cocaine. Signs of maternal cocaine use are dilated pupils and increased heart rate, blood pressure, respirations, and reflexes. Other signs include agitated sensorium, arrhythmias, and seizures. Preterm labor, pre-eclampsia, and acute pulmonary edema can all be caused by maternal cocaine use. Methods of testing for cocaine are urine or meconium drug screening. Hair analysis is presently being researched but is not yet at a level of clinical reliability. Getting the patient into prenatal care as early as possible has been shown to improve birth outcomes.

Cocaine↗
PubMed1992

Nasal administration of naloxone for detection of opiate dependence.

In clinical trials, nasally applied naloxone was used to identify opiate dependence in humans for the first time. Withdrawal distress was recorded, and pupillary response, pulse rate and blood pressure measured. A significant increase in withdrawal distress and pupillary dilation was observed after nasal administration of 1mg (1mg/400 microliters) naloxone in all subjects who also showed opiate-positive urine samples. In control subjects, no reaction to naloxone was observed. It may be concluded that the nasal route for naloxone administration is as effective as the parenteral route. This test is sensitive enough to identify the physically-dependent opiate user and might have a role in emergency medicine and withdrawal treatment.

Administration, Intranasal↗
PubMed2001

Marijuana abstinence effects in marijuana smokers maintained in their home environment.

BACKGROUND: Although withdrawal symptoms are commonly reported by persons seeking treatment for marijuana dependence, the validity and clinical significance of a marijuana withdrawal syndrome has not been established. This controlled outpatient study examined the reliability and specificity of the abstinence effects that occur when daily marijuana users abruptly stop smoking marijuana. METHODS: Twelve daily marijuana smokers were assessed on 16 consecutive days during which they smoked marijuana as usual (days 1-5), abstained from smoking marijuana (days 6-8), returned to smoking marijuana (days 9-13), and again abstained from smoking marijuana (days 14-16). RESULTS: An overall measure of withdrawal discomfort increased significantly during the abstinence phases and returned to baseline when marijuana smoking resumed. Craving for marijuana, decreased appetite, sleep difficulty, and weight loss reliably changed across the smoking and abstinence phases. Aggression, anger, irritability, restlessness, and strange dreams increased significantly during one abstinence phase, but not the other. Collateral observers confirmed participant reports of these symptoms. CONCLUSIONS: This study validated several specific effects of marijuana abstinence in heavy marijuana users, and showed they were reliable and clinically significant. These withdrawal effects appear similar in type and magnitude to those observed in studies of nicotine withdrawal.

Adolescent↗
PubMed1994

A 24-h inpatient detoxification treatment for heroin addicts: a preliminary investigation.

The present study describes a detoxification method which takes only 4 h to complete. Eleven polydrug users addicted to opiates were detoxified 12 h after their last dose of heroin, in an intensive care unit. The detoxification was carried out using naltrexone, after sedation with midazolan. After detoxification (12 h) patients were discharged without withdrawal symptoms. This procedure offers a rapid detoxification procedure which seems to be widely accepted by the addicts themselves.

Administration, Oral↗
PubMed1995

Mazindol treatment for cocaine dependence.

This double-blind placebo-controlled treatment study tested the efficacy of mazindol in currently cocaine-dependent out-patients. Forty-three patients were randomized to mazindol (2 mg QD) vs. placebo treatment for 6 weeks. All patients received weekly group counseling. Patients improved with respect to objective (urine toxicology) and subjective (self-report of times used, dollars spent, craving, etc.) measures. There was no response difference between patients treated with mazindol and those who received placebo.

Adult↗