Staff training makes a difference: improvements in neonatal illicit drug testing and intervention at a tertiary hospital

Abstract Identification of intrauterine drug-exposed newborns with toxicological screening may have benefits including close follow-up of the infant by both medical and social services. Applying specific written guidelines to select newborns for drug testing decreases bias and protects the physicians and hospitals involved. All drugs reported as positive should be confirmed by an appropriate second test. Urine and meconium testing are the best current options for identifying drug-exposed neonates. Urine testing sensitivity is low because of problems encountered in urine collections and the high thresholds used in current urine assays. The disadvantage to meconium testing is the increased labor and time required to work with this material. Testing of newborn hair is unlikely to be widely used until technically less demanding assays become available. Testing of amniotic fluid or gastric lavage is still in the developmental stages. Adopting lower urine assay thresholds for newborn samples would increase sensitivity and would be an appropriate modification of current methodologies.

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Trends in reports of driving following illicit drug consumption among regular drug users in Australia, 2007–2013: Has random roadside drug testing had a deterrent effect?

Accident Analysis & Prevention ◽

10.1016/j.aap.2017.05.008 ◽

2017 ◽

Vol 104 ◽

pp. 146-155 ◽

Cited By ~ 5

Author(s):

Danielle Horyniak ◽

Paul Dietze ◽

Simon Lenton ◽

Rosa Alati ◽

Raimondo Bruno ◽

...

Keyword(s):

Drug Testing ◽

Drug Users ◽

Illicit Drug ◽

Drug Consumption ◽

Deterrent Effect

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The Role of Drugs in Workplace Injuries: Is Drug Testing Appropriate?

Journal of Drug Issues ◽

10.1177/002204269502500404 ◽

1995 ◽

Vol 25 (4) ◽

pp. 703-722 ◽

Cited By ~ 21

Author(s):

Scott Macdonald

Keyword(s):

Drug Use ◽

Drug Testing ◽

Illicit Drug ◽

Household Survey ◽

Illicit Drug Use ◽

Alcohol Problems ◽

Age Group ◽

Workplace Injuries ◽

The Relationship

In the past decade, many employers have adopted drug-testing programs to reduce workplace injuries. However, little scientific evidence shows that drug use is a significant and substantial cause of total workplace injuries. The purpose of this study was to empirically assess the role of drugs and alcohol in causing workplace injuries. Questionnaires were received from 882 Ontario employees in a household survey. Results showed that many variables were significantly related to job injuries. The variables were ranked according to the relative importance of each variable's contribution to total job injuries. Alcohol problems, licit drug use, and illicit drug use ranked 7, 11, and 12 respectively among a group of 12 significant variables. In order to examine the likelihood that drug use was a cause of job injuries, the relationship between job injuries and alcohol problems, licit drug use, and illicit drug use was examined across categories of third variables. For age, the relationship between drug use and injuries remained strong for the youngest age group, but disappeared for the oldest age group. Logistic regression analysis confirmed the plausibility of noncausal explanations of job injuries for illicit drug use, but not for alcohol problems or licit drug use. Overall, the results indicated that illicit drug use does not appear to be a major cause of job injuries. The implications of these results for drug-testing programs are discussed.

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Under-reporting of drug use among individuals with schizophrenia: prevalence and predictors

Psychological Medicine ◽

10.1017/s0033291713000548 ◽

2013 ◽

Vol 44 (1) ◽

pp. 61-69 ◽

Cited By ~ 22

Author(s):

A. L. Bahorik ◽

C. E. Newhill ◽

C. C. Queen ◽

S. M. Eack

Keyword(s):

Drug Use ◽

Justice System ◽

Regression Models ◽

Drug Testing ◽

Illicit Drug ◽

Significant Proportion ◽

Neurocognitive Deficits ◽

Logistic Regression Models ◽

Methamphetamine Use ◽

Urine Drug

BackgroundIllicit drug use is common in individuals with schizophrenia, and it has been suspected that many individuals under-report their use of substances, leading to significant barriers to treatment. This study sought to examine the degree to which individuals with schizophrenia disclose their use of drugs on self-rated assessments, compared to laboratory assays, and to determine the contributors of under-reported drug use in this population.MethodA total of 1042 individuals with schizophrenia who participated in screening/baseline procedures for the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) completed self-rated assessments of substance use and laboratory drug testing. Laboratory tests assayed cannabis, cocaine and methamphetamine use; the procedures included radioimmunoassay (RIA) and urine drug screens.ResultsA significant proportion of participants tested positive for drug use on laboratory measures (n = 397; 38%), and more than half (n = 229; 58%) did not report using these drugs. Logistic regression models confirmed that patients who were most likely to conceal their use tended to be older, and presented with greater neurocognitive deficits. Patients who accurately reported drug use tended to have greater involvement with the criminal justice system. Illness severity and psychopathology were not associated with whether patients disclosed drug use.ConclusionsRates of under-reported drug use are considerable among individuals with schizophrenia when compared to laboratory assays, and the exclusive reliance on self-rated assessments should be used with caution. Patients who under-report their drug use are more likely to manifest neurocognitive deficits, which could be improved by interventions attempting to optimize treatment.

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Adulterants causing false negatives in illicit drug testing.

Clinical Chemistry ◽

10.1093/clinchem/34.11.2333 ◽

1988 ◽

Vol 34 (11) ◽

pp. 2333-2336 ◽

Cited By ~ 75

Author(s):

S L Mikkelsen ◽

K O Ash

Keyword(s):

Relative Density ◽

Drug Testing ◽

Drug Users ◽

Illicit Drugs ◽

Illicit Drug ◽

False Negative ◽

Lemon Juice ◽

Urine Ph ◽

Drug Assays

Abstract Illicit-drug users may attempt to falsify results by in vitro adulteration of specimens. We investigated eight additives (NaCl, Visine, handsoap, Drano, bleach, vinegar, golden-seal tea, and lemon juice) claimed by drug users to invalidate enzyme immunoassay (EIA) drug assays. We also analyzed adulterated urine specimens to determine if they could be identified, adding adulterants at several concentrations to 222 EIA-positive specimens confirmed by gas chromatography and mass spectrometry (GC/MS) to contain illicit drugs. To identify adulterated urines, we monitored pH, relative density, and urine color and turbidity at adulterant concentrations that falsified EIA results. Specimens contaminated with NaCl had relative densities greater than 1.035. Liquid Drano, bleach, and vinegar shifted urine pH outside the physiological range. Golden-seal tea caused a dark appearance, and specimens containing liquid soap were unusually cloudy. Lemon juice had no effect on the assays. Visine was the only adulterant not detected. The adulterants interfered somewhat differently with each of the drug assays. EIA assays for illicit drugs can be invalidated by specimen adulteration producing false-negative results. Therefore, if urine drug testing is to be conducted, pH, relative density, and appearance should be assessed and suspect specimens should be rejected. Not all adulterants can be detected, so observed collection is strongly recommended.

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Illicit Drug Use in the Pain Patient Population Decreases with Continued Drug Testing

January 2018 - Pain Physician ◽

10.36076/ppj.2011/14/189 ◽

2011 ◽

Vol 3;14 (2;3) ◽

pp. 189-193 ◽

Cited By ~ 2

Author(s):

Amadeo Pesce

Keyword(s):

Drug Use ◽

Drug Testing ◽

Illicit Drugs ◽

Illicit Drug ◽

Illicit Drug Use ◽

Pain Patient ◽

Spearman Correlation ◽

Urine Drug Testing ◽

Urine Drug ◽

Pain Patients

Background: A major concern of physicians treating pain patients with chronic opioid therapy and similar drugs is determining whether the patients are also using illicit drugs. This is commonly determined by urine drug testing (UDT). However, there are few studies on whether or not monitoring patients by this technique decreases illicit drug use. Objective: To determine if the presence of illicit drugs decreases over a number of physician visits where UDT was performed. Method: The method involved a retrospective study of tests for the illicit drugs marijuana, cocaine, methamphetamine, ecstacy (MDMA) phencyclidine (PCP) and the heroin metabolite, 6-acetylmorphine as confirmed by Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS). A database of 150,000 patient visits was examined for the presence of any of these 6 drugs. Results: A total of 87,000 patients were initially tested. The number of patients who were repeatedly tested decreased over time. The percentage of patients positive for any of these illicit drugs decreased from 23% to 9% after 14 visits where UDT was performed. When graphed there was a trend to decreasing use. The Spearman correlation = -0.88, P < 0.0001. The major illicit drug was marijuana. When this was removed from the analysis, there was an even greater correlation with decreased illicit drug use. Spearman correlation = -0.92 (P < 0.0001) using a weighted correlation. Limitation: Patients continuing to use illicit drugs might be dismissed from practices thus biasing the study towards illicit drug avoidance. Conclusion: Continued UDT might decrease illicit drug use among pain patients. Key words: Pain patients, UDT, urine drug testing, LC-MS/MS, illicit drugs, decrease drug use

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