Screening for drugs of abuse (II): Cannabinoids, lysergic acid diethylamide, buprenorphine, methadone, barbiturates, benzodiazepines and other drugs.
Requirements for the provision of an efficient and reliable service for drugs of abuse screening in urine have been summarized in Part I of this review. The requirements included rapid turn-around times, good communications between requesting clinicians and the laboratory, and participation in quality assessment schemes. In addition, the need for checking/confirmation of positive results obtained for preliminary screening methods was stressed. This aspect of the service has assumed even greater importance with widespread use of dip-stick technology and the increasing number of reasons for which drug screening is performed. Many of these additional uses of drug screening have possible serious legal implications, for example, screening school pupils, professional footballers, parents involved in child custody cases, persons applying for renewal of a driving licence after disqualification for a drug-related offence, doctors seeking re-registration after removal for drug abuse, and checking for compliance with terms of probation orders; as well as pre-employment screening and work-place testing. In many cases these requests will be received from a general practitioner or drug clinic with no indication of the reason for which testing has been requested. This also raises the serious problems of a chain of custody, provision of two samples, stability of samples, and secure and lengthy storage of samples in the laboratory-samples may be requested by legal authorities several months after the initial testing. The need for confirmation of positive results is now widely accepted but it may be equally important to confirm unexpected negative results. Failure to detect the presence of maintenance drugs may lead to the patient being discharged from a drug treatment clinic and, if attendance at the clinic is one of the terms of continued employment, to dismissal. It seems likely that increasing abuse of drugs and the efforts of regulatory authorities to control this, will lead to the manufacture of more designer drugs. Production of substituted phenethylamines was facilitated by the drug makers' cook book, 'PIHKAL' (Phenethylamines I Have Known And Loved) by Dr Alexander Shulgin and Ann Shulgin, and production of substituted tryptamines is promised in their next book, TIHKAL. Looking to the future, laboratories will need to ensure that they can detect and quantitate an ever-increasing number of drugs and related substances. The question of confidence in results of drugs of abuse testing raised in 1993 by Watson has assumed even greater importance as a result of attention focused on the OJ Simpson trial in Los Angeles. Toxicological investigations are likely to be challenged more frequently in the future. Even if analyses have been performed by GC-MS, there is a need to establish the level of match between the spectrum of the unknown substance and a library spectrum which is considered acceptable for legal purposes. It will also be essential to ensure that computer libraries contain spectra for all substances likely to be encountered in drugs of abuse screening.
Simpson
D
D
Department of Clinical Biochemistry, Royal Infirmary, Edinburgh, UK.
Braithwaite
R A
RA
Jarvie
D R
DR
Stewart
M J
MJ
Walker
S
S
Watson
I W
IW
Widdop
B
B
D001463:Barbiturates / Q000652:urine*; D001569:Benzodiazepines / Q000097:blood / Q000652:urine; D002047:Buprenorphine / Q000097:blood / Q000652:urine*; D002186:Cannabinoids / Q000652:urine*; D003501:Cyclizine / Q000032:analysis; D011431:Dextropropoxyphene / Q000032:analysis; D004338:Drug Combinations; D005283:Fentanyl / Q000652:urine; D006801:Humans; D007649:Ketamine / Q000097:blood / Q000652:urine; D008238:Lysergic Acid Diethylamide / Q000652:urine*; D008691:Methadone / Q000031:analogs & derivatives / Q000032:analysis / Q000097:blood / Q000652:urine; D010423:Pentazocine / Q000032:analysis; D015813:Substance Abuse Detection / Q000379:methods*
D001463:Barbiturates; D002186:Cannabinoids; D004338:Drug Combinations; D001569:Benzodiazepines; D002047:Buprenorphine; D007649:Ketamine; C007358:diconal; D008238:Lysergic Acid Diethylamide; D003501:Cyclizine; D010423:Pentazocine; D011431:Dextropropoxyphene; D008691:Methadone; D005283:Fentanyl