title: The reliability of immunoassay for determining the presence of opiates in the forensic setting.
abstract: Urine immunoassays are commonly used as a rapid screen for drugs of abuse in emergency room, hospital, clinic, and forensic settings. The authors were concerned whether or not a negative screen of the urine for opiates was of significance and indicative that analysis of blood for opiates was not necessary. Specifically, we wished to determine whether a negative test for opiates by immunoassay absolutely rules out an acute overdose, and if not, what percentage of cases with negative results have opiates in the blood. A retrospective analysis was performed using the toxicology results for cases ruled an acute narcotic overdose at the Bexar County Medical Examiner's Office between 1998 and 2003. One hundred eighty-three cases met the criteria for the study. A false-negative rate of approximately 15% was found using an immunoassay as compared with blood analysis for narcotics. The authors feel that while this rate may be acceptable in a clinical setting, it is unacceptable in a forensic setting.
authors.affiliation: Bexar County Forensic Science Center, San Antonio, TX 78229, USA. kmolina@co.bexar.tx.us
authors.forename: D Kimberley
authors.initials: DK
authors.lastname: Molina
authors.forename: Vincent J
authors.initials: VJ
authors.lastname: Dimaio
mesh_terms: D062787:Drug Overdose; D005188:False Negative Reactions; D016231:Fluorescence Polarization Immunoassay; D005554:Forensic Medicine; D008401:Gas Chromatography-Mass Spectrometry; D006801:Humans; D009020:Morphine / Q000097:blood / Q000652:urine; D009022:Morphine Derivatives / Q000097:blood / Q000652:urine; D009294:Narcotics / Q000097:blood* / Q000506:poisoning / Q000652:urine*; D015203:Reproducibility of Results; D012189:Retrospective Studies
chemical_list: C049827:6-monobutanoylmorphine; D009022:Morphine Derivatives; D009294:Narcotics; D009020:Morphine