0
0

Chapter 46. Testing to Identify Recent Drug Use

Robert L. DuPont, M.D.; Carl M. Selavka, Ph.D.
DOI: 10.1176/appi.books.9781585623440.358399

Sections

Excerpt

The diagnosis of substance use disorder, like most other medical diagnoses, is primarily clinical, with the patient's history and the mental status examination playing central roles in the diagnostic process. Nevertheless, laboratory testing to identify recent drug use is increasingly important in clinical settings, ranging from the initial diagnosis to treatment management and from research and epidemiology to health care assessment. Drug testing identifies the recent use of specific abused substances and in some settings can help to differentiate chronic or repetitive ingestions from single or low-frequency uses. Laboratory testing is especially helpful in medical settings as part of the screening process to identify patients for evaluation for substance use disorder.

Your session has timed out. Please sign back in to continue.
Sign In Your Session has timed out. Please sign back in to continue.
Sign In to Access Full Content
 
Username
Password
Sign in via Athens (What is this?)
Athens is a service for single sign-on which enables access to all of an institution's subscriptions on- or off-site.
Not a subscriber?

Subscribe Now/Learn More

PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing PsychiatryOnline@psych.org or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

Table Reference Number
TABLE 46–1. Comparisons by race in preemployment testing in police applicants
Table Reference Number
TABLE 46–2. Urine, hair, oral fluid, and sweat patch testing for drugs of abuse
Table Reference Number

Because drugs of abuse are distributed to virtually every part of the user's body, they can be detected in all fluids and tissues.

Urine is the most commonly used matrix for drug testing, but hair, oral fluid (saliva), and sweat patches are increasingly used. No one matrix is best; they each have their strengths and weaknesses.

Drug tests detect recent drug use. They do not detect dependence, intoxication, impairment, or addiction.

Most drug test results are confirmed by the sample donor's admission of recent drug use. Difficult and disputed cases benefit from additional help in interpretation, including assistance from the laboratory that conducted the test or the kit manufacturer for on-site tests and a certified medical review officer.

Smarter drug testing requires the use of all four common test matrices (urine, hair, oral fluid, and sweat patches) so the donor does not know which matrix will be used. It is desirable to vary the drugs tested for. This approach reduces cheating, improves the deterrent effect of testing, and permits comparison over time of the rates of positive results for the various matrices.

References

Barnes AJ, Kim I, Schepers R, et al: Sensitivity, specificity, and efficiency in detecting opiates in oral fluid with the Cozart Opiate Miroplate EIA and GC-MS following controlled codeine administration. J Anal Toxicol 27:402–407, 2003
[PubMed]
 
Charles BK, Day JE, Rollins DE, et al: Opiate recidivism in a drug-treatment program: comparison of hair and urine data. J Anal Toxicol 27:412–428, 2003
[PubMed]
 
Cone EJ, Sampson-Cone AH, Darwin WD, et al: Urine testing for cocaine abuse: metabolic and excretion patterns following different routes of administration and methods for detection of false-negative results. J Anal Toxicol 27:386–401, 2003
[PubMed]
 
DuPont RL: Do random workplace drug tests primarily identify casual or regular drug users? MRO Update July/August:5–7, 1996
 
DuPont RL: Addiction: a new paradigm. Bull Menninger Clin 62:231–242, 1998
[PubMed]
 
DuPont RL: The Selfish Brain: Learning From Addiction. Washington, DC, American Psychiatric Press, 2000
 
DuPont RL, Baumgartner WA: Drug testing by urine and hair analysis: complementary features and scientific issues. Forensic Sci Int 70:63–76, 1995
[PubMed]
 
DuPont RL, Brady LA: Drug Testing in Schools: Guidelines for Effective Use. Center City, MN, Hazelden, 2005
 
DuPont RL, Bucher RH: Guide to responsible family drug testing and alcohol testing. Rockville, MD, Institute for Behavior and Health, Inc., 2005
 
DuPont RL, Gold MS: Withdrawal and reward: implications for detoxification and relapse prevention. Psychiatr Ann 25:663–668, 1995
 
DuPont RL, Graves H: Smarter student drug testing. Rockville, MD, Institute for Behavior and Health, Inc., 2005
 
DuPont RL, Selavka CM: Drug testing addiction treatment and criminal justice settings, in Principles of Addiction Medicine, 3rd Edition. Edited by Graham AW, Schultz TK, Mayo-Smith MF, et al. Chevy Chase, MD, American Society of Addiction Medicine, 2003, pp 1001–1008
 
DuPont RL, Griffin DW, Siskin BR, et al: Random drug tests at work: the probability of identifying frequent and infrequent users of illicit drugs. J Addict Dis 14:1–17, 1995
[PubMed]
 
DuPont RL, Mieczkowski T, Newel R: Drug Testing in the Criminal Justice System. Center City, MN, Hazelden, 2005a
 
DuPont RL, Newel R, Brethen P: Drug Testing in Drug Abuse Treatment. Center City, MN, Hazelden, 2005b
 
Graham AW, Schultz TK, Mayo-Smith MF, et al. (eds): Principles of Addiction Medicine, 3rd Edition. Chevy Chase, MD, American Society of Addiction Medicine, 2003
 
Jufer R, Wstadik A, Walsh S, et al: Elimination of cocaine and metabolites in plasma, saliva, and urine following repeated oral administration to human volunteers. J Anal Toxicol 24:467–477, 2000
[PubMed]
 
Mieczkowski T, Lersch K: Drug testing police officers and police recruits: the outcome of hair analysis and urinalysis compared. Policing: An International Journal of Police Strategies and Management 25:581–601, 2002
 
Mieczkowski T, Newel R: Statistical examination of hair color as a potential biasing factor in hair analysis. Forensic Sci Int 107:13–38, 2000
[PubMed]
 
Morrison JF, Chesler SN, Yoo WJ, et al: Matrix and modifier effects in the supercritical fluid extraction of cocaine and benzoylecgonine from human hair. Anal Chem 70:163–172, 1998
[PubMed]
 
Politi L, Morini L, Leone F, et al: Ethyl glucuronide in hair: is it a reliable marker of chronic high levels of alcohol consumption? Addiction 101:1408–1412, 2006
[PubMed]
 
Politi L, Zucchella A, Morini L, et al: Markers of chronic alcohol use in hair: comparison of ethyl glucuronide and cocaethylene in cocaine users. Forensic Sci Int 172:23–27, 2007
[PubMed]
 
Schwartz H: Urine testing in the detection of drugs of abuse. Arch Intern Med 148:2407–2412, 1998
 
Selavka C: Testing for drugs in hair. The Prosecutor 31:38–44, 1997
 
Skipper GE, Weinmann W, Theirauf A, et al: Ethyl glucuronide: a biomarker to identify alcohol use by health professionals recovering from substance use disorders. Alcohol 39:445–449, 2004a
 
Skipper GE, Weinmann W, Wurst FM: Ethylglucuronide (EtG): a new marker to detect alcohol use in recovering physicians. Journal of Medical Licensure and Discipline 90(2):14–17, 2004b
 
Uematsu T, Sato R, Fujimori O, et al: Human scalp hair as evidence of individual dosage history of haloperidol: a possible linkage of haloperidol excretion into hair with hair pigment. Arch Dermatol Res 282:120–125, 1990
[PubMed]
 
U.S. Department of Health and Human Services: Mandatory guidelines for federal workplace drug testing programs. 53 Federal Register 11979 (1988)
 
U.S. Department of Health and Human Services: Proposed revisions to mandatory guidelines for federal workplace drug testing programs. 59 Federal Register 29908 (1994)
 
Volkow ND, Wang G, Fowler JS, et al: Brain DA D2 receptors predict reinforcing effects of stimulants in humans; replication study. Synapse 46:79–82, 2002
[PubMed]
 
Volkow ND, Fowler JS, Wang G: The addicted human brain viewed in the light of image studies: brain circuits and treatment strategies. Neuropharmacology 47 (suppl 1):3–13, 2004
 
Walsh JM, Flegel R, Crouch D, et al: An evaluation of rapid point-of-collection oral fluid drug-testing devices. J Anal Toxicol 27:429–439, 2003
[PubMed]
 
Wise R: Brain reward circuitry: insights from unsensed incentives, in Principles of Addiction Medicine, 3rd Edition. Edited by Graham AW, Schultz TK, Mayo-Smith MF, et al. Chevy Chase, MD, American Society of Addiction Medicine, 2003, pp 57–71
 
Wurst FM, Skipper GE, Weinmann W: Ethyl glucuronide—the direct ethanol metabolite on the threshold from science to routine use. Addiction 98 (suppl 2):51–61, 2003a
 
Wurst FM, Vogel R, Jachau K, et al: Ethyl glucuronide detects recent alcohol use in forensic psychiatric inpatients. Alcohol Clin Exp Res 27:471–476, 2003b
 
Yacoubian GS, Wish ED, Perez DM: A comparison of saliva testing to urinalysis in an arrestee population. J Psychoactive Drugs 33:289–294, 2001
[PubMed]
 
+

CME Activity

Add a subscription to complete this activity and earn CME credit.
Sample questions:
1.
A test of which of the following specimens is generally least expensive and completed at most clinical laboratories?
2.
A test of which of the following specimens has the shortest window of detection?
3.
A test of which of the following specimens can detect drug use for up to 90 days?
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Related Content
Articles
Topic Collections
Psychiatric News
PubMed Articles
Not All Tumor Lysis Syndromes Are Due to Malignancy. Chest 2014;146(4_MeetingAbstracts):181A.doi:10.1378/chest.1992331.
 
  • Print
  • PDF
  • E-mail
  • Chapter Alerts
  • Get Citation