Caution in workplace drug testing: Controlled drugs

Abstract

Increasing substance abuse in the world, affects many areas of life, and this situation in workplaces causes exceptionally low work performance and even occupational accidents, resulting in problems that can create high costs for employers. In this context, workplace drug testing (WDT) programs are designed to detect the status of alcohol, illegal substances, or certain abused prescription drugs. These drug tests are a deterrent and preventive application of substance use in the workplace. The increase in the non-medical use and misuse of prescription drugs such as pregabalin (PGB) is a serious public issue in most countries such as Turkey. PGB was included controlled drug list in 2019. In the routine practice of WDT, classical substances are analyzed and PGB is not. In this study it's aimed to Evaluate the toxicological data obtained via a comprehensive retrospective investigation of urine samples of cases from a medico-legal aspect by creating a wide perspective for investigating psychoactive substances susceptible to abuse in Turkey. Furthermore, the study aimed to raise awareness on the subject by conducting a more comprehensive retrospective scan to determine the status of abused drugs, particularly the status of prescription/controlled ones. Forty-seven cases were admitted to Ege University Addiction Toxicology Laboratory between 2017 and 2021 due to special WDT requests. Thirty-one samples of the cases, of which there was a witness sample, were included in the study. The cases consisted of current employees or the ones who applied to work in companies from different transportation sectors and those who were asked for a drug test to be able to travel abroad. During the pre-interview of the cases by the physician, sociodemographic information, data on drug use, and urine samples were collected following the safety chain procedures. Urine samples were first subjected to screening analysis by immunoassay (Biochip). Confirmation analysis was performed with GC-MS of positive samples. All samples were subjected to a general toxicological screening in terms of 147 parameters with LC-MS/MS. Among the cases, 61.3% ( n = 19) were male, and the ages varied between 22 and 56. There were cases declaring drug use in the last 72 hours for the treatment of analgesic, cardiac, hypertension, osteoporosis problems etc. In case No. 1, cannabis (THC) and ATS were detected in the screening analysis and confirmed by GC-MS. In the analysis with LC-MS/MS, PGB, which was not included in the analysis scale in GC-MS, was detected in this case. He stated no drug/substance use. Case No. 1 was also reported to have attempted to forge the identity card upon identifying the personnel performing identity verification during the workplace drug test. PGB was found positive for case No. 29 with LC-MS/MS, while he also was noted to have been referred for toxicological analysis as the employer noticed the decrease in work performance. Employer-reported data overlapped with clinical signs of PGB use and a positive laboratory PGB result. Additionally, there was no drug containing PGB among the cold medicine and analgesic drugs (Voltaren) declared. The increase in the non-medical use and misuse of prescription drugs is a serious public issue in most countries such as Turkey. Most of the abusers have perceptions that the prescribed drugs are more reliable, and healthier than illegal substances, in addition, it is much more easy access. It is remarkable that we detected pregabalin, one of the controlled/prescription drugs in 2 cases in our study. In addition to conventional substance screening included in the international WDT guideline, the study's findings demonstrated, from a medico-legal perspective, the importance of meticulous investigation with clinical awareness of the prescripted substances susceptible to abuse such as PGB due to their increasing abuse potential.