Screening For Illicit Drug Use Research Articles

Rates and types of urine drug screen false negative results compared with confirmatory toxicology testing in major trauma patients

Background Trauma centers are required to screen patients for alcohol use, and if necessary, intervene and refer to treatment (SBIRT). Similar screening for illicit drug use is recommended but not required. Urine drug screening (UDS) underestimates problematic substance use. This study aimed to estimate the types and rates of UDS false negatives (FN) compared to comprehensive testing by liquid chromatography-mass spectrometry (LC-MS) in trauma patients. Methods We performed a prospective cohort study of deidentified urine samples from adult trauma and burn activation patients. Both UDS and LC-MS comprehensive testing of >200 analytes were performed by a reference laboratory on all samples. Iatrogenic medications were excluded from the FN count. Crosstab analyses were conducted for UDS versus LC-MS outcomes to establish FN types and rates. We dichotomized the results by creating an “intentionality” variable (intentional injuries by self/others versus accidental injuries). A series of crosstabs with odds ratios considered intentionality by substance class and demographics. Statistically significant variables by Chi-Square were assessed by logistic regression. Results Psychoactive FN were detected in 56/100 urine samples analyzed; the most frequent included anticonvulsants (primarily gabapentin, N = 13), opioid agonists (N = 12), antihistamines (primarily diphenhydramine, N = 10), and phenethylamines (primarily bupropion, N = 5). Nonpsychoactive FN were detected in 70/100 samples; the most common were nicotine (N = 33), caffeine (N = 23), acetaminophen (N = 22), and antidepressants (N = 12). Of substance classes included in the UDS and also tested by LC-MS, FN occurred for opiates (3%), amphetamines (5%) and opioids (25%). Polypharmacy was associated with fall injuries in elderly patients. Cocaine (p = 0.015) and cannabinoids (p = 0.002) were significantly associated with intentionality. Conclusions Our results indicate that FN for potentially important psychoactive and nonpsychoactive substances are common when toxicologic testing is limited to routine UDS in trauma patients. We recommend expanding SBIRT in this patient population to include misuse of tobacco products, prescription analgesics, and over-the-counter antihistamines.

Screening for Young Adults for Illicit Drug Use: A Good Idea Although Evidence Is Lacking.

* Abbreviations: AAP — : American Academy of Pediatrics USPSTF — : US Preventive Services Task Force In the latest review, the US Preventive Services Task Force (USPSTF) concluded that the evidence is “insufficient to assess the balance and benefits and harms of screening for illicit drug use in adolescents” and of “primary care-based behavioral counseling interventions to prevent or reduce illicit drug use” in adolescents and young adults (defined as ages 12–17 and 18–25, respectively).1–3 In these statements, illicit drugs are substances that are illegal drugs or medications used non-medically but do not include alcohol or nicotine. These recommendations were based on 2 new evidence reviews.2,3 The USPSTF had previously concluded the evidence was insufficient for screening and brief intervention for unhealthy alcohol use among adolescents.4,5 These statements notwithstanding, the American Academy of Pediatrics (AAP) 2016 policy statement on substance use screening and brief intervention recommends that pediatricians “increase their capacity in substance use detection, assessment, and intervention; and become familiar with adolescent” screening, intervention, and referral practices and “their potential to be incorporated into universal screening and comprehensive care.”6 The AAP also advocates for brief intervention research and for insurers to pay for screening and brief intervention. More importantly, the AAP, in its recommendations for preventive pediatric health care, recommends “tobacco, alcohol or other drug use assessment…with appropriate action to follow, if positive” for adolescents.6 Herein we report how the USPSTF has summarized the … Address correspondence to Richard Saitz, MD, MPH, Department of Community Health Sciences, School of Public Health, Boston University, 801 Massachusetts Ave, Crosstown 4th Floor, Boston, MA 02118. E-mail: rsaitz{at}bu.edu

USPSTF in draft recommends screening for illicit drug use

The United States Preventive Services Task Force (USPSTF) has recommended screening for illicit drug use in adults — including pregnant adults — in a draft released Aug. 9.

Substance use disorders in pregnancy: clinical, ethical, and research imperatives of the opioid epidemic: a report of a joint workshop of the Society for Maternal-Fetal Medicine, American College of Obstetricians and Gynecologists, and American Society of Addiction Medicine

Substance use disorders in pregnancy: clinical, ethical, and research imperatives of the opioid epidemic: a report of a joint workshop of the Society for Maternal-Fetal Medicine, American College of Obstetricians and Gynecologists, and American Society of Addiction Medicine

Preoperative screening for illicit drug use in patients undergoing emergency surgery: A prospective observational study

Knowledge of illicit drug users (IDUs) is important because of the comorbidity related to drug use. In this prospective, observational study, we screened 1007 patients undergoing emergency surgery and found that 75 of them (7.5%) were IDUs The results of preoperative screening showed that the rates of HIV and syphilis infection were significantly higher in IDUs (HIV (+) 2.6%, syphilis (+) 10.7%) than in non-IDUs (HIV (+) 0, syphilis (+) 0.5%). Intraoperative consumption of remifentanil (IDUs: 1.85 ± 1.30 vs. non-IDUs: 1.31 ± 0.86, p = 0.009), midazolam (IDUs: 4.82 ± 1.52 vs. non-IDUs: 4.15 ± 1.81, p = 0.002), and atracurium (IDUs: 31.5 ± 15.1 vs. non-IDUs: 25.5 ± 11.9, p = 0.006) and the proportion of patients requiring postoperative fentanyl (IDUs: 15 (20.0%) vs. non-IDUs: 95 (1.2%), p = 0.031) were significantly increased in IDUs compared to non-IDUs. Postoperative complications were observed in 22.7% (17/75) of patients who were IDUs, which was significantly increased when compared with non-IDUs (6.0%, 56/932, p < 0.001). The mortality rate within 30 days after surgery was similar between the two groups. These findings suggested that the IDUs were associated with increased rates of HIV and syphilis infection; greater consumption of intraoperative opioids, sedatives, and muscle relaxants; increased postoperative complications and a similar mortality rate within 30 days after surgery when compared with non-IDUs.

Gas Chromatography Mass Spectrometry (GC-MS) for Identification of Designer Stimulants Including 2C Amines, NBOMe Compounds, and Cathinones in Urine.

Phenethylamine derivatives are being increasingly exploited for recreational use as "designer" stimulants designed to mimic psychostimulant properties of amphetamine or other illicit substances like 3,4-methylenedioxymethamphetamine (MDMA [ecstasy]). Clandestine operations meticulously design phenethylamines so the user can bypass legal action when detected, as many of these are yet to be regulated by government authorities. Substituted phenethylamines or 2C amines, N-methoxybenzyl derivatives of the corresponding 2C amines commonly known as NBOMe compounds, and cathinones are among the most commonly abused phenethylamines. Current FDA-approved assays used in screening for illicit drug use lack the sensitivity needed to detect designer stimulants making it challenging for toxicologists to accurately identify these compounds. Gas chromatography mass spectrometry (GC-MS) is a sensitive method for identifying designer stimulants. This unit describes and compares two qualitative GC-MS methods for identifying 2C amines, NBOMe compounds, and cathinones in urine. © 2017 by John Wiley & Sons, Inc.

HIV sexual transmission risks in the context of clinical care: a prospective study of behavioural correlates of HIV suppression in a community sample, Atlanta, GA, USA.

IntroductionAntiretroviral therapy (ART) improves the health of people living with HIV and has the potential to reduce HIV infectiousness, thereby preventing HIV transmission. However, the success of ART for HIV prevention hinges on sustained ART adherence and avoiding sexually transmitted infections (STI).ObjectivesTo determine the sexual behaviours and HIV transmission risks of individuals with suppressed and unsuppressed HIV replication (i.e., viral load).MethodsAssessed HIV sexual transmission risks among individuals with clinically determined suppressed and unsuppressed HIV. Participants were 760 men and 280 women living with HIV in Atlanta, GA, USA, who completed behavioural assessments, 28-daily prospective sexual behaviour diaries, one-month prospective unannounced pill counts for ART adherence, urine screening for illicit drug use and medical record chart abstraction for HIV viral load.ResultsIndividuals with unsuppressed HIV demonstrated a constellation of behavioural risks for transmitting HIV to uninfected sex partners that included symptoms of STI and substance use. In addition, 15% of participants with suppressed HIV had recent STI symptoms/diagnoses, indicating significant risks for sexual infectiousness despite their HIV suppression in blood plasma. Overall, 38% of participants were at risk for elevated sexual infectiousness and just as many engaged in unprotected sexual intercourse with non-HIV-infected partners.ConclusionsImplementation strategies for using HIV treatments as HIV prevention requires enhanced behavioural interventions that extend beyond ART to address substance use and sexual health that will otherwise undermine the potential preventive impact of early ART.

Primary Care Behavioral Interventions to Reduce Illicit Drug and Nonmedical Pharmaceutical Use in Children and Adolescents: U.S. Preventive Services Task Force Recommendation Statement

Update of the 2008 U.S. Preventive Services Task Force (USPSTF) recommendation on screening for illicit drug use. The USPSTF reviewed the evidence on interventions to help adolescents who have never used drugs to remain abstinent and interventions to help adolescents who are using drugs but do not meet criteria for a substance use disorder to reduce or stop their use. This recommendation applies to children and adolescents younger than age 18 years who have not been diagnosed with a substance use disorder. The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of primary care-based behavioral interventions to prevent or reduce illicit drug or nonmedical pharmaceutical use in children and adolescents. (I statement).

Substance Abuse in Primary Care

The 2010 National Household Survey on Drug Abuse 1 US Department of Health and Human ServicesResults from the 2010 National Survey on Drug Use and Health: Summary of National Findings. Substance Abuse and Mental Health Services Administration, Rockville, MD2011 Google Scholar estimated the number of users of illicit drugs in the United States to be over 22 million. The survey also found that nearly 7% of Americans over 12 years old are binge drinkers and almost 70 million of Americans smoke cigarettes. An estimated 20% of patients seen in family practice have substance abuse (SA) disorders. These disorders currently rank as 1 of the 10 leading preventable risk factors for years of life lost to death and disability. 2 American Academy of Family Physicians. Screening for illicit drug use: recommendations statement. http://www.aafp.org/afp/2009/0915/p623.html. Accessed March 26, 2013. Google Scholar Section Editor Laurel Halloran, PhD, APRN, is coordinator of the master’s and doctoral programs in nursing at Western Connecticut State University and a family nurse practitioner.

Pautas y problemas derivados del consumo de fármacos entre los consumidores de éxtasis en Australia

There has been a significant incursion of prescription drugs in to the club scene worldwide. The concomitant use of ecstasy and pharmaceutical drugs is associated with potentially serious health-related harms. This has ramifications for people who deliberately combine pharmaceutical drugs with ecstasy to achieve a specific effect and for people legitimately using pharmaceutical drugs for a health condition who may incidentally use ecstasy. This exploratory study had the broad aim to investigate the patterns and harms of concomitant use of pharmaceutical drugs and ecstasy, and to explore participants' experiences when visiting a General Practitioner (GP). In-depth interviews were conducted with 30 ecstasy/pharmaceutical drug users. Users reported deliberately combining stimulants (dexamphetamine, methylphenidate (e.g. Ritalin), antidepressants and sildenafil (e.g. Viagra) for non-medical purposes with ecstasy. A wide range of effects were reported. Several clear relationships emerged between the use of pharmaceutical drugs and ecstasy, and the distinctions between these in terms of motivations for use and consequences are discussed. The attitudes of GPs were professional and non-judgemental and there was little reluctance among participants to disclose illicit drug use. Screening for illicit drug use was limited. Findings have important implications for clubbers in regard to harm reduction strategies and highlight a number of areas for future research.

Screening for illicit drug use in psychiatric hospitals: whose job is it?

This review focuses on screening and assessment in general psychiatric settings, where drug use is unlikely to be known to service providers. It builds on the recurrent finding that psychiatric patients are at high risk of substance misuse. The application of self-report questionnaires and rating scales and more in-depth assessment instruments is outlined, as are biological screening techniques. The use of brief self-completion questionnaires probably offers the most practical approach to routine screening by non-specialist staff in general hospital settings. The importance of implementing such tools lies in reaching an accurate diagnosis, choosing treatments more appropriately and monitoring the management of patients' psychiatric disorders.

Plasma Cocaethylene Concentrations in Patients Treated in the Emergency Room or Trauma Unit

Cocaethylene and cocaine concentrations were measured by high-pressure liquid chromatography in the plasma of 18 patients whose corresponding blood demonstrated ethanol and whose urine contained either benzoylecgonine and/or cocaine on screening for illicit drug use. Although sixteen patients had suffered trauma, only 15 were admitted to the trauma unit. Three patients were seen only in the emergency room. Both cocaethylene and cocaine were detected together in the plasma of 10 patients and not all in 5 patients. In two patients, cocaine was found without cocaethylene, and in one patient cocaethylene was present without cocaine. For the entire series, cocaine concentrations showed significant correlation with those of cocaethylene. Plasma cocaethylene concentrations varied and were as high as 784 nmol/L (249 micrograms/L), and those of cocaine were as high as 1,455 nmol/L (441 micrograms/L). Before this study, published measurements of cocaethylene have been limited almost exclusively to postmortem specimens.

Screening for Illicit Drug Use in Drug Development Studies

Increased attention is being focused on illicit drug use in the general public, but little information exists on the pattern of illicit drug use for volunteers for Phase I. The Upjohn Research Clinics, Kalamazoo, MI, conducted a retrospective survey of the incidence of positive drug screens found in the subject population of Phase I studies initiated between 1987 and 1989. Research subjects were recruited from a pool of 8,052 males and females over the age of 17 years. The use of illicit drugs was recorded for 621 (7.7%) of these subjects.There was a total of 99 studies of which only 57 (58%) actually required drug screens. Of these studies with drug screens, 17,033 tests were completed with 377 tests (1.4%) in 291 individual subjects reporting positive for illicit drugs including cannabinoids, amphetamines, cocaine, opiates, benzodiazepines, and barbiturates. Most but not all studies requested screening for all six drugs listed.The drugs encountered in decreasing order of frequency (total number of reque...