Selection Of Drugs To Be Tested

A number of different criteria can be applied to the drug(s) or category of drugs that should be tested or monitored. Drug availability, clinical effects and robustness of the analytical method(s) used for analysis are probably the most important.

Availability. Prescription patterns of psycho-active and other drugs vary from place to place and country to country. Abuse of BENZODIAZEPINE nitrazepam is common in Europe but almost unknown in North America, since it is not sold here. The psychoactive chemical CATHINON (cathine), the active ingredient in the leaves of the KHAT plant, is chewed in northeast Africa, is not a problem in North America. CODEINE, an OPIOID available in Canada as OVER-THE-COUNTER preparations, is sold only by prescription in the United States.

A wide availability of "legal" STIMULANTS poses an interesting problem since they are a common finding in accident victims. A study carried out by the U.S. National Transportation Safety Board from October 1987 to September 1988 showed that over-the-counter stimulants—such as ephedrine, pseudoephedrine and phenylpropanolamine— were commonly found among drivers killed in heavy truck accidents. Amongst the eight States that participated in this safety study almost all AmPHETAMINE use was in the California region. Similar findings are also reported from emergency rooms over the past five years as well as from admissions in a trauma unit due to motor-vehicle accidents. All this suggest that drug use varies not only from place to place but also region to region within a given country.

Thus, the selection of a drug to be tested and monitored, appropriate for one country and place, may not necessarily be appropriate for another country.

Clinical Effects. Drugs that manifest abuse potential and impair behavior such that job performance can be affected are prime candidates for testing or monitoring in the workplace. Alcohol and cocaine are examples of this.

Analytical Methods. A false positive finding can have a serious impact on the livelihood of the person being tested. Therefore, special attention needs to be paid to the testing methods. Ideally the analytical method should be specific for the drug being tested (i.e., no false positive), easy and inexpensive to perform. Confirmation methods should also be readily available. Availability of technical and scientific expertise to perform the tests is also essential.

Interpretation of the analytical results also needs to be carefully considered as even a normal diet can result in a positive drug identification. For example, poppy seed ingestion can result in a true positive analytical result (OPIATES, like heroin, are derived from the poppy plant PAPAVER SONIFERUM) but it is a false positive for drug use. Some ethnic diets may also lead to these confounding problems, as when food containing poppy seeds is eaten during Ramadan.

What should be analyzed? Ideally the analysis should look for the parent drug rather than its metabolite, although this may not always be possible as some drugs are very rapidly metabolized (e.g., heroin metabolism to MORPHINE). Sensitivity of the analytical procedure should be dictated by the drugs' psychoactive pharmacological properties. If the drug is shown to be devoid of abuse potential then its detection beyond the time of pharmacological activity, although important in the clinical management of the patient, does not necessarily serve a useful purpose for a workplace drug screening programme.

The guidelines developed by the NATIONAL Institute on Drug Abuse in April 1988, address five "illegal" drugs: marijuana, PHENCYCLIDENE, AMPHETAMINE, cocaine and heroin. Rapid screening methods that allowed for "mass screening'' were available at that time, as were the confirmation methods for these five drugs. Mood altering substances such as benzodiazepines, BARBITURATES and some stimulants such as antihistamines are at present excluded from these regulations in the United States. This is probably due to the wide availability of these drugs as medications within the general population and the technological re quirements for screening and monitoring of these drugs.

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