Your abstract conclusion "Unless proper procedures are used in
collecting, analyzing, and interpreting laboratory testing for drugs,
there is substantial risk for error" could apply to any laboratory test
being performed for any reason.
Your article does a good job in describing your protocol and
demonstrating how not to set up an effective drug- screening program,
especially one that looks for something other than the standard "DOT"
required drugs.
It is a well published fact that standard opiate assays will not
detect oxycodone, and that most employment-related GC/MS confirmation
procedures are not designed to look for anything other than codeine and
morphine. That is equivalent to being critical for not detecting abormal
electrolyte levels, when you are testing for only glucose and BUN. If you
don't look for it, you're not going to see it. The issue is not lacking
the ability to detect opioids, but rather establishing a proper protocol
if your need warrants looing for oxycodone or other "non-standard" drugs.
We offer opioid testing as part of one of our routine panels and
counsel our clients on this matter. We are able to confirm the opioids at
the same time as codeine and morphine with minimal additional analytical
expense. MDMA is routinely detected in our screening method along with
amphetamine and methamphetamine and again is confirmed at the same time.
Any program that does not include at least basic specimen validity
testing is signficantly flawed from the beginning, regardless of the
application of your drug-screening process.
You indicated that some over-the-counter medications could result in
false-positive results, but I saw no data indicating what those products
were. I believe that this statement is in error. Properly performed
GC/MS confirmation analysis eliminates this issue. Positive results from
prescriptions medications (Adderal for amphetamine, Marinol for THC,
Tylenol#3 for codeine and morphine, etc.) are not false-positive results,
but
rather positive results with a medical explanation. There is a huge
difference in the two and one that must always be investigated with a
positive result.
To suggest that because a drug-screening program is not perfect, that
it is not effective is an unfortunate implication, because history has
already demonstrated that at least within specific populations (DoD and
DoT) that it has been amazingly effective. The key is to do it correctly
and to continue to look for ways to do it better. Again, this concept
applies to all laboratory testing not just testing for drugs of abuse.
While the body of the paper goes into some detail outlining
weaknesses in "basic" programs, the abstract and its conclusion paints a
very negative picture with a very broad brush, and one that effective
programs do not deserve. Please do not fault the tool, when it is
placed in the hands of the unskilled.
Conflict of Interest:
Director of Toxicology, HHS Responsible Person, Doctors Laboratory, Inc. Valdosta, GA
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