Drug Abuse Screening in the Emergency Department
On a global scale, emergency departments have been providing critical access to the health care system for many years, however, more recently visits to the emergency department has been an opportunity to identify patients with substance use disorders. Screening patients for illicit drugs and drug abuse has become increasingly more regular when a patient is admitted to the emergency department. Screening is vital to treat a patient with effective treatment. Nearly half of all emergency department visits in the US are categorized as relating to substance use disorders.
In a study completed at Ghent University Hospital in 2017 it was found that the most frequently reported drugs abused by emergency department patients are cannabis, cocaine, amphetamines, and opiates. It is important to screen patients in the emergency department if the patient is showing signs of confusion, deliriousness, unconsciousness, panic attacks, chest pain, difficulty breathing, vomiting, or seizures as these symptoms usually indicate drug intoxication or overdose.
Randox Toxicology’s Evidence MultiSTAT is a fully automated immunoanalyser that enables on-site simultaneous detection of up to 21 analytes from a single sample, making it ideal for an emergency department. It requires a small sample volume and generates results in 20 minutes. The process from sample entry to results can be completed in 3 simple steps, with minimum room for human error. The MultiSTAT is designed to analyse as quick, simple and reliable as possible.
|Barbiturates||Benzodiazepines I (Oxazepam)||Benzodiazepines II (Lorazepam)|
|Benzoylecgonine (Cocaine Metabolite)||Buprenorphine||Cannabinoids (THC)|
|Creatinine||Ethyl Glucuronide (EtG)||Fentanyl|
|Tricyclic Antidepressants (TCA)||UR-144/XLR-11||α-PVP (Flakka)|
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In the past year, Scotland’s drug related deaths have increased dramatically by 27%.
This almost levels the fatality rate per capita with the US. The latest figures showed the majority of fatalities was from the over 35 age group, known as the “Trainspotting generation.”
Westminster currently hold the power on the Misuse of Drugs Act, which Scotland believes should be relaxed as a method of controlling the issue in the country. One of Scotland’s most senior police officers has described the Misuse of Drugs Act as a relic that was “ripe for reform.”
The chair of the Scottish government’s task force on drug deaths, Catriona Matheson believes that treatment challenges should be investigated alongside decriminalisation;
“I understand why decriminalisation grabs most attention, but legislation, criminal justice, healthcare and public attitudes are intertwined”.
There is also a significant increase in the number of fatalities amongst the under 35 age group. These deaths are heavily linked to poly-drug use, including the relatively newly available drug named “street benzodiazepines.”
The lead pharmacist for addiction services at the city’s health and social care partnership, Dr Carole Hunter, said;
“The major problem for Glasgow is heroin and illicit benzos like etizolam or street Valium, which have never been cheaper or more available.”
International trials have shown that medicinal heroin can be an effective treatment for a number of opioid users who do not respond to regular methods of treatment. Hunter proposes opening an enhanced drug treatment centre in Glasgow for this medicinal heroin to be administered under supervision.
Dave Liddell, chief executive of Scottish Drugs Forum stated;
“Neither decriminalisation nor one drug consumption room in Glasgow is going to impact substantially on the death rate. The key focus needs to be on improving our drug treatment and care services. We need to look at access to opioid replacement therapy. Only 40% of people with a drug problem in Scotland are currently in treatment, compared with far higher numbers in England and many countries in England.”
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The prevalence of drug addiction and abuse across the globe has become a growing concern. It is currently estimated that 71 million people use drugs of abuse with around 166,000 direct deaths occurring from drug use in 2017.
The WHO (World Health Organisation) estimate that 11 million people inject drugs across the globe, of which 1.3 million are living with HIV, 5.5 million with hepatitis C, and 1 million with both HIV and hepatitis C. In addition to infectious disease, long term drug abuse increases the risk of several cancers, cardiovascular effects, respiratory effects, gastrointestinal effects, kidney & liver damage and mental health issues.
The abuse of drugs is one of the most pressing issues in the USA and other countries globally. Drug abuse not only affects the individual, but can also have far-reaching consequences that affect family, employment, personal health, health care systems, local communities, and society as a whole.
Global Drug Abuse – The buzz that keeps on going!
> Misuse of illicit drugs affects society through secondary costs incurred such as crime, reduced productivity at work, and health care expenses.
> Substance abuse costs the US health care system about $11 billion, with overall costs reaching $193 billion.
> Substance abuse and addiction also affects other areas of life leading to broken families, destroyed careers, death due to negligence or accident, domestic violence, physical abuse and child abuse.
> Drug abuse and addiction changes the chemistry of your brain. The longer an individual abuses drugs, the more damage is caused, making it more difficult to return to ‘normal’ during drug rehabilitation.
> Treating and tackling drug addiction is a challenge. As drug treatment and health services continue to fall short, there is an increased need to continuously adapt drug detection and analysis.
Randox laboratories are at the forefront, aiding the fight against drugs of abuse with a comprehensive range of 10 drugs of abuse assays including several stimulants, sedatives and opioids available to run on Randox’s very own clinical chemistry analysers, the RX series. To find out now how Randox is helping to tackle the ongoing prevalence of drugs of abuse click here or buy directly from the Randox Online Store.
About Randox Laboratories
As a world leader in the in-vitro diagnostic industry with over 35 years’ experience, Randox is leading the charge in moving from a one-size-fits-all approach towards decisions, practices and products tailored to the needs of the individual. This innovative approach to diagnostics has facilitated the development of revolutionary products designed specifically to enhance a patients’ quality of life.
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Therapeutic Drugs Monitoring
In early May 2019, over 550 state employees in Egypt were referred to the Egyptian public prosecution office after being forced to take a drug test under a new law.
The Ministry of Social Solidarity announced on May 5th that 15,877 state employees had recently been drug tested, and that 555 had been referred to the Administrative Prosecution Authority (APA) for testing positive for illegal drugs.
The sudden crackdown on drug users follows the government in Egypt approving a bill in March that authorised the required drug testing of all state employees from ministerial to the local level. Alongside members of the civil service, employees working for public transportation, hospitals, and other state-run institutions must also be drug tested. Anyone who refuses to be drug tested will have their employment terminated.
The new law was brought in with explicit support from Prime Minister Moustafa Madbouli, following a deadly train crash in Cairo after which the train driver tested positive for drug use.
Egyptian law does not specify the punishment for someone who tests positive for drug use, but the director of Egypt’s Fund for Drug Control and Treatment – Amr Osman – has warned that any state bus or rail drivers testing positive for drug use face imprisonment for at least two years, and a fine of 10,000 Egyptian pounds ($582).
University students and employees will also be subject to mandatory drug testing, the education minister has announced. In this case, people who test positive will be offered “treatment” and will be sacked or expelled from the university if they refuse to comply.
Randox Toxicology offer the Evidence MultiSTAT, a fully automated immunoanalyser that, utilising Biochip Array Technology (BAT), enables on-site simultaneous detection of up to 21 drugs of abuse from a single sample. The Evidence MultiSTAT requires only a small sample volume and can generate results in under 20 minutes. The process from sample entry to results is completed in only 3 simple steps, with minimal room for human error. The MultiSTAT is designed to make set-up and analysis as quick, simple and reliable as possible.
There has been an established link between disorder at football games and increasing cocaine use in society, according to Deputy Chief Constable Mark Roberts, the UK’s lead on football policing. Over the past two seasons, disorder at football matches has increased (45%), and has been linked to the increase prevalence of cocaine use inside stadiums.
According to the Home Office, 2.6% of 16 – 59 year olds took cocaine in 2017-18, up 2.4% in 2013-14. The drug in the UK is becoming cheaper, purer and more accessible than before. A senior football official said, when speaking with The Independent, that it is the “massive elephant in the room”, with police sources claiming that it is “rife” at football grounds across the country.
Football policing units carry out drug checks inside football stadiums with drug detection dogs and swabbing areas such as toilets. Arrests are made at the football grounds for drug possession. In 2017, cocaine related arrests at football grounds more than doubled from 32 to 68. These numbers may seem small, however DCC Mark Roberts says a reduction in match day policing, due to budget constraints, is the reason for these low numbers. 50% of games are either police-free (11.3%) or spotter only (39.3%).
Inspector Andy Bridgewater, the head of West Midlands’ Police football unit, believes there is a real cocaine problem stating that “there is a really strong correlation today between cocaine use and football-related violence.”
Overall disorder incidents at matches jumped 36% in 2016-17 and again last year, while cocaine-related deaths in England and Wales increased in 2017 for the sixth year in a row, from 112 in 2011 to 432 in 2017.
Using Randox Toxicology’s revolutionary Biochip Array Technology, the Evidence MultiSTAT is an automated analyser that enables detection of a wide variety of multiple drug groups and provides simultaneous on-site screening with our CE marked urine and blood panels. As minimal sample preparation is required, qualitative results can be provided in less than 20 minutes, offering an effective toxicology screen for cocaine and other drugs/drug metabolites.
Amidst growing concerns of an opioid-abuse epidemic in the United States, it has been established that kratom (Mitragynine) is increasing in popularity amongst opioid users and has been reported as the new ‘legal high’.
Kratom is an unendorsed herb substance which has not yet been criminalized in the United States and is considered a powerful analgesic with opioid-like effects at high doses and acts as a stimulant at lower doses. Often used as a treatment for chronic pain or opiate withdrawal patients, it also comes in the form of a dietary supplement. As there are no Federal regulations monitoring the sale and distribution of Kratom the substance continues to be readily available and easily accessible via the internet, increasing its abuse by chronic pain patients on prescription opioids.
Kratom has been associated with psychosis, seizures, and has recently cited 100 deaths over a 17-month period by the Centers for Disease Control and Prevention (CDC). In previous reports, the Food and Drug Administration had warned against the use of Kratom to ease opioid withdrawal, as many pain physicians are not familiar about its addictive properties. Further the DEA plans to classify kratom as a Schedule 1 substance.
Are you testing for Kratom?
Randox Toxicology are the only suppliers for the detection of Kratom. Alongside our exclusive highly sensitive kratom ELISA test, this drug of abuse is available on our New Psychoactive Substances II panel, which utilises our universally available patented Biochip Array Technology.
Offering excellent cross-reactivity and unrivalled limits of detection over a range of routine and novel assays Biochip Array Technology is the world’s first multiplex screening technology. Designed to work across multiple matrices such as urine, blood, and oral fluid its intra and inter assay precision is typically <10% giving excellent correlation with confirmatory methods.
For more information regarding our Kratom tests get in touch with us by emailing firstname.lastname@example.org
Types of Drug Testing
At Randox Testing Services (RTS) we provide a range of testing solutions to enable you to conduct employee testing. Our screening procedure is efficient and involves an experienced sample collection officer visiting your premises to collect samples and transport them back to our laboratories for analysis. Alternatively, we can also train a member of your staff to collect samples on site with the same degree of accuracy as an RTS collection officer. Our testing solutions ensure coverage of all types of employee testing and meet the needs of all businesses.
For-cause drug and alcohol testing is conducted when there is suspected drug abuse or alcohol misuse in the workplace. Suspicion may arise because of the employee exerting signs of substance abuse, if an allegation has been made, if drugs or alcohol have been found within the workplace or following an accident at work.
The key benefits include;
- Legal compliance with correct measurements being taken if an employee is suspected of being under the influence of drugs or alcohol.
- Can deter employee misuse of drugs or alcohol due to a workplace drug and alcohol testing policy being in place.
Pre-employment screening for substance abuse is an increasingly common type of workplace drug and alcohol testing. As an indicator of candidate suitability, it forms an essential part of a company’s recruitment process and helps maintain the safety of its current employee workforce and business environment.
The key benefits include,
- Pre-employment screening is one of the easiest programmes to implement.
- Screening applicants for use of drugs and alcohol ensures you employ the right people for your business.
- Effective way of preventing future issues such as absenteeism and decreased productivity.
- Pre-employment screening can help protect the integrity of a company by acting as an effective deterrent.
- A pre-employment drug test is proved helpful to boost the repute of an organisation. The drug abusers usually stay away from applying in any firm that held a drug test at the time of employment.
Random testing for drugs and alcohol is a popular type of employee testing. With knowledge that a test could be conducted on anyone at any time it acts as an effective deterrent of drug abuse or alcohol misuse among employees.
The key benefits include;
- Random testing is a deterrent for employees as they are aware they could be asked to undertake a test at any time.
- It is a convenient and easy way to maintain a safe working environment free from substance abuse.
- Employees are less likely to tactfully try to disguise results, or alter their habits, as they will be given little or no notice that a test is going to be conducted.
- Employees are less likely to feel singled out due to random selection.
Post-incident testing occurs after an accident or incident in the workplace to determine if drugs or alcohol may have contributed to the cause. Incidents include injury to an employee, assault of an employee by another member of staff or damage to property.
If this is required, it is recommended that all employees involved in the incident are tested.
The key benefits include;
- Safeguards the rights of the employees and employers to proving or disproving if drugs or alcohol were a factor in an incident.
- Minimises the chance of a similar incident occurring.
Abstinence monitoring provides employees with the support and opportunity to remain abstinent and continue to successfully at work. This type of testing is an effective tool to track progress towards addiction recovery for both the employee and the employer. Regular drug screens also give the recovering person added motivation to protect their sobriety.
For the employer abstinence monitoring provides greater security in knowing that their employee is safe to work. This is particularly important for safety critical roles.
The key benefits include;
- Ensures that an employer is tackling and reducing the instances of substance abuse in the workplace.
- Shows support from an employer throughout an employee’s rehabilitation process.
- Increases employee morale and productivity.
- Helps prevent staff turnover by offering a second chance.
- Studies have shown that close monitoring by physicians, especially in early recovery, results in abstinence rates of over 80%.
At RTS we offer varied testing methods to be as flexible as the customer needs to fit in with their requirements.
For any further questions about implementing a workplace drug and alcohol testing policy or just general questions on workplace testing, please get in touch today!
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Scotland is set to introduce a new “zero tolerance” policy to those caught driving under the influence of drugs. Ministers in Scotland want to make it easier for police officers to target people driving with illegal drugs in their bloodstream. The policy will supersede the current need to prove that someone was driving in an impaired manner as a result of drug consumption. The law in Scotland currently states that it is illegal to drive if impaired by drugs, be it prescription or illegal drugs.
Justice Secretary Humza Yousaf said “The introduction of drug driving limits will strengthen the power of Scotland’s police and prosecutors to tackle the minority of drivers who irresponsibly put themselves and other road-users at risk. Drug driving is completely unacceptable, and we will continue to use all of the tools at our disposal to prevent the avoidable deaths and damage caused by those who drive under the influence of drugs. Together with our stringent drink-driving limits, these new laws will ensure that Scotland have the UK’s most robust laws against impaired and unsafe driving.”
Under the new plan, eight of the most commonly abuse illegal drugs – including heroin, ketamine and ecstasy – will have limits set very close to zero to rule out claims of accidental exposure. A further eight drugs, which can have medicinal purposes – such as diazepam and methadone – will have higher limits based on their ability to impair drivers. These proposals would mean just having drugs in your system that breach the limits, this is sufficient evidence to prosecute.
In the turn of the new year, we look at the current trends in drug abuse in 3 key continents and what their key 2018 figures say about drug use in their countries.
New psychoactive substances have been an emerging drug market in the Americas, with a total of 130 different new psychoactive substances being reported in seven South American countries in August 2017. This was more than a 50% increase within the year, as over 60 different substances had been reported in 2016 alone, according to the OAS and CICAD Report on Drug Use in The Americas 2019. Latin America have experienced a surge in LSD, synthetic cannabinoid, plant substance and ketamine use among the general population as well.
Meanwhile, opioids and prescription opioids have been a major cause for concern in the Americas, with opioid analgesics involved in more overdose fatalities than any type of illicit drug, exceeding cocaine and heroin-related fatalities in Canada and USA combined. Users are increasingly turning to street opioids as well, which are often mixed with heroin and other drugs. The major challenge noted in the same report is the complexity of the appearance of NPS and the counterfeit substances it contains.
Cannabis has had the highest use among males, with most cases being regular patterns of use. Around 1% of European adults are considered daily users according to the European Drug Report 2018. Regarding opioids, heroin is the most common drug of abuse in this category, and prevalence of high risk opioid use among adults is estimated to be at 0.4% of the EU population.
Synthetic opioids, such as fentanyl, are growing in use in Europe. In 2016, over 18 European countries reported more than 10% of all opioid clients entering specialised services suffering from opioid addiction other than heroin.
Opioids present the largest drug problem in Asia, having the highest proportion of causes of drug users going to treatment centres, followed by amphetamine-type stimulants and cannabis. Production of drug substances in Asia have been significant in the last 3 years, with cocaine and opium production hitting record highs. Methamphetamine is also an emerging threat to Asia, with production of the synthetic drug overtaking heroin.
Our testing solution
Randox Toxicology are first to market when it comes to testing for the latest drugs of abuse and new psychoactive substances in the market. Our revolutionary Biochip Array Technology provides state-of-the-art drug detection, utilizing simultaneous drug detection from a single sample across multiple matrices.
Our ELISA kits provide a comprehensive test menu, covering a broad range of drugs of abuse, stimulants, analgesics and sedatives. Randox Toxicology develop the highest quality 96-well microtitre plates available to the market, with results providing excellent correlation with confirmatory methods.
To find out more email us at: firstname.lastname@example.org or visit our website: www.randoxtoxicology.com
The 2018 UN World Drug Report calculated that around 275 million people worldwide used drugs at least once in 2016 and some 31 million of those suffer from a drug use disorder.
Cannabis was the most commonly used drug in 2016, with 192 million people using it at least once that year. The global number of cannabis users continues to rise and appears to have increased by roughly 16 per cent in the decade ending 2016, which is in line with the increase of the world population.
The quantities of cannabis seized worldwide fell by 27 per cent, to 4,386 tons in 2016. This decline was particularly noticed in North America, where the medical cannabis in many states and the legalisation of cannabis for recreational use may have played a role in the declining figures. There is evidence from Western countries that the perceived easy availability of cannabis, coupled with perceptions of a low risk of harm, makes the drug among the most common substances whose use is initiated in adolescence. Cannabis is often used in conjunction with other substances and the use of other drugs is typically tried after recreational cannabis use.
As the need for vital drug screening continues to increase, Randox Toxicology are leading the way in developing new and novel drugs of abuse tests. Capable of detecting up to 21 classical, prescription and synthetic drugs from a single sample including cannabinoids, our fully automated Evidence MultiSTAT analyser utilises our Biochip Array Technology to deliver reliable and accurate results in under 20 minutes.
For further information about the Evidence MultiSTAT and our cutting-edge multiplex testing capabilities, contact email@example.com to be put in touch with a sales member or visit www.randoxtoxicology.com.