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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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 email@example.com
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
Enzyme-linked immunosorbent assay, or ELISA, has been utilised as a screening tool for some time. The immunoassay technique is a popular choice for the evaluation of various research and diagnostic targets including drugs of abuse testing.
As primary manufacturer of the Biochip Array Technology, Randox Toxicology also provide highly sensitive ELISA kits that are compatible with all microplate processing instruments. Our test menu covers a broad range of drugs of abuse and metabolites including new psychoactive substances, stimulants, analgesics and sedatives. With low specificity, our ELISA kits are available across whole blood, urine and oral fluid matrices. Randox Toxicology develop the highest quality 96-well microtitre plates available on the market, with results providing excellent correlation with confirmatory methods.
Our range of ELISAs are precoated with our own antibodies which are cultivated in the UK. The ready to use reagent format facilitates optimum laboratory efficiency and allows up to 80 samples to be analysed in 2 to 3 hours with ELISA procedures.
* EXCLUSIVE to Randox Toxicology
Randox Toxicology offers the most comprehensive Drugs of Abuse (DoA) test menu across multiple forensic matrices. Our level of expertise in toxicology research and development allows us to adapt quickly to the ever-changing market influences and develop assays for current and novel drugs trends. Excellent assay precision and performance eliminates false reporting, therefore reducing unnecessary confirmatory tests and time lost in the laboratory as a result. Our Biochip Arrays offer CVs typically less than 10%, producing an accurate drug profile to ensure confidence in results.
The Evidence Series of immunoassay analysers are powered by Biochip Array Technology and combine the latest technological advances for drug residue detection using immunoassay principles. The Drugs of Abuse II panel is available for both the Evidence and the Evidence Investigator analysers. The Evidence has a throughput of 90 samples per hour, testing up to 44 tests per sample. The Evidence is a fully automated batch immunoanalyser, allowing for 3960 tests per hour, while the Evidence Investigator is a semi-automated, bench top analyser with testing capabilities of 2376 tests in 70 minutes.
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.