Urinalysis drug tests

Crouch DJ, Frank JF, Farrell LJ, Karsch HM, Klaunig JE. A multiple-site laboratory evaluation of three onsite urinalysis drug-testing devices. J Anal Toxicol 1998 22 493-502. 

Increasingly, in both private and public sectors, employees are subject to urinalysis drug testing whether use is suspected or not. Failure to pass that test can jeopardize employment. The most common illegal drug turned up by... 

Although this text mainly addresses urinalysis, I try to cover methods for beating all drug tests. 

Standard drug tests, including urinalysis, do not currently detect the presence of 2C-B. 

Only in the case of marijuana is unannounced urinalysis slightly more effective than hair analysis, i.e., by a factor of 1.3. This is attributed to the wider detection window of marijuana urinalysis relative to the other urine drug tests, and to the lower sensitivity of the marijuana hair test used in this study as compared to the hair assays for the other drugs. Since that time the sensitivity of the hair marijuana assay has been improved to a point where the positive rate of hair analysis is approximately twice that of urinalysis in arrestee populations. However, incomplete concordance between the two tests shows that both urinalysis and hair analysis still miss some marijuana users, most likely the light users. 

A third issue is very basic yet crucial—the accuracy of the drug tests themselves. Urinalysis test results are often unreliable. In some cases the presence of a drug is missed, and in other cases a legitimate drug (such as a prescribed medication) is identified by the test as an illicit... 

It also is important to take and record vital signs before the first dose of die antibiotic is given. The primary health care provider may order culture and sensitivity tests, and tiiese should also be performed before die first dose of die drug is given. Odier laboratory tests such as renal and hepatic function tests, complete blood count, and urinalysis may also be ordered by the primary health care provider. 

The nurse monitors die patient s response to therapy daily. If after several days die symptoms of the UTI have not improved or if they become worse, the nurse notifies the primary healtii care provider as soon as possible Periodic urinalysis and urine culture and sensitivity tests may be ordered to monitor die effects of drug dierapy. 

Our current study of drug use and crime in arrestees in Manhattan overcame some of these measurement problems and enabled us to address some of these basic questions regarding POP use and crime. The recent use of PCP (as well as other drugs) in male arrestees was measured by a urinalysis of a specimen obtained within hours after arrest. We therefore did not have to rely on each person s accurate report that he had taken PCP. We shall use the urinalysis test results, with information from interviews with the arrestees, and from their criminal records, to describe the prevalence of PCP use in arrestees, the demographic characteristics of users and the types of offenses for which they are arrested. The next section describes our study of drug use and crime in arrestees in Manhattan. 

Table 1 provides the urinalysis test results for the 4,847 arrestees, While PCP was tested for by an EMIT test only, cocaine, opiates and methadone were tested for by both EMIT and thin layer chromatography (TLC). (The EMIT test for opiates is not specific to morphine, the metabolite of heroin, and can detect the recent use of a variety of opiates. A specimen positive for opiates is most likely to indicate the use of heroin in this population, however.) Our analyses will use only the results from the EMIT tests, because we have learned that the TLC general drug screen is less sensitive for detecting recent use of these illicit street drugs (Wish et al. 1983 Wish et al. 1984). 

Basic laboratory tests complete blood count, blood chemistry screen, thyroid function, urinalysis, urine drug screen... 

Monitoring When indicated, monitor drug toxicity or efficacy through urinalysis. In rheumatoid arthritis patients, discontinue the drug if unexplained gross hematuria or persistent microscopic hematuria develops. Perform liver function tests and an annual x-ray for renal stones. 

Objective data include a thorough physical evaluation (including a thorough neurological exam), supplemented by laboratory data such as routine blood work, urinalysis, chest x-ray, EGG, and drug screen (see Role of the Laboratory later in this chapter). All this information is routinely collected when a person first enters the hospital on an outpatient basis, however, the clinician may select only those tests deemed appropriate at the time. 

A 59-year-old woman presents to an urgent care clinic with a 4-day history of frequent and painful urination. She has had fevers, chills, and flank pain for the last 2 days. Her physician advised her to immediately come to the clinic for evaluation. In the clinic she is febrile (38.5°C [101.3°F]) but otherwise stable and states she is not experiencing any nausea or vomiting. Her urine dipstick test is positive for leukocyte esterase. Urinalysis and urine culture are also ordered. Her past medical history is significant for three urinary tract infections in the past year. Each of these episodes was uncomplicated, treated with trimethoprim-sulfamethoxazole, and promptly resolved. She also has osteoporosis for which she takes a daily calcium supplement. The decision is made to treat her with oral antibiotics for a complicated urinary tract infection with close follow-up. Given her history what would be a reasonable empiric antibiotic choice Depending on the antibiotic choice are there potential drug interactions she should be counseled on ... 

In 1994 in U.S. v Neely, positive hair tests provided by the FBI were not admitted in a probationary hearing. The court-directed urinalysis program had detected no drug use for 60 days. However, the probation period was extended and the number of urine tests performed per week were increased by the court. 

Baumgartner et al." and Mieczkowski and NeweB" compared cannabinoid detection in urine and hair samples. They concluded that hair analysis and urinalysis were complementary rather than competing tests. Urinalysis provides short-term information of an individual s drug use, whereas long-term histories are accessible through hair analysis. Moreover, in contrast with qualitative information from urinalysis, hair analysis provides quantitative information on the severity and pattern of an individual s drug use. 

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