From the Guidelines
An ER drug abuse panel is moderately effective for detecting common substances used to spike drinks, but has significant limitations, and therefore, it is crucial to seek medical attention immediately and consider additional specific tests if certain drugs are suspected based on symptoms experienced. These panels typically test for common drugs like benzodiazepines (Xanax, Valium), opioids, amphetamines, cocaine, and sometimes GHB 1. However, they may miss newer synthetic drugs, certain date rape drugs like Rohypnol (flunitrazepam), and ketamine unless specifically included in the panel 1.
Key Considerations
- Timing is crucial - most substances are detectable for only 24-72 hours after ingestion, with some clearing the system in just 12 hours 1.
- For best results, testing should occur as soon as possible after suspected drugging 1.
- Urine samples are most commonly used, though blood tests may be necessary for certain substances.
- If drink spiking is suspected, it's essential to seek medical attention immediately rather than waiting, as this increases the chances of detection.
- The effectiveness is also impacted by individual metabolism, hydration levels, and the specific laboratory's testing capabilities.
Recommendations
- Consider requesting additional specific tests if certain drugs are suspected based on symptoms experienced 1.
- Consultation with a sexual assault center, toxicologist, or state forensic laboratory may be required for interpretation of drug testing results 1.
- Toxicology screens for drugs of abuse generally are inadmissible in legal settings because false-positive and false-negative results may occur, and therefore, confirmatory testing by using gas chromatography or mass spectroscopy should be performed if a general toxicology screen has a positive result 1.
From the Research
Effectiveness of ER Drug Abuse Panels
The effectiveness of an Emergency Room (ER) drug abuse panel in detecting substances used for drink spiking can be evaluated based on the types of substances commonly used for this purpose and the detection methods employed by these panels.
- Substances like γ-hydroxybutyrate (GHB) are potent central nervous system depressants often encountered in forensic investigations of drink spiking 2.
- Benzodiazepines are also commonly abused substances that can be used for drink spiking, and their use has reached epidemic levels, particularly when combined with other central nervous system depressants 3.
- The detection of these substances in biological samples is crucial for clinical and legal toxicology, and various spectroscopic methods have been developed for this purpose, including gas chromatography-Mass spectrometry (GC-MS), liquid chromatography (LC-MS), and Surface-enhanced Raman spectroscopy (SERS) 4.
Limitations of Traditional Drug Screening Approaches
Traditional clinical toxicology involves targeted drug screening approaches that may not be effective in detecting new psychoactive substances used for drink spiking.
- These approaches typically involve immunoassays designed to detect specific drugs or drug metabolites, followed by confirmatory assays using liquid chromatography-tandem mass spectrometry 5.
- However, the explosion of new psychoactive substances in recent years has highlighted the need for more advanced detection methods, such as high-resolution mass spectrometry (HRMS), which can detect a wider range of substances, including unknown or unsuspected compounds 5.
Importance of Advanced Detection Methods
The use of advanced detection methods, such as HRMS, is essential for detecting substances used for drink spiking in ER settings.
- These methods can provide more comprehensive and accurate detection of a wide range of substances, including new psychoactive substances, and can help identify cases of drink spiking that may not be detected by traditional screening approaches 5.
- The combination of HRMS with other detection methods, such as spectroscopic techniques, can provide a more complete picture of the substances present in a biological sample, and can help improve patient outcomes in cases of suspected drink spiking 4, 5.