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June 12, 1987, Vol 257, No. 22 >
ARTICLE | June 12, 1987

Scientific Issues in Drug Testing FREE

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Report J of the Council on Scientific Affairs, adopted by the House of Delegates of the American Medical Association, as amended in lieu of Resolutions 84 and 106, at the 1986 Interim Meeting.

This report is not intended to be construed or to serve as a standard of medical care. Standards of medical care are determined on the basis of all of the facts and circumstances involved in an individual case and are subject to change as scientific knowledge and technology advance and patterns of practice evolve. This report reflects the views of the scientific literature as of December 1986.

Reprint requests to Council on Scientific Affairs, American Medical Association, 535 N Dearborn St, Chicago, IL 60610 (William R. Hendee, PhD).


JAMA. 1987;257(22):3110-3114. doi:10.1001/jama.1987.03390220108031
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References

Testing for drugs in biologic fluids, especially urine, is a practice that has become widespread. The technology of testing for drugs in urine has greatly improved in recent years. Inexpensive screening techniques are not sufficiently accurate for forensic testing standards, which must be met when a person's employment or reputation may be affected by results. This is particularly a concern during screening of a population in which the prevalence of drug use is very low, in which the predictive value of a positive result would be quite low. Physicians should be aware that results from drug testing can yield accurate evidence of prior exposure to drugs, but they do not provide information about patterns of drug use, about abuse of or dependence on drugs, or about mental or physical impairments that may result from drug use.

(JAMA 1987;257:3110-3114)

REFERENCES

1 +
Chamberlain J: Analysis of Drugs in Biological Fluids . Boca Raton, Fla, CRC Press Inc, 1985;, pp 122-125.
2 +
Caplan YH:  Analytical techniques , in Baselt RC (ed): Introduction to Forensic Toxicology . Davis, Calif, Biomedical Publications, 1981;, pp 161-162.
3 +
Kogan JD:  Expert testimony , in Baselt RC (ed): Introduction to Forensic Toxicology . Davis, Calif, Biomedical Publications, 1981;, pp 247-274.
4 +
Henion J, Covey T, Maylin G:  Forensic mass spectrometry in equine drug testing . Spectra 1985;; 10:21-28.
5 +
Dogoloff LI, Angarola RT, Price SC: Urine Testing in the Workplace . Rockville, Md, American Council for Drug Education, 1985;.
6 +
Biasotti AA, Valentine TE:  Blood alcohol concentration determined from urine samples as a practical equivalent or alternative to blood and breath alcohol tests . J Forensic Sci 1985;;30: 194-207.
7 +
Payne JP, Hill DW, King NW:  Observations on the distribution of alcohol in blood, breath and urine . Br Med J 1966;;1:196-202.
8 +
Morgan WHD:  Concentrations of alcohol in samples of blood and urine taken at the same time . J Forensic Sci Soc 1965;;5:15-21.
9 +
Heise HA:  Concentrations of alcohol in samples of blood and urine taken at the same time . J Forensic Sci 1967;;12:454-462.
10 +
Payne JP, Foster DV, Hill DW, et al:  Observations on interpretation of blood alcohol levels derived from analysis of urine . Br Med J 1967;;3: 819-823.
11 +
Bittirofer JA, Benton B: Rapid Drug Screening in the Hospital Clinic Laboratory . Kansas City, Mo, Marion Laboratories Inc, 1982;.
12 +
Baselt RC: Disposition of Toxic Drugs and Chemicals in Man , ed 2. Davis, Calif, Biomedical Publications, 1982;.
13 +
Gorodetsky CW:  Detection of drugs of abuse in biological fluids . Handbook Exp Pharmacol 1977;; 45:319-409.
14 +
Clarke EG (ed): Isolation and Identification of Drugs . London, The Pharmaceutical Press, 1969;, vol 1.
15 +
Rutter ER:  Automated method for screening urine for amphetamine and some related primary amines . Clin Chem 1972;;18:616-620.
16 +
Parker KD, Elliot HW, Wright JA, et al:  Blood and urine concentrations of subjects receiving barbiturates, meprobamate, glutethimide, or diphenylhydantoin . Clin Toxicol 1970;;3:131-145.
17 +
Ravn-Jonsen A, Luding M, Secher O:  Excretion of phenobarbitone in urine after intake of large doses . Acta Pharmacol Toxicol 1969;;27:193-201.
18 +
Waters N, Gaha TJ, Reynolds I:  Random urine analysis from drug addicts in a methadone treatment programme . Med J Aust 1975;;2:170-172.
19 +
Van Dyke C, Byck R, Barash PG, et al:  Urinary excretion of immunologically reactive metabolite(s) after intranasal administration of cocaine, as followed by immunoassay . Clin Chem 1977;;23:241-244.
20 +
Hamilton HE, Wallace JE, Shimek EL Jr, et al:  Cocaine and benzoylecgonine excretion in humans . J Forensic Sci Soc 1977;;22:697-707.
21 +
Lui CT, Adler FL:  Immunological studies on drug addiction: Antibodies reactive with methadone and their use for detection of the drug . J Immunol 1973;;111:472-477.
22 +
Amundson ME, Johnson ML, Manthey JA:  Urinary excretion of d-propoxyphene hydrochloride in man . J Pharm Sci 1965;;54:684-686.
23 +
Levine S: EMIT dau and EMIT st Urine Cannabinoid Assays: Accuracy, Passive Inhalation and Detection Time in Clinical Studies . Palo Alto, Calif, Syva Co, 1983;.
24 +
Dackis CA, Pottash ALC, Annitto W, et al:  Persistence of urinary marijuana levels after supervised abstinence . Am J Psychiatry 1982;;139:1196-1198.
25 +
Kogan MJ, Jukofsky D, Verebey K, et al:  Detection of methaqualone in human urine by radio immunoassay and gas-liquid chromatography after a therapeutic dose . Clin Chem 1978;;24:1425-1426.
26 +
Gupta RC, Lu I, Oei GL, et al:  Determination of phencyclidine (PCP) in urine and illicit street samples . Clin Toxicol 1975;;8:611-621.
27 +
Ellis GM:  Excretion patterns of cannabinoid metabolites after last use in a group of chronic users . Clin Pharmacol Ther 1985;;38:572-578.
28 +
Trinder P:  Rapid determination of salicylate in biological fluids . Biochem J 1954;;57:301-303.
29 +
Frings CS, Cohen PS:  Rapid colorimetric method for the quantitative determination of ethchlorvynol (Placidyl) in serum and urine . Am J Clin Pathol 1970;;54:833-836.
30 +
Kozelka FL, Hine CH:  Method for the determination of ethyl alcohol for medicolegal purposes . Ind Engl Analyt Chem Educ 1941;;13:905.
31 +
Sunshine I:  Use of thin-layer chromatography in the diagnosis of poisoning . Am J Clin Pathol 1963;;40:576-582.
32 +
Sunshine I, Fike WW, Landesman H:  Identification of therapeutically significant organic bases by thin-layer chromatography . J Forensic Sci 1966;;11:428-439.
33 +
Davidow B, Li Petri N, Quame B:  A thin-layer chromatographic screening procedure for detecting drug abuse . Am J Clin Pathol 1968;;50:714-719.
34 +
Heaton AM, Blumberg AG:  Thin-layer chromatographic detection of barbiturates, narcotics, and amphetamines in urine of patients receiving psychotropic drugs . J Chromatogr 1969;;41:367-370.
35 +
Kaistha KK, Jaffe JH:  TLC techniques for identification of narcotics, barbiturates, and CNS stimulants in a drug abuse urine screening program . J Pharm Sci 1972;;61:679-689.
36 +
Chamberlain J: Analysis of Drugs in Biological Fluids . Boca Raton, Fla, CRC Press Inc, 1985;, pp 115-136.
37 +
Baselt RC:  Urine drug screening by immunoassay: Interpretation of results , in Baselt RC (ed): Advances in Analytical Toxicology . Foster City, Calif, Biomedical Publications, 1984;, vol 1, pp 81-123.
38 +
Mule SJ:  Routine identification of drugs of abuse in human urine: I. Application of fluorometry, thin-layer and gas-liquid chromatography . J Chromatogr 1971;;55:255-265.
39 +
Costello CE, Hertz HS, Sakai T, et al:  Routine use of a flexible gas chromatography-mass spectrometer-computer system to identify drugs and their metabolites in body fluids of overdose victims . Clin Chem 1974;;20:255-265.
40 +
Ullucci PA, Cadoret R, Stasiowski PD, et al: A  GC/MS drug screening procedure in current use . Clin Chem 1976;;22:1197-1198.
41 +
Frethold D, Joves P, Sebrosky G, et al:  Testing for basic drugs in biological fluids by solvent extraction and dual capillary GC/NPD . J Anal Toxicol 1986;;10:10-14.
42 +
Newton B, Foery RF:  Retention indices and dual capillary gas chromatography for rapid identification of sedative hypnotic drugs in emergency toxicology . J Anal Toxicol 1984;;8:129-134.
43 +
Hime GW, Bednarczyk LR:  Identification of basic drugs in urine by dual fused silica capillary column GC . J Anal Toxicol 1982;;6:247-249.
44 +
Kvoppasalmi K, Karjalainen V: Doping Analysis in Helsinki 1983: The First IAAF World Championships . Helsinki, Clinical Chemistry Research Foundation Library, 1984;, vol 1.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

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1 +
Chamberlain J: Analysis of Drugs in Biological Fluids . Boca Raton, Fla, CRC Press Inc, 1985;, pp 122-125.
2 +
Caplan YH:  Analytical techniques , in Baselt RC (ed): Introduction to Forensic Toxicology . Davis, Calif, Biomedical Publications, 1981;, pp 161-162.
3 +
Kogan JD:  Expert testimony , in Baselt RC (ed): Introduction to Forensic Toxicology . Davis, Calif, Biomedical Publications, 1981;, pp 247-274.
4 +
Henion J, Covey T, Maylin G:  Forensic mass spectrometry in equine drug testing . Spectra 1985;; 10:21-28.
5 +
Dogoloff LI, Angarola RT, Price SC: Urine Testing in the Workplace . Rockville, Md, American Council for Drug Education, 1985;.
6 +
Biasotti AA, Valentine TE:  Blood alcohol concentration determined from urine samples as a practical equivalent or alternative to blood and breath alcohol tests . J Forensic Sci 1985;;30: 194-207.
7 +
Payne JP, Hill DW, King NW:  Observations on the distribution of alcohol in blood, breath and urine . Br Med J 1966;;1:196-202.
8 +
Morgan WHD:  Concentrations of alcohol in samples of blood and urine taken at the same time . J Forensic Sci Soc 1965;;5:15-21.
9 +
Heise HA:  Concentrations of alcohol in samples of blood and urine taken at the same time . J Forensic Sci 1967;;12:454-462.
10 +
Payne JP, Foster DV, Hill DW, et al:  Observations on interpretation of blood alcohol levels derived from analysis of urine . Br Med J 1967;;3: 819-823.
11 +
Bittirofer JA, Benton B: Rapid Drug Screening in the Hospital Clinic Laboratory . Kansas City, Mo, Marion Laboratories Inc, 1982;.
12 +
Baselt RC: Disposition of Toxic Drugs and Chemicals in Man , ed 2. Davis, Calif, Biomedical Publications, 1982;.
13 +
Gorodetsky CW:  Detection of drugs of abuse in biological fluids . Handbook Exp Pharmacol 1977;; 45:319-409.
14 +
Clarke EG (ed): Isolation and Identification of Drugs . London, The Pharmaceutical Press, 1969;, vol 1.
15 +
Rutter ER:  Automated method for screening urine for amphetamine and some related primary amines . Clin Chem 1972;;18:616-620.
16 +
Parker KD, Elliot HW, Wright JA, et al:  Blood and urine concentrations of subjects receiving barbiturates, meprobamate, glutethimide, or diphenylhydantoin . Clin Toxicol 1970;;3:131-145.
17 +
Ravn-Jonsen A, Luding M, Secher O:  Excretion of phenobarbitone in urine after intake of large doses . Acta Pharmacol Toxicol 1969;;27:193-201.
18 +
Waters N, Gaha TJ, Reynolds I:  Random urine analysis from drug addicts in a methadone treatment programme . Med J Aust 1975;;2:170-172.
19 +
Van Dyke C, Byck R, Barash PG, et al:  Urinary excretion of immunologically reactive metabolite(s) after intranasal administration of cocaine, as followed by immunoassay . Clin Chem 1977;;23:241-244.
20 +
Hamilton HE, Wallace JE, Shimek EL Jr, et al:  Cocaine and benzoylecgonine excretion in humans . J Forensic Sci Soc 1977;;22:697-707.
21 +
Lui CT, Adler FL:  Immunological studies on drug addiction: Antibodies reactive with methadone and their use for detection of the drug . J Immunol 1973;;111:472-477.
22 +
Amundson ME, Johnson ML, Manthey JA:  Urinary excretion of d-propoxyphene hydrochloride in man . J Pharm Sci 1965;;54:684-686.
23 +
Levine S: EMIT dau and EMIT st Urine Cannabinoid Assays: Accuracy, Passive Inhalation and Detection Time in Clinical Studies . Palo Alto, Calif, Syva Co, 1983;.
24 +
Dackis CA, Pottash ALC, Annitto W, et al:  Persistence of urinary marijuana levels after supervised abstinence . Am J Psychiatry 1982;;139:1196-1198.
25 +
Kogan MJ, Jukofsky D, Verebey K, et al:  Detection of methaqualone in human urine by radio immunoassay and gas-liquid chromatography after a therapeutic dose . Clin Chem 1978;;24:1425-1426.
26 +
Gupta RC, Lu I, Oei GL, et al:  Determination of phencyclidine (PCP) in urine and illicit street samples . Clin Toxicol 1975;;8:611-621.
27 +
Ellis GM:  Excretion patterns of cannabinoid metabolites after last use in a group of chronic users . Clin Pharmacol Ther 1985;;38:572-578.
28 +
Trinder P:  Rapid determination of salicylate in biological fluids . Biochem J 1954;;57:301-303.
29 +
Frings CS, Cohen PS:  Rapid colorimetric method for the quantitative determination of ethchlorvynol (Placidyl) in serum and urine . Am J Clin Pathol 1970;;54:833-836.
30 +
Kozelka FL, Hine CH:  Method for the determination of ethyl alcohol for medicolegal purposes . Ind Engl Analyt Chem Educ 1941;;13:905.
31 +
Sunshine I:  Use of thin-layer chromatography in the diagnosis of poisoning . Am J Clin Pathol 1963;;40:576-582.
32 +
Sunshine I, Fike WW, Landesman H:  Identification of therapeutically significant organic bases by thin-layer chromatography . J Forensic Sci 1966;;11:428-439.
33 +
Davidow B, Li Petri N, Quame B:  A thin-layer chromatographic screening procedure for detecting drug abuse . Am J Clin Pathol 1968;;50:714-719.
34 +
Heaton AM, Blumberg AG:  Thin-layer chromatographic detection of barbiturates, narcotics, and amphetamines in urine of patients receiving psychotropic drugs . J Chromatogr 1969;;41:367-370.
35 +
Kaistha KK, Jaffe JH:  TLC techniques for identification of narcotics, barbiturates, and CNS stimulants in a drug abuse urine screening program . J Pharm Sci 1972;;61:679-689.
36 +
Chamberlain J: Analysis of Drugs in Biological Fluids . Boca Raton, Fla, CRC Press Inc, 1985;, pp 115-136.
37 +
Baselt RC:  Urine drug screening by immunoassay: Interpretation of results , in Baselt RC (ed): Advances in Analytical Toxicology . Foster City, Calif, Biomedical Publications, 1984;, vol 1, pp 81-123.
38 +
Mule SJ:  Routine identification of drugs of abuse in human urine: I. Application of fluorometry, thin-layer and gas-liquid chromatography . J Chromatogr 1971;;55:255-265.
39 +
Costello CE, Hertz HS, Sakai T, et al:  Routine use of a flexible gas chromatography-mass spectrometer-computer system to identify drugs and their metabolites in body fluids of overdose victims . Clin Chem 1974;;20:255-265.
40 +
Ullucci PA, Cadoret R, Stasiowski PD, et al: A  GC/MS drug screening procedure in current use . Clin Chem 1976;;22:1197-1198.
41 +
Frethold D, Joves P, Sebrosky G, et al:  Testing for basic drugs in biological fluids by solvent extraction and dual capillary GC/NPD . J Anal Toxicol 1986;;10:10-14.
42 +
Newton B, Foery RF:  Retention indices and dual capillary gas chromatography for rapid identification of sedative hypnotic drugs in emergency toxicology . J Anal Toxicol 1984;;8:129-134.
43 +
Hime GW, Bednarczyk LR:  Identification of basic drugs in urine by dual fused silica capillary column GC . J Anal Toxicol 1982;;6:247-249.
44 +
Kvoppasalmi K, Karjalainen V: Doping Analysis in Helsinki 1983: The First IAAF World Championships . Helsinki, Clinical Chemistry Research Foundation Library, 1984;, vol 1.

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