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Try out PMC Labs and tell us what you think. Learn Drug detox 24 hours. Drug testing, when carefully collected and thoughtfully interpreted, offers a critical adjunct to clinical care and substance use treatment. However, because test can be misleading if not interpreted in the correct clinical context, clinicians should always conduct a careful interview with adolescent patients to understand what testing is likely to show and then use testing to validate or refute their expectations.
Due to the ease with which samples can be tampered, providers should also carefully reflect on their own collection protocols and sample validation procedures to ensure optimal accuracy. It is incumbent on clinicians to detect substance use early and intervene to reduce acute risks and to improve the life course trajectory of addiction and its harms. For clinicians working with adolescents, screening for alcohol and drug use is a critical skill that allows for brief intervention and referral to treatment, an approach endorsed by major professional bodies [ 1 — 3 ] including the American Academy of Pediatrics AAP [ 4 ].
Screening is best conducted using a validated instrument such as the S2BI instrument [ 5 ] that can then prompt a discussion between the clinician and adolescent. At first blush, routine screening of adolescents by testing urine or other bodily fluids might seem like a reasonable strategy for detecting substance use, but this approach is fraught with inaccurate findings and misinterpretation, and worse, le to mistrust on the part of the adolescent and missed opportunities for nuanced discussions about substance use with a clinician.
Abstinence from all substances is recommended throughout adolescence because of the impact of alcohol, marijuana and other drugs on brain development [ 6 ]. Routine drug testing of all adolescents, however, is insensitive for detecting sporadic use, and risks obscuring opportunities for counseling and brief interventions that may be better identified by self-report [ 7 ].
While routine laboratory testing is not recommended for adolescents there are several indications for which this procedure may provide useful information to supplement a clinical history or to Drug detox 24 hours monitor patients in treatment for substance use disorders. Here, we review drugs commonly included in testing panels, bodily fluids and tissues tested, indications for testing, practical concerns, and issues unique to drug testing adolescents as contrasted with its use in adults. Although it is possible to test for use of an individual drug, multiple drugs or classes are usually tested at the same time using a single biological sample [ 8 ].
The SAMHSA-5 includes amphetamines, marijuana tetrahydrocannabinol [THC]cocaine metabolites, opiates including heroin, morphine, and codeine, but not synthetic opioids such as oxycodone, hydrocodone, buprenorphine, or methadoneand phencyclidine PCP [ 89 ].
Most drug screens available commercially have panels that expand beyond the SAMHSA-5 to also include benzodiazepines, barbiturates, and additional opiates [ 8 ]. Alcohol and drugs vary substantially in their windows of detection, largely owing to their degree of fat solubility. For example, THC and other highly fat-soluble compounds have a very long half-life of elimination and can be detected in urine up to weeks after last use among heavy users. The various windows of detection for a of commonly used substances are shown in Table 1 [ 10 ]. These various tissues and bodily fluids exhibit different rates and durations of excretion that result in different detection windows for substances, as demonstrated in Figure 1.
However, most laboratories analyze the amount of hair equivalent to 3 months of growth. When substances are ingested, they are absorbed in the gastrointestinal tract and distributed to tissues of the body [ 9 ]. Substances that are injected, inhaled or snorted bypass gastrointestinal absorption and are delivered immediately to tissues. Since many drugs are lipid soluble, they must undergo metabolism in the liver to render them water soluble which then allows them to be eliminated in urine.
Blood and breath reflect moment-to-moment serum levels of an ingested substance, and offer the earliest and shortest windows of detection for substances [ 8 ]. Sweat and saliva reflect the presence of a drug within the body several hours later. Urine offers a somewhat Drug detox 24 hours window of detection for substances, usually varying from one day after consumption to several weeks. Hair and meconium offer Drug detox 24 hours longest windows of detection weeks to months. Advantages and disadvantages of different matrices for drug testing are shown in Table 2.
Advantages and disadvantages of various matrices i. Possibility of contamination from residual drug in mouth that cannot be correlated with blood concentrations. Cannabinoids in oral fluid have been shown to arise Drug detox 24 hours contamination of the oral cavity rather than excretion in saliva from blood.
Detects recent use fewer than 24 hours with a sweat swipe or allows for cumulative testing with the sweat patch worn for up to 7—14 days. Only a single sweat collection patch available so multiple analyses cannot be done if needed i. May be able to detect changes in drug use over time from 7—10 days after drug use to 3 months, depending on length of hair tested.
May be biased with hair color dark hair contains more of some basic drugs [cocaine, methamphetamine, opioids] due to enhanced binding to melanin in hair. May be difficult to obtain adequate sample, especially with patients who are very intoxicated or uncooperative.
Narrow collection window that can be missed, especially in babies with low birth weight. Of all the matrices, urine is the most commonly used for adolescent drug testing and is the most thoroughly studied [ 911 ]. However, for an adolescent patient, its collection is somewhat invasive since it requires either a sophisticated collection protocol which is not readily available in medical offices or direct observation e.
Compounding this, many pediatricians are unfamiliar with proper collection procedures and with the limitations of urine drug screening [ 11 ]. Currently, the most commonly used urine drug testing approach involves automated immunoassay either alone as a point-of-care test or as an initial screen for a 2-step testing procedure [ 78 ]. from IA are qualitative i. If any substances are positive on the initial IA, a separate quantity of the same sample is then subjected to GC-MS as a confirmatory test for those same substances, with negative on the IA disregarded.
GC-MS provides a quantitative result to help guide the clinician, which can be used to follow serial samples and determine whether the metabolite concentration is rising Drug detox 24 hours falling, which may suggest ongoing use or abstinence, respectively. Even still, caution is warranted as levels may vary with urine concentration, the amount of drug used, and time since last use, thus making an absolute determination regarding whether use is ongoing difficult.
IA is often used as a point-of-care test given its convenience, low cost, and relatively rapid although are often not available quickly enough to guide clinical management in emergent situations [ 7 ]. Most home urine drug test kits use IA.
Although IA has high sensitivity, it has poorer specificity than GC-MS owing to cross-reactivity, whereby compounds in the biologic specimen other than the actual substance or its metabolite bind to the assay and trigger a false-positive result. For example, PCP assays can turn positive if an individual consumes dextromethorphan, a common component of cough syrup.
Additionally, IA drug tests performed in isolation do not distinguish among drugs within a class i. GC-MS is not performed as a point-of-care test and usually must be sent to a laboratory, resulting in a delay [ 7 ]. Newer but less widely used technologies include liquid chromatography-mass spectrometry and tandem mass-spectrometry, which can be used to bypass the initial screening IA and identify a larger of substances and metabolites [ 8 ].
Often, laboratories report the urine creatinine, which helps the clinician correct for the relative concentration or dilution of the urine. Concentration of the urine by the kidneys in elevated levels of drug metabolites; therefore, urine concentrations of certain drugs and their metabolites are usually divided by the urine creatinine.
An example of this is THC, whose excretion in the urine can continue for up to one month after most recent use in heavy users [ 13 ], and urine samples positive for THC must be carefully interpreted to distinguish ongoing excretion from new use. Urine THC concentration should be divided by the urine creatinine concentration in order to determine whether the creatinine-normalized THC concentration is increasing or decreasing with consecutive urine samples [ 14 ] and these ratios can then be compared to nomograms of THC excretion in order to make a clinical interpretation [ 15 ].
Practical issues, such as timing of the urine sample collection, specimen collection techniques, validation of the sample, and result interpretation are covered later in this chapter. Drug testing of blood samples is usually only performed in emergency situations, and due to the invasiveness of obtaining a blood sample, the need for specially trained phlebotomists, and the expense of blood drug testing, it is rarely performed in primary care settings [ 79 ]. An additional limitation is that obtaining blood samples requires venipuncture and locating venous access among injection drug users can be very difficult Drug detox 24 hours 9 ].
Unlike urine samples, blood samples generally detect alcohol and drug compounds themselves rather than their metabolites. Blood testing typically detects substance use that occurred within 2 to 12 hours of the test [ 7 ]. Oral fluid testing is less commonly used but oral samples represent a convenient, promising matrix for many settings. Unlike urine samples, oral samples are not easily tampered with, and can be collected with minimal invasion of privacy [ 1516 ].
Oral secretions contain either the original drug compound or its metabolite for approximately hours after last use [ 91516 ]. Importantly, use of breath sprays, mouthwash or other oral rinses containing alcohol does not affect drug testing result as long as they are not used within 30 minutes of Drug detox 24 hours collection [ 17 Drug detox 24 hours. To collect an oral sample, a swab is placed adjacent to the lower gums against the inner cheek and left in place for several minutes before being inserted into a vial for transportation to the laboratory [ 9 ].
Point-of-care oral testing is also available in some settings [ 18 ]. Hair drug tests have the advantage of detecting substance use days to months, or in some cases, years, later [ 919 ]. Drug metabolites are present in hair as early as one week after most recent use, and because metabolites remain trapped in the core of the hair as it grows, hair provides a rough timeline of use over an Drug detox 24 hours period [ 920 ]. Hair grows at a rate of approximately one-half inch per month, and so the standard 1.
Conversely, hair testing is not helpful in detecting sporadic use when weekly or even monthly drug testing is required as part of a drug treatment plan [ 9 ]. Additionally, drug use often must relatively heavy in order for testing to detect levels in hair.
Other limitations of hair testing include that individuals can surreptitiously remove the sample through shaving, that sweat production can cause drug metabolites to travel proximally up the hair shaft thus affecting drug test interpretation, and that drugs can be incorporated into hair through simple exposure from second-hand smoke [ 2324 ].
An additional potential consideration is that drug concentrations can be affected by the melanin content of hair, resulting in potentially higher concentrations of certain drugs in dark hair as compared to blond or red hair [ 1525 ]. Bleaching or coloring the hair may also alter concentrations of metabolites [ 26 ]. The hair sample is typically cut from the back of the head using scissors, cutting as close to the scalp as possible to estimate most recent drug use [ 9 ].
For patients who are bald or who have shaved their head, hair can be taken from the armpit, face, or other unshaven part of the body, so long as a sufficiently long enough sample can be taken. No point-of-care hair drug testing currently exists.
Breath testing provides an accurate measure of the actual blood alcohol content at that moment in time, and is more frequently used in law enforcement or in emergency departments than in primary care. The US Food and Drug Administration FDA has approved a patch for collection of sweat for drug testing that is placed on the skin for days prior to being sent to a laboratory for interpretation [ 89 ]. In Europe. Sweat testing checks for substances and their metabolites in the bloodstream in the hours before and during the time that the patch is applied [ 89 ].
Patches that pucker or show other evidence of interference when removed have been deed in attempt to reduce tampering Drug detox 24 hours 8 ]. Meconium is obtained from newborns and used as a measure of maternal substance use in the third trimester [ 8122829 ]. Meconium testing is used as a screen in the newborn nursery or neonatal intensive care unit when maternal substance use during pregnancy is suspected, and can have critical legal consequences for guardianship of the child [ 30 ].
Meconium testing can also inform clinical management of neonatal abstinence syndrome and other newborn withdrawal syndromes. Indications for adolescent drug testing are explored here. Drug tests are commonly used in emergent situations, such as when an adolescent presents with altered mental status [ 78 ].
Some common clinical scenarios include attempted suicide, motor vehicle injury or other injury in which substance use may have been a contributor, unexplained seizures, syncope, arrhythmia, or toxidromal s that suggest a particular intoxication or withdrawal pattern Drug detox 24 hours 7 ].Drug detox 24 hours
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