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On-site testing for drugs of misuse in the acute psychiatric ward

  • Sharif Ghali (a1)
Abstract
Aims and Method

To explore why and how on-site urine drug testing is performed in in-patient settings. Data were collected by questionnaire in four acute psychiatric wards.

Results

The most commonly cited reasons for testing were suspected drug use and as a routine part of the admission procedure. On-site testing was typically favoured over laboratory methods owing to the rapid turnaround of results and ease of use. In 81% of cases the result of the tests had no effect on immediate management. the majority of staff had not received formal training in their use.

Clinical Implications

Clinical use of on-site drug tests does not reflect their established limitations. Guidance is required to direct staff in the use of this commonly used assessment tool.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution (CC-BY) license (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
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BJPsych Bulletin
  • ISSN: 0955-6036
  • EISSN: 1472-1473
  • URL: /core/journals/bjpsych-bulletin
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On-site testing for drugs of misuse in the acute psychiatric ward

  • Sharif Ghali (a1)
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eLetters

The use of on-site testing for illicit drugs in forensic settings

Ian J Yanson, specialty doctor in forensic psychiatry
24 September 2009

The paper by Ghali1 highlights the importance of training staff on the use of on-site urine testing kits. While these are widely used in forensic settings where testing for illicit drugs forms an integral part of the overall management of patients2, staff receive very little training on the interpretation of test results. There are four possible interpretations: true positive, false positive, true negative and false negative3. A true positive test indicates that the person has used the drug, while a true negative test indicates absence of drugs in the sample. On the other hand, a false positive result can occur from the incorrect identification of the presence of substances, failure to acknowledge the chemical similarity of a prescribed medication with the drug of interest, and passive drug exposure. A false negative result may occur when the test’s cut off level is set above the limit of detection of the drug or due to sample adulteration.A rigid interpretation of test results may have several undesirable consequences4. For instance a false positive result may lead to false accusations being made against an innocent person resulting in suspension of leave, loss of privileges and possibly discharge from hospital. The latter is more likely to be the case in personality disordered patients. In contrast, a false negative result may lead to a false perception that things are under control.Training should incorporate understanding of the context of drug screening and ensuring the quality of samples to minimize errors in test result interpretation.References

1.Ghali, S. On-site testing for drugs of misuse in the acute psychiatric ward. Psychiatric Bulletin 2009; 33: 343-346 2.Durant, M., Lelliott, P., & Coyle, N. Availability of treatment for substance misuse in medium secure psychiatric care in England: A national survey. The Journal of Forensic Psychiatry & Psychology 2006, 17(4): 611-625. 3.Wolff, K., Farrell, M., Marsden, J., Monteiro, G., Ali, R., Welch, S., & Strag, J. A review of biological indicators of illicit drug use, practical considerations and clinical usefulness. Addiction 1999; 94 (9): 1279-1298. 4.Harvey Gordon and Daniel Haider. The use of ‘drug dogs’ in psychiatry. Psychiatric Bulletin 2004; 28: 196-198.
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