Reference Abraham and LutyAbraham & Luty (2010) provide a useful overview of testing for illicit drugs in clinical practice. I had hoped that the article would also tackle the more thorny issue of designer drugs. Our team is increasingly involved in cases of designer drug misuse that results in complex management problems.

At present there is no way of testing for designer drugs on the ward, so tests have to be sent to one of a handful of national testing centres. Conventional drug testing involves immunoassay of urine, but to accurately identify designer drugs requires the use of mass spectrometry. This means that it takes an average of 2 months for results to become available. We find it very difficult to make use of such old data as all too often they are no longer relevant.

This problem is not likely to be resolved in the near future, owing to the nature of the ever-evolving designer drugs industry. In view of this, we need to rethink our traditional approach to drug testing and monitoring.