An investigation of drug abuse and the utility of toxicology screening for use in emergency centers

The results of toxicology screening of samples from 725 patients admitted to the Critical Care Medical Center (CCMC) of Nippon Medical School during a 10-month period from 1992-1993 (Group A) and a 4-month period from 1995-1996 (Group B) were discussed. We investigated the drug use of emergency patients using immunoassay, EMIT and Triage. The results were confirmed by Gas Chromatography/Mass Spectrometry (GC/MS). Blood samples were analyzed for ethanol (EtOH) by head space gas chromatography. Overall, 18% of the 725 cases tested positive for drugs, 13% for EtOH. Recently the positive rates of drugs and EtOH have been increasing. The positive rates for drugs in Group A and Group B were 15% and 23%, and EtOH were 11% and 17%, respectively. False positive cases caused by the cross-reactivity to analog were found in both EMIT and Triage. But the reliability of both methods was sufficient for clinical use. Rapid in easy toxicology screening can provide useful clinical information for patients admitted to a CCMC, especially for patients who have been injured, have sustained unknown-etiology consciousness disturbances, have CPAOA (Cardio Pulmonary Arrest on Arrival) or have committed drug abuse. We conclude that toxicology screening using immunoassay methods is suitable for use in an emergency center. (J Nippon Med Sch 1997; 64: 344-352)