Drugs of abuse testing may seem like the most obvious point of connection between addiction and the clinical laboratory, but addiction, in one form or another, is a hidden driver behind much diagnostic lab testing and many medical procedures.
Whether the culprit is alcohol, drugs, tobacco or sex, the pathway between addictive behavior and contact with the healthcare system is well worn. Certainly, the numbers back that up. Sexually transmitted diseases have reached epidemic proportions in the United States. Cardiac testing and therapeutic procedures are growing rapidly in response to the aging population, but also because too many smokers can’t part with their Lucky’s and just as many couch spuds won’t relinquish the remote control.
Of all the addictions, alcohol, America’s favorite drug, is probably the most thoroughly studied and documented. For example, according to the American Medical Association, alcohol contributes to 100,000 deaths annually, making it the third leading cause of preventable mortality in the United States after tobacco and diet/activity patterns.
Nearly one-fourth of all persons admitted to general hospitals have alcohol problems or are undiagnosed alcoholics being treated for the consequences of their drinking, according to the National Institute of Alcohol Abuse and Alcoholism (NIAA).
On average, untreated alcoholics incur general healthcare costs at least 100 percent higher than those of non-alcoholics, and this disparity may exist as long as 10 years before entry into treatment, also according to NIAA.
If alcohol is the oldest and most well understood drug, Ecstasy, and other so-called “designer” or “club” drugs such as GHB and Rohypnol, are among the newest and least understood. Ecstasy, a hallucinogenic, is a favorite among teens and young adults attending all-night dance parties or “raves.” GHB and Rohypnol have been associated with date rape and sexual assault cases around the country.
“Club drugs are not harmless ‘fun drugs,’” said Dr. Alan I. Lesher, National Institute on Drug Abuse director. “While users of club drugs might think they’re taking them simply for energy to keep on dancing or partying, research shows these drugs can have long-lasting negative effects on the brain that can alter memory function and motor skill. When these drugs are combined with alcohol, they become even more dangerous and potentially life-threatening.”
As Nick Borgert reports in this month’s Disease Management article, the diagnostics industry is beginning to address the need to test for these new “club” drugs by adding them to their drug screening panels.
Workplace drug screening turns its attention to popular club drugs — Ecstasy, Rohypnol
After concentrating for years on seven drug categories, diagnostics industry manufacturers are paying greater attention to a couple of new players on the illegal drug scene: club drugs such as Ecstasy and Rohypnol.
Federal guidelines have long called for testing for PCP, amphetamines, marijuana (THC), morphine, cocaine, barbiturates and benzodiazepine in work places, rehab centers, emergency rooms and criminal justice environments. While most studies indicate declines in use of established drugs, statistics point to a dramatic increase in the use of Ecstasy and other designer drugs — particularly among the young.
Ecstasy, a methamphetamine also called MDMA, is a synthetic mind-altering drug with amphetamine-like and hallucinogenic properties. Its chemical structure is similar to other synthetic drugs known to cause brain damage. Frequent symptoms are confusion, depression, sleep problems, drug cravings, severe anxiety and paranoia. These symptoms can appear weeks after the drug is ingested. Ecstasy increases heart rate and blood pressure; it has been linked to long-term damage to parts of the brain that control thought and memory.
Rohypnol, also known as the “date rape” drug and “forget pill,” is manufactured worldwide but is neither manufactured nor approved for medical use in the United States. The drug’s low cost (often under $5 a tablet) has made it popular among youths, especially in the South and Southwest. Rohypnol has most of the same physiological effects as Valium but is 10 times more potent. Side effects include decreased blood pressure, memory impairment, drowsiness, visual disturbances, dizziness and confusion.
Testing for club drugs
This year, Beckman Coulter of Fullerton, Calif., released four more chemistries for its Synchron LX and CX clinical systems. The new test’s amphetamine screen is so sensitive to Ecstasy, it can detect as little as 2.5 micrograms of the drug per milliliter of urine.
“Ecstasy and Rohypnol are getting more popular and they’re causing a lot of problems,” said Irena Markowski, senior applications scientist at Beckman Coulter. “In the transportation area especially, it’s very much a safety issue and something the government is concerned about.”
“On the job, at probation departments, schools, in hospitals … more drug testing is being done today than ever before,” said Joan Fitzgerald, Beckman Coulter’s field marketing manager. “Ecstasy use is gaining in the college population and among bright people in their twenties who work on Wall Street.”
“Traditionally, marijuana and cocaine have accounted for about 90 percent of illegal drug use within the workplace,” said Jackie Pirone, product manager for Roche Diagnostics’ Workplace Segment. “Ecstasy has been on the margin, but that is changing.”
Indianapolis-based Roche has been providing drug testing systems for more than 25 years, according to Pirone. Roche also makes the point-of-care On Trak TesTcup and TesTstik for detecting presence of drugs of abuse through a five-minute test.
Also this year, Dade Behring’s Syva subsidiary in San Jose introduced a line of drugs-of-abuse testing products that use a ready-mixed liquid reagent instead of the traditional powder that requires mixing with water.
The upgraded Emit II Plus reagent bottles feature color-coded caps to reduce the potential for cross-contamination. The Syva RapidCup is a complete urine collection and DAT panel in one device. The single-user cup system allows a specimen to be collected and tested without sample handling.
A 1998 federal study of household drug use found 3.4 million Americans 12 years and older had used Ecstasy at least once during their lifetime. Heaviest use was reported by those 18 to 25. Those findings sparked an additional $54 million in the budget of the U.S. Department of Health and Human Services for research and public education on the dangers of Ecstasy and related drugs.
Bucking the trend
Not every company is sold on drug testing. In October, the online Los Angeles Times reported that Microsoft, Cisco Systems and Yahoo are among technology companies who have never adopted any kind of drug-testing policies. In other cases, Silicon Valley companies, the Times reported, require drug screening for delivery and factory personnel but exempt their “idea” staffs who sit in cubicles with computers all day.
According to the Times, Agilent Technologies, a leading seller of drug testing equipment, stopped drug testing new employees this year. “We were hearing that people were taken aback and offended by the process,” the Times quoted Wendy Miller, Agilent’s senior director of talent.
— Nicholas Borgert
