Introduction

One difference between clinical and forensic toxicology laboratories is the importance of turnaround time in the completion of the results. In postmortem and human performance toxicology laboratories, a turnaround time of days or weeks may be

From: Handbook of Drug Monitoring Methods Edited by: A. Dasgupta © Humana Press Inc., Totowa, NJ

acceptable. As a result, the approach to drug testing may be more comprehensive. A battery of tests, rather than a single type of test, can be utilized. On the other hand, a clinical toxicology laboratory needs to provide results back to the clinician more rapidly, usually within hours of specimen receipt. Moreover, with cost reduction becoming a significant factor in healthcare facilities, toxicology laboratories have moved from a more general toxicology screen to a more limited screen (1). This limited screen will usually consist of a serum ethanol test by an enzymatic assay and a urine immunoassay screen for 5-10 drug classes based on commercially available immunoassay kits. These may be supplemented by serum tests for salicylate, acetaminophen, benzodiazepines and tricyclic antidepressants by immunoassay or spot tests. Because these tests are cheaper and less labor intensive than general screening techniques such as thin layer chromatography and gas chromatography, they have largely replaced these more classical techniques in the clinical toxicology laboratory.

Although immunoassays are quite useful for rapid screening of many drugs, there are some limitations associated with this limited screening approach. Obviously, there are drugs other than abused drugs that can necessitate a trip to the emergency department. Within a class of drugs, there will be differences in cross-reactivities between drugs. This chapter will discuss many of these limitations. Specifically, four areas will be covered: drug-facilitated sexual assault (DFSA) drugs, hallucinogenic amines, miscellaneous hallucinogens and opiates.

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