The abuse of drugs, both medications and illicit drugs, is widespread. The risk to public safety, loss in workplace productivity, and impact on the health and welfare of the drug abusers have resulted in many government, business, public health, medical, and educational initiatives to combat drug abuse. Drug testing is used increasingly as a deterrent to illicit drug use and as an objective means to document drug abuse among patients, job applicants, employees, athletes, and students.

The traditional clinical toxicology service has been to support the emergency department for the diagnosis and treatment of suspected drug overdose patients. This

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

role in recent years has been largely supplanted by demands from other clinical services for managing the medical consequences of drug abuse; pediatrics for testing newborns suspected of in utero drug exposure, adolescence medicine for drug dependency; obstetrics for pregnant addicts at risk for drug-related complications; organ transplant for assessment of candidates; pain management for monitoring patients on narcotic medications for compliance and for deterrence against diversion of drug for street sale; psychiatry and addiction medicine for monitoring drug treatment/rehabilitation outcome.

Drug testing in the workplace for nonmedical purposes (e.g., pre-employment and random workplace testing) is forensic testing, requiring detailed documentation of the chain of custody of test specimens and aliquots from collection to analysis and the use of the highest standards of analytical methodologies. The focus of this chapter is on clinical drugs of abuse testing, but forensic testing will be mentioned whenever it is relevant to the discussion of clinical testing.

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