Advancing analytical technology and the explosion in pharmaceutical and illicit drug use bring into question our continuing use of presumptive drug screening methods in many clinical and forensic testing protocols.
While definitive methods of confirmation testing serve as a safeguard against false positives, screening protocols in many areas of toxicology practice still rely on presumptive methods with their potential for false positive as well as hidden false negative test results.
Practice experience with over 5000 pain management and addiction medicine cases has been initially analyzed by a 95-panel definitive method to allow an evidence-based answer to the question of whether presumptive screening still makes sense. Selective and sensitive drug detection by liquid chromatography coupled with tandem mass spectroscopy is evidenced in the practice findings.
Also, evident in the comparison of definitive and presumptive screening is not only the finding of presumptive false positives caught by confirmation testing but also the high rate of false negatives that are unrevealed in current presumptive screening protocols.
Prescription review in the 5000 cases screened by definitive methodology also reveals a high frequency of psychoactive drug misuse in the casework that was missed by presumptive screening.
The findings indicate the efficacy of definitive drug screening and point to the need for conversion to definitive methods of screening with expanded drug panels throughout the practice of clinical and forensic toxicology.
- The false positive as well as false negative rate of presumptive drug screening in routine practice
- Selectivity and sensitivity of presumptive compared to definitive methods of drug testing
- Pharmaceutical and illicit drug misuse not monitored by presumptive screening protocols
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