طب انتظامی (Jan 2023)
Rapid and Accurate Diagnosis of Substance Abuse: A Narrative Review
Abstract
Introduction One of the major problems in the world is drug abuse [1]. ... [2]. For accurate diagnosis of drug abuse, two important principles are the amount of substance remaining in the body and the time of testing ... [3, 4]. ... [5-10]. Iran has higher rate of drug use than other countries in the world; so its consumption in the country has trebled rather than the population growth rate [11]. ... [12]. Laboratories typically use urine, blood, breath, saliva, sweat, and hair to diagnose drug use. Studies have been published on the use of nails to diagnose abuse [13, 14]. Taking certain medications may interfere with the diagnosis of addiction. There is also the possibility of fraud in some tests. Accurate and rapid diagnosis of drug abuse has great clinical importance [13, 14]. …. [15]. Aim (s) In various areas of police force, such as traffic police, crime detection and forensics science, accurate and rapid diagnosis of drug use is very important. The present study aims to review subsequent studies in the field of rapid and accurate diagnosis of substance use. Research Type This research is a narrative review. Research Society, Place and Time The statistical population of this review study was articles that had studied rapidly and accurately diagnosed drug abuse in different years (regardless of the time limit in the year of publication). Articles were searched with the keywords substance abuse, drug abuse, detection, drugs. English articles were searched in the databases of Science Direct, Google Scholar, Springer, Scopus and PubMed, and Persian articles were searched in the scientific databases of Jihad Daneshgahi (SID) and the Iranian Scientific Information and Document Research Institute (Irandoc) and the Iranian Journal of Magazines (Magiran). Finding by Text Among 76 articles after search and screening, 24 articles were obtained in the field of rapid and accurate diagnosis of drug abuse. Urine testing: The most common method for measuring drug abuse [16]. ... [17]. Urine collection is a non-invasive method compared to blood and collected in larger volumes and contains metabolites that can be used to measure drug abuse. However, urine use depends on the amount of drug used, the type of drug, the half-life of the drug, and the last time of use. There are also three problems with urine testing: false positives, degeneration of observed urine collection, and cases of fraud (false negatives) [18]. There are two common methods for diagnosing urinary abuse: TLC detection and Liquid – Liquid Extraction (LLE) detection [19]. Urine toxicology is usually positive up to two days after most drugs abuse. More precisely, this period is three days for heroin, amphetamine, cocaine, seven days for nicotine, 10 days for opium, and more than 30 days for long-term use of marijuana. Although the abuse of many of these drugs are identified in the urine, some of them are better detectable in the blood [16]. Blood test: blood test is one of the most reliable and accurate methods in the list of methods to diagnose substance abuse due to the fact that the type of drug and the amount of use detected in the blood from a few hours to a few days and then enter other parts of the body. However, due to the cost of this method, low material retention in the blood and the need for advanced equipment and devices to identify the material, it is less used than other methods [20]. Most drugs can be detected in the blood or plasma in the lowest amount (in Nano grams per milliliter) for a day or two. Detection of drugs in body fluids, especially in the blood as well as tissue, is hampered by the small size of the biodegradable samples. Therefore, sample optimization and the use of whole blood instead of plasma have been considered [21]. Hair test: Hair has the advantage of calculating the medication taken a few days or months in advance, and as a result, hair analysis is considered a time indicator [22]. ... [23]. Instrumental methods used in hair analysis include Immunochemical Techniques, Gas Chromatography Mass Spectrometry (GC – MS) and (LC – MS) Liquid Chromatography – Mass Spectrometry. Hair has been considered for the diagnosis of previous and chronic drugs due to its wider detection period, non-invasive collection, and greater stability compared to body fluids or other tissues [24]. ... [25-27]. The wider detection range is the biggest advantage of hair tests over urine and blood tests for medications. Hair can also indicate the history and frequency of drug use. Hair analysis can protect against false positive urine test materials due to sample mixing, sample contamination, or administrative errors. Hair testing in the treatment of abuse can identify patterns of long-term use. Studies conducted at a detoxification center have shown that hair analysis is more sensitive than urine screening to detect illicit drug use [28, 29]. Despite the benefits of hair testing, this technique is not widely used due to the increased cost and longer analysis time compared to urine. Also, the hair test cannot detect recent exposure to the substance or give instant results [24]. Nail tests: Nails have become a useful example for diagnosing drug abuse over the past few decades. Chemicals such as illicit substances, drugs, alcohol, etc. can remain in the fingernails for 3 to 5 months and in the toenails for 8-14 months. ... [30]. A review study of the application of nail testing in drug treatment programs, identification of drug exposure in utero has been done by Cappelle et al. [31]. ... [32]. Nail sampling is relatively simple, and advances in analytical equipment technology make it possible to accurately measure in very small amounts of major constituents as well as metabolites [33]. Sweat test: Sweat is chemically similar to blood plasma, but some of its compounds are selectively excreted [34]. ... [35]. Drugs are excreted by the body through sweat ... [16]. The use of special pads for collecting and testing sweat may cause skin blockage problems such as skin irritation, skin pH change and accumulation of skin bacteria, which are mentioned as the disadvantages of this method [36]. ... [37]. The use of sweat for drug testing has problems in sample collection and sensitivity of analysis methods [38]. Sweat tests are also used to diagnose drugs such as marijuana, cocaine, opiates, amphetamines, benzodiazepines, barbiturates, phencyclidine and nicotine [39]. Saliva test: The saliva test provides information similar to a blood test but is less invasive. By analyzing saliva, various drugs and chemicals such as cocaine, heroin, amphetamines, etc. can be identified. On the other hand, this type of test is similar to urine test in terms of characteristics, but saliva analysis can be done in a shorter period of time (24 to 48 hours) than urine because the concentration of substances in saliva is low. This test has two advantages over a urine test: first, the sample is easier to collect than urine; second, the possibility of deceptions which is in the urine test is not possible in this method [40]. Saliva tests may be a good complement to blood samples; in some cases, it may be a good alternative to blood. Problems such as oral retention and pH change of the sample and access to saliva test only in living patients are the disadvantages of this method, but due to the ability of non-invasive sampling and easy access to the sample and lack of sample screening in techniques such as spectrophotometry, etc., it is considered as an alternative to blood tests. [41]. ... [42].]. Spirometry test: Spirometry test has been introduced as a matrix for drug detection. The finding that amphetamines, methadone, and tetrahydrocannabinol are readily detectable after inhalation has led to further development of this matrix for the detection of substance abuse [43]. ... Respiratory, plasma, and urine data are well-matched and support expiratory respiration as a new matrix in clinical toxicology. The expiratory breathing technique is as accurate as plasma and urine and is a good alternative in cases where the latest consumption should be considered [44]. ... [45]. On-site testing using portable devices is one of the benefits of respiratory testing, which is sometimes important for traffic police [46]. Conclusions The choice of test method depends on factors such as cost, ease of sample collection, risk of fraud, type of test (immediate or laboratory), period of use (acute or chronic), time of last use. Clinical & Practical Tips in Police Medicine For police in different areas such as traffic police, crime detection, and forensics science, access to accurate and rapid diagnostic tests to measure drug abuse is critical; therefore, studies in this field and the development of methods are ongoing. Conflict of Interest The authors state that there is no conflict of interest in the present study.
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