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Seek out the information that testing provides
Laboratory testing for the presence of drugs offers information that is relevant to all professionals involved in the treatment of patients afflicted with drug abuse problems and other comorbid conditions. I am pleased to launch an ongoing series of columns in Addiction Professional that will examine the usefulness and intricacies of drug testing and its various technologies. Knowledge of drug use by patients in treatment settings is important information for counselors as well as medical professionals.
A drug's presence in an individual patient might mimic symptoms of psychiatric illness. The opiate class of drugs such as heroin, morphine, and OxyContin illustrates this best. To the trained eye, it is obvious when a patient is under the influence of an opiate. Examination will reveal pupillary miosis (constriction), euphoric anxiolytic sedation, mental clouding, sweating, and constipation.
But on long-term use, tolerance to some of these symptoms will develop and the subject will appear normal. Subjects dependent on opiates in the absence of the drug will demonstrate various degrees of signs of withdrawal, such as pupillary mydriasis (excessive dilation), agitation, anxiety, muscle aches, gooseflesh, and often diarrhea. These symptoms disappear on re-administration of an opiate.
It is not unusual to find that behavior similar to a textbook description of psychosis identified as paranoid schizophrenia can be triggered in predisposed individuals by drugs such as phencyclidine (PCP), amphetamine,1 and cannabis.2 Drug-induced “model” psychosis can apparently be produced in anyone given the adequate dose of LSD, PCP, amphetamine, or cocaine. Drug-induced psychoses must be recognized because they have a different prognosis and must be treated differently from psychoses related to endogenous anatomic or neurochemical aberrations.
Urgency of testing
The treatment of individuals with drug abuse problems is extremely handicapped if drug abuse monitoring is not provided, or the tests used are not accurate. It is necessary to monitor the success or failure of any treatment or therapy via the available technologies of drug testing.
Comprehensive drug testing to distinguish the presence and/or absence of drugs is now an important tool for therapists and counselors in making a precise evaluation of their patients and in mapping an appropriate course of treatment. Addiction treatment specialists and psychiatrists also need to be more aware of the role of laboratory testing as it relates to the care of their patients.
Upcoming topics
Future articles in the area of drug testing will focus on topics such as testing for various drugs of abuse; alcohol abuse and testing; polydrug abuse; analysis of testing methodology; choice of sample and time of collection; and interpretation of positive and negative reports.
If there is a topic or challenge associated with drug testing that you would like to see addressed in the magazine, please contact Addiction Professional editor Gary A. Enos via e-mail at genos1@cox.net with your suggestions.
Karl Verebey, PhD, is the Clinical Laboratory Director of Ammon Analytical Laboratory, LLC. He is a former Chief Toxicologist for the New York City Department of Health and Associate Professor of Psychiatry at the State University of New York's Downstate Medical Center. His e-mail address is k.verebey@att.net. If you would like to write a column for the magazine on drug testing issues, or want to share your thoughts on the role testing has played in your treatment program, contact Addiction Professional editor Gary A. Enos at genos1@cox.net.References
- Yago KB, Pitts FN, Burgoyne RW, et al. The urban epidemic of phencyclidine (PCP) use: clinical and laboratory evidence from a public psychiatric hospital emergency service. J Clin Psychiatry 1981; 42:193-6.
- Thacore VR, Shukla SRP. Cannabis psychosis and paranoid schizophrenia. Arch Gen Psychiatry 1976; 33:383-6.
