Characteristics and Laboratory Testing Standards for Drugs of Abuse

Neurologists and other clinicians may not have extensive experience in their practice with patients who use drugs and alcohol either naively or chronically. However, substance use disorders (SUDs) resulting in overdose are a major cause of death in certain demographics, such as young adults, ages 18–25 (Botticelli and Koh, 2016). In the United States alone, there were 105,263 overdose deaths in the 12-month period ending in January 2023 (CDC, 2023). Drug testing is the technology for SUD early diagnosis and treatment, the same way glucose testing is the technology of diabetic diagnosis and treatment. Both SUDs and diabetes are chronic, deadly diseases, but they can be controlled with appropriate testing, monitoring and lifestyle changes. Unlike glucose tests, not all drug tests are the same, nor do they use the same technology. Modern drug and alcohol testing technologies have evolved greatly in the last 20 years and are now a part of the new science of evidence-based medical diagnostics and treatment of SUDs (Moeller et al., 2008). If the wrong technology is ordered, it may lead to misdiagnosis, compromised treatment, and could have tragic consequences. These new drug testing technologies and profound changes in street drugs with multiple pharmaceuticals, toxic adulterants, veterinary medications and novel psychoactive substances (NPS) are reviewed. Specific drug test panels with a focus on workplace, healthcare professional and athlete testing are reviewed. Along with the interpretation of drug testing on various specimen types, individual drugs and technologies will provide clinicians insight on how best to use these new technologies. It is important to treat the patient, not the drug test, and contact the laboratory toxicologist and Medical Review Officer (MRO) to review any results not consistent with the patient's presentation.