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New Guidelines

The way forward

 

The way forward was considered by the EWDTS technical committee during 2014 and and published at the end 2015.

Considerations.

  1. The European drug scene had dramatically changed in the preceding years.
  2. Many smaller labs screened with mass spectrometers and were not inhibited by high throughput chemistries.
  3. Due to improvements in instrumentations, lower limits of quantitation were easier to achieve and expanded drug panels which reflected the current drug scene were simpler to include in the Service Level Agreement.

 

 

Within the EWDTS there was a difference of opinion.

 

Larger, established testing laboratories wanted to maintain their core panel.

Their core panel was derived due to the availability of the test reagents which their robotic high throughput processes used. Almost all of these chemical tests were derived by US companies to allow laboratories in the US conduct their DOT Federal programmes.

If a new drug hit the scene and no test reagent was available, then mass spectrometry would be required to perform the initial screen. This is especially true if the new drug was European sourced, e.g. Phenazepam and Mephedrone.

That meant inefficiency and more cost, combined with the longer reporting cycle.

In the other corner were the smaller labs.

100% mass spectrometry for screening and confirmation.

Larger test panels, more agile to adjust to changing drug patterns.

By definition, less samples as they were smaller, but taking the attitude that sample growth would result in more equipment purchases due to the increased revenue.

 

New Guidelines

 

For Urine, Oral fluid and urine the new screening panels and subsequent confirmation panels are a step in the right direction. They are not the two or three steps necessary.

If mandated panels actually reflected what I would term “drug reality” then the large labs could not sustain their current business model.

In the UK Tramadol is an opioid like prescription drug which is very commonly used by the NHS. It is commonly abused but it is not a common drug on standard panels.

Ketamine is a similar story, with several deaths reported due to its abuse.

In Ireland, Gabapentin is a common street drug as is Pregabilin (Lyrica).

Employers should be encouraged to review their SLAs to ensure that the reporting panels reflect reality.

Almost all testing laboratories advise employer clients that their results should be shared with an MRO a medical review officer. This medical or toxicologist expert will review donor information and relate this with laboratory results.

I would strongly suggest that clients also employ the MRO to review the SLA to make sure it is current too.

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