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Table 2 Toxicological screening

From: Management of pharmaceutical and recreational drug poisoning

Toxicological screening methods Comments–interpretation
Rapid screening methods on an automated chemistry analyzer Immunological and enzymatic Urine screens for illicit drugs and/or their metabolites (cocaine, amphetamines, opiates, etc.) without assay Useful for “conventional” drugs, excluding NPS
These tests need to be carefully interpreted (molecule identified by antibody, toxicokinetics, screening window, interferences, etc.)
Limits of interpretation on urine
Specific drug or toxin screens with blood and/or urine assays Useful for blood assays (drugs, ethanol, etc.)
Limits of interpretation on urine
Drug class screens (benzodiazepines, tricyclic antidepressants, etc.) in blood and/or urine Limits of interpretation for a drug of the class identified by antibody due to cross-reactions with other drugs of the same class and possible interferences
Need for biological interpretation with respect to the toxicity thresholds of each drug
Limits of interpretation for urine
Chromatographic confirmation of screening methods Liquid or gas chromatography Detection by diode arrays and/or mass spectrometry in blood and/or urine Useful for broader targeted screening (up to 1200 molecules and/or metabolites)
Need for biological interpretation of the nature of the molecules identified, the level of screening (sensitivity) and interpretation with respect to reported toxic concentrations
A semiquantitative approach can be used simultaneously with screening for certain molecules
Limits of interpretation on urine
Liquid chromatography High-resolution mass spectrometry (HRMS) Useful to identify unknown chemical structures (non-targeted screening) (e.g. NPS)