A major portion of toxicology testing deals with urine drug screening for the adult
population. This group can be divided into two major applications: preemployment urine
drug screening and periodic scheduled pain management screening. Pain management clinics
usually require patients to sign opiate contracts that allow for regular testing as
a means to assess compliance. The presence or absence of drugs and metabolites must
match the patient's prescribed medications, and any discrepant compounds found during
routine screening are grounds for dismissal from the pain management program. In addition
to these two applications, toxicology drug testing plays an important but often overlooked
role in newborn drug screening. Testing this population comes with its own set of
unique analytical, therapeutic, and legal issues that can make screening and result
interpretation challenging.
KEY POINTS
- •Drug screening in the newborn population comes with a set of unique analytical, therapeutic, and legal issues that can make testing and result interpretation challenging.
- •Assessment of in utero drug exposure to cocaine, amphetamines, opiates, marijuana, and ethanol may allow better intervention and management of withdrawal symptoms for the neonate.
- •A range of maternal and neonatal specimens are available, but each comes with a unique set of limitations regarding sensitivity, invasiveness, and window of detection.
- •Preanalytical issues such as specimen collection and sample extraction can influence test accuracy, and the particular biological specimen evaluated determines the window of detection achieved.
- •Meconium provides the longest window, but the extraction technique greatly impacts sensitivity, and unique drug metabolites in meconium may lead to discrepancies between maternal and neonate results.
Keywords
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References
- Results from the 2010 National Survey on Drug Use and Health: summary of national findings.(Accessed April 10, 2012)
- Factors associated with substance use during pregnancy: results from a national sample.Drug Alcohol Depend. 2009; 99: 89-95
- Screening for prenatal substance use: development of the Substance Use Risk Profile-Pregnancy scale.Obstet Gynecol. 2010; 116: 827-833
- Substance abuse in pregnancy.(Published 2009) (Accessed April 10, 2012)
- SOGC clinical practice guidelines: substance use in pregnancy: no. 256.Int J Gynaecol Obstet. 2011; 114: 190-202
- Identifying infants at risk for neonatal abstinence syndrome: a retrospective cohort comparison study of 3 screening approaches.J Perinat Neonatal Nurs. 2010; 24: 366-372
- Clinical guidelines for urine toxicology screening.University of North Carolina Department of Labor and Delivery, Chapel Hill (NC)2011
- Child Welfare Information Gateway.(Published 2009) (Accessed April 10, 2012)
- Child Abuse Prevention and Treatment Act.(Accessed April 10, 2012)
- Drug testing for newborn exposure to illicit substances in pregnancy: pitfalls and pearls.Int J Pediatr. 2011; 2011: 951616
- The role of alternative specimens in toxicological analysis.Biomed Chromatogr. 2008; 22: 795-821
- Biological matrices for the evaluation of in utero exposure to drugs of abuse.Ther Drug Monit. 2007; 29: 711-734
- Analysis of meconium for cocaine in neonates.J Chromatogr. 1992; 575: 158-161
- Postmortem drug analysis of meconium in early-gestation human fetuses exposed to cocaine: clinical implications.J Pediatr. 1994; 124: 477-479
- Detection of intrauterine illicit drug exposure by newborn drug testing.Clin Chem. 1997; 43: 235-242
- Time of first stool in extremely low birth weight (< or = 1000 grams) infants.J Pediatr. 1993; 122: 626-629
- Prevalence and disposition of drugs of abuse and opioid treatment drugs in oral fluid.J Anal Toxicol. 2007; 31: 424-433
- Oral fluid testing for drugs of abuse.Clin Chem. 2009; 55: 1910-1931
- Placental handling of fatty acid ethyl esters: perfusion and subcellular studies.J Pharmacol Exp Ther. 2004; 310: 75-82
- Langman's Medical Embryology.in: 12th edition. Lippincott Williams & Wilkins, Philadelphia2011: 106
- Detection of cocaine and its metabolites in amniotic fluid and umbilical cord tissue.J Anal Toxicol. 1997; 21: 97-104
- Detection of cocaine and its metabolites in human amniotic fluid.J Anal Toxicol. 1992; 16: 328-331
- Detection of fetal cocaine exposure by analysis of amniotic fluid.Obstet Gynecol. 1993; 81: 787-790
- Detection of cocaine exposure in the neonate.Arch Pathol Lab Med. 1994; 118: 988-993
- Cocaine in the hair of mother-infant pairs: quantitative analysis and correlations with urine measures and self-report.Am J Drug Alcohol Abuse. 1993; 19: 159-175
- Maternal cocaine use without evidence of fetal exposure.J Pediatr. 1994; 125: 652-654
- Unexpected interference of baby wash products with a cannabinoid (THC) immunoassay.Clin Biochem. 2012; 45: 605-609
- Toxicological screening for drugs of abuse in samples adulterated with household chemicals.S Afr Med J. 2002; 92: 547-549
- Adulterants causing false negatives in illicit drug testing.Clin Chem. 1988; 34: 2333-2336
- An LC-MS-MS method for the comprehensive analysis of cocaine and cocaine metabolites in meconium.Anal Chem. 2000; 72: 764-771
- Quantitation of benzoylnorecgonine and other cocaine metabolites in meconium by high-performance liquid chromatography.J Chromatogr. 1993; 613: 330-335
- Vitros Chemistry.Ortho Clinical Diagnostics, Rochester (NY)2010
- Gestational cocaine exposure and intrauterine growth: maternal lifestyle study.Obstet Gynecol. 2002; 100: 916-924
- The Maternal Lifestyle Study: drug exposure during pregnancy and short-term maternal outcomes.Am J Obstet Gynecol. 2002; 186: 487-495
- Estimated effects of in utero cocaine exposure on language development through early adolescence.Neurotoxicol Teratol. 2011; 33: 25-35
- Preadolescent behavior problems after prenatal cocaine exposure: relationship between teacher and caretaker ratings (Maternal Lifestyle Study).Neurotoxicol Teratol. 2011; 33: 78-87
- Vitros Chemistry.Ortho Clinical Diagnostics, Rochester (NY)2010
- Delta 9-THC metabolites in meconium: identification of 11-OH-delta 9-THC, 8 beta,11-diOH-delta 9-THC, and 11-nor-delta 9-THC-9-COOH as major metabolites of delta 9-THC.J Anal Toxicol. 1998; 22: 329-335
- Simultaneous analysis of delta9-THC and its major metabolites in urine, plasma, and meconium by GC-MS using an immunoaffinity extraction procedure.J Anal Toxicol. 2000; 24: 395-402
- Meconium for drug testing.Am J Dis Child. 1991; 145: 650-652
- Comparison of meconium and neonatal hair analysis for detection of gestational exposure to drugs of abuse.Arch Dis Child Fetal Neonatal Ed. 2003; 88: F98-F100
- Immunoassay and GC-MS procedures for the analysis of drugs of abuse in meconium.J Anal Toxicol. 1999; 23: 436-445
- The determination of 11-nor-delta 9-tetrahydrocannabinol-9-carboxylic acid (THCCOOH) in meconium.J Anal Toxicol. 1996; 20: 50-51
- Interference of common household chemicals in immunoassay methods for drugs of abuse.Clin Chem. 1989; 35: 648-651
- Effect of marijuana use in pregnancy on fetal growth.Am J Epidemiol. 1986; 124: 986-993
- Intrauterine cannabis exposure affects fetal growth trajectories: the Generation R Study.J Am Acad Child Adolesc Psychiatry. 2009; 48: 1173-1181
- Prenatal marijuana exposure and intelligence test performance at age 6.J Am Acad Child Adolesc Psychiatry. 2008; 47: 254-263
- Prenatal marijuana exposure: effect on child depressive symptoms at ten years of age.Neurotoxicol Teratol. 2005; 27: 439-448
- Prenatal marijuana exposure contributes to the prediction of marijuana use at age 14.Addiction. 2006; 101: 1313-1322
- Prenatal marijuana exposure and neonatal outcomes in Jamaica: an ethnographic study.Pediatrics. 1994; 93: 254-260
- Effects of marijuana use during pregnancy on newborn cry.Child Dev. 1989; 60: 765-771
- Characteristics of pregnant illicit drug users and associations between cannabis use and perinatal outcome in a population-based study.Drug Alcohol Depend. 2010; 109: 243-247
- Identifying prenatal cannabis exposure and effects of concurrent tobacco exposure on neonatal growth.Clin Chem. 2010; 56: 1442-1450
- Placental permeability for drugs of abuse and their metabolites.NIDA Res Monogr. 1995; 154: 152-162
- Kinetics of drug transfer to the fetus.Clin Obstet Gynecol. 1993; 36: 246-254
- Analysis of methadone and its primary metabolite in meconium.J Anal Toxicol. 1997; 21: 154-159
- The opioid-exposed newborn: assessment and pharmacologic management.J Opioid Manag. 2009; 5: 47-55
- Management of neonatal abstinence syndrome in neonatal intensive care units: a national survey.J Perinatol. 2006; 26: 15-17
- Sublingual buprenorphine for treatment of neonatal abstinence syndrome: a randomized trial.Pediatrics. 2008; 122: 601-607
- Treatment of neonatal abstinence syndrome with clonidine and chloral hydrate.Acta Paediatr. 2010; 99: 209-214
- Methamphetamine: history, pathophysiology, adverse health effects, current trends, and hazards associated with the clandestine manufacture of methamphetamine.Dis Mon. 2012; 58: 38-89
- Methamphetamine use during pregnancy: maternal and neonatal implications.Obstet Gynecol. 2010; 116: 330-334
- False-positive amphetamine toxicology screen results in three pregnant women using labetalol.Obstet Gynecol. 2011; 117: 503-506
- Trace evidence of trans-phenylpropene as a marker of smoked methamphetamine.J Anal Toxicol. 2008; 32: 705-708
- Prenatal amphetamine exposure and birth outcomes: a systematic review and metaanalysis.Am J Obstet Gynecol. 2011; 205 (e1–7): 219
- Drugs of abuse testing in meconium.Clin Chim Acta. 2006; 366: 101-111
- Fatty acid ethyl esters: toxic non-oxidative metabolites of ethanol and markers of ethanol intake.Front Biosci. 2003; 8: e202-e217
- Fatty acid ethyl esters: ethanol metabolites which mediate ethanol-induced organ damage and serve as markers of ethanol intake.Prog Lipid Res. 1998; 37: 307-316
- Fetal alcohol spectrum disorders: an overview.Neuropsychol Rev. 2011; 21: 73-80
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Footnotes
The author has nothing to disclose.
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© 2012 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
