DRUG SCREENING OF PATIENTS WHO DELIBERATELY HARM THEMSELVES ADMITTED TO THE EMERGENCY DEPARTMENT

This study was a retrospective analysis of drugs present in blood and urine samples taken from patients (n = 200) admitted to the emergency department of a major teaching hospital with a provisional diagnosis o f deliberate self-harm. The aim was to assess the current limited drug screening strategy to see whether it needed to be changed in any way. Drugs present in blood and urine were identified by immunoassay or ch romatography, categorized, and concentration-toxicity effects evaluate d when practicable. For each case, the various drugs/drug classes dete cted were correlated with those reported by the patient. A questionnai re evaluation of doctor's perceptions of the influence of the primary blood drug screen on patient destinations was administered. The rapid primary drug screen using a blood/plasma sample detected some 46% of a ll drugs identified. The doctors considered that it was influential in deciding on immediate patient destination, and therefore, it is likel y to be a cost-effective measure, in addition, the screen detected tox ic concentrations of drugs in a significant proportion of patients who did not report their ingestion correctly. A primary drug screen using a urine sample detected opiates, cannabinoids, and amphetamines but s uch detection was considered unlikely to alter short-term treatment. A high-performance liquid chromatography and gas chromatography-mass sp ectroscopy secondary screen using blood and urine detected a significa nt number of additional drugs, but was slow, costly, and not likely to alter short-term treatment. The authors conclude that the primary scr een for alcohol, benzodiazepines, paracetamol, salicylate, and tricycl ic antidepressants remains the optimal drug screening strategy. Quanti tative or qualitative estimation of patient-reported drugs such as qui nine, theophylline, verapamil, and antiepileptics may be justifiable i n individual patients.