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Toxicology screen
Barbiturates - screen; Benzodiazepines - screen; Amphetamines - screen; Analgesics - screen; Antidepressants - screen; Narcotics - screen; Phenothiazines - screen; Drug abuse screen; Blood alcohol test
A toxicology screen refers to various tests that determine the type and approximate amount of legal and illegal drugs a person has taken.
How the Test is Performed
Toxicology screening is most often done using a blood or urine sample. However, it may be done soon after the person swallowed the medication, using stomach contents taken through gastric lavage (stomach pumping) or after vomiting.
Gastric lavage
Gastric suction is a procedure to empty the contents of your stomach.
How to Prepare for the Test
No special preparation is needed. If you are able, tell your health care provider what drugs (including over-the-counter medications) you have taken, including when you took them and how much you consumed.
This test is sometimes part of an investigation for drug use or abuse. Special consents, handling and labeling of specimens, or other procedures may be required.
How the Test will Feel
Blood test:
When the needle is inserted to draw blood, some people feel moderate pain, while others feel only a prick or stinging sensation. Afterward, there may be some throbbing.
Urine test:
A urine test involves normal urination. There is no discomfort.
Why the Test is Performed
This test is often done in emergency medical situations. It can be used to evaluate possible accidental or intentional overdose or poisoning. It may help determine the cause of acute drug toxicity, monitor drug dependency, and determine the presence of substances in the body for medical or legal purposes.
Acute
Acute means sudden or severe. Acute symptoms appear, change, or worsen rapidly. It is the opposite of chronic.
Additional reasons the test may be performed:
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Alcoholism
Alcoholism
Alcohol use disorder is when your drinking causes serious problems in your life, yet you keep drinking. You may also need more and more alcohol to f...
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Alcohol withdrawal state
Alcohol withdrawal state
Alcohol withdrawal refers to symptoms that may occur when a person who has been drinking too much alcohol on a regular basis suddenly stops drinking ...
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Analgesic nephropathy
(kidney poisoning)
Analgesic nephropathy
Analgesic nephropathy involves damage to one or both kidneys caused by overexposure to mixtures of medicines, especially over-the-counter pain medici...
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Complicated alcohol abstinence (delirium tremens)
Complicated alcohol abstinence (deliriu...
Delirium tremens is a severe form of alcohol withdrawal. It involves sudden and severe mental or nervous system changes.
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Delirium
Delirium
Delirium is sudden severe confusion due to rapid changes in brain function that occur with physical or mental illness.
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Dementia
Dementia
Dementia is a loss of brain function that occurs with certain diseases. It affects memory, thinking, language, judgment, and behavior.
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- Fetal alcohol syndrome
- Intentional overdose
- Seizures
- Stroke caused by cocaine use
- Suspected sexual assault
- Unconsciousness
If the test is used as a drug screen, it must be done within a certain amount of time after the drug was taken, or while forms of the drug can still be detected in the body. Examples are below:
- Alcohol: 3 to 10 hours
- Amphetamines: 24 to 48 hours
- Barbiturates: up to 6 weeks
- Benzodiazepines: up to 6 weeks with high level use
- Cocaine: 2 to 4 days; up to 10 to 22 days with heavy use
- Codeine: 1 to 2 days
- Heroin: 1 to 2 days
- Hydromorphone: 1 to 2 days
- Methadone: 2 to 3 days
- Morphine: 1 to 2 days
- Phencyclidine (PCP): 1 to 8 days
- Propoxyphene: 6 to 48 hours
- Tetrahydrocannabinol (THC): 6 to 11 weeks with heavy use
Normal Results
Normal value ranges for over-the-counter or prescription medications may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.
A negative value usually means that alcohol, prescription medications that have not been prescribed, and illegal drugs have not been detected.
A blood toxicology screen can determine the presence and level (amount) of a drug in your body.
Urine sample results are usually reported as positive (substance is found) or negative (no substance is found).
What Abnormal Results Mean
Elevated levels of alcohol or prescription drugs can be a sign of intentional or accidental intoxication or overdose.
The presence of illegal drugs or drugs not prescribed for the person indicates illicit drug use .
Illicit drug use
Substance use is the continued use of alcohol, illegal drugs, or the misuse of prescription or over-the-counter drugs with negative consequences. Th...
Risks
Veins and arteries vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others.
Other risks associated with having blood drawn are slight but may include:
- Excessive bleeding
- Fainting or feeling light-headed
- Hematoma (blood accumulating under the skin)
- Infection (a slight risk any time the skin is broken)
Considerations
Substances that may be detected on a toxicology screen include:
- Alcohol (ethanol) -- "drinking" alcohol
- Amphetamines
- Antidepressants
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Barbiturates and
hypnotics
Hypnotics
Benzodiazepines; Sedatives; Hypnotics; Sleeping pills; Insomnia - medicines; Sleep disorder - medicines
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- Cocaine
- Flunitrazepam (Rohypnol)
- Gamma hydroxybutyrate (GHB)
- Marijuana
- Narcotics
- Non-narcotic pain medicines, including acetaminophen and anti-inflammatory drugs
- Phencyclidine (PCP)
- Phenothiazines (antipsychotic or tranquilizing medicines)
- Prescription medicines, any type
References
McPherson RA, Pincus MR. Toxicology and therapeutic drug monitoring. In: McPherson RA, Pincus MR, eds. Henry's Clinical Diagnosis and Management by Laboratory Methods . 21st ed. Philadelphia, PA: Elsevier Saunders; 2006:chap 23.
Sachs C, Wheeler M. Examination of the sexual assault victim. In: Roberts JR, Hedges JR, eds. Clinical Procedures in Emergency Medicine . 5th ed. Philadelphia, PA: Elsevier Saunders; 2009:chap 58.
Tintinalli JE, Kelen GD, Stapczynski JS, Ma OJ, Cline DM. Toxicology and pharmacology. In: Tintinalli JE, Kelen GD, Stapczynski JS, Ma OJ, Cline DM, eds. Emergency Medicine: A Comprehensive Study Guide . 6th ed. Columbus, OH: McGraw-Hill; 2006:section 14.
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Blood test - illustration
Blood is drawn from a vein (venipuncture), usually from the inside of the elbow or the back of the hand. A needle is inserted into the vein, and the blood is collected in an air-tight vial or a syringe. Preparation may vary depending on the specific test.
Blood test
illustration
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Blood test - illustration
Blood is drawn from a vein (venipuncture), usually from the inside of the elbow or the back of the hand. A needle is inserted into the vein, and the blood is collected in an air-tight vial or a syringe. Preparation may vary depending on the specific test.
Blood test
illustration
Review Date: 1/26/2015
Reviewed By: Jacob L. Heller, MD, MHA, Emergency Medicine, Virginia Mason Medical Center, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.
