A toxicology screen is a test used to determine if an individual has been exposed to certain legal or illegal drugs. Toxicology screens are usually ordered to see if a patient has taken drugs that could endanger his or her health. If a patient is suspected of taking illegal drugs, a screen for specific drugs that are commonly abused may be ordered.

Toxicology screens are often ordered by hospital emergency department personnel when a patient appears to be impaired or is unconscious. Testing is also done in patients who have a change in mental status, in cases of seizures, and onset of dementia. Toxicology testing can also be useful in cases of suspected sexual assault.

In some cases, a patient may have been exposed to a prescription drug accidentally or overdose may be suspected. Some employers require random drug screening. Employees who test positive for illegal drug abuse may be suspended or fired.

The test can be performed fairly quickly. Results can help doctors treat the patient effectively and safely.

 Types of Toxicology Screens

There are several types of toxicology screens. Most screening methods use a sample of urine to test for the presence of illegal narcotics or prescription drugs. Some, like the blood alcohol test, can determine the precise concentration of a particular drug. Others, like the urine screen, can indicate if a person has been exposed to drugs or poisons. Drug screens can also be performed on saliva.

One common type of toxicology test looks for evidence of alcohol abuse by a mother during pregnancy. Her newborn’s first stool is examined to predict a condition called fetal alcohol syndrome.

Most screens provide limited information about how much or how often a patient has taken a drug. Once the presence of a drug has been identified by screening, the doctor may order a more specific test, which will show exactly how much of the drug is present in the patient’s system.

The contents of the stomach may also be screened when doctors suspect a patient may have taken a drug orally.

How Samples for Toxicology Screens Are Obtained

Some toxicology screens are obtained by doing blood tests, which involve drawing one or more small tubes of blood. A medical professional inserts a needle into a vein and removes enough blood to perform the necessary tests.

If a urine sample is required, the patient may be asked to urinate into a small sample cup in the presence of law enforcement or medical personnel. This prevents the patient from tampering with the sample.

Types of Drugs Screened

Many types of drugs can be identified by toxicology screens. Depending on the drug, it may show up in the blood or urine hours or weeks after exposure to the drug. For example, alcohol is eliminated from the body relatively rapidly. It’s necessary to draw blood within about three hours of an automobile accident to accurately reflect a patient’s blood alcohol status at the time of the incident.

Other drugs, such as THC, a component of marijuana, may show up in urine for months after exposure. How long THC remains detectable depends on whether the patient is a heavy user.

Common classes of drugs that may be detected by toxicology screens include:

•  alcohol (including ethanol and methanol)
• amphetamines (such as Adderall)
• barbiturates
• benzodiazepines
• methadone
• cocaine
• opiates (including codeine, oxycodone, heroin)
• phencyclidine (PCP)
• tetrahydrocannabinol (THC)

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Chemicals taking a toll on reproductive health

Chemicals from a variety of sources are having an increasingly negative effect on human health—especially in children—so ob-gyns need to step up efforts to reverse this trend through advocacy and education, said Linda C. Giudice, MD, PhD, during the Donald F. Richardson Memorial Lecture on Monday, May 6, at the Annual Clinical Meeting.

Dr. Giudice presented “Environmental Chemical Effects on Reproductive Health Outcomes: Strength of the Evidence and What We Can Do for Our Patients, Learners, and Communities.” She is the Robert B. Jaffe, MD, Endowed Professor in the Reproductive Sciences at the University of California, San Francisco.

“Our scientists are taking a good look at the data and are finding trends that are disconcerting. We now have an opportunity to do something,” she said, pointing out that since lead was phased out of gasoline in 1973, blood lead levels have plummeted. “We can transform exposures.”

In the past 20 years, impaired fecundity in the US has increased from 8% to 12%, and 90% of that change has come in the 15–24 age group. In males, sperm counts and testosterone levels have declined about 1% per year in recent decades, Dr. Giudice said. At the same time, hypospadias and testicular germ cell tumors have increased.

“Malformations of the male reproductive system are among the most common birth defects today,” she said.

In adults, unhealthy trends have also developed. Prostate and breast cancers are increasing, and aggressive breast cancer has increased 36%.

Today, 80,000 chemical substances are registered for use in US commerce, and 700 new industrial chemicals are introduced into commerce each year. However, these chemicals are not monitored closely. “It is only when something happens and there are questions that this product or chemical is looked into in more depth,” Dr. Giudice said.

Evidence for adverse reproductive outcomes from exposure to endocrine-disrupting chemicals is strong, she said. “What can we as health professionals do? I think we can strengthen professional education in reproductive and environmental health at the undergraduate and medical education levels and at the graduate medical education level,” Dr. Giudice said. “I think we should share what we know with our patients. We should together advocate for chemical policy reform.”

Call to Action

Those who attend the Edith Louise Potter Memorial Lecture will be left with a challenge. Presenters Mary E. D’Alton, MD, New York, NY, and Sarah J. Kilpatrick, MD, PhD, Los Angeles, are hoping attendees are moved to action after hearing the lecture, “Maternal Morbidity and Mortality in the US: Time to Wake Up and Take the Lead,” from 11:15 am to 12:15 pm Tuesday in Skyline Ballroom (ABC).

“What I’m going to present is a plan that we believe every birthing center, hospital, and facility that delivers babies in the US should have within three years,” Dr. D’Alton said. “It’s going to focus on efforts that we believe will have a significant impact on reducing maternal mortality and morbidity.”

Dr. D’Alton said data suggest that maternal mortality has been increasing in the US during the last decade and serious maternal morbidity has increased even more so.

“We believe this is for several reasons, but some of it is related to the increased age of mothers as they become pregnant, so they have higher incidence of comorbidities such as diabetes and hypertension, and also the national epidemic of obesity,” she said.

As a result of these increases, ACOG is joining several other societies to form the National Partnership for Maternal Safety.

“We felt because of there being no minimal progress in this area that all societies that deliver care to women needed to come together to make a plan,” Dr. D’Alton said. “The energy behind this is palpable right now. … The challenge before us is implementation.”

Dr. D’Alton knows not all maternal mortalities and morbidities are preventable, but the partnership’s goal is to reduce those that are preventable by 50% in five years.

Future of Patient Safety

Today, Joanna M. Cain, MD, will take her ACM attendees on a journey six years into the future for a unique, forward-thinking look at patient safety.

Dr. Cain’s one-hour presentation is this year’s Morton and Diane Stenchever Lecture. “Keeping Our Patients Safe: Key Actions for Ob-Gyn for All Stages and Sites of Patient Care,” begins at 4 pm in Ballroom ABC. It will examine the direction patient safety is going—and what it could look like in the year 2020.

Dr. Cain’s presentation will cover actions that ob-gyns need to take to change how they educate students and residents and how they manage their own practice, taking into consideration the effects of all the new technology. How does that influence patient safety and how ob-gyns deliver care in the future?

Dr. Cain said present day is a tumultuous time in medicine because of technological innovations such as electronic medical records, and even Google Glass, the computerized eyewear. These technologies may affect students’ education and help train and evaluate ob-gyn surgical competence.

“How we teach is changing,” Dr. Cain said. “The cost of education is probably too high, so how we structure our future will make a difference in making sure we have a pipeline for the future.”

Dr. Cain will emphasize education that equips residents to be leaders in safety education and will discuss restructuring ambulatory practices. She’ll also look at what role ACOG’s Safety Certification in Outpatient Practice Excellence for Women’s Health Program (SCOPE) might play down the road.

The look ahead offers the chance for several intriguing “what-if” questions.

“What if, instead of seeing students as sort of a burden to practice, what if they came with skills that we could leverage to make practices safer?” Cain said. “What if they knew those skills from early on? What if medical schools worked together in the first years and shared a similar national curriculum with flipped classrooms?

“And what would it look like if there were students in almost every practice in the country and that’s how we educated students—and they were the front line of making sure we continue to improve safety and quality?”

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