False-positive and false-negative rates in meconium drug testing

US Drug Testing Laboratories, Chicago, IL 60612, USA.
Clinical Chemistry (Impact Factor: 7.91). 12/1995; 41(11):1614-6.
Source: PubMed


To determine the number of false-negative results produced by inefficient extraction of drugs from meconium, three published procedures were compared by using previously confirmed positive and negative meconium specimens. The methods were not equivalent in their ability to extract drugs from the matrix. To determine the number of false positives reported by the use of screen-only (unconfirmed) results, 535 screen-positive meconium specimens were subjects to confirmation by gas chromatography-mass spectrometry. Fifty-seven percent of the samples were confirmed positive for one or more of the drugs under investigation, showing that a false-positive rate as high as 43% may exist when unconfirmed screening results are used.

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Available from: Christine Moore, Mar 09, 2015
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    • "olarization immunoassay ( FPIA ) , radioimmunoassay ( RIA ) and enzyme - linked immunosorbent assay ( ELISA ) have also been utilized ( Moore et al . , 1998 ; Gareri et al . , 2006 ) . All these provide high sensitivity ; for example , cut - off values for cocaine and metabolites are less than 50 ng / mg ( Ostrea , 2001 ; Bar - Oz et al . , 2003 ; Moore et al . , 1995 ) . Meconium is particularly useful in documenting in utero drug exposure ( Moore et al . , 1998 ; Gareri et al . , 2006 ; Lozano et al . , 2007 ; Gray and Huestes , 2007 ) , and a number of papers have been published on the deter - mination of several substances , such as cocaine and meta - bolites , opiates , cannabinoids , amphetamin"
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    ABSTRACT: The use of alternative specimens in the field of toxicology was first described in 1979, when hair analysis was used to document chronic drug exposure. Since then, the use of these 'alternative' samples has gained tremendous importance in forensic toxicology, as well as in clinic toxicology, doping control and workplace drug testing. It is not surprising, therefore, that a large number of papers dealing with the determination of several classes of drugs in saliva, sweat, meconium and hair have been published ever since, owing to the fact that chromatographic equipment is becoming more and more sensitive, mass spectrometry (and tandem mass spectrometry) being the most widely used analytical tool, combined with gas or liquid chromatography. 'Alternative' specimens present a number of advantages over the 'traditional' samples normally used in toxicology (e.g. blood, urine and tissues), namely the fact that their collection is not invasive, their adulteration is difficult, and they may allow increased windows of detection for certain drugs. The main disadvantage of this kind of samples is that drugs are present in very low concentrations, and therefore high-sensitivity techniques are required to accomplish the analysis. This paper reviews a series of publications on the use of alternative specimens, with special focus on the main analytical and chromatographic problems that these samples present, as well on their advantages and disadvantages over traditional samples in documenting drug exposure.
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    • "This rate is probably unacceptable for most situations, and the benefits do not outweigh the drawbacks of such inaccurate results. A number of researchers have warned against basing reports of substance use solely on chemical tests (Moore et al., 1995; Pollack, Danziger, Jayakody, & Seefeldt, 2002; Schwartz et al., 1990). Pollack et al., for example, argue that though tests will identify a small percentage of cases where the mother is truly dependent, there will be many others who test positive but are only casual users whose use would not indicate the need for treatment or other services. "
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    ABSTRACT: Recent federal legislation mandates that newborns identified as prenatally substance-exposed be reported to local child protective agencies. However, the legislation does not outline methods of identifying such newborns. A number of methods of identifying substance-exposed newborns exist, including maternal self-report, urine tests of either mother or newborn, and meconium testing, each with its own benefits and drawbacks. Alcohol poses special challenges, as it is arguably as damaging to newborns as illegal substances, but it is treated differently by the medical profession and by child protective agencies than are illegal substances. There is inconsistency in the reporting by hospitals to child protective agencies, in terms of substances and maternal characteristics. This paper calls for hospitals to develop formal protocols for ascertaining prenatal substance exposure, including establishing objective criteria that both identifies a newborn as substance-exposed and dictates under what circumstances a newborn should be brought to the attention of child protective services. The child protective response is also seemingly inconsistent, and the system should develop appropriate responses for this population of newborns and their families.
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