Be the first to know about drug testing device
March 1, 1999
Be the first to know about drug testing device
A newly approved drug testing device, OnTrak Test Cup ER, can reduce delays in waiting for test results from hours to minutes.
"This is a very efficient way of obtaining urine toxicology screening," reports Howard Freed, MD, chairman of the department of emergency medicine at District of Columbia General Hospital, in Washington, DC, and principal investigator for a clinical testing protocol for the device.
"In the ED, it’s not unusual to have to wait a week for results," Freed says. "Now we can get them back within minutes. As a result, our patterns of care could change."
OnTrak TestCup ER from Roche Diagnostics in Somerville, NJ, is a self-contained, integrated collection and testing device that screens for drugs commonly linked to ED admissions. The device can simultaneously detect cocaine, morphine, amphetamines, barbiturates, and benzodiazepines and provide positive or negative results in five minutes, Freed notes. (See information on how to use the test, p. 73. See ordering information, p. 74.)
The device is similar to the original OnTrak Test Cup used for workplace and criminal justice drug testing, which was approved several years ago. Test Cup tests for five substances: marijuana, cocaine, amphetamines, opiates, and PCP.
"The difference with the Test Cup ER is that the marijuana and PCP have been replaced with tests for barbiturates and benzodiazapenes," says Stuart Bogema, PhD, a clinical toxicologist at Forensic Testing, a Clifton, VA-based research consulting firm that evaluated OnTrak Test Cup ER. "These drugs are more common with overdose situations."
The Clinical Laboratory Improvement Act (CLIA) requires clinical labs to be licensed. Currently, there are no on-site drug testing devices available that have waived-test status for CLIA, which means most EDs can’t currently use the test. Waived-test status is expected later this year.
Here are some benefits of OnTrak TestCup:
• Rapid results may save lives.
Nearly 500,000 annual ED visits are directly linked to illicit drug abuse, according to the Department of Health and Human Services. Treatment of these patients can be positively impacted, says Freed.
"It would be most helpful in cases where we need to rule out drugs as a cause of a patient’s behavior," he says. "Cocaine in particular is associated with MIs and arrhythmias, and this would give us a heads up on whether cocaine is involved."
The device enables quick screening for cocaine in those potential cardiac cases, says Freed. "If we have a young patient with suggestive symptoms of myocardial ischemia, I think we’ll be more likely to take it seriously as a potential hospitalization if we know that cocaine is involved," he explains.
Rapid results can potentially save patients’ lives, says Bogema. "With drug tests performed in the laboratory, the result arrives back at the ED after the patient has been treated and released, so the information is not available to make treatment decisions," Bogema notes.
Getting results within minutes could also smooth the interface between the ED and acute psychiatric intervention. "If we are doing a screening evaluation for a detox center, they may not want to take a patient if there is still morphine in their system," says Freed.
• Accuracy of results.
"In my experience, it’s the most accurate of the on-site drug testing devices," says Bogema. It has very low false positive and false negative rates, he notes.
With all the devices, you have a positive or negative based on the presence of a colored line, set above and below a threshold concentration, Bogema says. "This device is very accurate in determining whether a drug is positive, which is the most difficult thing for a manufacturer to do properly," he says.
• Cost-effective testing.
Each device is disposable and can only be used once. "This would be less expensive than performing the test in the laboratory. If performed in the lab, the reagent cost would be comparable to the disposable device," notes Bogema.
• Reduction of delays.
Little drug testing currently takes place directly in the ED, notes Bogema.
"Currently, all drug tests have to be sent to the laboratory in the hospital or clinic," he says. "Just the process of collecting it, sending it, and waiting for results takes at least an hour or two hours."
If you need to wait hours or days for results, delays are increased throughout the ED.
"You are possibly extending the stay of the patient for several hours in the ED, which is analogous to somebody staying an extra day in the hospital bed," notes Bogema. "You save a significant amount of money over the course of a year by making make that space available for other patients."
OnTrak Test Cup ER reflects a growing trend toward point of care testing in the ED, predicts Freed. "We can get results without the delays of specimen transport, handling of urine samples, timing, pipetting, mixing, instrument calibration, and maintenance," he says. "Any time we can perform a test much faster than we otherwise would, it has a very beneficial effect on reducing delays overall."
Sources
OnTrak Test Cup ER can be ordered through:
• Roche Diagnostics, 1080 U.S. Highway 202, Somerville, NJ 08876-3771. Telephone: (317) 576-4755. Web site: www.roche.com.
For more information about OnTrak Test Cup ER, contact:
• Stuart Bogema, PhD, Forensic Testing, P.O. Box 196, Clifton, VA 20124. Telephone: 703) 968-7002. E-mail: [email protected]
• Howard Freed, MD, Emergency Care Center, District of Columbia General Hospital, 1900 Mass Ave. S.E., Washington, DC 20016. Telephone: (202) 675-5098. Fax: (202) 675-8053. E-mail: [email protected].
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