Skip to main content Accessibility help

Testing for illicit drug use in mental health services

  • Abu Abraham and Jason Luty


Testing for illicit drug use is used in pre-employment checks, the criminal justice system, sports medicine and for screening and confirmatory purposes in patients with physical and mental illnesses. The types of drugs tested for and the methods used vary depending on the indication. This article focuses primarily on blood, urine and oral fluids, which are specimens more commonly used in mental health settings, although hair and sweat are increasingly used in medico-legal cases and in child protection issues. The main drugs and their metabolism are discussed to gain a better understanding of the methods used and for accurate interpretation. Methods to ensure validity during sample collection are explored. False-positive and false-negative tests are common and possible confounders are discussed.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Testing for illicit drug use in mental health services
      Available formats

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Testing for illicit drug use in mental health services
      Available formats

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Testing for illicit drug use in mental health services
      Available formats


Corresponding author

Dr Abu Abraham, ST5 in General Adult Psychiatry, South Essex Partnership NHS Foundation Trust, Mental Health Unit, Basildon Hospital, Basildon SS16 5NL, UK. Email:


Hide All

Declaration of Interest




Hide All
Armbruster, DA, Schwarzhoff, RH, Hubster, EC et al (1993) Enzyme immunoassay, kinetic microparticle immunoassay, radioimmunoassay, and fluorescence polarization immunoassay compared for drugs-of-abuse screening. Clinical Chemistry 39: 2137–46.
Baden, LR, Horowitz, G, Jacoby, H et al (2001) Quinolones and false-positive urine screening for opiates by immunoassay technology. JAMA 286: 3115–9.
Borrey, D, Meyer, E, Duchateau, L et al (2003) Longitudinal study on the prevalence of benzodiazepine misuse in a prison: importance of analytical strategy. Addiction 98: 1427–32.
Casavant, MJ (2002) Urine drug screening in adolescents. Pediatric Clinics of North America 49: 317–27.
Cody, JT (2002) Precursor medications as a source of methamphetamine and/or amphetamine positive drug testing results. Journal of Occupational and Environmental Medicine 44: 435–8.
Cone, EJ, Dickerson, S, Paul, BD et al (1993) Forensic drug testing for opiates. V. Urine testing for heroin, morphine, and codeine with commercial opiate immunoassays. Journal of Analytical Toxicology 17: 156–64.
Crome, IB, Bloor, R, Thom, B (2006) Screening for illicit drug use in psychiatric hospitals: whose job is it? Advances in Psychiatric Treatment 12: 375–83.
Daher, R, Haidar, JH, Al-Amin, H (2002) Rifampin interference with opiate immunoassays. Clinical Chemistry 48: 203–4.
De Giorgio, F, Rossi, SS, Rainio, J et al (2004) Cocaine found in a child's hair due to environmental exposure? International Journal of Legal Medicine 118: 310–2.
Department of Health (2007) Drug Misuse and Dependence: UK Guidelines on Clinical Management. Department of Health (
Dolan, K, Rouen, D, Kimber, J (2004) An overview of the use of urine, hair, sweat and saliva to detect drug use. Drug Alcohol Review 23: 213–7.
Drummond, C, Ghodse, H (1999) Use of investigations in the diagnosis and management of alcohol use disorders. Advances in Psychiatric Treatment 5: 366–75.
Elkader, A, Sproule, B (2005) Buprenorphine: clinical pharmacokinetics in the treatment of opioid dependence. Clinical Pharmacokinetics 44: 661–80.
Elliott, S, Burgess, V (2006) Investigative implications of the instability and metabolism of mebeverine. Journal of Analytical Toxicology 30: 91–7.
Eskridge, KD, Guthrie, SK (1997) Clinical issues associated with urine testing of substances of abuse. Pharmacotherapy 11: 491510.
Fitzgerald, RL, Herold, DA (1997) Improved CEDIA benzodiazepine assay eliminates sertraline cross reactivity. Journal of Analytical Toxicology 21: 32–5.
Fraser, AD, Howell, P (1998) Oxaprozin cross-reactivity in three commercial immunoassays for benzodiazepines in urine. Journal of Analytical Toxicology 22: 50–4.
Garcia Callejo, FJ, Velert Vila, MM, Costa, I et al (1998) Unusual analytical interference caused by benzathine penicillin G. Acta Otorrinolaringológica Española 49: 671–2.
Garretty, DJ, Wolff, K, Hay, AW et al (1997) Benzodiazepine misuse by drug addicts. Annals of Clinical Biochemistry 34 (pt 1): 6873.
Gilbert, RB, Peng, PI, Wong, D (1995) A labetalol metabolite with analytical characteristics resembling amphetamines. Journal of Analytical Toxicology 19: 84–6.
Home Office (2006) Drug Misuse Declared: Findings from the 2005/06 British Crime Survey. England and Wales. Home Office.
Hsu, J, Liu, C, Liu, CP et al (2003) Performance characteristics of selected immunoassays for preliminary test of 3,4-memylene-dioxymetluimphetamine, methamphetamine, and related drugs in urine specimens. Journal of Analytical Toxicology 27: 471–8.
Jaffee, WB, Trucco, E, Levy, S et al (2007) Is this urine really negative? A systematic review of tampering methods in urine drug screening and testing. Journal of Substance Abuse Treatment 33: 3342.
Joseph, R, Dickenson, S, Willis, R et al (1995) Interference by nonsteroidal anti-inflammatory drugs in EMIT and TDx assays for drugs of abuse. Journal of Analytical Toxicology 19: 13–7.
Jufer, R, Walsh, S L., Cone, E J et al (2006) Effect of repeated cocaine administration on detection times in oral fluid and urine. Journal of Analytical Toxicology 30: 458–62.
Kim, I, Barnes, AJ, Oyler, JM et al (2002) Plasma and oral fluid pharmacokinetics and pharmacodynamics after oral codeine administration. Clinical Chemistry 48: 1486–96.
la Porte, CJ, Droste, JA, Burger, DM (2006) False-positive results in urine drug screening in healthy volunteers participating in phase 1 studies with efavirenz and rifampin [letter]. Therapeutic Drug Monitoring 28: 286.
Laloup, M, Ramirez Fernandez, MD, Wood, M et al (2007) Detection of diazepam in urine, hair and preserved oral fluid samples with LC-MS-MS after single and repeated administration of Myolastan and Valium. Analytical and Bioanalytical Chemistry 388: 1545–56.
Lancelin, F, Kraoul, L, Flatischler, N et al (2005) False-positive results in the detection of methadone in urines of patients treated with psychotropic substances. Clinical Chemistry 51: 2176–7.
Lichtenwalner, MR, Mencken, T, Tully, R et al (1998) False-positive immunochemical screen for methadone attributable to metabolites of verapamil. Clinical Chemistry 44: 1039–41.
Manzi, S, Law, T, Shannon, MW (2002) Methylphenidate produces a false-positive urine amphetamine screen. Pediatric Emergency Care 18: 401.
Mazor, SS, Mycyk, MB, Wills, BK et al (2006) Coca tea consumption causes positive urine cocaine assay. European Journal of Emergency Medicine 13: 340–1.
Merigian, KS, Browning, R, Kellerman, A (1993) Doxepin causing false-positive urine test for amphetamine. Annals of Emergency Medicine 22: 1370.
Nice, A, Maturen, A (1989) False-positive urine amphetamine screen with ritodrine. Clinical Chemistry 35: 1542–3.
Niedbala, RS, Kardos, KW, Fritch, DF et al (2001) Detection of marijuana use by oral fluid and urine analysis following single-dose administration of smoked and oral marijuana. Journal of Analytical Toxicology 25: 289303.
Niedbala, S, Kardos, K, Salamone, S et al (2004) Passive cannabis smoke exposure and oral fluid testing. Journal of Analytical Toxicology 28: 546–52.
Olsen, KM, Gulliksen, M, Christophersen, AS (1992) Metabolites of chlorpromazine and brompheniramine may cause false-positive urine amphetamine results with monoclonal EMIT d.a.u. immunoassay. Clinical Chemistry 38: 611–2.
Parliamentary Office of Science and Technology (2004) Postnote. Drug Tests. September 2004, Number 228. Parliamentary Office of Science and Technology (
Peace, MR, Tarnai, LD (2002) Performance evaluation of three on-site adulterant detection devices for urine specimens. Journal of Analytical Toxicology 26: 464–70.
Pehrsson, A, Gunnar, T, Engblom, C et al (2008) Roadside oral fluid testing: comparison of the results of drugwipe 5 and drugwipe benzodiazepines on-site tests with laboratory confirmation results of oral fluid and whole blood. Forensic Science International 175: 140–8.
Perez-Reyes, M, Di Guiseppi, S, Mason, AP et al (1983) Passive inhalation of marihuana smoke and urinary excretion of cannabinoids. Clinical Pharmacology and Therapeutics 34: 3641.
Poklis, A, Hall, KV, Still, J et al (1991) Ranitidine interference with the monoclonal EMIT d.a.u. amphetamine/methamphetamine immunoassay. Journal of Analytical Toxicology 15: 101–3.
Poklis, A, Moore, KA (1995) Response of EMIT amphetamine immunoassays to urinary desoxyephedrine following Vicks inhaler use. Therapeutic Drug Monitoring 17: 8994.
Politi, L, Zucchella, A, Morini, L et al (2007) Markers of chronic alcohol use in hair. Comparison of ethyl glucuronide and cocaethylene in cocaine users. Forensic Science International 172: 23–7.
Purdue Pharma, LP (2009) OxyContin Package Insert. Purdue Pharma LP (
Reisfield, GM, Haddad, J, Wilson, GR et al (2008) Failure of amoxicillin to produce false-positive urine screens for cocaine metabolite. Journal of Analytical Toxicology 32: 315–8.
Roberge, RJ, Luellen, JR, Reed, S (2001) False-positive amphetamine screen following a trazodone overdose. Journal of Toxicology: Clinical Toxicology 39: 181–2.
Rollins, DE, Jennison, TA, Jones, G (1990) Investigation of interference by nonsteroidal anti-inflammatory drugs in urine tests for abused drugs. Clinical Chemistry 36: 602–6.
Romberg, RW, Needleman, SB, Snyder, JJ et al (1995) Methamphetamine and amphetamine derived from the metabolism of selegiline. Journal of Forensic Sciences 40: 1100–2.
Saxon, AJ, Calsyn, DA, Haver, VM et al (1988) Clinical evaluation and use of urine screening for drug abuse. Western Journal of Medicine 149: 296303.
Steinagle, GC, Upfal, M (1999) Concentration of marijuana metabolites in the urine after ingestion of hemp seed tea. Journal of Occupational and Environmental Medicine 41: 510–3.
Stout, PR, Klette, KL, Horn, CK (2004) Evaluation of ephedrine, pseudoephedrine and phenylpropanolamine concentrations in human urine samples and a comparison of the specificity of DRI amphetamines and Abuscreen online (KIMS) amphetamines screening immunoassays. Journal of Forensic Sciences 49: 160–4.
United States Department of Transportation (2009) Urine Specimen Collection Guidelines for the US Department of Transportation Workplace Drug Testing Programs (revised). Office of Drug and Alcohol Policy and Compliance (
Wang, G, Vincent, M, Rodrigues, W et al (2007) Development and GC–MS validation of a highly sensitive recombinant G6PDH-based homogeneous immunoassay for the detection of buprenorphine and norbuprenorphine in urine. Journal of Analytical Toxicology 31: 377–82.
Warner, A (1989) Interference of common household chemicals inimmunoassay methods for drugs of abuse. Clinical Chemistry 35: 648–51.
Weintraub, D, Linder, MW (2000) Amphetamine positive toxicology screen secondary to bupropion. Depression and Anxiety 12: 53–4.
Workplace Drug Testing Forum (2001) United Kingdom Laboratory Guidelines for Legally Defensible Workplace Drug Testing: Urine Drug Testing. Version 1.0. WDT Forum (
Wyeth (2009) Protonix: Full Prescribing Information. Wyeth (


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Testing for illicit drug use in mental health services

  • Abu Abraham and Jason Luty
Submit a response


But what of designer drugs?

Michael C F Smith, Forensic Psychiatrist
11 November 2010

Abraham and Luty provide a useful overview of illicit drug testing inclinical practice.

I had hoped the article might have tackled the more thorny issue of designer drugs. Our team is increasingly involved in cases of designer drug misuse resulting in complex management problems.

At present there is no way of testing for designer drugs on the ward which means tests have to be sent to one of a handful of national testing centers. Conventional drug testing involves immunoassay testing of urine,but to accurately identify designer drugs requires the use of mass spectrometry. This means that results take an average of two months before they become available. We find it very difficult to make use of such old data as all too often it is no longer relevant.

This problem is not likely to be resolved in the near future due to the nature of the ever evolving designer drug industry. In view of this we need to rethink our traditional approach to drug testing and monitoring.
... More

Conflict of interest: None Declared

Write a reply


Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *