Clinical toxicology is a discipline within toxicology that is concerned with the impact of drugs and other chemicals on humans. The role of the clinical toxicologist encompasses the traditional therapeutic role, that is the management of patients with acute and chronic poisoning. In addition, the clinical toxicologist will usually provide expert advice via a poison information service and will be familiar with the occupational and environmental impact of a wide range of chemicals.
The Toxtyper solution was developed to meet the needs of forensic and clinical research labs. Toxtyper is the most robust productive and easy-to-use LCMS seeing solution for toxicology. The Toxtyper can perform screening, confirmation, and semiquantitative in one run at part per billion sensitivity beyond what conventional GCMS screening solutions can offer. This means it is possible to detect the targeted substances and its metabolites in a wide range of biological matrices at concentrations down to low Nanograms/milliliters.
Indian statistics for Drug of abuse
The Ministry of Social Justice and Empowerment, Government of India, has published a report titled, Magnitude of Substance Use in India, 2019. The key finding of the survey is that there are major variations in different states in the extent and prevalence of the use of psychoactive substances. The prevalence of alcohol use is 4.6%, with the male: female ratio being 17:1, followed by cannabis at 2.8% and opioids at 2.1%. Coming to harmful and dependent use, 19% of alcohol users use it in a dependent pattern, whereas 0.25% of cannabis users use it in the dependent pattern.
Detection of drugs of abuse in urine using the Bruker Toxtyper™: Experiences in a routine clinical laboratory setting
Urine screening can be used to detect misuse of illicit drugs and validate opioid replacement therapy compliance. It is common that immunochemical assays are combined with GC-MS for these applications. Bruker has recently released an ion trap mass spectrometer, called Toxtyper™, with the potential to replace current screening algorithms to detect drug misuse. The lower limits of detection and identification for acetylcodeine, amphetamine, benzoylecgonine, methadone, and nordiazepam was below the common cut-offs for immunological screening assays and comparable to GC-MS. Imprecision and accuracy, both within- and between-series, were consistently <25%. Toxtyper screening for pregabalin and sufentanil was less sensitive than a targeted LC-MS/MS assay. Concordance met the predefined criterion of >90% for all drugs, except for pregabalin. Cannabis misuse could not be detected due to the limited sensitivity of the Toxtyper assay protocols used and the inherent imprecision of the assay.
The typical toxicology approach includes two analytical steps: a first screening step, performed with broad-spectrum, sensitive, rapid, and low-cost techniques, aimed at avoiding “false negative” results, followed by more specific and quantitative analyses, although more complex, time-consuming and expensive, aimed at excluding “false positives”.
Today's forensic toxicology and clinical research labs are challenged by demands for fast and accurate results, along with lab efficiency and cost reduction. Further pressure results from the continuous emergence of new drugs into the market, requiring frequent updates of sample screening methods.
The detection of drugs ingested by humans by analyzing for their presence is now one of the imperative techniques in the field of forensic toxicology. The number of drug-facilitated crimes in India has increased significantly over the last few years. According to the National Crime Record Bureau (NCRB), India, a large number of drug abuse cases have been registered under the Narcotic Drugs and Psychotropic Substances (NDPS) Act over the last few years and the ones pertaining to the abuse of opium derivatives contribute the highest percentage of such cases.
Screening for toxic substances is now routine in most emergency departments. However, healthcare workers need to know that in many cases, the results of a toxicology screen are not immediately available, and clinical acumen is required. Toxicological screens take place for various reasons, including a forensic investigation, use of illicit drugs, and drug overdose. The use of toxicological screening can help to guide acute management or chronic treatment.