Antenatal urinary screening for drugs of addiction: usefulness of sideroom testing?

Based on a pilot study of 400 samples at our Antenatal Clinic (which yielded 3.5% positives when assessed for amphetamines, cannabinoids and opiates) 600 consecutive patients attending Antenatal Booking Clinic had urine samples tested in the sideroom for amphetamines, barbiturates, cocaine metabolites, methadone and opiates using the Syva EMIT ETS apparatus. Positive samples were checked in the West Midlands Regional Laboratory for Toxicology, initially by EMIT-dau on a second ETS instrument and then by thin layer and gas chromatography. Two per cent produced a total of 14 positive EMIT results. Cocaine metabolites and methandone were not detected. Four specimens could not be confirmed as positive. In one sample, amphetamine-like compounds were isolated but not identified. Positive identification was made in the remaining seven specimens (two cannabinoid, two pseudoephedrine, one pseudoephedrine plus dihydrocodeine and two dihydrocodeine). There was a serious problem of false positive results observed in the initial sideroom testing. The value of sideroom testing for drugs of abuse was assessed in relation to the technical problems and to the small rate of drug positive samples.