Patients in medical treatment for attention deficit/hyperactivity disorder (ADHD): Are they at risk in drug screening?

Research output: Contribution to journalLetterResearchpeer-review

39 Downloads (Pure)

Abstract

The use of medicines to treat attention deficit/hyperactivity disorder (ADHD) has increased worldwide, including the use of amphetamine-based medicines or prodrugs that metabolise to amphetamine in vivo. At the same time, drugs-of-abuse testing by non-specific, point-of-care immunoassay methods ('quick tests') has increased. This article discusses the risk of 'false positive' results or post-analytical misinterpretations of results when immunoassays are used to analyse biological samples from ADHD patients. A rapid evidence review was conducted to identify studies that have focused on the risk of 'false positive' test results in immunoassay testing of patients treated with atomoxetine, bupropion, clonidine, guanfacine, methylphenidate, and modafinil. There is only evidence to suggest that bupropion should cause 'false positive' immunoassay results. However, there is a lack of systematic, updated evaluations and validations of cross-reactivity patterns for immunoassays in the literature. Advanced laboratory methods can distinguish the use of medicines from illicit amphetamine by stereospecific analysis of dextro- and levoamphetamine; however, these analytical services are not commonly available for routine drug testing. The present situation calls for more awareness, proper education and information on these critical ethical issues in drug testing, both for clinicians, other healthcare professionals involved in drug testing and for patients in medical treatment for ADHD. The pitfalls of immunoassays due to cross-reactivity and insufficient specificity/sensitivity can have serious negative consequences for patients safety with regard to incorrect laboratory drug-testing results. Consequently, confirmatory laboratory analysis should always be performed for 'presumptive' positive immunoassay screening results.

Original languageEnglish
JournalA D H D - Attention Deficit and Hyperactivity Disorders
Volume11
Issue number3
Pages (from-to)333-340
Number of pages8
ISSN1866-6116
DOIs
Publication statusPublished - Sep 2019

Fingerprint

Preclinical Drug Evaluations
Attention Deficit Disorder with Hyperactivity
Immunoassay
Amphetamine
Bupropion
Pharmaceutical Preparations
Therapeutics
Substance Abuse Detection
Guanfacine
Point-of-Care Systems
Methylphenidate
Prothrombin Time
Prodrugs
Clonidine
Street Drugs
Patient Safety
Ethics
Delivery of Health Care
Education
Sensitivity and Specificity

Keywords

  • Attention deficit/hyperactivity disorder
  • Drug testing
  • False positive
  • Immunoassay
  • Public health ethics

Cite this

@article{c8f232cf667947ce83052c6bec7bde6f,
title = "Patients in medical treatment for attention deficit/hyperactivity disorder (ADHD): Are they at risk in drug screening?",
abstract = "The use of medicines to treat attention deficit/hyperactivity disorder (ADHD) has increased worldwide, including the use of amphetamine-based medicines or prodrugs that metabolise to amphetamine in vivo. At the same time, drugs-of-abuse testing by non-specific, point-of-care immunoassay methods ('quick tests') has increased. This article discusses the risk of 'false positive' results or post-analytical misinterpretations of results when immunoassays are used to analyse biological samples from ADHD patients. A rapid evidence review was conducted to identify studies that have focused on the risk of 'false positive' test results in immunoassay testing of patients treated with atomoxetine, bupropion, clonidine, guanfacine, methylphenidate, and modafinil. There is only evidence to suggest that bupropion should cause 'false positive' immunoassay results. However, there is a lack of systematic, updated evaluations and validations of cross-reactivity patterns for immunoassays in the literature. Advanced laboratory methods can distinguish the use of medicines from illicit amphetamine by stereospecific analysis of dextro- and levoamphetamine; however, these analytical services are not commonly available for routine drug testing. The present situation calls for more awareness, proper education and information on these critical ethical issues in drug testing, both for clinicians, other healthcare professionals involved in drug testing and for patients in medical treatment for ADHD. The pitfalls of immunoassays due to cross-reactivity and insufficient specificity/sensitivity can have serious negative consequences for patients safety with regard to incorrect laboratory drug-testing results. Consequently, confirmatory laboratory analysis should always be performed for 'presumptive' positive immunoassay screening results.",
keywords = "Attention deficit/hyperactivity disorder, Drug testing, False positive, Immunoassay, Public health ethics",
author = "Jensen, {Christina Mohr} and Torben Breindahl",
year = "2019",
month = "9",
doi = "10.1007/s12402-018-0282-9",
language = "English",
volume = "11",
pages = "333--340",
journal = "A D H D - Attention Deficit and Hyperactivity Disorders",
issn = "1866-6116",
publisher = "Springer",
number = "3",

}

TY - JOUR

T1 - Patients in medical treatment for attention deficit/hyperactivity disorder (ADHD)

T2 - Are they at risk in drug screening?

AU - Jensen, Christina Mohr

AU - Breindahl, Torben

PY - 2019/9

Y1 - 2019/9

N2 - The use of medicines to treat attention deficit/hyperactivity disorder (ADHD) has increased worldwide, including the use of amphetamine-based medicines or prodrugs that metabolise to amphetamine in vivo. At the same time, drugs-of-abuse testing by non-specific, point-of-care immunoassay methods ('quick tests') has increased. This article discusses the risk of 'false positive' results or post-analytical misinterpretations of results when immunoassays are used to analyse biological samples from ADHD patients. A rapid evidence review was conducted to identify studies that have focused on the risk of 'false positive' test results in immunoassay testing of patients treated with atomoxetine, bupropion, clonidine, guanfacine, methylphenidate, and modafinil. There is only evidence to suggest that bupropion should cause 'false positive' immunoassay results. However, there is a lack of systematic, updated evaluations and validations of cross-reactivity patterns for immunoassays in the literature. Advanced laboratory methods can distinguish the use of medicines from illicit amphetamine by stereospecific analysis of dextro- and levoamphetamine; however, these analytical services are not commonly available for routine drug testing. The present situation calls for more awareness, proper education and information on these critical ethical issues in drug testing, both for clinicians, other healthcare professionals involved in drug testing and for patients in medical treatment for ADHD. The pitfalls of immunoassays due to cross-reactivity and insufficient specificity/sensitivity can have serious negative consequences for patients safety with regard to incorrect laboratory drug-testing results. Consequently, confirmatory laboratory analysis should always be performed for 'presumptive' positive immunoassay screening results.

AB - The use of medicines to treat attention deficit/hyperactivity disorder (ADHD) has increased worldwide, including the use of amphetamine-based medicines or prodrugs that metabolise to amphetamine in vivo. At the same time, drugs-of-abuse testing by non-specific, point-of-care immunoassay methods ('quick tests') has increased. This article discusses the risk of 'false positive' results or post-analytical misinterpretations of results when immunoassays are used to analyse biological samples from ADHD patients. A rapid evidence review was conducted to identify studies that have focused on the risk of 'false positive' test results in immunoassay testing of patients treated with atomoxetine, bupropion, clonidine, guanfacine, methylphenidate, and modafinil. There is only evidence to suggest that bupropion should cause 'false positive' immunoassay results. However, there is a lack of systematic, updated evaluations and validations of cross-reactivity patterns for immunoassays in the literature. Advanced laboratory methods can distinguish the use of medicines from illicit amphetamine by stereospecific analysis of dextro- and levoamphetamine; however, these analytical services are not commonly available for routine drug testing. The present situation calls for more awareness, proper education and information on these critical ethical issues in drug testing, both for clinicians, other healthcare professionals involved in drug testing and for patients in medical treatment for ADHD. The pitfalls of immunoassays due to cross-reactivity and insufficient specificity/sensitivity can have serious negative consequences for patients safety with regard to incorrect laboratory drug-testing results. Consequently, confirmatory laboratory analysis should always be performed for 'presumptive' positive immunoassay screening results.

KW - Attention deficit/hyperactivity disorder

KW - Drug testing

KW - False positive

KW - Immunoassay

KW - Public health ethics

UR - http://www.scopus.com/inward/record.url?scp=85058105047&partnerID=8YFLogxK

U2 - 10.1007/s12402-018-0282-9

DO - 10.1007/s12402-018-0282-9

M3 - Letter

C2 - 30536198

VL - 11

SP - 333

EP - 340

JO - A D H D - Attention Deficit and Hyperactivity Disorders

JF - A D H D - Attention Deficit and Hyperactivity Disorders

SN - 1866-6116

IS - 3

ER -