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Year : 2019  |  Volume : 150  |  Issue : 6  |  Page : 646-647

Critical issues in alcohol and drugs of abuse testing

Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi 110 029, India

Date of Submission23-Jul-2019
Date of Web Publication30-Jan-2020

Correspondence Address:
Raka Jain
Department of Psychiatry, National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi 110 029
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijmr.IJMR_1274_19

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How to cite this article:
Jain R. Critical issues in alcohol and drugs of abuse testing. Indian J Med Res 2019;150:646-7

How to cite this URL:
Jain R. Critical issues in alcohol and drugs of abuse testing. Indian J Med Res [serial online] 2019 [cited 2021 May 5];150:646-7. Available from:

2nd ed, A. Dasgupta, editor (Academic Press, London) 2019. 560 pages. Price: Not mentioned.

ISBN 978-0-12-815607-0

The first edition of this book was published in 2009 and thereafter, significant changes in the field of alcohol and drugs of abuse testing have occurred. These changes are reflected in this updated second edition, published in 2019. The target readers of this book are clinical pathologists, toxicologists, clinicians, psychiatrists, medical review officers and regulators. The book covers the general principles and technological advances for measuring drugs and alcohol, along with the pitfalls of drugs of abuse testing. The book also presents the genetic aspects of alcohol and alcohol biomarkers. It comprises 34 chapters written by experts in their fields. Each chapter of this edition has been updated to represent findings from the latest research:

Chapter 1 covers alcohol pharmacokinetics and toxicity. It also describes guidelines for alcohol use, the benefits of consuming alcohol in moderation and the health hazards of heavy drinking. Chapter 2 discusses the analytical methods used to detect alcohol in various matrices and factors influencing the effects of ethanol. The differences between clinical and forensic alcohol measurement have been explained. Chapter 3 gives a description of alcohol biomarkers with a discussion on the clinical issues and analytical methods. The fourth chapter addresses genetic markers related to alcohol use and abuse. This chapter also adds information on the pharmacogenetics of alcohol dependence treatment. Chapter 5 focuses on ethylene glycol and other glycols with discussion on analytical and interpretation issues. The next chapter provides a general introduction to the drugs of abuse including natural and synthetic cannabinoids, cocaine, amphetamine-type stimulants, opiates and opioids, benzodiazepines, etc.

Chapter 7 addresses the legal aspects of drug testing in US military and civil courts with discussion on scientific evidence, laboratory records and the court; expert witness in the court; key elements of laboratory operations and the legal system and case law pertaining to forensic toxicology. The issue of marijuana decriminalization and medical use, federal versus State statutes, have also been covered in this chapter. Chapter 8 includes information on pharmacogenomics of drugs of abuse. In addition, significant emphasis has been placed on metabolizing enzymes, endogenous opioid receptors and monoamine neurotransmitter system. The next chapter gives details of immunoassays designed for screening drugs of abuse along with the limitations. Chapter 10 addresses the issues of interferences with immunoassays used for screening of drugs of abuse in urine. Chapter 11 is devoted to point-of-care devices for drugs of abuse testing along with limitations and pitfalls. Details of drug of abuse screening and confirmation with lower cut-off values are provided in the next chapter. Chapter 13 provides an overview of analytical methods in drugs of abuse testing with an update on gas chromatography/mass spectrometry, liquid chromatography combined with tandem mass spectrometry and related methods. The next chapter covers high-resolution mass spectrometry used for both qualitative and quantitative analyses in clinical and forensic toxicological laboratories. This is an emerging analytical method for drug testing.

Chapter 15 addresses confirmation methods for SAMHSA (Substance Abuse and Mental Health Services Administration) drugs and other commonly abused drugs. The subsequent chapter provides a description of critical issues for testing amphetamine-type stimulants. This chapter also covers the pitfalls of immunoassay screening and mass spectrometric confirmation for amphetamines, methamphetamines and designer amphetamines. Chapter 17 focuses on cocaine and crack cocaine and their routes of administration, metabolism and toxicity. The consumption of ethanol along with cocaine, their combined toxicity, the role of coca ethylene in toxicity and analytical methods for detection are also covered in this chapter. Chapter 18 covers drug-assisted sexual assaults with a discussion on toxicology, fatality, and analytical challenge. Chapters 19-22 present an overview of the common designer drugs, new psychotropic substances, bath salts and synthetic cannabinoids in the illicit drug market followed by a detailed discussion of the pharmacology, toxicology and bio-analytical approaches of these substances.

Chapter 23 covers the application of liquid chromatography combined with high-resolution mass spectrometry (HRMS) for urine drug testing. This chapter also discusses the history and fundamentals of HRMS, types of mass analyzers and relevance of HRMS in drug testing. Forensic toxicology in death investigation has been covered in the next chapter. The chapter also covers the utility of computed tomography in investigating drug poisoning deaths, role of autopsy in drug poisoning deaths and specimen collection at autopsy. It also brings out the discussion on toxicology reports, determining the cause and manner of death along with case reports. Chapter 25 covers drug testing in pain management and adds information on the use of opioids in pain management, detection methods and analytical challenges. The next chapter entitled “How do people try to beat drugs test/effects of synthetic urine, substituted urine, diluted urine and in vitro urinary adulterants on drugs of abuse testing' gives a detailed account of urine drug testing programmes and the methods used by laboratories to counteract urine adulteration. Chapter 27 discusses the issues when a hospital report is negative in a suspected overdosed patient. The chapter also addresses the strategy of comprehensive drug screening using liquid chromatography combined with mass spectrometry. The next chapter includes new information of testing of drugs of abuse in various biological matrices such as oral fluid, sweat, hair and nail along with analytical, interpretative, and specimen adulteration issues. Chapter 29 contains advances in meconium analysis for assessment of neonatal drug exposure. Chapter 30 discusses the analytical true-positive drug tests due to the use of prescription and non-prescription medications, as in recent years, there has been a significant rise in prescription drug misuse (especially opioids and benzodiazepines).

Chapter 31 focuses on poppy seed products and opiate analysis. Consumption of poppy seed-containing foods may give true-positive results for opiate testing as poppy seeds contain both codeine and morphine. This has been discussed in detail as to how to differentiate heroin abusers from individuals consuming poppy seed-containing food. Chapter 32 covers some miscellaneous issues such as handling paper money contaminated with cocaine and other drugs, cocaine-containing herbal teas, passive exposure to marijuana and ingestion of hemp oil. The chapter also adds information on occupational exposure to controlled substances i.e., personnel working in law enforcement, crime laboratories or manufacturing plants for opioid medications get exposed to controlled substances as part of their occupation. Chapter 33 addresses abuse of magic mushroom, peyote cactus, lysergic acid diethylamide, Khat and volatiles. This chapter also includes information on their street names, pharmacology and toxicology, with discussion of their mechanism of action of active ingredients and laboratory detection. These substances have recently gained popularity among drug users. The last chapter provides a comprehensive review of performance-enhancing drugs in sports. This includes history, World Anti-Doping Agency-prohibited list, overview of the testing procedure, general testing methods, anabolic agents, erythropoiesis-stimulating agents, growth hormones, supplements and pro-hormones, and future challenges.

Overall, this book covers all aspects of alcohol and drugs of abuse testing in clinical and forensic toxicological laboratories. The content of the book bridges a gap between technical and clinical information. The book is informative and well organized. The writing is clear and concise. The goal of this book is to provide a platform to the readers to familiarize with the latest advancement in the detection of alcohol and drugs of abuse in various biological matrices. The information provided is comprehensive and is based on case reports in routine clinical practice. This multi-authored book is a valuable reference not only for clinical and forensic scientists, toxicologists, policymakers, but also for healthcare professionals who are involved in drug de-addiction programmes.


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