Changes in the pattern of drugs detected in a toxicology screen in an Upstate New York Hospital.

We analyzed the results from our clinical toxicology service over two consecutive 24-month periods from 1980 to 1983. The frequencies of drug or drugs detected, tabulated by patient and type of specimen submitted to the laboratory were studied. A toxicology screen or the identification of one drug was requested on 3328 patients in the 48 months of the study. Alcohol was the most frequently requested test--1221 requests in 1980 to 1981, and 627 in 1982 to 1983. Seventy-five percent of these requests were positive. Ethanol, in fact, accounted for 53 percent of all drugs detected in all specimens received. There were 989 requests for a drug screen (530 in 1980 to 1981, and 459 in 1982 to 1983) for which 1734 serum, urine, or gastric specimens were received. Serum or serum and urine were the most frequently submitted specimens. Gastric contents with or without a urine sample were sent least often. After alcohol, the most frequently detected drug classification was analgesic/antipyretic. The most dramatic change in prevalence was seen in over-the-counter stimulants which accounted for almost 11 percent of all drugs in 1982 to 1983, an increase from only 4 percent in 1980 to 1981. More than one drug per patient was found in 24 percent of the requests in 1982 to 1983; an increase from 18 percent in 1980 to 1981. We identified 81 different drug combinations in 1982 to 1983, up from 71 combinations in the first half of the study. Toxicology data may have significantly affected immediate therapy--either through the administration of an antidote or by initiation of aggressive intervention--in 7 percent of the patients whose specimens were analyzed in our laboratory. The laboratory technologist and the clinician should be cognizant of changing patterns of drug use to increase and maintain their effectiveness in the detection or treatment of drug intoxication. We have demonstrated that changes did occur in our facility over a 4-year period, and also when our data were compared to previous reports. Retrospective studies of this type are essential to meet those objectives.