Diagnosis

The use of amphetamine or cocaine can be detected by drug screening of a plain urine sample. Laboratory testing is the usual option, while instant testing kits of high specificity and sensitivity are also available. The importance of urine testing as a relatively simple procedure to employ, in any setting, in cases where drug use is suspected must be emphasized, as it is surprisingly often neglected. A limitation of this method, however, is that most drugs of misuse only remain detectable in urine for a few days at maximum, and with cocaine this may be as little as 24 h. In contrast, most drugs stay in the hair for as long as that is present. Although this method of hair analysis has the advantage that drug use may be detected over the period during which hair has grown, it has not been incorporated into routine clinical practice.(4)

Clearly self-reports of drug use are often reliable, especially when it is known that they are to be backed up by testing, but a history may be unavailable in, for example, psychotic states. Testing is therefore indicated, although there may be particular problems of compliance. Where a positive result is obtained in a patient with a psychiatric condition, it is important to realize that drug use may be incidental rather than necessarily causative. (5)

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