Introduction

Amphetamine abuse becomes an important public health and social problem in the present day. Amphetamine is classified as a stimulant narcotic drug (King GR and Ellinwood, 1997). In the recent year, amphetamine becomes a seriously spread narcotic drug in Thailand. Although the best attempt of the government to control the outbreak of amphetamine abuse the problem remains a big problem.

Presently, the problem of Illicit drugs in Thailand can be defined as the transit point for narcotics en route to the international drug market from the communities of minorities in Burma and Laos. Although there have been effective eradication of some narcotic as heroin and cannabis, the amphetamine play dominant role as the common narcotic in Thailand (Dasananjali T et al, 1999; Verachai et al 2001).

Screening for drug abuse becomes a common clinical laboratory testing in Thailand. Also, the amphetamine becomes a requirement screening for many situations as screening before applying for a job and screening before going aboard. However, here the authors raise a debate topic that if inform consent is useful or useless in urine amphetamine screening test.

Materials and Methods

Background for debate

Effectiveness analysis

Results

Interestingly, no positive urine amphetamine result was detected in the subjects with informed performance. Comparing to the data from the police department in the same period and setting, up to 5 % of positive results can be obtained in forced screenings for urine amphetamine by the police.

Discussion

Substance abuse poses both economic and social threats. From the recent previous study of Verachai et al (Verachai et al 2001), pattern of drug addicts changed from heroin to amphetamine, especially among young students in the recent years. An important factor behind the boom in amphetamines -- known as ““ya baa'‘ or ““crazy medicine'‘ -- is an efficient new smuggling route which extends from the drug factories in the minorities communities in Myanmar and Thailand to Thai ports.

It is estimated that millions of amphetamine pills flooded into Thailand per year across its long border with Myanmar and Laos. Presently this drug addiction is reaching crisis proportions, with up to a million of Thais reportedly addicted of ya baa (Soomyai, 2000). The Office of Narcotics Control Board of Thailand has announced a plan to tackle the problem at the community level to ensure they are drug-free in the near future. Screening for urine amphetamine becomes an activity according to the control program.

At present, both health care workers and police perform the screening tests for urine amphetamine. Although the target of the two performances is the same, a critical difference in the method can be detected. Since the health care workers use the principle of patient rights, therefore, informed consent comes first. Hence, it can be expected that the abusers should reject to screen. Also in case that they accept, some special preparation or specimen contamination, purposing to disguise the screening result can be expected. Unlike the screening by the police, by legal enforcement, to request forensic examination to study possible conditions of drug addiction, the subjects were forced to collect the urine specimen without previous preparation. Also strict control of urine specimen collection can be done.

According to our study, in interest, null prevalence can be observed in the subjects asked for informed consent before screening. While up to 5 % of the forced subjects can be detected the positive result for urine amphetamine. Furthermore, considering the cost effectiveness of both performances, if we accepted the cost of urine amphetamine screening test as the cost and the detection rate as the effectiveness, the cost per detection by the police was also lower.

However, as we previously mentioned at the start of this paper, this is only a debate. A few data were focused. However, comparing the rate of the positive urine amphetamine samples in King Chulalongkorn Memorial Hospital (< 1 %) to the report of Police Department (up to 5 %) (Soomyai, 2000) fewer positive cases in the first setting were detected. Therefore, the urine amphetamine screening after asking for informed consent may be less useful than forced screening. Presently, in some country (da Costa et al, 2000) it is possible to request examination without informed consent, by legal enforcement.