Similarly to the US system, testing for DOA relies on a two-tier system for screening and confirmation. The initial screening phase may be realized either on the POC format (small desktop instrument, hand-held devices, cassettes, strips, swabs) or on a laboratory platform. Confirmation analysis, if required, is typically performed in the laboratory using the gas chromatography (GC)-mass spectrometry (MS) technique, widely considered as the "gold standard." Alternative methods such as high-performance liquid chromatography (HPLC) and GC may also be employed (see Chapter 3). Currently, laboratory analysis is still the method of choice for DOA screening throughout Europe. This is unlikely to change in the near future, because laboratory assays are preferred as a result of their standardized quality control and high-throughput capabilities. High levels of sensitivity and specificity and low costs are also important determining factors. Despite these advantages, laboratory operation often requires skilled technicians, whereby the delivery of results takes days rather than minutes, in stark contrast with the convenience of disposable or re-usable POC tests (11). Singleparameter, multi-parameter, and customized panels, on both the laboratory and POC formats, may be easily procured either through a known supplier or via the
Internet. Multi-panel POC assays are often preferred, since they give a more complete profile of a person's recent drug-consumption tendencies. Methadone clinics, on the other hand, may choose a more specific and cheaper test detecting only the consumption of heroin.
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