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As an alternative, the SDS should include a referral mechanism through which advice on treatment is available from a physician board-certified in medical toxicology.

If one is not available, advice can be obtained from a poison control center.

The specific drug responsible for intoxication may not be identified by history or drug screening.

Drug screening in the clinical setting is not comprehensive, so a negative drug screen does not exclude intoxication.

Routine urine toxicologic immunoassays have limited sensitivity, even for common drugs, and a "negative" urine drug screen should not be used to exclude drug intoxication, and a "positive" urine drug screen cannot be used to assess the extent or degree of intoxication.

For example, a typical opiate screen does not reliably identify oxycodone and hydrocodone and does not identify synthetic opioids such as fentanyl or buprenorphine, and a typical benzodiazepine screen does not reliably identify clonazepam.

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Although most hospital laboratories can readily measure serum concentrations of some common drugs in overdose, including lithium, digoxin, phenobarbital, phenytoin, and valproic acid, there are many drugs that cannot be measured in a clinically relevant time frame.

Disclaimer While individual practitioners may differ, this is the position of the College at the time written, after a review of the issue and pertinent literature.

References The position of the American College of Medical Toxicology, endorsed by the American Academy of Clinical Toxicology and the Society of Critical Care Medicine, is as follows: We agree with the American Academy of Neurology (AAN) recommendation that the clinical determination of brain death should only be made in the absence of drug intoxication or poisoning.

First aid recommendations should be intended for first responders and include specific treatment only when there is an antidote or intervention generally accepted as effective, and early administration could substantially improve outcome.

The first aid section should be developed under the supervision of a physician.

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