Toxicological Evaluation of Emerging One-Step Urinary Multi-Drug Test Panels for Detecting Substance Abuse among Apparently Healthy Prospective Blood Donors: A Systematic Review
Jacques Forwah Ndeh *
Department of Hematology and Blood Transfusion Sciences, Faculty of Clinical Sciences, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.
Ofonime Benjamin Essien
Department of Hematology and Blood Transfusion Sciences, Faculty of Clinical Sciences, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.
Edung Emen Samuel
Emergency Department, Basildon and Thurock University Hospital London NHS Trust Foundation, United Kingdom.
Oghenerukevwe Anthony Ovadje
Department of Family Medicine, University of Port Harcourt, Asaba Specialist Hospital, Asaba, Nigeria.
Catherine Samuel Edung
Department of Clinical Microbiology, Cerba Lamcet Africa Lagos, Lagos State, Nigeria.
Benjamin Maji Faith
Department of General Medicine, Abuja, Nigeria.
Uwem Akpan Uko
Department of Acute Medicine, Northwick Park Hospital, London, United Kingdom.
Nathan Ehizeme Ehioghae
Department of General Medicine, Zitadel Medicals and Diagnostics, Abuja, Nigeria.
Etieno Isong-Asuquo
Department of General Surgery, Cedar Park Healthcare Telford, United Kingdom.
Kelechi Chukwuemeka Nwaozuzu
Department of Medicine, St joseph Catholic Hospital, Asaba, Delta State, Nigeria.
Eberechukwu Emmaculata Oyere
Department of Surgery, Spencer Private Hosital, Queen Elizabeth Queen Mother, Kent, United Kingdom.
Bukunade P Adenusi
Department of Psychiatry, Lancashire South Cumbria, NHS Foundation Trust (LSCFT), Preston, United Kingdom.
Ogochukwu Chinwoke Etoniru
Psychiatry Priory Hospital, Barnt Green Birmingham, United Kingdom.
Theresa Chukwuwa
Department of Occupational Medicine, International SOS, Port-Harcourt, River State, Nigeria.
O. Nwankwo Chukwudubem
Department of General Practice, Doncaster and Bassetlaw Teaching Hospital, Doncaster, UK.
Kelechi Nkemakolam Ezeigbo
Department of General Medicine, Trinity Specialist Hospital, Aba, Abia State, Nigeria.
Abdulraheem Olayinka
Department of Family Medicine, Federal Teaching Hospital, Birnin Kebbi State, Nigeria.
Ejike Emmanuel Ogbodo
Department of Public Health, Glasgow Caledonian University London, United King.
Oke Opeoluwa Oluwaseun
General Outpatient Department, Lagos State University Teaching Hospital, Ikeja, Lagos State, Nigeria.
Ekpe Okpala Aribo
Department of Physiology, University of Calabar, Calabar, Cross Rivers State, Nigeria.
Ofor Joshua Obase-Otumoyi
Department of Public Health, National Open University, Lagos State, Nigeria.
Idiege Idiege Omang
Department of Surgery, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.
Immaculate Ihuoma Ekeagba
Worcaccce Union Group Integrated Healthcare Sciences, Technological Development and Training and Innovative Research Foundation (WUGIHSTTAIRF), P.O Box 45 Bamenda, North West Region, Cameroon.
O. Kingsley Akabat
Department of Hematology and Blood Transfusion Sciences, Faculty of Clinical Sciences, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.
Abeshi Sylvester Etenikang
Department of Obstetrics and Gynecology, University of Calabar Teaching Hospital, Calabar, Cross River State, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
Background: Blood safety is threatened by prospective donors under the influence of psychoactive substances such as opioids, cannabinoids, and amphetamines. These substances can go undetected during routine donor screening, posing a risk to blood supplies worldwide. Urinary multi-drug test kits offer rapid screening, but their effectiveness and reliability require evaluation.
Aim: To evaluate the toxicological performance and operational impact of urinary multi-drug screens for detecting substance use in blood donors.
Methods: A literature review was conducted of studies evaluating urinary multi-drug test kits for detecting substance use among prospective blood donors. Searches included PubMed, Scopus, Google Scholar, and other databases. A total of 466 articles (77.7%) were retrieved out of 600 articles (100%) screened. The search terms used as in the text were: "urinary multi-drug test kits", "blood donor screening", "substance abuse detection", "psychoactive substances", "donor safety", and "toxicology testing". The systematic review triangulated manufacturer inserts, WHO/FDA guidance, and forensic toxicology literature (2020–2026).
Results: Test panels showed high sensitivity (>90%) for classical drugs, but specificity was lower (75–88%) due to cross-reactivity and designer drug analogs. Fentanyl analogs and xylazine were frequently undetected. Cut-off values designed for workplace testing misclassified passive tetrahydrocannabinol(THC) exposure. Urine adulteration occurred in ∼5–12% of unsupervised collections. Confirmatory LC-MS/MS testing was required for positive screens, increasing operational costs by ∼2.5-fold.
Main Findings: Emerging urinary multi-drug test kits require careful evaluation and validation before implementation. Unmodified workplace panels are unsuitable for donor screening without confirmatory testing and updated antibodies targeting newer substances.
Conclusion: These kits can be a useful adjunct but have important limitations and biases. When embedded in ethical, consent-driven pathways, multi-drug panels may deter high-risk donations; otherwise, they risk undermining donor trust and analytical validity.
Keywords: Blood donor screening, multi-drug urine test panel, toxicology, cross-reactivity, transfusion safety and quality.