Improving the diagnosis and clinical outcomes on drug addict patients through quantitative spectrometer testing.

Background
The drug addict patients adapt their drug use according to the new illicit black market offer, leading to multi drug addiction to a mixture of illicit drugs and licit psychotropic substances. As a result, patients manifest cognitive decline, neurological impairment and polymorphic psychiatric manifestations (hallucinations, psychotic behavior, anxiety, sleep disorders, depression, violence, suicide attempts).  
Quantitative testing using the spectrometer revealed the severity of the intoxication because only few of the abuse drugs samples are pure. They are using mixtures of different substances and those are inducing cumulative devastating effects on brain and the other major organ functions. 
Method: 
Observational retrospective study based on laboratory testing corelated with psychiatric exam, on consenting patients (n=270) in substitution treatment with methadone, that shows poor clinical outcomes and worsen psychiatric symptoms on the last year of monitorization.
Results
A total of 300 urine samples were analysed by LC mass spectrometry for the study purposes. The main substances found besides methadone, were   opioids, cocaine, amphetamines, cannabinoids, cathinone, benzodiazepines, barbiturate, hypnotics a.o. Most of the patients were positive at 7 to 38 substances. They are polydrug users and the findings were directly corelated to clinical status, present symptoms on the moment of samples collection and the psychiatric diagnosis. Qualitative methods were used to find out the professionals’ opinion.
Conclusions
The  patients  included in study confronts with polydrug abuse of mixture of substances, expressing worsening of the initial psychiatric condition, added neurological impairment and cognitive decline.
The classic methadone substitution treatment has poor results in these cases and medium to long term hospitalization on psychiatric and neurology wards becomes a necessity. Laboratory spectrometer tests are required to identify the substances of abuse used, in order to avoid overlapping and adverse reactions with psychiatric medication they take as daily treatment.
 
New methods of complex and integrated treatment and investigations are necessary to be used-cerebral magnetic stimulation, psychedelic therapy, physical therapy, long term community therapy.  The use of functional MRI might be necessary to detect brain injuries in early stages and preserve brain function. Using only combinations of psychiatric medication without a neurologic exam and neurologic associated treatment may leads to poor clinical outcomes. Future longitudinal and prospective studies will be developed for a better view of the phenomena.