Addiction (1993) 88, 1291-1292

Letters to the Editor

The editor welcomes all letters whether they are short case reports, preliminary reports of research, discussion

or comments on papers published in the journal. Authors should follow the same guidelines given for the

preparation and submission of articles on the inside back cover of each issue.

Hair analysis for monitoring drug useSIR— I agree with Strang et al. (1993) that hairanalysis "should not be considered as being incompetition with urine analysis [but] rather as anadjunct to obtain information concerning pat-terns of drug use". However, the suggestion that"it is difficult to envisage how hair analysis mightbecome incorporated into routine clinical prac-tice at present" does not bear much examination.The Stapleford Centre has been using hair anal-ysis for three years as the increasinglypredominant method for monitoring unpre-scribed drug use in both patients on methadonetreatment and supposedly drug-free (or at anyrate opiate-free) patients taking naltrexone fol-lowing opiate detoxification. We have found it tohave a number of practical advantages whichshould commend it to anyone working in thisfield, especially in Britain where patients gener-ally attend methadone clinics weekly orfortnightly (rather than daily as in the US) andrandom, unpredictable urine sampling is there-fore difficult or impossible.

First, it removed the indignities inherent inproperly supervised urine testing and eliminatesthe slight risk of infection from samples. Second,hair can easily be collected during an ordinaryconsultation and patients cannot refuse withouttheir motives being questioned. Third, there isno need for special storage or transport arrange-ments and specimens can be easily and cheaplymailed in an ordinary envelope.

However, perhaps the greatest advantage of

hair testing is the way in which it can change therelationship between patient and clinic staff(Brewer, 1992). In our experience, patientsbelieve—not altogether incorrectly in principle—that hair testing is all-seeing and evasion-proof.The belief that they cannot use unprescribeddrugs without the fact being discovered makesthem much more willing to admit such usageand the unique ability of hair testing to quantify,even roughly, the level of use of a particular drugmeans that the results can be used in negotia-tions with the patient. Stitzer et al. (1986) haveshown that making privileges, such as increasingthe number of take-home days, contingent onclean urines is one of the best incentives tominimizing illicit drug use in methadone pro-grammes. Hair testing greatly strengthens thisnegotiating position and increases the deterrenteffect of testing.

By the ability to identify patients in stablemaintenance programmes with zero or minimalproblematic drug use, hair testing means thatmore attention—including more urine tests—canbe concentrated on those who are less compliant.In both the clinical and financial senses, one hairtest covering a three month period can be bettervalue than half a dozen urine tests taken duringthe same time. It does not always matter if theresult of a hair test is not available for three orfour weeks, as has been our experience using anAmerican laboratory, but it would often be use-ful to have the results available more quickly,especially for probation-linked monitoring, and

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1292 Letters to the Editor

to be able to test for a range of drugs reflectingpatterns of use in Britain rather than in the USA.

COLIN BREWER

The Stapleford Centre,25A Eccleston Street,Belgravia, London SWIW 9NP

ReferencesBREWER, C . (1992) Hair analysis as a tool for monitoring

and managing patients on methadone maintenance. Pa-per presented at the 1st international meeting onhair analysis as diagnostic tool for drug of abuseinvestigation. Genoa.

STITZER, M . L., BICKEL, W. K., BIGELOW, G. E. &LJEBSON, I. A. (1986) Effect of methadone dosecontingencies on udnalysis test results of polydrug-abusing methadone-maintenance patients, Drug andAlcohol Dependence, 18, pp. 341-348.

STRANG, J., BLACK, J., MARSH, A. & SMITH, B. (1993)Hair analysis for drugs: technological breakthroughor ethical quagmire? Addiction, 88, pp. 163-166.

Further ethical issues raised by hairanalysis for drugs

I read with interest the editorial Hair analysis fordrugs: technological breakthrough or ethical quag-mire?^ and have thought of a further area inwhich this new technology could be used whichraises ethical issues.

Intimate samples of blood and urine can betaken from suspects in police detention, withtheir consent, for drug analysis. The guidelinesfor the taking of the samples are laid down in thePolice and Criminal Evidence Act 1984.̂

A sample of hair other than pubic hair is

defined in the Act as a non-intimate sample andcan be taken from a person without the appropri-ate consent if he is in police detention or is beingheld in custody by the police on the authority ofa court and an officer of at least the rank ofsuperintendent authorizes it to be taken withoutthe appropriate consent. An officer may only givean authorization if he has reasonable grounds forsuspecting the involvement of the person firomwhom the sample is to be taken in a seriousarrestable offence and for believing that thesample will tend to confirm or disprove his in-volvement. Reasonable force may be used ifnecessary to take non-intimate samples. Obvi-ously these samples will be taken by policeofficers as the medical profession is not likely tobe involved in the taking of any sample withoutthe patient's consent.

Therefore an officer suspecting that a prisonermay have given inaccurate information with re-spect to a personal history of drug misuse toenable a defence at a later date or for some otherreason, could take a hair sample to dispute this,without the prisoner's consent.

MARGARET M . STARK

Forensic Medical Examiner South London,20 Sandy Lane.Cheam, Surrey SM2 7NR

References1. STRANG, J., BLACK, J., MARSH, A. & SIVUTH, B.

(1993) Hair analysis for drugs: technological break-through or ethical quagmire? Addiction, 88, pp.163-166.

2. Police and Criminal Evidence Act 1984 (London,HMSO).