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December 2014 CFTN

An AACC/CAP Educational Newsletter for Toxicology Laboratories

Read the December 2014 Issue
This issue features an article on the challenges, opportunities and laboratory assessment of next generation oral anticoagulants, information on the homemade injectable street drug known as “krokodil,” and a summary of new rules that allow patients to have direct access to their laboratory results.

Next-Generation Oral Anticoagulants
NOACs Are Game Changers But Offer Challenges for Anticoagulant Therapy
By Jamie Noguez, PhD

Unlike warfarin, NOACs can reduce blood clotting without inhibiting the action of vitamin K. In most cases, routine laboratory testing is not required for the NOACs, but assessment of the anticoagulant effect or plasma drug concentration may be useful in some circumstances. Laboratories should be prepared to help clinicians manage patients treated with these new agents.

Krokodil
Desomorphine Returns As a Flesh-Eating Drug
By Heather Signorelli, DO, and Kamisha L. Johnson-Davis, PhD

Easily manufactured by boiling codeine with chemicals like paint thinner, gasoline, or iodine, krokodil’ s name derives from its effect on an addict’s skin. Death after a single use is not uncommon, and chronic abusers rarely survive for more two years. Exposure to krokodil can be confirmed by mass spectrometry in hospitalized patients.

Patient Access to Lab Results
Laboratories Should Be in Compliance With New Rules Giving Better Access
By Jennifer Collins, PhD

As of October 6, clinical laboratories must be in compliance with new rules that allow patients to have direct access to their laboratory results. The final rule applies to test results that are subject to CLIA regulations, but not to employers or other entities performing employment-related substance abuse testing. The policy does not specify how patients must request or providers must respond to requests for lab reports.