Clinical Evaluation of a Customized POCT cup for Detecting 16 Psychoactive Substances in Urine at Abu Dhabi’s National Rehabilitation Center Laboratories

Abstract

Point-of-care testing (POCT) provides rapid, cost-effective, and patient-centric solutions for the detection of drugs of abuse (DOA), particularly in rehabilitation environments. While traditional laboratory-based toxicology screening is precise, it is often associated with delays that hinder timely clinical decision-making. This study aimed to assess the performance and reliability of a custom-developed POCT cup for the detection of 16 psychoactive substances in urine samples, using immunoassay and liquid chromatography-tandem mass spectrometry (LC-MS/MS) as reference methods. A total of 504 urine samples were analyzed with the newly developed POCT device, followed by immunoassay screening and confirmatory LC-MS/MS analysis. The substances tested included amphetamines, benzodiazepines, cocaine, cannabis, opioids, MDMA, among others. The POCT device demonstrated an average concordance rate of 98.4% with confirmatory LC-MS/MS results (range 91-100%). High agreement was observed for cocaine, barbiturates, and opiates, while MDMA exhibited the highest rate of misidentification. Immunoassay screening was effective for preliminary detection but showed limitations in specificity. The customized POCT device demonstrated high reliability in clinical settings, presenting a valuable tool for frontline screening. However, confirmatory LC-MS/MS testing remains critical for ensuring diagnostic accuracy, particularly for substances with a propensity for cross-reactivity or false positives.