Handheld devices that screen for ethanol in expired air can be used to discern whether a patients breath smells of alcohol or something else.
Any suspicion of drug use should be followed by a urine toxicology screen. Cocaine and its metabolites can persist in the urine for 48-96 hours, especially after an episode of heavy use. Opioids, with the exception of methadone, clear more quickly. Hydrocodone is often undetectable in the urine unless it has been used in high doses. Quinine and quinidine, which are used to dilute cocaine and heroin, often remain in the urine for several days to a week.
Phenobarbital can be detected in the urine for well over a week, while shorter-acting barbiturates such as butalbital disappear much more rapidly. Benzodiazepines with long half-lives (e.g., diazepam, chlordiazepoxide hydrochloride, and clonazepam) can persist for well over a week, especially in elderly patients. Shorter-acting benzodiazepines (e.g., alprazolam, triazo-lam) often escape detection in the urine except when used in large doses.
Alcohols, including isopropyl, can be detected and quantified in a blood volatile screen. Other drugs—either suspected or initially detected in the urine—can also be quantified in the blood.
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