New Technologies for Drug Testing: Hair, Urine, Saliva and More. Joseph Jones, MS, NRCC-TC
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1 New Technologies for Drug Testing: Hair, Urine, Saliva and More Joseph Jones, MS, NRCC-TC
2 EDUCATIONAL OBJECTIVES o Evolution Drug Testing in the last 25 years o Workplace vs Health Professionals Drug Tests o Modern Technologies of Drug Testing o Urine, Hair, Nails, Blood Spot, Saliva, Breath o Alcohol Testing o Case Studies
3 National Survey of Drug Use and Health Illicit Drug Use Ages 26 and Up 14 Prevalence (%) Past Year Use Past Month Use Year
4 Prevalence of Substance Use Disorders Healthcare Professionals o Approximately 10%-15% during career } Baldisseri, M. (2007) Crit Care Med, 35, S106-S116. o Most frequent misconduct o Most frequent disciplinary action } Drug Screening as a Regulatory Tool-Executive Summary
5 Goals of Alternative Programs o Early identification o Entry into treatment o Safe re-entry into practice
6 DRUG FREE FEDERAL WORKPLACE
7 DRUG FREE FEDERAL WORKPLACE Amphetamine/Methamphetamine Cocaine Opiates (codeine, morphine, heroin) Phencyclidine Marijuana
8 Changing Drug Use Patterns o Amphetamines Amphetamine Methamphetamine MDA MDMA MDEA o Opiates Codeine Morphine Hydrocodone Hydromorphone 6-MAM Oxymorphone Oxycodone Buprenophine Methadone Meperidine Propoxyphene Tramadol Cocaine Marijuana PCP Barbiturates Butabital Amobarb Pentobarbital Secobarb Phenobarbital Fentanyl Sufentanil Soma Zolpidem Dextromethorphan Methylphenidate Ethylglucuronide Benzodiazepines Oxazepam Nordiazepam Temazepam Lorazepam Flurazepam Nitrazepam Triazolam Alprazolam Flunitrazepam Midazolam Clonazepam Phentermine Propofol Ketamine Sevoflurane Gabapentin
9 PERFECT STORM OF DRUG ABUSE o Pill Mills o Medical Marijuana o Internet Pharmacies o Synthetic THC o Bath salts
10 ANTI-DRUG TESTING PRODUCTS
11 Health Professional Access WIDE VARIETY OF DRUGS?
12 Recommended Parameters o Frequency first year, less there after o Collection Observed preferred o Notification Daily call-in strategy o Timeframe Same day o Profiles Must include drugs of choice o Cutoffs Must be appropriate for monitoring o Validity testing Must be normal urine o Chain of custody Result may be litigated o Compliance issues Failure to test and relapse
13 HEALTH PROFESSIONAL DRUG PANEL o o Amphetamines Amphetamine Methamphetamine MDA MDMA MDEA Opiates Codeine Morphine Hydrocodone Hydromorphone 6-MAM Oxymorphone Oxycodone Buprenophine Methadone Meperidine Cocaine Marijuana PCP Barbiturates Butabital Amobarb Pentobarbital Secobarb Phenobarbital Dextromethorphan Methylphenidate Ethylglucuronide Fentanyl Propofol Ketamine Tramadol Propoxyphene Benzodiazepines Oxazepam Nordiazepam Temazepam Lorazepam Flurazepam Nitrazepam Triazolam Alprazolam Flunitrazepam Midazolam Clonazepam Soma Zolpidem Phentermine
14 Sophisticated and Knowledgeable The Right Test, Right Technology
15 Tools in the Tool Belt
16 Tools in the Tool Belt
17 Tools in the Tool Belt
18 Tools in the Tool Belt
19 Tools in the Tool Belt Urine On-site Urine devices Hair Oral Fluid Nails Blood Interview
20 Detection Windows Nail Mec/Cord Hair Urine Oral Fluid Blood Detection Window (days)
21 FORENSIC DRUG TESTING Two different methodologies Chain of custody
22 FORENSIC DRUG TESTING Two different methodologies Immunoassay Mass Spectrometry Chain of custody
23 IMMUNOASSAY RIA EMIT CEDIA ELISA LAMINAR FLOW
24
25 Gas Chromatography Mass Spectrometry
26 Gas Chromatography
27 Confirmation GCMS
28 Confirmation GCMS or LCMSMS
29 Liquid Chromatography Tandem Mass Spectrometry
30 Instant Urine Drug Test Kits > 70 KITS ON MARKET Not all CLIA Waived Not all have similar tests Not all have similar cutoffs Not all standard manufacturing Not all perform consistently Not all have validity tests False negatives, positives
31 Laminar Flow Immunoassay
32 Oral Fluid Drug Testing
33 Oral Fluid Drug Testing Advantages Direct observed collection Non-clinical collection setting No gender issues Under the influence determination Difficult to adulterate Disadvantages Short detection window More expensive than urine Dry mouth
34 Hair Drug Testing
35 HOW DO DRUGS GET INTO THE HAIR? #1 ENVIRONMENTAL EXPOSURE SMOKE FUMES TRANSFERANCE CONTACT
36 HOW DO DRUGS GET INTO THE HAIR? #2 SWEAT AND OIL THESE DRUG AND METABOLITE CONTAINING FLUIDS BATHE THE HAIR SHAFT
37 HOW DO DRUGS GET INTO THE HAIR? #3 THE BLOOD
38 Barcode Matching Receipt of Specimen Test Request
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48 Color bias Limitations Interferes Bleach Perm Dye Chemical Relaxer
49 Other Limitations Hair?
50 Nail
51
52 5x More THCA in Nail than Hair 22 matched pairs Concentration THCA (pg/mg) Hair 4662 Nail Jones et al (2013) Am J Anal Chem, 4, 1-8
53 2.5x More EtG in Nail than Hair 22 matched pairs Concentration EtG (pg/mg) Hair Nail 75 Jones et al (2012) Am J Anal Chem, 3,
54 ALCOHOL
55 ALCOHOL TESTING Standard Technology Breath Hours/Drink Saliva - Hours/Drink Blood Hours/Drink Urine Hours/Drink Recovery Technology: 3 x 3 x 3 1) Urine Ethyl Glucuronide(EtG) - 3 Days binge 2) Phosphatidylethanol(Peth)- 3 weeks binge 3) Hair/Nails EtG 3 months binge
56 EtG in URINE Ethyl glucuronide Direct Metabolite of Alcohol In standard use since 2000 Cutoff for recovery 100 ng/ml Affected by bacteria Abstinence monitoring Detection 2-3 days
57 EtG in HAIR Society of Hair Testing Suggestions Consistent with Abstinence Increasing Risk Consistent with Chronic Excessive Drinking EtG Hair (pg/mg)
58 EtG in NAILS First Reported 2011 Grant 1 R44 AA matched hair/nail pairs UW-Milwaukee Self Reports
59 PHOSPHATIDYLETHANOL (PEth)
60 Phosphatidylethanol (PEth) o Phosphatidylethanols (PEth) are a group of phospholipids with a common phosphoethanol head group onto which 2 fatty acid chains are attached. Fatty acid chains Phosphoethanol head group
61 PEth can form in red blood cells as a component of the cellular membrane. PEth is a direct alcohol biomarker, meaning that ethanol is incorporated into the final product.
62 CASE STUDY #1 2 Social Drinkers Male 250 lbs Female 150 lbs Male 2 drinks per day Female 1 drink per day 14 days All negative PETH spots, EtG Hair & Nail
63 CASE STUDY #2 Male-social drinker No history of DWI 5-night cruise-2 binges per day Day 1 following cruise PETH spot 81 ng/ml Day 9 PETH spot 23 ng/ml
64 CASE STUDY #3
65 CASE STUDY #4
66 CASE STUDY #5
67 CONCLUSIONS o Know your laboratory, technology and cutoffs o What are the screening and confirmation technology and cutoffs? o Vary testing panels, urine, saliva, hair, blood o Custom design testing programs individual addiction o Random drug testing is the technology of recovery
68 Thank You Questions? All Rights Reserved. Copyright 2015 United States Drug Testing Laboratories, Inc.
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