Oral Fluid Drug Testing March 23 rd, 2015 Drug Testing Options Breath Blood Meconium Vitreous Hair Sweat Urine Oral Drug Testing Options Oral Fluid and Blood and Breath Actual levels (immediate use, up to four days) * Urine Measures metabolites /past use (several hours after use, up to four/five days) * Meconium Chronic drug consumption in the last trimester of pregnancy * Hair Indication of chronic use only, 1.5 inches of hair = 90 days * * Peer reviewed papers available 1
Window of Detection Window of Detection Oral Fluid Testing Non invasive, easily obtained, fast collection time, no facilities needed or specialize personnel, preserves dignity Drug concentrations in saliva are proportional to drug concentrations in plasma/blood If observed correctly, eliminates cheating 2
Oral Fluid Testing Oral fluid has a number of advantages: 1. OF is well proven as accurate, effective and robust. OF has been used for many years in Europe and the rest of the world in both clinical and criminal justice marketplaces and actively for the past 10 years here in the US. 2. A drug detected in OF is the active (parent) drug component as well as any metabolite(s). 3. The passive diffusion rate of a drug from the blood to oral fluid is governed by the free drug fraction in the circulation. This gives the distinct advantage that there is a direct relationship between blood levels of a drug and the presence of the drug found in saliva. 4. As the presence of drugs in oral fluid is related to the amount of drug in the blood stream, oral fluid testing may serve as a better real time indicator of the presence and level of active drug in the patient, thus measures impairment. 6. Blood flow to the 5 glands, in the mouth, is rapid. Drug transfer occurs relatively quickly after drug dose. Drug transfer to oral fluid will continue as long as there is drug in the circulatory system. 7. Toxic, lethal levels, and Steady state ONLY FROM ORAL FLUID 8. Oral Fluid detects 67% more positive Heroin than Urine. Oral Fluid Lab Testing Screening Assays and LC/MS/MS Testing Technology Screening Confirmation 3
Screening 5 panel example: AMPHETAMINE (Adderall, Vyvanse, MDA/Adam, Phentermine/Adipex) METHAMPHETAMINE (MDMA/Ecstacy, Methcathinone) OPIATES (Heroin/6MAM, Morphine, Codeine, Hydrocodone) COCAINE (Cocaine, Benzoylecgonine, Ecgonine methyl ester, Cocaethylene) THC (delta 9 THC) Screening Why Is a Screen a Screen? PCP Dextromethorphan Opiates Hydrocodone, Oxycodone, Oxymorphone, Hydromorphone (not measured) Naproxen, NSAIDs THC Benzodiazepines Alprazolam, other antidepressants Barbiturates Phenobarbital not always measured Screening (±) Amphetamine (±) Methamphetamine Ephedrine 4
Confirmation What does LCMSMS mean? Liquid Chromatography, Tandem Mass Spectrometry It identifies drugs by their fingerprint Each drug has a unique structure LC/MS/MS Liquid Chromatography/Tandem Mass Spectrometry (LC/MS/MS). LC/MS/MS or Confirmation testing is analytically precise and extremely accurate, by measuring the specific molecular mass, and the concentration (amount) of any drug(s), in a sample. The testing identifies not only the parent drug but also its metabolites. Thus providing data on the exact drug and amount of drug found. LC/MS/MS Marijuana Chocolate 5
Metabolism Chart Oral Fluid Drug List Drug List Amphetamines Amphetamine (Adderall, Vyvanse) Adam (MDA) Ecstacy (MDMA) Methamphetamine Methcathinone *Chlorpheniramine *Ephedrine *Phenylpropanolamine *Cold pills that screen positive for Meth/Amp Cocaine Cocaine Benzoylecgonine Ecgonine methyl ester Marijuana Delta 9 THC Date Rape Drugs GHB Ketamine Nicotine Cotinine Alcohol Monitoring EtG (Ethyl glucuronide) Disulfiram (Antabuse) 6
Drug List Opiates Opiate Antagonists 6 Acetylmorphine (Heroin) Codeine (Tylenol 3) Hydrocodone (Vicodin, Lortab, Lorcet, Hycodan, Norco, Xodol, Vicoprofen) Hydromorphone (Dilaudid) Morphine (Kadian, Oramorph, Avinza, MSIR, MS Contin, MSI, MSER) Oxycodone (Percocet, Endocet) Oxymorphone (Numorphan, Opana) Fentanyl Pentazocine (Talwin) Meperidine (Demerol) Propoxyphene (Darvon) Dextromethorphan Naloxone (Narcan) Naltrexone (Depade) Methadone (Dolophine) EDDP Buprenorphine (Suboxone, Subose) Norbuprenorphine Antipsychotics Risperidone (Risperdal) Quetiapine fumarate (Seroquel) Aripiprazole (Abilify) Olanzapine (Zyprexa) Haloperidol (Haldol) Thiothixene (Navane) Fluphenazine (Prolixin) Ziprasidone (Geodon) Drug List Tricyclic Antidepressants Amitriptyline (Elavil) Desipramine (Norpramin) Doxepin (Sinequan) Imipramine (Tofranil) Maprotiline (Ludiomil) Nortriptyline (Aventyl, Pamelor) Trimipramine (Surmontil) SSRIs Paroxetine (Paxil) Citalopram (Celexa) Sertraline (Zoloft) Escitalopram (Lexapro) Fluoxetine (Prozac) Fluvoxamine (Luvox) Benzodiazepines Alprazolam (Xanax) Bromazepam (Lexotan) Chlordiazepoxide (Librium) Clonazepam (Klonopin) Diazepam (Valium) Estrazolam (Doral) Flunitrazepam (Rohypol Roofies ) Flurazepam (Dalman) Lorazepam (Ativan) Lormetazepam (Loramet) Midazolam (Versed) Nitrazepam (Mogadom) Nordiazepam Oxazepam (Serax) Prazepam (Centrax) Temazepam (Restoril) Triazolam (Halcion) Drug List Therapeutic Drugs Topiramate (Topomax) new Divalproex sodium/valproic acid (Depakote) Gabapentin (Neurontin) Carbamazepine (Tegretol) Bupropion (Wellbutrin) Venlafaxine (Effexor) new Mirtazapine (Remeron) Trazodone (Desyrel) Buspirone (Buspar) Propranolol (Inderal) Benzytopine mesylate (Cogentin) Duloxetine (Cymbalta) new Zolpidem (Ambien) Lamotrigine (Lamictal) Tramadol (Ultracet, Ultram) Carisoprodol (Soma) Meprobamate Methylphenidate (Ritalin, Concerta) Clonidine Strattera Special Request PCP & LSD Psilocin (Mushrooms) Methaqualone (Qualudes) Salvinorin A Bisacodyl (Dulcolax) Phentermine ( Phen Phen ) Atropine Scopolamine Synthetic Marijuana Bath Salts Kratom and Krocodil 7
Sample Collection Sample Collection Chain of Custody 8
Lab Report Simple Easy Fast Painless method for measuring drug levels Turn around time Same day we receive the samples (meconium too!) Knowledgeable Customer Service Department Your questions are answered either immediately or go directly to the Toxicologist and those questions are answered within hours Number of drugs detected (we can detect over 130 compounds) LC/MS/MS More sensitive instrument lower levels of detection reduces incidence of false negatives THANK YOU Email blemberg@forensicfluids.com for more information 9