Drug Testing in Society

Donor Manipulation Dilution

Internal ingestion (fluids, diuretics) or external

Donor Manipulation Adulteration

Internal ingestion (in-vivo) or external (in-vitro)

Donor Manipulation Substitution

Urine replaced with alternative sample or donor sample

Federal Workplace Drug Testing

-All individuals must be informed they are subject to testing -Confidentiality of test results maintained -Positive test results on preliminary screen must be confirmed by alternate methodology -Random screening allowed and legally defensible -Urine preferred specimen

Other Segments

-Athletics --Amateur, Olympics, college-level, professional sports -Schools -Welfare programs (for qualification purposes) -Insurance -Clinical e.g. prenatal or newborn drug screening

Hair Disadvantages

-Bias of color/texture of hair -Environmental contamination -Possible Inability to detect recent drug use -Commercial hair testing labs relatively limited as yet -New technology

NIDA 5

-Cannabis/MJ -Cocaine -Opiates -PCP -Amphetamines

Sweat Disadvantages

-Risk of accidental removal during testing period -Potential for environmental contamination -New technology

Saliva Advantages

-Easy collection & accessibility -No privacy issues -Parent drug is present (similar to blood) -Known S/P ratios for some drugs -Indicates recent drug use (12-24h)

Drug Test Example #2

-Employee at local hardware store falls off ladder and is subject to post-accident drug test -States he consumed a poppy seed bagel at breakfast -Urine sample collected & tested by clinical (hospital) laboratory -Test results "positive for opiates" using immunoassay (1000 ng/mL cutoff) -Is the poppy seed defense legitimate? --below the cut off so yes it is.

Alternative Specimens (Antemortem)

-Meconium: First baby poop

Private Sector

-Prevalent among private sector, particularly manufacturing, utility industries -Pre-employment -Random -For cause -Post accident

Hair

-Technology for hair testing has progressed rapidly during past decade -Much controversy surrounding hair testing -Drugs likely incorporated into hair through multiple mechanisms -Diffusion from blood into hair follicle, cells and subsequently hair itself -Excretion in sweat which bathes hair follicles and strands -Excretion from oils into the follicle and on skin surface -Entry from the environment: could have marijuana smoke on the hair but you didn't smoke it. -Assuming a growth rate (1 cm/month) allows a segmented analysis and approximate timeframe of drug use: good for welfare cases, rehab, etc.

On-Site Drug Tests

-Testing of samples at site of collection -Typically immunoassay-based tests -Similar to preliminary drug screens -Results not defensible; presumptive positive; require confirmation by another methodology -May be useful in safety sensitive positions where preliminary results needed immediately -Results available rapidly -Often self contained (cassette-type or dipstick-type) -Often no instrumentation required; read with naked eye -Some workplace drug testing programs prohibit use of these devices

When does a sample or test become FORENSIC?

If they start to involve legal action

General Drug Testing Issues Ideal Specimen Selection:

-Biological matrix should be easily obtained and collection non-invasive -Drug and/or metabolite present in matrix -Can be identified accurately and precisely using existing technology -Amount of drug and/or metabolite in the matrix following a single psychoactive dose should be sufficient for routine detection (i.e. low false negative rate) -Relationship between concentration of drug and/or metabolite and the drug dose should be established -Time course for appearance and disappearance of the drug and/or metabolite from the matrix should be known (i.e. recent or long-term drug use) -Risk of false positive test results from external or environmental contamination should be low -Should be unbiased towards all populations and ethnic groups

Drug Test Example #3

-Driver apprehended for DWI -Stopped for being asleep at the wheel at a busy intersection -Officer documents slurred, slow speech, ptosis, extreme lethargy, confusion, difficulty maintaining standing pose or exiting vehicle -States he consumed a poppy seed bagel at breakfast -Urine sample collected & tested by state laboratory by GCMS -Test results indicate morphine and codeine present in urine -Does consumption of a poppy seed bagel explain the behavior and/or test results? --Analytically possibly as poppy seeds can have morphine and codeine but his behavior does not match just a bagel.

Criminal Justice System

-Drug use in prison populations - George Bush's 1991 National Drug Control Strategy -Drug testing programs mandated at time of arrest in some states -Drug testing during probation, parole or upon release -Drug testing among drug offenders not mandated in all jurisdictions -Unlike forensic casework in death and criminal investigations, probation/parole testing relatively unregulated and varies by state, county, city

Urine Advantages

-Ease of collection -Ease of testing -Minimal sample preparation -Amenable to automated testing -High concentrations of drug and/or metabolite -Relatively inexpensive -Mature technology -On-site methods available -Established cutoffs

Drug Testing in the US

-Estimated 30 million working Americans subject to drug testing each year -35% state prison inmates admit being under the influence at time of offense -40% juvenile offenders in long-term correctional facilities admit being under the influence at time of offense -8-35% job applicants test positive for illicit drugs -10-23% use drugs while on the job -19.9 million illicit drug users in U.S. -7.5 million in need of substance abuse treatment -Economic impact estimated to be $46-85 billion annually - includes sick time, lateness, workplace accidents, worker compensation claims

Drug Test Example #1

-Federal government employee selected for random drug test -States he consumed a poppy seed bagel at breakfast -Urine sample collected & tested according to SAMHSA guidelines -Test results positive for opiates according to SAMHSA guidelines (>2000 ng/mL morphine; > 10 ng/mL 6-Acetylmorphine) -Is the poppy seed defense legitimate? --had heroin metabolites

Drug Test Example #4

-Female reports sexual assault -Became extremely drowsy and lost consciousness while consuming alcohol at drinking establishment -Reports crime 18 hrs after the event; evidential exam and specimens collected 24 hours after the incident -States she consumed a poppy seed bagel at breakfast the day before -Urine sample collected & tested by state laboratory by GCMS -Test results indicate morphine and codeine present in urine -Does consumption of a poppy seed bagel explain the behavior and/or test results? --Analytically possibly as poppy seeds can have morphine and codeine but not from one bagel but his behavior does not match just a bagel.

Military

-First to initiate employee drug testing -1990 General Military Law 10 USC 1090 -Regulations governing drug testing & to identify and treat drug- dependent military personnel -Drug-dependent personnel barred from service, referred to civilian treatment programs; those who cannot/will not be rehabilitated face disciplinary action and/or discharge -1990 "Drug Free Workplace" - precluded drug-dependent individuals from hiring process -Heavily regulated

SAMHSA/DHHS Guidelines

-Heavily regulated -Guidelines address specimen collection to reporting results -Updated to address legitimate scientific issues and defenses -Proposed new changes would have allowed alternative specimen tests - hair, saliva & sweat - in addition to urine. Has not been implemented yet -Proposed guidelines published in Federal Register. -Future uncertain?

Sweat Advantages

-High subject acceptability -Low rate of allergic reactions -Can monitor drug use over one week with one patch -Cumulative measure of drug use -Relatively tamper proof

Hair Advantages

-History of drug use (long- term use)/ months -Ease of collection, storing, shipping -No privacy issues -Low disease risk

SAMHSA Testing - "NIDA 5"

-Initial (screening) test -Immunoassay-based -Defined cutoff concentrations in urine -Samples below cutoffs are deemed negative - no further testing -Samples above cutoffs are deemed positive - additional testing -All samples subject to specimen validity tests to determine specimen integrity, substitution, adulteration etc

Public Sector - Federal Workplace Drug Testing

-Initiated by National Transportation Safety Board (NTSB), Federal Railway Administration and National Institute on Drug Abuse (NIDA) -Developed regulations for employee drug testing for use by the Department of Transportation (DOT) -1986 Reagan issued Executive Order requiring federal agencies to develop testing programs -Aim to provide a "drug-free federal workplace" at an estimated cost of $18 million annually

Testing & Regulation

-Majority of testing is in workplace - we will focus on this -Single test may be the only evidence in hiring/firing situation -Litigation possible -Quality of the result is as good as the quality of the entire process: specimen collection through to reporting

Areas of Drug Testing in Society

-Military -Criminal Justice System --Probation --Parole -Public Sector --Federal workplace drug testing --Transportation -Private Sector -Athletics -Insurance -Clinical

Urine

-More than 90% of private sector tests involve urine -Specimen of choice for most workplace drug tests -Elimination occurs at an exponential rate with most of the dug eliminated in the first 48h after use -Detection times vary between drugs depending on dose, frequency, cutoff and pharmacological factors -Generally detection times for most drugs are 2- 40 days following single use; longer for chronic use (e.g. 30 days for chronic marijuana smokers)

Initial Test - Immunoassay

-No extraction -Minimal sample preparation -Qualitative results based upon cutoff concentrations - Pos or Neg -High sensitivity -Moderate specificity depending on antibody cross- reactivity and target drug -Adulteration issues (ammonia, soap, bleach, nitrite, vinegar, glutaraldehyde, oxidizers etc) -RIA (Radioimmunoassay) EMIT (Enzyme mediated immuno technique) -ELISA (Enzyme linked immunosorbent assay) -FPIA (Fluorescence polarization immunoassay) -And others -Samples that screen positive by these techniques called "presumptive positives" -Drug presence MUST be confirmed using a secondary technique

Urine Disadvantages

-Not related to impairment -Drugs and/or metabolites may be present for days or weeks (variable) -Indicates only past use not recent use -Privacy issues (collection) -Potential for manipulation

Transportation

-Omnibus Transportation Employee Drug Testing Act of 1991 -Vehicle, aviation, railroad, mass transit, pipeline and maritime -Legislation affects more than 7.4 million transportation workers in the US -DOT testing heavily regulated -States and municipalities have introduced additional guidelines - variable policies and testing practices, less regulated, labs may not be accredited

SAMHSA Guidelines

-Only test for 6- Acetylmorphine when morphine exceeds cutoff of 2000 ng/mL -If methamphetamine positive (500 ng/mL or more) then amphetamine must also be present at a concentration of at least 200 ng/mL -Cutoff concentrations influenced by many factors -Poppy seed defense or dietary exposure (opiates) -Passive smoke inhalation (marijuana)

Confirmatory Test - GC/MS

-Required for all presumptive positive specimens in federal workplace drug testing programs and in criminal forensic casework (crime labs) -Sensitive and specific test for target drug or metabolite -Not subject to cross-reactivity issues -Allows definitive identification of substance based upon chromatographic and mass spectral properties -Involves sample preparation (liquid or solid phase extraction) -Labor intensive compared to immunoassays -Quantitative results possible -Drugs may require derivatization prior to GC/MS analysis

Saliva Disadvantages

-Risk of contamination or increased concentration (oral, smoked, intranasal) -Short detection time for drugs -Recent not historical drug use -S/P ratios vary with pH, flow rate, collection method -New technology

Saliva

-Saliva comprised of mostly water -Considered as filtered plasma -Saliva drug concentrations may be related to plasma drug concentrations (S/P ratios known for some drugs) -Most drugs appear in saliva relatively quickly and disappear within 12-24h (indicating recent drug use)

Federal Workplace Drug Testing Guidelines Regulation`

-Specimen collection -Transmitting samples to laboratory -Assay procedures -Evaluation of test results -QC procedures -Record-keeping -Reporting requirements -1998: Dept. Health Human Services (DHHS) and NIDA implemented the National Laboratory Certification Program (NLCP) for accreditation purposes -Highly regulated

Sweat

-Sweat collection device similar to "Band-Aid" - adhesive layer on thin transparent film of surgical dressing with absorbent cellulose pad -Worn for several days to weeks -Patch absorbs sweat; film allows oxygen, carbon dioxide and water vapor to escape but prevents loss of drug constituents -Drugs concentrate in the patch over time with excretion of sweat

Protocol

-Witnessed urine collection by trained personnel -Chain of custody initiated at time of collection -Labelling: Donor initials labeled specimen; collection personnel initials specimen & places integrity seals -Specimen packaged and sent with documentation to laboratory via US Mail, courier -Trained personnel at laboratory accession evidence, inspect specimen for tampering or breakage, compare specimen and documentation, assign lab identification number, initiates internal chain of custody, initiates testing request -Initial drug tests (IA) that are positive are subject to secondary test or confirmation using alternative testing methodology (GC/MS) prior to reporting results