Drugs of Abuse Testing Facts and Myths Mohammad Al-Ghoul, PhD Chief Technical Officer Diane A. Tennies, PhD Lead TEAP Health Specialist, Humanitas

Agenda Brief history - Drugs of abuse testing and the TEAP program Explain the testing options available from the CDD Describe Opioid testing: facts and myths Clarify Cannabinoids testing: facts and myths Identify drugs of abuse on the horizon

Job Corps’ Mission As a national, primarily residential training program, Job Corps' mission is to attract eligible young adults, teach them the skills they need to become employable and independent, and place them in meaningful jobs, higher education, or the military.

Trainee Employee Assistance Program TEAP

TEAP Responsibility Overall goal—Assist students in developing appropriate health and wellness practices that will enhance their ability to obtain/maintain employment, aka “Employability Skills” 5

So how do we do this?

Drug and Alcohol Testing (6.11;R1,e) Drug testing procedures – who gets tested: – New and readmitted students – Students who tested positive on entrance shall be retested between the 37th and 40th day after arrival on center. – Students who are suspected of using drugs at any point after arrival on center – Students who test positive on suspicion are retested Biochemical testing is never permissible on a random basis (exception being vocations that require random screening, such as for DOT)

Types of Drug Screens Only Four Types: – Entry screen – “45-day” screen – Suspicion screen – DOT-required screen

Drug and Alcohol Testing (6.11;R1,e(1,d-f)) Collection of urine for drug testing shall be in accord with chain-of-custody principles and conducted by health and wellness staff or a staff member trained in urine collection procedures Use the CDD

History Drug-testing methods have been available for approximately 50 years (Reynolds, 2005) 1984, the military established standards for laboratories and testing methods 1986, an Executive Order - Federal Drug-Free Workplace Program 1987, Public Law outlined provisions for drug testing programs in the Federal sector

1988, Federal mandatory guidelines set scientific and technical standards for testing Federal employees. In 1989, the U.S. Department of Transportation (DOT) issued regulations requiring the testing of nearly 7 million private-sector transportation workers in industries regulated by DOT. History

Federally mandated by Drugs of Abuse Amphetamines/Methamphetamines Panel Cannabinoids (THC) Cocaine (Benzoylecgonine) Opiates PCP

Drug Testing Clinical Drug Testing –Screening –Confirmation (Not Required) Workplace Drug Testing –Screening –Confirmation (Required) Job Corps

Screening vs. Confirmatory Testing Screening tests – Qualitative (Present / Not Present) – Identify classes of drugs present in the urine – Use immunoassay Confirmatory tests – Quantitative * NoteNote – Confirm a Positive Screen Result – Use gas chromatography/mass spectrometry (GC/MS) – Identify a specific drug

Reliability and Validity of Urine Toxicology Specimen More than 70% of lab errors occur prior to testing

Federally mandated by SAMSHA Test Menu Job Corps Toxicology Panel – Amphetamines/MethAmphetamines – Cannabinoids (THC) – Cocaine (Benzoylecgonine) – Opiates – PCP

Urine Drug Testing Limitations Urine drug testing only indicates prior use Not useful for determining: – Time since last use – Extent/Frequency of use – Additional use since last positive test – Current impairment

Drugs of Abuse Drug GroupScreen Cut-off (ng/mL) Confirm Cut-off (ng/mL) Amphetamines / Methamphetamine Cannabinoids (THC)5015 Cocaine Opiates2000 Phencyclidine25 Testing Methods and Cutoffs Regulated as required by Job Corps Contract

False-Negative Results Dilute urine (excess fluid intake, diuretics ) Prolonged time since last use Recent ingestion Insufficient quantity ingested Metabolism Adulteration – Tetrahydrozoline (Eye Drops) – Bleach – Acids (Vinegar, Lemon Juice) – Bases (Soap, Ammonia)

Drugs of Abuse Drug Group Approximate Detection Time Amphetamines / Methamphetamine 2-4 days Cannabinoids (THC)1-30 days Cocaine< 72 hours Opiates2-5 days Phencyclidine< 3 days Kaplan and Pesce, Clinical Chemistry, Fourth edition, P1008.

Opiates

Opiates Metabolism The laboratory test detects Morphine and Codeine NO legal source 6-AM = 6-Acetylmorphine

Poppy seed ingestion is a contributing factor to opiate-positive test results Fact or Myth ?

$ 147,000 settlement Opiates and Poppy Seeds Screening only Test cutoff = 300 ng/mL

Opiates and Poppy Seeds Case still in court Screening only Test cutoff = 300 ng/mL

The Bad Guy

Poppy Seeds Bagel

So … Fact or Myth? Because the drug screen for the presence of opiates is so sensitive, the federal guidelines for agencies that rely on it have raised the cut-off level for a Positive from 300 ng/mL to 2000 ng/mL, which eliminates many of the poppy seed false positives. However, this standard has still not been implemented everywhere.

Heroin Addiction and Suboxone Baby was diagnosed with Neonatal Abstinence Syndrome (NAS)

Question from the Field Why don’t we test for opioids such as oxycodone? Is there a plan to offer a test for synthetic opiates? Answer: CDD does offer the option to order opioids (synthetic opiates), however the testing is performed at our reference laboratory.

Cannabinoids

Cannabinoids (THC) Cannabis sativa plant contains natural components, of which 66 have been classified as cannabinoids Delta-9-tetrahydrocannabinol (Δ9-THC), is the substance primarily responsible for the psychoactive effects of cannabis.

Cannabinoid Metabolism Iranian J Psychiatry 7:4, Fall 2012

THC Metabolism The half life for THC is long THC is stored in the body’s fat cells The urinary half-life of THC are best estimated at 3 – 4 days after ingestion Half-life: is the amount of time it takes for measured amount of drug in urine to decrease by half

THC Detection in Urine : 30 Day Assumption “Some parts of the body still retain THC even after a couple of months.” Substance abuse treatment literature. “At the confirmation level of 15 ng/ml, the frequent user will be positive for perhaps as long as 15 weeks.” Health information websites Urine tampering promotions in magazines High Times days,” and detection times for smokers who use “5-6x per week days.” Cary Paul, National Drug Court Institute, 2006, 4, 2.

THC Detection in Urine Dr. Drew Pinsky - co-host on the popular call- in radio show "Loveline “Pot stays in your body, stored in fat tissues, potentially your whole life.” Cary Paul, National Drug Court Institute, 2006, 4, 2.

How to Pass a Drug Test

Confused ?????

Case Report A social service officer suspected that a 20- year old pregnant female was using illicit drugs. A urine specimen was collected in the 31st week of pregnancy. It was confirmed Positive for THC by LC–MS She was tested again four and seven days later, still with Positive for THC.

Case Report The woman admitted a history of heavy cannabis use with daily smoking of approximately 5 g of cannabis resin or hashish for several months, including during pregnancy. However, she claimed to have stopped using cannabis after the first cannabinoid-positive specimen.

Case Report The social service officer needed a clear answer from the laboratory: Had she or had she not used cannabis after the first positive specimen? The social service officer was advised to keep collecting specimens from the patient at several-day intervals throughout the pregnancy.

Case Report Conclusion Alterations in the plasma volume and the volume of distribution for drugs, altered drug protein binding, changes in metabolic capacity Urine excretion The amounts of body fat increase during pregnancy In the present case, THC was detected in the woman’s urine for 84 days Negative Negative in 28 days

Questions How many days will it take for a chronic marijuana user to reach a negative urine drug test result? How many days will it take for a non-chronic marijuana user to reach a negative urine drug test result? How many days should you wait to test after a positive urine drug test for cannabinoids has been obtained? How should you interpret a positive urine drug test for cannabinoids after a student has completed an initial 30-day period to detoxify their system?

Variables Drug Dose and frequency of use Metabolism Specimen collection and handling Cutoff and Test Sensitivity / Specificity

THC Detection Time THC detection time based on daily usage of 2000 ng/mL Usage at 1 time only5-8 days Usage 2-4 times per month11-18 days Usage 2-4 times per week23-35 days Usage 5-6 times per week33-48 days These are approximate detection times for the drug or metabolites in urine. The actual detection time depends on dose, frequency of use, and individual metabolism.

Cannabinoid Detection Window in Urine Screening: at the 50 ng/mL cutoff concentration for the detection of cannabinoids in urine it would be unlikely for a chronic user to produce a positive urine drug test result for longer than 10 days after the last smoking episode Cary Paul, National Drug Court Institute, 2006, 4, 2.

Confirmation: at the 15 ng/mL cutoff concentration for the detection of cannabinoids in urine it would be uncommon for a chronic marijuana smoker to produce a positive urine drug test result longer than 21 days after the last smoking episode Cannabinoid Detection Window in Urine Cary Paul, National Drug Court Institute, 2006, 4, 2.

Screening: for occasional marijuana use (or single event usage), at the 50 ng/mL cutoff level, it would be unusual for the detection of cannabinoids in urine to extend beyond 3-4 days following the smoking episode Confirmation: at the 15 ng/mL cutoff for cannabinoids, positive urine drug test results for the single event marijuana use would not be expected to be longer than 7 days Cary Paul, National Drug Court Institute, 2006, 4, 2. Cannabinoid Detection Window in Urine

Questions How many days will it take for a chronic marijuana user to reach a negative urine drug test result? How many days will it take for a non-chronic marijuana user to reach a negative urine drug test result? How many days should you wait to test after a positive urine drug test for cannabinoids has been obtained? How should you interpret a positive urine drug test for cannabinoids after a student has completed an initial 30-day period to detoxify their system?

We are here to help you with your questions when needed Remember

Other Tests Spice / Synthetic Cannabinoids Bath Salts Panel –Barbiturates –Benzodiazepines –Methadone –Propoxyphene –Methaqualone

Conclusion We perform screening and confirmation – All screening positive results are confirmed by GC-MS Urine drug testing only indicates prior use – Not useful in detecting drug use since last test Opiates: 2000 ng/mL cut-off for screening & confirmation – Positive results due to Poppy seeds is unlikely Cannabinoids: 50 ng/mL &15 ng/mL cut-off for screening and confirmation respectively. – Positive results due to chronic use or increase body fat beyond 35 days of initial test is unlikely

Thank You

Quantitative Results Although confirmatory tests are reported with as quantitative result (a number), with Urine Drug Testing the result is NOT necessarily indicative of the amount of drug consumed nor is it possible to tell when the drug was taken. Variables such as body weight, dosage, time taken, and amount of fluid intake all affect the measured amount of drug in the urine. A Positive Confirmatory Urine drug test can only indicate drug use prior to when the sample was provided. No conclusion about dosage, frequency, duration or time since last dose should be inferred.