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Drug Testing Updates As of May 20, 2015
Presented by David Green, Ph.D., DABCC (CC&TC), FACB for Alere Toxicology Service, Inc.
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Overview of Drug Testing Process
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Drug Testing Process Collection Accessioning Screening Result?
Confirmation Review Reporting Data Entry Non-Negative Negative
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Screening Highly automated Uses antibodies to detect a drug class
Specificity varies Adequate sensitivity Used to eliminate negative specimens
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Confirmation Very Specific Very Sensitive Little Automation
Usually designed to detect single chemical compounds
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New vs. Residual Use Case Study - THC
Positive test results separated by one month or more normally indicate new use. The exception is long-term, chronic use. All results should be normalized to the measurement of ngTHC/mgCreatinine A ratio of 1.5 or greater between sequential positive test results separated by a week or more indicates new use. This has a degree of certainty of 95% or greater. The longer the period between testing, the higher the degree of certainty. Formula ng Drug X 100 mg Creatinine
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New vs. Residual Use Case Study - THC
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Federally Regulated Drug Testing
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Federally Regulated Testing Panels
Prior to September 30, 2010 Effective October 1, 2010 Drug Screen (ng/mL) Confirm (ng/mL) Amphetamines (AMPHS) 1000 500 Cocaine metabolite (BE) 300 150 Opiates (OPA) 2000 Phencyclidine (PCP) 25 Marijuana metabolite (THC) 50 15 Drug Screen (ng/mL) Confirm (ng/mL) Extended Amphetamines (AMPHEX)* 500 250 Cocaine metabolite (BE) 150 100 Opiates (OPA) 2000 6AM 10.0 Phencyclidine (PCP) 25 Marijuana metabolite (THC) 50 15 *includes MDMA, MDA, & MDEA
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Regulated Updates on the Horizon
Oral Fluid Testing Expanded Opiate test panels to include Synthetic Opiates New proposal published May 15, 2015 Comments due 60 days.
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Opiate Testing
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Federally Regulated Opiate Testing
HHS only allows for Morphine & Codeine confirmation. Screen vs. Confirmation (2009 data) 346,990 regulated specimens tested 3,141 regulated specimens screening positive for an opiate 430 regulated specimens confirmed positive for an opiate
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Construction Industry Breakdown of Opiate Positives
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Metabolism of Opiates Heroin 6-AM Morphine Codeine Hydrocodone
Hydromorphone Dihydrocodeine Oxycodone Oxymorphone
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Considerations When Using Expanded Opiate Testing
Increased positives detected by the Laboratory Hydrocodone Oxycodone Most likely covered by legal prescription What does the MRO do? Overturn lab positive Notify employer for safety sensitive issues
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Synthetic Marijuana / Designer Drugs
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Synthetic Marijuana Psychoactive research chemicals sprayed on herbal mixtures Mimic the effect of THC, the active ingredient of cannabis Found to be 4 to 100 times stronger than marijuana Deceptively marketed as incense or herbal smoke products since early 2000s Available via the internet and in head shops and convenience stores Sold under names such as K2, K3 Legal, Spice, Syn, Haze, and Cloud Nine Smoked by wrapping it in joints, smoking it in pipes, or inhaling fumes via vaporizers
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Synthetic Marijuana Effects
Not regulated by FDA, “not approved for human consumption.” Immediate onset Short effect time of 30 minutes Similar impairment issues as marijuana Dangers Agitation → Psychosis Rapid heart rate → Heart attack Confusion Dizziness Nausea → Vomitting Convulsions Overdose John W. Huffman (who first synthesized these – “JWH”): “People who use it are idiots.”1 Year to year number of calls to poison centers about exposures to synthetic marijuana 2 Annual increase of 140% As of February 29, 2012 = 622, 46% increase over February 2011 1. 2. Data from American Association of Poison Control Centers
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Synthetic Marijuana’s Legality
Potential active ingredients include: CP C8 WIN JWH-05 WIN JWH-018 JWH-253/306 JWH-019 JWH-362/246 JWH-073 JWH-007/019 JWH-049 Nabilone Analogues – V, VII, VIII, and XVI JWH-081 JWH-175 JWH-199 JWH-200 JWH-250 JWH-398 Delta-9-THC HU-210 CP-55940 CP C7 Chemists are constantly changing the formulations. The DEA has listed 5 highlighted substances as Schedule 1.
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Designer Drugs Stimulant like amphetamine or hallucinogen like PCP
Describes drugs which are created (or marketed if they had already existed) to get around existing drug laws Early 2000s, explosion in designer drugs being sold over the Internet “Research Chemicals” – selling the chemicals for "scientific research" rather than human consumption to avoid the intent clause of the U.S. drug laws
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Designer Drugs Forms of use: Cost: $4 to $20 per pack
Snorted Smoked Taken orally Cost: $4 to $20 per pack Can be purchased at: Corner stores Truck stop Head shops Internet Some common names: Black Rob • Blue Silk Bolivian Bath • Cloud 9 Down2Earth • Energizing Aromatherapy Hurricane Charlie • Ivory Wave Kamikaze • Maddie Ocean Burst • Purple Wave Red Dove • Super Coke Vanilla Sky • White Horse
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Cathinone
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Designer Drug Effects Not regulated by FDA, “not approved for human consumption. “ Insomnia Teeth grinding Agitation → Psychosis Paranoia → Suicide Rapid heart rate → Heart attack Nausea → Vomiting Seizures Kidney Failure Death Year to year number of calls to poison centers about exposures to synthetic marijuana 2 Annual increase of nearly 2,000% As of February 29, 2012 = 229, 52% decrease over February 2011 1. Data from American Association of Poison Control Centers
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Designer Drugs’ Legality
Includes: Cathinones – 43 compounds created by modifying the molecular structure MDPV – “Bath Salts,” stimulant & euphoric effects for 3 to 8 hours Mephedrone – “Plant Food,” stimulant & euphoric effects for 30 minutes to 3 hours Methylone – “Room Odorizer” Piperazines – (BZP, TFMPP, mCPP)* stimulant & euphoric effects for 4 to 6 hours Phenethylamine – “Bromo-DragonFLY,” hallucinatory effects for 12 to 24 hours The DEA listed 3 highlighted substances as Schedule 1 (October 2011) “Except as authorized by law, this action makes possessing and selling these chemicals, or the products that contain them, illegal in the United States … The temporary scheduling action will remain in effect for at least one year while the DEA and the United States Department of Health and Human Services (DHHS) further study whether these chemicals should be permanently controlled.” Other Federal Legislation includes Federal House Bill HR1254 Federal Senate Bill S409 State Legislation (as of 2/29/2012) 22 States with current legislation 12 States with proposed legislation 3 States awaiting enactment of legislation *DEA listed BZP and TFMPP as Schedule 1 on March 18, 2004.
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David Green, Ph.D., DABCC (CC&TC), FACB
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