trends in drug testing - american bar association · author: matthew t. fagnani subject:...

Trends in Drug TestingTrends in Drug Testing

Matthew T. Fagnani, C-SAPAPresident

Substance Abuse Program Administrator’sAssociation

WorkSafe, Inc.341 West Tudor Road

Anchorage, AK 99503

907-563-TEST

Trends in Drug Testing

Copyright American Bar Association 1




Copyright American Bar Association 1 http://www.bna.com/bnabooks/ababna/adr/2000/mexico.pdf



Drug Testing Trends AffectingDrug Testing Trends Affectingthe Workplacethe Workplace

vvMedical Use of MarijuanaMedical Use of Marijuana

vvGrowth of Instant Test Result KitsGrowth of Instant Test Result Kits

vvOther methods of Testing for DrugsOther methods of Testing for Drugs









Where are We Now?Where are We Now?

v Urine testing for drugs ofabuse

v Screening test - enzymeimmunoassay technique

v Confirmation test - gaschromatography/massspectrometry

v Proven history ofreliability

v Many positive results goto MRO for review









Emerging TechnologiesEmerging Technologies

Here to Stay or Testing TechnologyGone Tomorrow?

vOral Fluid Testing

vSweat Testing

vHair Testing

vNon-Instrumented Drug Testing (NIDT)

vInstrumented On-Site Testing









Instant Test Devices and NewTechnologies are not DOT

Approved









Drug Testing Advisory BoardDrug Testing Advisory Board

v Established in 1990v Advises the Administrator of SAMHSA on new

areas for emphasis or de-emphasisv Currently evaluating emerging and current

technologies and alternative specimens• Meet principles and criteria for workplace drug

testing program• Forensically defensible









Alternative TestingAlternative TestingMethodologiesMethodologies

“Technological advances havecreated alternatives to urine”









Oral Fluid (Saliva) TestingOral Fluid (Saliva) Testing

v Laboratory based testing using GC/MS/MSv Used in workplace testing, criminal justice ,corrections, probation, etc.v Insurance companies have been using oral fluids

laboratory based testing for over 3 yearsv Oral fluids detect recent use - urine detects residual drug

Provided by STC Technologies, Inc.









Drug Class Saliva Time of Detection Urine Time of DetectionCannabinoids 1 to 14 Hours 1 to 30 Days

Cocaine 12 Hours to 10 Days 1 to 3 DaysPhencyclidine N/A 1 to 30 DaysOpiates 3 to 24 Hours 1 to 2 Days

Amphetamines 1 to 2 Days 1 to 2 Days

Window of Detection --Drugs of Abuse in Saliva/Urine

Provided by STC Technologies, Inc.









Provided by STC Technologies, Inc..

Oral Fluid TestingOral Fluid TestingAdvantagesAdvantages

v Easy to administerv Quick, 2 minute collectionv Next day resultsv Hard to adulteratev Preserves donor/collector

dignity (no urine)v Cost is comparable to urine

testing









Sweat TestingSweat Testing

v Sweat patch is most common method of collectionv Used primarily in criminal justice, rehabilitation and

drug court applicationsv Patch must be worn over a period of time - 24 hours

up to 7 daysv Detects both parent drug and drug metabolitev Not ideal for workplace testing

Provided by PharmChem Laboratories, Inc.









Sweat Testing AdvantagesSweat Testing Advantages

vNo urine collectionvQuick application and removalvLonger window of detectionvNo sample substitution / adulterationvLaboratory tested - GC/MSvMonitors 24 hours a day / 7 days a week

Provided by PharmChem Laboratories, Inc.









Hair TestingHair Testing

vTested at laboratory using same methods as urine testing (screen and confirmation)v Approximate 60-90 day window of detectionv Used predominantly for pre-employment testingv Not suitable for post-accident or reasonable cause testing (does not test current impairment)v Sensitive to environmental contaminationv Used in workplace testing, child custody, court system,

etc.









Hair Testing AdvantagesHair Testing Advantages

v Greater ability to detect drug use with a 60- 90 daydetection period

v Less invasive collection for donor (than urinecollection)

v Ease of collection adds more conveniencev Fewer adulteration issues









Instrumented On-Site DeviceInstrumented On-Site Device









Instrumented On-Site DeviceInstrumented On-Site Device

v Screening Result available in 15 minutesv Collector NOT responsible for interpreting resultv Testing conducted on-sitev Positives must be confirmedv Used in workplace testingv Provides solutions to instant testing barriers









1. Addressing the issues related to on-site drug testing2. Technologically advanced

a. Barcodeb. OCR (digital imaging)

3. EMIT Testing/0 False Negatives4. Ability to interpret a line

a. Presence=negativeb. absence-positive

5. Communicationa. Negative results in 15 minutesb. Positives sent to lab for GC/MS

Provided by

Instrumented On-Site TestingInstrumented On-Site TestingAdvantagesAdvantages









“NIDT”“NIDT”

Non-Instrumented Drug Testing









“NIDT”“NIDT”

NIDT NIDT vsvs. Lab-Based Testing. Lab-Based Testingvv SimilaritiesvHomogeneous ImmunoassaysvCompetitive binding assaysvUtilizing urine as samplevScreen only (requires confirmation)vBoth are qualitative screens

vDifferences:vResults interpretation Provided by MedTox Scientific









NIDT - Cup DeviceNIDT - Cup Device









NIDT - Aliquot DeviceNIDT - Aliquot Device









NIDT - Dipping DeviceNIDT - Dipping Device









Why do Companies UseWhy do Companies UseNIDT?NIDT?

v Turnaround Time

v Cost ???

v Instant Test Result









TechnologyTechnology

Lateral Flow Technology

v Similar to home pregnancy testsv Gold coated antibodies dried on padv Drugs “dried” on strip at each locationv Urine specimen added to sample wellv Antibodies attach to drug at pad / sitev If drug in urine, antibody not available to attach at site

(non-negative result)v If no drug in urine, antibody attachment at site creates

line (negative result)Provided by MedTox Scientific










Y Y Y Y Y Y Y Y Y

Y Y Y Y Y Y Y Y Y

Gold coated antibody to each of the drugs are dried onto the sample pad

Drugs are dried downstream in the window area of the device

Provided by MedTox Scientific









When Urine Containing Drug is added to the Device, the Drug in the Urine Will Bind to the Antibody












As the complex migrates down the device, it will pass by the drug on thedevice and no line develops Provided by MedTox Scientific









When Drug Free Urine is Added to the Device,theAntibody is Free to Bind To the Drug On the Device

and a Line Develops

Technology










CAUTION!!!

Not all devices are created equal.

Sensitivity VS. Specificity









AccuracyAccuracy

vFalse Positives

vNegligent Negatives

vAdulteration Testing

vCollection Errors









False Positive?False Positive?

vPositive on-site resultthat tests negative atlaboratory









Negligent Negative?Negligent Negative?

On-Site Testv Pre-employment

Negative Resultv Goes to Work

Confirmation Testv Post-accident Positive

Resultv Already Employee









Adulteration MethodsAdulteration Methods

4 Dilution4 Nitrite4 Gluteraldehyde4 Soap4 Bleach4 Water









Questions???









trends in drug testing - american bar association · author: matthew t. fagnani subject:...

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