Understanding Drug Tests: What They Tell

You and What They Don’t?

Joseph Jones

FSMB 2019

New Orleans, LA

Case Study 1

o Pharmacist

o 6 tabs prescription for Vicodin

o Hair test was positive

• Hydrocodone 2186 pg/mg

• Norhydrocodone 820 pg/mg

oQuestion?

▪ Taking as prescribed or abusing?

▪ Why?

Case Study 2

o Nurse

o Positive urine for cocaine metabolite

o Donor denies using cocaine

o 2 weeks later hair was collected

o Hair result was negative.

o Question?

▪ Was the urine test incorrect?

▪ Does the hair test refute the urine test?

DRUG FREE FEDERAL

WORKPLACE

19861981

DRUG FREE FEDERAL WORKPLACE

• Amphetamine/Methamphetamine

• Cocaine

• Opiates (codeine, morphine, heroin)

• Phencyclidine

• Marijuana

Changing Drug Use Patterns

o Amphetamines• Amphetamine

• Methamphetamine

• MDA

• MDMA

• MDEA

o Opiates• Codeine

• Morphine

• Hydrocodone

• Hydromorphone

• 6-MAM

• Oxymorphone

• Oxycodone

• Buprenophine

• Methadone

• Meperidine

• Propoxyphene

• Tramadol

• Cocaine• Marijuana• PCP

• Barbiturates

– Butabital

– Amobarb

– Pentobarbital

– Secobarb

– Phenobarbital

• Fentanyl

• Sufentanil

• Soma

• Zolpidem

• Dextromethorphan

• Methylphenidate

• Ethylglucuronide

• Benzodiazepines

– Oxazepam

– Nordiazepam

– Temazepam

– Lorazepam

– Flurazepam

– Nitrazepam

– Triazolam

– Alprazolam

– Flunitrazepam

– Midazolam

– Clonazepam

• Phentermine

• Propofol

• Ketamine

• Gabapentin

• Designer drugs

ANTI-DRUG TESTING PRODUCTS

Health Professional Access

WIDE VARIETY OF DRUGS?

Tools in the Tool Belt

Tools in the Tool Belt

• Urine

• On-site Urine devices

• Hair

• Oral Fluid

• Nails

• Blood

• Interview

Detection Windows

2

2

3

90

180

0 50 100 150 200

Blood

Oral Fluid

Urine

Hair

Nail

Detection Window (days)

FORENSIC DRUG TESTING

• Two different methodologies

• Chain of custody

FORENSIC DRUG TESTING

• Two different methodologies

Immunoassay

Mass Spectrometry

• Chain of custody

Common Metabolic PathsYou Need to Know

Compound Metabolite

nTHC Carboxy-THC

All CBD preparations contain varying amounts of THC

Common Metabolic PathsYou Need to Know

Compound Metabolite

Methamphetamine Amphetamine

MDMA MDA

Common Metabolic PathsYou Need to Know

Compound Metabolite

Heroin* 6MAM

6MAM Morphine

Codeine Morphine

Common Metabolic PathsYou Need to Know

Compound Metabolite

Hydrocodone Norhydrocodone

Hydrocodone Hydromorphone

Oxycodone Noroxycodone

Oxycodone Oxymorphone

Common Metabolic PathsYou Need to Know

Compound Metabolite

Cocaine*

Benzoylecgonine

Cocaethylene

Norcocaine

Instant Urine Drug Test Kits

▪ > 70 KITS ON MARKET

▪ Not all CLIA Waived

▪ Not all have similar tests

▪ Not all have similar cutoffs

▪ Not all standard manufacturing

▪ Not all perform consistently

▪ Not all have validity tests

▪ False negatives, positives

Laminar Flow Immunoassay

Oral Fluid Drug Testing

Advantages

• Direct observed collection

• Non-clinical collection setting

• No gender issues

• Under the influence determination

• Difficult to adulterate

Disadvantages

• Short detection window

• More expensive than urine

• Dry mouth

Hair Drug Testing

#1 ENVIRONMENTAL EXPOSURE

SMOKE

TRANSFERANCECONTACT

FUMES

HOW DO DRUGS GET INTO THE HAIR?

HOW DO DRUGS GET INTO THE HAIR?

#2 SWEAT AND OIL

THESE DRUG AND METABOLITE CONTAINING FLUIDS BATHE THE HAIR SHAFT

HOW DO DRUGS GET INTO THE HAIR?

#3 THE BLOOD

• White, Brown, & Black Rats

• 40 mg/kg daily

• 5 days

Gygi et al (1996) Drug Metab. & Disp, 24(4), 495-501.

Codeine Color Bias Study

White Rat 980 pg/mg

Brown Rat 5990 pg/mg

Black Rat 111,930 pg/mg

Gygi et al (1996) Drug Metab. & Disp, 24(4), 495-501.

Codeine – Color Bias Results

Rollins, D. (2004) Role of Melanin in Drug Incorporation into Hair,

Presentation, SOHT, Des Plaines, IL

• Each subject received 30 mg oral dose

• 3x daily for 5 days

• Hair collected weeks 0, 4, 5, 6, and 7.

• Analyzed first 1.5 inches

Rollins et al (2003) J Anal Tox, 27, 545-550

Codeine Concentrations

Black Brown

RedBlonde

(pg/mg hair)

Black

1134.0

Brown

250.8

Red

66.6

Blonde

119.6

Rollins, D. (2004) Role of Melanin in Drug Incorporation into Hair,

Presentation, SOHT, Des Plaines, IL

Codeine Concentrations

Other

Limitations

Hair ?

Nail

Reservoir Specimen Type

Where analytes

tend to accumulate

Reservoir Specimen Type

Cannot backtrack to determine

• Time

• Dosage

• Frequency

There are too many variables

How to Refute a Drug Test

• Do not collect ano her specimen

• RETEST the original specimen

Revisit the Case Studies

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United States Drug Testing Laboratories, Inc.