Presentation on theme: "Central Iowa Juvenile Detention Center Established 1993 Providing the Following Services: Detention Transportation Tracking Fiscal Coordination Drug Testing."— Presentation transcript:
Central Iowa Juvenile Detention Center Established 1993 Providing the Following Services: Detention Transportation Tracking Fiscal Coordination Drug Testing In-Home Counseling Evaluation Program
A Brief History 1994- Began Drug Testing at CIJDC Detention Facility 2008- Began contracting with DHS thru local RFP Process 2013- Began Statewide Drug Testing Contract for DHS thru Statewide RFP Process. We offer Fixed Sites in 47 counties We offer In-Home and Emergency Testing in 99 counties CIJDC has over 100,000 collections for DHS clients
Why do we drug test? “Drug use affects every sector of society, straining our economy, our healthcare and criminal justice systems, and endangering the futures of young people.” -Office of National Drug Control Policy
Effects of Drug Usage on Kids Higher rates of hospitalization for children with parents who abuse drugs Higher rates of child abuse and neglect Higher rates of birth defects Higher risk for the children to develop substance abuse problems later in life Higher rate of mental disorders Higher rate of eating disorders Higher rate of anxiety and depressive disorders Higher rate of pathological gambling later in life Higher rate of sociopathic (Antisocial Personality Disorder) tendencies later in life Lower performance in school Children in these homes also experience higher rates of mistrust, guilt, shame, confusion, ambivalence, fear, insecurity, and conflicts about sexuality "Effects of Parental Substance Abuse on Children and Families": Source is The American Academy of Experts in Traumatic Stress www.aaets.org/article230.htmwww.aaets.org/article230.htm
Drug Usage Stats $193,000,000,000/yr U.S. Drug Usage Cost in Productivity, Health Care and Criminal Justice. $6,120/second ( National Drug Intelligence Center U.S. Dept. of Justice) 33% Drug Usage Reduction since 1970 (SAMHSA) 12% Percent of Americans Driving, weekend nights under the influence of an illicit drug (NHTSA)
10 Most Common Drugs of Abuse Per Clinical Reference Laboratory Amphetamines Barbiturates Benzodiazepines Cannabinoids Cocaine Methadone MDMA- Ecstasy Opiates Phencyclidine Propoxyphene
Amphetamines Screening cutoff: 1000 NG/ML Confirmation cutoff: 500NG/ML Amphetamines are strong central nervous system stimulants with high abuse potential. They produce an initial state of euphoria (high) followed by restlessness, agitation, irritability and sometimes extreme paranoia. Tolerance develops rapidly and, although physical dependence has not been proved, psychological dependence is very high. Amphetamines may be used in the treatment for obesity, attention disorder, hyperactivity and narcolepsy, but, because of the high abuse potential, these compounds are used as a last resort in these treatments.
Barbiturates Screening cutoff: 300NG/ML Confirmation cutoff: 300NG/ML There is a variety of these major sedative-hypnotic drugs. However, all are derivatives of barbituric acid. Depending on the derivation, the particular drug may be long acting, as is phenobarbital or short acting, as in pentobarbital. The long- acting barbiturate phenobarbital selectively reduces the excitability of rapidly firing neurons and is therefore an effective anticonvulsant drug. The short and ultra-short drugs inhibit arousal, hence their sedative and hypnotic effects. Low doses produce sedation, drowsiness, sleep and also impaired judgment. At high doses, anesthesia is produced. Very high doses can cause stupor, convulsions and death.
Benzodiazepines Screening cutoff: 300NG/ML Confirmation cutoff: 300NG/ML Among this group of drugs, the most prominent is Valium. Benzodiazepines are used therapeutically as so-called minor tranquilizers. Doses between 2.5 and 10mg produce a calming effect while higher doses produce muscle-relaxing effects. Drug addicts utilize Valium in high doses to counter the excitatory effects of other drugs or as a means of inducing tranquil states. Acutely, benzodiazepine overdose may produce somnolence, confusion, seizures, and coma. Rarely, hypertension, respiratory depression, and cardiac arrest may occur. Chronically, physical and psychological dependence occur. Sudden discontinuance of the drug may lead to anxiety, sweating, irritability, hallucination, diarrhea, and seizures.
Cannabinoids Screening cutoff: 50NG/ML Confirmation cutoff: 15NG/ML Marijuana consists of the dried leaves and flowering tops of the Cannabis sativa plant and is a source of psychoactive agents, a major one being delta 9- tetrahydrocannabinol (D9-THC). The gastrointestinal tract and the respiratory system rapidly absorb this drug after oral or inhalation routes of ingestion. The drug is extensively and rapidly metabolized and can be detected in the urine within a couple of hours and for as long as several days after use. Regular users report feelings of euphoria, hallucinations, and relaxed inhibitions.
Cocaine Screening cutoff: 300NG/ML Confirmation cutoff: 150NG/ML Cocaine is a central nervous system stimulant. It usually appears in the form of a fine crystal-like powder, although it can come in larger pieces called rocks. It may be injected, snorted or smoked as the free base. The effects of the drug begin within minutes and peak within 15 to 20 minutes. The effects include dilated pupils, increase in blood pressure, heart rate, breathing rate, and body temperature. The dangers associated with cocaine use vary depending on how the drug is taken, the dose, and the individual. Feelings of restlessness, irritability, anxiety, and sleeplessness are reported by some regular users. Even low doses of cocaine may create psychological problems. Use of high doses of cocaine over a prolonged period of time may lead to paranoia, commonly called cocaine psychosis, which includes hallucinations of touch, sight, taste, and smell.
Methadone Screening cutoff: 300NG/ML Confirmation cutoff: 300NG/ML Methadone is a nonbicyclic drug, which binds competitively with morphine to receptors in the brain. Although it can become addictive, the effects are less than those of equivalent concentrations of heroin. Thus, administration of methadone to heroin addicts allows them to experience the effects of heroin but in a modulated manner. A gradual lowering of the dose reduces the physical dependence, however addiction to methadone can also occur. Methadone is also used as a pain medication.
MDMA-Ecstacy Screening cutoff: 500NG/ML Confirmation cutoff: 500NG/ML MDMA is 3,4-methylenedioxymethamphetamine. It was originally manufactured as a weight loss product, but was never marketed because of its side effects. The white powder/solid is supplied in the form of capsules or tablets, which are easy to counterfeit, which in turnleads to contaminated or substituted products being sold as ecstasy and a true ‘buyers beware’ market. MDMA effects last three to six hours and the doses are often ‘piggy-backed’, leading to cases of severe over-heating and cardiac emergencies. Depression, anxiety, disruption of sleep and paranoia have been reported to occur days or weeks after use. Symptoms of toxicity can include confusion, agitation, hallucinations, seizures, hyperpyrexia, coma and hypotension. Large doses can cause malignate hyperthermia, leading to muscle breakdown as well as kidney and cardiovascular failure. As a real capper, MDMA is neurotoxic and can cause irreversible brain damage
Opiates Screening cutoff: 2000NG/ML Confirmation cutoff: 2000NG/ML Opiates are drugs such as heroin, codeine and morphine, which can produce a very high physical and/or psychological dependence by their users. Samples may be tested for codeine and morphine (a metabolite of both codeine and heroin), and follow-up testing for 6-acetylmorphine, also a metabolite of heroin, is allowed on morphine-positive samples. Testing for the opiates, hydrocodone (Vicodin, Lortabs), hydromorphone (Dilaudid), is performed on non-regulated samples. Feelings of euphoria, analgesia, drowsiness, and respiratory depression are reported by users.
Phencyclidine Screening cutoff: 25NG/ML Confirmation cutoff: 25NG/ML Phencyclidine is almost exclusively seen as a drug of abuse. It has numerous effects on a variety of different neural pathways and hence a wide array of bizarre symptoms can be seen in the same patient. Its physiological effects appear to be analgesic, anesthetic, and, paradoxically, stimulating. Because of its varied actions, clinically acute manifestations vary from depression to euphoria and can induce catatonia, violence, rage and auditory and visual hallucinations. Vomiting, hyperventilation, tachycardia, shivering, seizures, coma, and death are also common occurrences that result from abuse of this drug.
Propoxyphene Screening cutoff: 300NG/ML Confirmation cutoff: 300NG/ML Propoxyphene is an analgesic drug, which has very similar pharmacologic properties to those of the opiates like morphine. A major cause of drug-related deaths is propoxyphene overdose, either alone or in combination with CNS depressants like barbiturates and alcohol. Toxic symptoms are similar to those seen with opiate overdoses i.e, respiratory depression, cardiac arrhythmias, seizures, pulmonary edema, and coma.
Standard Cutoff Levels A “cutoff” is the concentration of analyte (drug) in a urine sample at or above which the sample is considered positive for that drug. The purpose of the cutoff is to insure consistency and reliability throughout the testing process. The screening cutoff may be different than the confirmation cutoff when the screening test is detecting all forms of the drug and the confirmation cutoff is measuring only one form (metabolite) of the drug in question. For example, in testing for marijuana the screening test looks for all forms of cannibinoid while the confirmation test looks only at the major metabolite D9 THCA. Test results in excess of the confirmation cutoff levels are consistent with recent ingestion of the analyte or an analyte-producing medication.
Lab-Based UA Types/ Drugs Tested Drugs Tested in 9- Lab 1) Amphetamines AMP 6) Propoxyphene 2) Cocaine COC 7) Barbiturates 3) Marijuana THC 8) Benzodiazepines 4) Opiates OPI 9) Methadone 5) Phencyclidine PC Drugs Tested in 9+LAB Items 1-9 from above AND ALCOHOL Drugs Tested in 14- test Items 1-9 from above and the following prescription type drugs 10) Fentanyl 11) Meperidine 12) Nalbuphine 13) Oxycodone 14) Pentazocine Synthetic Cannibinoid Lab K2 Spice Synthetic Amphetamine Lab Bath Salts
Lab-Based UA Cont. UA Chain of Custody Form UA Lab Testing Cup and Vials
Instant UA Tests Drugs tested in 10+ Instant Alcohol(ALC) Amphetamine(AMP) Cocaine(COC) Marijuana(THC) Opiates(OPI) Phencyclidine(PCP) Propoxyphene(PPX) Barbituates(BAR) Benzodiazepines(BZO) Methadone(MTD) Chem. Compounds Tested in Syn-Can JWH-018 Pentanoic Acid JWH-073 Butanoic Acid
Omega Hair Test Drugs Tested Amphetamines Cocaine Marijuana Opiates Phencyclidine Retention Times 10-40 days ago - 1 st ½ inch of hair 40-70 days ago - 2 nd ½ inch of hair 70-100 days ago - 3 rd ½ inch of hair
Omega Hair Testing Cont. Hair Chain of Custody Form Hair Collection Kit and Specimen Bag
Pharmchem Patch Test Drugs Tested Amphetamines Cocaine Marijuana Opiates Phencyclidine Detection Times 24 hours before application through patch removal. General Information The sweat patch is a non-occlusive, hypoallergenic collection device. The sweat patch was approved as a collection device by FDA on 10- 04-1990. The FDA cleared the sweat patch for the detection of cocaine, opiates, and amphetamine in 1995; for marijuana and phencylidine in 1996.
Pharmchem Patch Cont. PharmChem Patch Chain of Custody Form PharmChem Overlay and Patch
Collection Process Central Iowa Collector will ensure client’s number was called for testing Clients will present a form of photo ID If Client does not have an ID, CIJDC collectors will take a photo and email to worker to confirm correct person. Collector will fill out Chain of Custody Form Collector will ask client for list of medication Client will sign Chain of Custody Form Collection of test will ensue
Techniques Used to Reduce Probability of Tampering/Altering of Sample Collector will ensure UA temp is within acceptable range Sample is Visually inspected for: Temp, Color, Solids, Irregularities Security Seals will be affixed on vials of urine Opposite gender protocol used for all non-gender matched collections Items pulled from pockets, layers are also removed Colorant added to toilet No water may be ran Audio Cues observed Collector will seal bag in front of client to show that no tampering has occurred Collector will complete the Chain of Custody Form and give the client a copy
Fixed Site Referral Process For Client’s with Multiple Tests Scheduled Once approved online, Central Iowa Schedulers will begin scheduling these tests as indicated by the worker on the Authorization form in the county indicated These tests can also be set up at the workers discretion. If you have a specific dates the clients are coming in, please state these in the comments section of the authorization or email firstname.lastname@example.org@cijdc.com For Client’s with One Test and Stop CIJDC will not schedule these tests unless: 1.The worker states in the comments section when the client is coming to the fixed site. 2.The worker emails email@example.com or calls 641-858-3852 with a specific date and firstname.lastname@example.org
In Home Referral Process When making authorization, select In Home. Be sure to include address and phone numbers of clients CIJDC will attempt test with in 5 business days after test is authorized If you have any specific instructions, please list them in the comments section of the authorization Emergency Referral Process When making authorization, select Emergency. CIJDC will attempt test within 24 hours Please email email@example.com or call firstname.lastname@example.org