1. Drug Court

2. Myth Cannabis levels are really useful in determining relapse.

3. Reality Basically…not See the monograph on the NDCI.org

4. Myth : The presence of urine sediment (material that settles to the bottom of the collection cup) is a good indicator of sample tampering. True or False

5. Urine sediment occurs naturally & is comprised of: cells - (epithelial, kidney, blood) casts - (cylindralical particles formed by WBC, RBC, granular material, fat, etc. crystals - organisms (bacteria, yeast, fungi)

6. Myth Treatment doesn’t work. Nobody can change.

7. Myth Treatment doesn’t work. Nobody can change.

8. Myth: A urine creatinine level of 475 ng/mL is reasonable evidence to indicate specimen tampering. True or False

9. Normal Urine Creatinine: 2005 study “Urinary Creatinine Concentrations in the U.S. Population” determine the mean (based upon 22,245 participants) was 130 mg/dL –less than 1% below 20 mg/dL –less than 1% greater than 400 mg/dL it’s all about patterns

10. Creatinine Math healthy adult produces/eliminates approximately 1 mg of creatinine per minute or about 1440 mg in a 24-hour day. in order to achieve a urine creatinine level of 475 mg/dL the client would only be excreting only about 11.4 ounces of urine in a 24-hour period (or about a cup and a half). proof of tampering "beyond a reasonable doubt" - no.

11. Myth Methadone/Suboxone are: Evil Just another Addiction Can’t work with Drug Court

12. ORT Substitutes One Addictive Drug With Another? ORT uses medication (methadone/Suboxone) to overcome craving and need for illicit opioids. ORT pharmacologic actions differ from other opioids; not mere substitute. –Orally effective, long acting, cross tolerance (blockade) Addictive, opioid-seeking, behaviors cease. ORT benefits overshadow reliance on dependency-producing medication. Consequences of untreated opioid addiction include: destitution, prison, disease, and/or early death.

13. MMT Patients Get “High”? At appropriate and adequate stable doses, normal function – no lasting euphoria or sedation. Adequate methadone dose avoids extremes of intoxication or withdrawal. After dosing, some patients may “sense” onset of methadone effects or have vague feelings of “well-being” (soon wears off after blood level peaks).

14. Taming the Roller Coaster Adequate methadone smooths peaks & valleys – shifting from opioid intoxication to withdrawal. Patients can live more comfortably normal lives throughout each day.

15. ORT Patients Abuse Other Drugs? ORT not a “cure” for addiction. –Addresses illicit opioid withdrawal and craving. Pharmacologically little effect on alcohol, cocaine, etc. With adequate ORT, most patients do eliminate or reduce other drug abuse. Ongoing counseling, psychosocial treatment, needed services and self help groups are important.

16. Benefits to Drug Court It can save lives! The treatment does work with Drug Court Fairfield County, Ohio –62% grad rate with Suboxone –13% grad rate without

17. Myth Methadone/Suboxone are: Evil Just another Addiction Can’t work with Drug Court

18. Myth: A urine with a negative EtG and an ethyl sulfate (EtS) concentration of 457 ng/mL is inclusive to establish the consumption of alcohol by a client. True or False

19. EtS Without EtG EtG “discovered” first large lab testing 2000 samples a month, incidence of EtS without EtG = 3% EtG can be “eaten” by bacteria (e. coli) client with UTI could destroy EtG reasonable EtS cutoff = 100 ng/mL using LC/MS/MS

20. Myth Poppy seed bagels can cause a positive reaction on a urine test

21. Myth: A reasonable “failure to confirm” rate (presumptively positive sample that fails to confirm by GC/MS)is about 25%. True or False

22. Failure to confirm rate should be in the low single digits. Issues to consider:

23. Failure to Confirm discrepant cutoffs misreading of on-site device –“Any band, even if faint, partial or broken, indicates a negative result. The absence of color is a presumptive positive result.” cross-reactivity - false positive –amphetamines & benzodiazepines re-screening at confirmation lab

24. Myth Everyone needs residential treatment

25. Reality Some need it Many/most don’t Long term residential is expensive Some jurisdictions don’t have it Being in the community helps develop connections: court, judge, self help, etc. And remember…only a trained treatment person can determine clinical level of care.

26. Myth Everyone needs residential treatment

27. Myth A client with diabetes is likely to produce dilute specimens (with urine creatinine levels of less tha 20 mg/mL) because of his/her disease. True or False

28. Diabetes & Creatinine To the research: –some people with diabetes have slightly lower urinary creatinine levels –this finding is not universal across all racial/ethnic groups or even age groups. –non-Hispanic blacks with diabetes had urinary creatinine levels about 30 mg/dL lower than those without diabetes –no significant differences were observed in other racial/ethnic groups. –similar variations were observed in different age group categories –urinary creatinine levels for persons with diabetes 30-39 years of age were about 40 mg/dL lower than those without diabetes in the same age group.

29. Diabetes & Creatinine how to apply this research to drug court question is whether diabetes causes dilute urine samples - the answer is NO! average urine creatinine level for a non- Hispanic black participant, 20-49 years of age is 180 mg/dL - subtract 30 mg/dL of creatinine for a diabetic condition, starting with an average urine creatinine level of 150 mg/dL

30. Creatinine Facts some diseases that produce low urinary creatinines –muscle wasting disease - RARE –some kidney aliments - RARE low creatinines ARE NOT routinely associated with: –pregnancy –diabetes –obesity –exercise –high-blood pressure –being vegetarian

31. Myth A client with diabetes is likely to produce dilute specimens (with urine creatinine levels of less tha 20 mg/mL) because of his/her disease. True or False

32. Myth If taken in large dosages, niacin (vitamin B-3) can be utilized by clients to speed the elimination of THC from their bodies resulting in a shorter detection window for cannabinoids. True or False

33. All About Niacin niacin - vitamin that affects more than 50 metabolic functions, releasing energy from carbohydrates absolutely NO scientific or medical data indicating niacin has ANY effect on a urine drug test adds a more intense "yellow" color to the urine niacin used to disguise diluted samples niacin overdose is often accompanied by skin“flushing”

34. Myth If taken in large dosages, niacin (vitamin B-3) can be utilized by clients to speed the elimination of THC from their bodies resulting in a shorter detection window for cannabinoids. True or False

35. Myth Well I got my recovery doing it this way so everyone should do it exactly like me.

36. Reality Everyone has different needs/ experiences Show what worked for you, don’t force it Take what fits and leave the rest

37. thanks to Dave Wallace – Photographer Meghan Wheeler Cinderella The nice popcorn lady The eventually nice Secret Service