1. Advanced Drug Detection Questions & Answers
By: Paul L. Cary
Toxicology Laboratory
University of Missouri

2. What is meant by the term “zero tolerance” drug testing
What is meant by the term “zero tolerance” drug testing? Why do drug tests use a cutoff anyway? Isn’t it possible to detect drugs down to a level of zero?

3. Negative or None Detected Results
indicates that no drugs or breakdown products (metabolites), tested for, were detected in the sample tested
does not mean NO drugs present

4. Negative/None Detected Interpretation
donor is not using a drug that can be detected by the test OR
donor not using enough drug
donor’s drug use is too infrequent
collection too long after drug use
urine is tampered
test being used not sensitive enough

5. Negative/None Detected Interpretation
assess none detected drug testing results in the context of your client’s overall program compliance (or non-compliance) and their life’s skills success (or lack thereof)

6. Positive Test Result Interpretation
indicates that drug(s) or breakdown products (metabolites), tested for, were detected in the sample tested
drug presence is above the “cutoff” level
greatest confidence achieved with confirmation
ALWAYS confirm positive results in original sample

7. Typical Cutoff Levels screening & confirmation
amphetamines * ng/mL ng/mL
benzodiazepines 300 ng/mL variable
cannabinoids * 50 ng/mL ng/mL
cocaine (crack)* 300 ng/mL ng/mL
opiates (heroin) * 300/2000 ng/mL variable
phencyclidine (PCP) * 25 ng/mL ng/mL
alcohol 20 mg/dL mg/dL
* SAMHSA (formerly NIDA) drugs

8. How should I deal with a client who claims to have used or ingested something that caused a “false” positive?

9. Drug tests & cross reactivity:
screening tests can and do react to “non-target” compounds
amphetamines
benzodiazepines
obtain list of interfering compounds from lab or on-site test vendor
on-site testing devices (“instant” tests) are only 60-70% accurate
confirm positive results

10. Client Accountability:
the court should not assume the role of client “excuse evaluator”
clients need to be held responsible for their own behavior and maintaining a drug-free physiology
if testing performed appropriately (with confirmation) –
HOW the drug got into their sample is mostly irrelevant
a positive drug test results put the client in violation
as a practical and resource matter – the court cannot afford to argue over or dispute with every client who has a positive test result or comes up with a new excuse

11. I heard that urine drug concentrations have no meaning or interpretive value for assessing client drug use behavior - is that true ?

12. Drug Tests are Qualitative
screening/monitoring drug tests are designed to determine the presence or absence of drugs - NOT their concentration
drug tests are NOT quantitative

13. Drug concentrations or levels associated with urine drug testing are, for the most part, USELESS !
cocaine metabolite 517 ng/mL
opiates negative
cannabinoids negative
amphetamines negative

14. THE ISSUE:
Urine drug concentrations are of little or no interpretative value. The utilization of urine drug test levels by drug courts generally produces interpretations that are inappropriate, factually unsupportable and without a scientific foundation. Worst of all for the court system, these urine drug level interpretations have no forensic merit.

15. Scientific Rationale Technical Issues Physiological testing not linear
tests measure total drug concentrations
Physiological
variability of urine output
differential elimination of drug components

16. The Vicious Cycle Courts provided with a number assume
it has value and
requires interpretation
The Vicious Cycle
Labs know the
urine levels are
of little or no inter-
pretive value, and
yet are reported
because of customer
demand
Courts become
dependent on
urine levels attempting to define client drug use behavior and justify sanctions & rewards
Labs are reluctant
to discontinue
practice and risk
revenue loss or customer
dissatisfaction

17. “Expected Values:
When the test is used as a qualitative assay,
the amount of drugs and metabolites detected
by the assay in any given specimen cannot be
estimated. The assay results distinguish
between positive and negative specimens only.”

18. Advantages of Eliminating Drug Levels
court decisions have a strong scientific basis & forensically sound
no longer attempt to interpret data that is not interpretable
greater confidence in decision making process
removes ambiguity associated with manipulating numbers that few in drug court are trained to do
adds additional fairness/equity in sanctions & incentives process

19. NDCI Practitioner Fact Sheet: http://www. ndci

20. Does marijuana really stay in a client’s body for 30 days or longer after use?

21. Cannabinoid Detection in Urine
Conventional wisdom has led to the common assumption that cannabinoids will remain detectable in urine for 30 days or longer following the use of marijuana.
RESULT:
delay of therapeutic intervention
hindered timely use of judicial sanctioning
fostered denial of marijuana usage by clients

22. Many of the early cannabinoid studies often cited as proof of 30+ day detection periods suffered from . . .
unable to ensure abstinence during the study
detection cutoffs used very low
used testing methods no longer available - poor specificity

23. Cannabinoids - Recent/Relevant Research
30+ day detection window often exaggerates duration of detection window
reasonable & pragmatic court guidance
detection time: at 50 ng/mL cutoff
1 - 3 days for single event/occasional use
up to 10 days for heavy chronic use
detection time: at 20 ng/mL cutoff
5-7 days for single event/occasional use
up to 21 days for heavy chronic use

24. Recent Cannabinoid Use versus Non-recent use (double sanction issue):
How do drug courts discriminate between new drug exposure and continued elimination from previous (chronic) use ?
an issue only in first phase of program
only drug that poses concern is cannabinoids
“two negative test” rule – two back-to-back negative drug tests post clean out

25. Full Text of: The Marijuana Detection Window: Determining the Length of Time Cannabinoids Will Remain Detectable in Urine following Smoking: A Critical Review of Relevant Research and Cannabinoid Detection Guidance for Drug Courts, Drug Court Review (publication of the National Drug Court Institute, Arlington Virginia Volume V, Issue 1, Spring 2006, pages

26. What does it mean when a sample is reported as “dilute” or as having a “low creatinine” ?

27. What is creatinine ?
creatinine is derived from the non-enzymatic dehydration of creatine in skeletal muscle
creatinine is produced by the body at a relatively constant rate throughout the day
creatinine is a compound that is unique to biological material (i.e. urine, other body fluids)
creatinine can be measured to determine the “strength” or concentration of a urine sample

28. Water contains no drugs!
easiest, cheapest, simplest
urines with a creatinines of less than 20 mg/dL are considered “dilute” and rarely reflect an accurate picture of recent drug use
dilute samples are like water than like urine
all drug court samples should be screened for creatinine

29. How are creatinine measurements used ?
normal human creatinine levels will vary during the day based upon fluid intake - healthy individuals will rarely produce urine samples with creatinines of less than 20 mg/dL
incidence of low creatinines in a population undergoing random drug testing is times greater than a non-drug tested population
any fluid intake dilutes the concentration of drugs in urine (along with the creatinine)

30. Fluid intake & dilute samples:
rapid intake of 2 quarts of fluid routinely produces low creatinines & negative urine drug tests within one hour
rapid intake of 4 quarts of fluid almost always produces low creatinines and negative urine drug tests within one hour
limit fluid intake prior to collection

31. What is the most common method client’s use to “beat the drug test” and how can this cheating be controlled ?

32. Basics of Specimen Tampering - The Three Approaches
dilution
adulteration
substitution

33. Urine Specimen Dilution:
most common form of tampering
pre collection dilution (hydration, water loading, flushing)
post collection dilution
creatinine measurement
dilution detection (specimen validity tests - SVT)

34. Urine Specimen Adulteration
addition of foreign substances designed to “mask” drug presence
post-collection tampering
low-tech adulterants that cause “pH shift” (lime, vinegar, bleach, ammonia, lemon, drano)
low-tech adulterants that disrupt testing chemistry (salt, methanol, detergent)
common “high-tech” adulterants

35. Urinaid, Byrd Laboratories
gluteraldehyde
sterilization chemical
deactivates most screening tests - producing false negative results
can be identified by laboratories employing specimen validity checks
effects can not be reversed

36. Klear & Whizzies potassium nitrite, sodium nitrite
analytical chemistry
compromises the confirmation (GC/MS) of some drugs, notably carboxy-THC
oxidizes drug and standards
can be identified by laboratories employing specimen validity checks
effects can be reversed

37. Urine Luck pyridinium chlorochromate/dichromate
oxidizing agent in organic synthesis
compromises the confirmation (GC/MS) carboxy-THC and opiates
can also effect screening tests
oxidizes drug and standards
can be identified by laboratories employing specimen validity checks
effects can not be reversed

38. Urine Specimen Substitution
replacing donor urine sample with another drug-free specimen
biological substitution - someone else’s “clean” urine
non-biological substitution - replacing urine with urine “look-a-like” sample (diet Mountain Dew, water with food coloring)
non-biologicals can be detected with creatinine testing

39. Controlling Specimen Tampering
develop challenging collection strategy - ie. make the testing unannounced and RANDOM!
directly observed collections is the most effective approach to preventing adulteration and substitution
inspect sample - train collection staff
keep abreast of tampering techniques
take temperature measurements (90˚ - 100˚ F)
use laboratory employs specimen validity tests & use with on-site devices

40. Specimen Validity Tests (SVT)
creatinine, UUN
specific gravity pH
nitrites
gluteraldehyde
pyridine
chromium
Request SVT from testing laboratory or use dip-stick SVT products for on-site testing

41. The “witnessed” collection (for urine)
single most important aspect of effective drug testing program
urine collections not witnessed are of little or no assessment value
denial component of substance abuse requires “direct observation” collections of participants
The importance of witnessed collection (for urine monitoring) can not be over-emphasized. As indicated on the slide, urine collections which are not witnessed are of little or no assessment value because of the propensity of drug court participants not to provide a legitimate sample (denial; efforts to hide relapse). The definition of “witnessed collections” is direct line-of-sight observation – basically staring at a participants genitals. Difficult? - yes! Uncomfortable? - no doubt! Necessary? - absolutely critical. Put another way; if drug courts don’t directly observe urine collections, they should not waste their time and money on testing efforts! It’s THAT important!
The success of monitoring depends on a legitimate specimen for testing. The most likely guarantor that a legitimate specimen will be produced is with direct-observation collections. Remember, a drug court can employ the absolute best testing methods available, but that testing is worthless if the sample has been tampered with (by the participant) prior to the testing process.

42. What’s the best specimen for abused substance testing in a drug court population where we are monitoring abstinence?

43. Drug Testing Specimens
urine - current specimen of choice
generally readily available - large quantities
contains high concentrations of drugs
good analytical specimen
provides both recent and past usage
alternative specimens
breath
hair
sweat - patch test
saliva - oral fluids
eye scanning devices

44. Relative Detection Times – by Specimen

45. Characteristics of a Good Drug Test:
scientifically valid
employs proven methods & techniques
accepted by the scientific community
therapeutically beneficial
provides accurate profile of client’s drug use
provides rapid results for appropriate response
legally defensible
able to withstand challenge
established court track record
scrutinized by legal/judicial review

46. Your Questions ?

47. address: