Common Drug-Testing Methodologies

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Common Drug-Testing Methodologies

• Dr Charles Appleton
• Queensland Medical Laboratory
• Substance Abuse in the Workplace

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Common Drug-Testing Methodologies

• Scope
• Which methodologies strengths limitations
• Screening
• Confirmation
• The Standards Accreditation
• Includes compliance accreditation, quality
  control
• Quality practice
• Testing outside of Standards

Toxicology
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Common Drug-Testing Methodologies

• Approach
• The Standards
• The methodologies
• Where does synthetic cannabinoid testing sit?

Toxicology
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Common Drug-Testing Methodologies

• AS/NZS 43082008 for urine
• AS 4760-2006 for oral fluid
• define procedures for
• Collection
• Transportation
• Analysis
• Reporting
• (cover a relatively small number of substances
  but the principles are applicable outside of the
  standard)

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Common Drug-Testing Methodologies

• Methods of analysis
• Screening predominantly immunoassay -
  workplace/laboratory
• Confirmation exclusively mass spectrography -
• generally gas or liquid chromatography
• MS is the detection and characterisation stage

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Common Drug-Testing Methodologies

• Immunoassay
• Generally a class method
• Cannabinoids
• Opiates
• Sympathomimetic Amines
• Cocaine
• Benzodiazepines
• Barbiturates
• Phencyclidine
• Methadone
• and others

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Common Drug-Testing Methodologies

• Immunoassay
• Thresholds (mg/L) differ from Country to Country
• Recommended by Standards Australia
  SAMHSA
• (AS/NZS 4038)
• Cannabinoids 50 50
• Cocaine metabolites 300 300
• Sympathomimetic Amines 300 1000
• Opiates 300 2000
• Benzodiazepines 200
• Phencyclidine 25

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Courtesy of Bio-Rad Laboratories Ltd
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Common Drug-Testing Methodologies

• Confirmation procedures
• Sample cleanup/extraction
• Chromatographic separation of different drugs and
  metabolites of those drugs
• gas, high performance liquid chromatography
• Identification and quantitation of the individual
  parent and metabolite peaks
• mass spectrography

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Common Drug-Testing Methodologies

• Urine testing - Important considerations
• Sensitivity and specificity
• Adulteration/creatinine
• Other considerations
• Historical positives
• Legitimate innocent positives
• False positives
• Passive positives

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Common Drug-Testing Methodologies

• Adulteration -
• Process of compromising or attempting to
  compromise the integrity of the sample after
  passage but prior to testing

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Common Drug-Testing Methodologies

• Adulteration (urine) -
• water dilute substances in the sample to a
  level below the threshold for detection
• oxidising agents chemically burn the drug
• nitrites, acid, etc chemically alter the drug
  or the drug-antibody interaction
• Note adulterant checks do not detect sample
  substitution

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Common Drug-Testing Methodologies

• Creatinine -
• normal product of muscle metabolism
• concentration in urine is determined by the
  amount of muscle in the subjects body and the
  amount of water that his kidneys are excreting at
  the time of sample collection
• there is a (usually) minor contribution from diet
• an indicator of the overall concentration of the
  sample

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Common Drug-Testing Methodologies

• Urine Creatinine -
• average concentration
• 10-12 mmol/L in males
• 8-10 mmol/L in females
• usual range- 5-15 mmol/L
• creatinine less than 0.5 mmol/L (50 mg/L)
• not consistent with human urine
• creatinine 0.5 1.7 mmol/L (50 200 mg/L)
• may indicate dilution in some individuals

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Cases Cannabinoids Non-negative initial urine
screen

• GCMS ASSAY - URINE THC CONFIRMATION
• Date Lab No d9-THCA U.Creat
  Ratio
• ug/L mmol/L
  
• 14/12/09 12 1.4
  8.6
• The urine was very dilute. This suggests a large
  water intake prior to passage of the urine, or
  perhaps adulteration of the sample with water
  after collection. This may be used to dilute out
  any drug metabolites to concentrations below
  detection limits.

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Common Drug-Testing Methodologies

• Urine testing - Important considerations
• Sensitivity and specificity
• Adulteration/creatinine
• Other considerations
• Historical positives
• Legitimate innocent positives
• False positives
• Passive positives

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Common Drug-Testing Methodologies

• Urine testing - Historical positives
• Characteristic of lipid-soluble (dissolve in body
  fat) substances
• Seen predominantly after prolonged high dose use
• Within the Standard, consideration applies to
  cannabis and benzodiazepine users only
• Less well-defined with respect to other drugs
  such as synthetic cannabinoids

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Cases Cannabinoids Non-negative initial urine
screen

• GCMS ASSAY - URINE THC CONFIRMATION
• Date Lab No d9-THCA U.Creat
  Ratio
• ug/L mmol/L
  
• 06/11/09 596 37.6
  16
• 13/11/09 screen neg 8.2
• 20/11/09 18 45.1
  0.4
• Large fluctuations in the urinary creatinine will
  complicate interpretation of absolute values.

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Common Drug-Testing Methodologies

• Urine testing - Legitimate innocent positives
• Over-the-counter medications
• Prescribed medications
• Food constituents
• Products of metabolism of other drugs

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Cases Opiates Non-negative initial urine screen

• MS ASSAY - URINE OPIATE CONFIRMATION
• Date Codeine Morphine U.Creat Cod/Crea
  Mor/Crea
• (ug/L) (ug/L) (mmol/L) Ratio
  Ratio
• 18/12/09 265 556 18.7 14
  30
• Assayed to AS/NZS 43082008 requirements.
• The cutoff level for both Codeine and Morphine is
  300ug/L.
• MS confirms the initial opiate screen and reveals
  a pattern indicative of recent use of codeine.
• There is no suggestion of use of illicit opiates.

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The metabolic pathway of the opiates.XII-Biotech
-C-Opiate Chemistry-3
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Cases Opiates Non-negative initial urine screen

• MS ASSAY - URINE OPIATE CONFIRMATION
• Date Codeine Morphine U.Creat Cod/Crea
  Mor/Crea
• (ug/L) (ug/L) (mmol/L) Ratio
  Ratio
• 13/01/10 lt50 413 19.6 lt3
  21
• (27)
• MS confirms the initial opiate screen and reveals
  the presence of a small amount of morphine as
  well as a trace of codeine.
• Although it is not possible to exclude the
  possibility that this may reflect use of morphine
  or of heroin recently with use of codeine some
  days prior to that, this is the pattern typically
  seen after ingestion of foodstuffs containing
  poppy seed.
• There is no absolute indication of use of illicit
  opiates.

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Cases Sympathomimetic Amines Non-negative
initial urine screen

• MS ASSAY - URINE SYMPATHOMIMETIC AMINE
  CONFIRMATION
• Cut-off
• Amphetamine gt1500 ug/L 150 ug/L
• Methamphetamine gt1500 ug/L 150 ug/L
• MDMA Not detected 150 ug/L
• MDA Not detected 150 ug/L
• Phentermine Not detected 500 ug/L
  
• Ephedrine Not detected 500 ug/L
  
• Pseudoephedrine Not detected 500 ug/L
• Creatinine 14.8 mmol/L
• Amphetamine 1580 ug/L
• Methamphetamine 6100 ug/L

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Sympathomimetic Amines the faces
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Cases Sympathomimetic Amines Non-negative
initial urine screen

• MS ASSAY - URINE SYMPATHOMIMETIC AMINE
  CONFIRMATION
• Cut-off
• Amphetamine gt1500 ug/L 150 ug/L
• Methamphetamine Not detected 150 ug/L
• MDMA Not detected 150 ug/L
• MDA Not detected 150 ug/L
• Phentermine Not detected 500 ug/L
  
• Ephedrine Not detected 500 ug/L
  
• Pseudoephedrine Not detected 500 ug/L
• Creatinine 15.9 mmol/L
• Assayed to AS/NZS 43082008.
• Subject prescribed Dexamphetamine

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Cases Sympathomimetic Amines Non-negative
initial urine screen

• MS ASSAY - URINE SYMPATHOMIMETIC AMINE
  CONFIRMATION
• Cut-off
• Amphetamine Not detected 150 ug/L
• Methamphetamine Not detected 150 ug/L
• MDMA Not detected 150 ug/L
• MDA Not detected 150 ug/L
• Phentermine gt1500 ug/L 500 ug/L
  
• Ephedrine Not detected 500 ug/L
  
• Pseudoephedrine Not detected 500 ug/L
• Creatinine 17.9 mmol/L
• Phentermine 31300 ug/L

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Cases Sympathomimetic Amines Non-negative
initial urine screen

• MS ASSAY - URINE SYMPATHOMIMETIC AMINE
  CONFIRMATION
• Cut-off
• Amphetamine 917 ug/L 150 ug/L
• Methamphetamine 3040 ug/L 150 ug/L
• MDMA Not detected 150 ug/L
• MDA Not detected 150 ug/L
• Phentermine Not detected 500 ug/L
  
• Ephedrine Not detected 500 ug/L
  
• Pseudoephedrine Not detected 500 ug/L
• Creatinine 12.6 mmol/L
• Subject has Parkinson disease.

Toxicology
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Cases Benzodiazepines Non-negative initial
urine screen

• MS ASSAY - URINE BENZODIAZEPINE CONFIRMATION
• Cut-off
• Oxazepam 151 ug/L 200 ug/L
• Temazepam 215 ug/L 200 ug/L
• Diazepam Not detected 200 ug/L
• Nordiazepam lt50 ug/L 200 ug/L
• 7-Aminoclonazepam Not detected 100 ug/L
  
• 7-Aminoflunitrazepam Not detected 100 ug/L
  
• 7-Aminonitrazepam Not detected 100 ug/L
• Alpha OH-alprazolam Not Detected 100 ug/L
• Creatinine 11.0 mmol/L
• Assayed to AS/NZS 43082008.
• Subject reports prescribed Valium.

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Metabolite patterns of benzodiazepines(Source
taken amended from www.nature.com/clpt/jpurnal/v
76/n6/fig_tab/clpt2005539ft.html)

• Most simply inactivated by demethylation/hydroxyla
  tion/amination/conjugation but

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Common Drug-Testing Methodologies

• Urine testing - False positives
• Initial screen yields a non-negative finding but
  subsequent confirmation fails to reveal the
  presence of any recognised substance
• May be due to antibody cross-reactivity, presence
  of a related substance which is not included in
  the confirmation testing, analytical
  interference, etc

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Cases Opiates Non-negative initial urine screen

• MS ASSAY - URINE OPIATE CONFIRMATION
• Date Codeine Morphine U.Creat Cod/Crea
  Mor/Crea
• (ug/L) (ug/L) (mmol/L) Ratio
  Ratio
• 13/01/10 lt50 61 11.9 lt4
  5
• No trace of codeine is detected.
• Subject reports taking Duro-Tuss.

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Sympathomimetic Amines the faces
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Sympathetic Amines the family
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Sympathetic Amines the family
Toxicology
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Cases Benzodiazepines Non-negative initial
urine screen

• MS ASSAY - URINE BENZODIAZEPINE CONFIRMATION
• Cut-off
• Oxazepam Not detected 200 ug/L
• Temazepam Not detected 200 ug/L
• Diazepam Not detected 200 ug/L
• Nordiazepam Not detected 200 ug/L
• 7-Aminoclonazepam Not detected 100 ug/L
  
• 7-Aminoflunitrazepam Not detected 100 ug/L
  
• 7-Aminonitrazepam Not detected 100 ug/L
• Alpha OH-alprazolam Not Detected 100 ug/L
• Creatinine 3.7 mmol/L
• Assayed to AS/NZS 43082008.
• Subject reports prescribed Zoloft.

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Cases Benzodiazepines Non-negative initial
urine screen
Toxicology
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Common Drug-Testing Methodologies

• Urine testing - Passive positives
• This consideration applies to smoked substances
• Essentially only cannabis at presence although
  synthetic cannabinoids may become a concern
• Opium and cocaine smoking is no longer a common
  practice

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Cases Cannabinoids Non-negative initial urine
screen

• GCMS ASSAY - URINE THC CONFIRMATION
• Date Lab No d9-THCA U.Creat
  Ratio
• ug/L mmol/L
  
• 10/12/09 375 12.2
  30
• The subject is a flight attendant who claims that
  she attended a party in which cannabis may have
  been used 2 days prior to sample collection.

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Common Drug-Testing MethodologiesUrine
Conclusions

• Ensure that reports are adequate for the purpose
• Interpretation is often not intuitive
  potentially demand additional laboratory
  resources

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Common Drug-Testing Methodologies

• Oral fluid testing
• (AS 47602005)
• Important considerations
• History of the Standard
• Pros Cons

AS 4760-2006
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Procedures for specimen collection and the
detection and quantitation of drugs in oral fluid

• John Henry, Standards Australia, 2003
• Delegates agreed that a standard on saliva-based
  drug testing would be required eventually. We
  are not currently in possession of the
  information necessary for a standard to be
  commenced.
• Forum On Saliva-based Drug Testing (Held at
  Standards Australias Head Office in Sydney on
  Wednesday 23rd May, 2003)

AS 4760-2006
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Procedures for specimen collection and the
detection and quantitation of drugs in oral fluid

• 2005 Draft Standard DR 05590 released for
  public comment
• 2005 Victorian police commence trial of random
  roadside testing of oral fluid for 4 classes
• 2006 1st November, AS 4760-2006 published
• 2006 random road-side testing of oral fluid for
  drugs became widespread 2 classes only

AS 4760-2006
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Procedures for specimen collection and the
detection and quantitation of drugs in oral fluid

• Prior to 2005 oral fluid drug testing performed
  in few Australian industries
• Increasing pressure from unions to change from
  urine testing to oral fluid testing
• 25th Aug, 2008 Saliva testing OK AIRC
• In an important decision for employers across
  Aust, AIRC SDP Jonathan Hamberger has given the
  tick to saliva testing for workplace drug tests
  (OHN 753).

AS 4760-2006
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Shell Refining (Australia) Pty Ltd, Clyde
Refinery v Construction, Forestry, Mining and
Energy Union (DR2008/1238)
125 Once these two issues are satisfactorily
resolved, any random drug testing should be
conducted using oral fluids. Until then it would
not be unreasonable for the company to implement
a urine based testing regime on an interim
basis. existence of accredited
laboratories wish to test for drugs other than
those in the Standard
AS 4760-2006
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Procedures for specimen collection and the
detection and quantitation of drugs in oral fluid

• Monday, 05 December 2011 213pm
• FWA backs "role" for urine testing, finds saliva
  tests flawed

AS 4760-2006
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HWE Mining Pty Ltd v Construction, Forestry,
Mining and Energy Union (FWA 8288 (30 November
2011))

• Oral screening linked to false negatives
• Vice President Lawler accepted expert evidence
  indicating oral screening was flawed
• saliva testing devices were linked to a
  "significant incidence" of false negative results
  for some drugs, including cannabis
• a large number of Victorian motorists who tested
  positive to cannabis in laboratory tests after
  accidents had returned a negative result in the
  roadside saliva test
• on-site saliva testing devices had a low
  sensitivity for cannabis and their effectiveness
  could be reduced by the use of particular
  substances and
• there was no Australian Standard to test saliva
  for the prescription sedative benzodiazepine.
  On-site saliva tests could only detect high
  concentrations and could not detect levels where
  users would be impaired.
• In the light of these matters, HWE was "eminently
  reasonable" in its bid to retain urine testing,
  Vice President Lawler said.

AS 4760-2006
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Procedures for specimen collection and the
detection and quantitation of drugs in oral fluid

• Wednesday, 28 March 2012 1234pm
• Saliva swabs better indicator of "likely
  impairment" from cannabis
• FWA Senior Deputy President Jonathan Hamberger
  sided with the union on a number of issues, most
  notably the drug-test method.
• His decision in favour of oral testing appeared
  in conflict with another recent ruling by FWA on
  a similar issue.

AS 4760-2006
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Endeavour Energy v Communications, Electrical
and Plumbing Union (FWA s739 (28 March 2012))
Saliva swabs better indicator of "likely
impairment" from cannabis Senior Deputy
President Hamberger expressed concern about the
fairness of urine testing, given it could
identify the presence of cannabis consumed days
or even weeks prior to the test. "This means a
person may be found to have breached the policy
even though their actions were taken in their own
time and in no way affect their capacity to do
their job safely," he said. "The employer has a
legitimate right (and indeed obligation) to try
and eliminate the risk that employees might come
to work impaired by drugs or alcohol such that
they could pose a risk to health or safety.
Beyond that the employer has no right to dictate
what drugs or alcohol its employees take in their
own time. "It is precisely because it only
detects for recent use that oral fluid testing is
a better indicator of the likely impairment as a
result of smoking cannabis." FWA found that
oral fluid testing was the appropriate method for
determining whether employees were under the
influence of drugs at work.
AS 4760-2006
52

Common Drug-Testing Methodologies

• Oral fluid testing
• (AS 47602005)
• Important considerations
• History of the Standard
• Pros Cons

AS 4760-2006
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Advantages with oral fluid testing

• Privacy less of a consideration
• Recency of use
• no problem with historical positives
• Interpretation of reports
• generally straightforward

AS 4760-2006
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Problems with oral fluid testing

• Workplace health and safety risk.
• Only detects drug users who may potentially
  present affected if they have used prior to
  testing on the day of the test.
• Contrary to common claim, test result does not
  directly relate to performance/impairment
• On-site testing devices yet to meet Standard
• More work needed on interferences, adulterants,
  etc
• Laboratory confirmation includes ALL drugs listed
  in the Standard.

AS 4760-2006
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Review of findings FALSE NEGATIVES

• Look at 24 months 2010 2011 only
• 4 codeine in 83 controls
• 1 codeine in a false positive cocaine
• 1 amphetamine in 83 controls
• (1) cocaine in 83 controls
• 6 THC in samples positive for ATS only

AS 4760-2006
56
Onsite test performance

• THC looking at 2010 2011 only
• 13.9 of all referred non-negative samples
• 1.1 insufficient to confirm
• 78.7 false positive
• 20.2 true positive

AS 4760-2006
57
Onsite test performance

• Opiates looking at 2010 2011 only
• 42.5 of all referred non-negative samples
• 1.4 insufficient to confirm
• 31.4 false positive
• 67.2 true positive
• all (3) codeine
• 0 codeine with morphine
• 0 codeine with heroin
• 0 morphine

AS 4760-2006
58
Onsite test performance

• Amphetamine Type Stimulants looking at 2010
  2011 only
• 19.0 of all referred non-negative samples
• 2.3 insufficient to confirm
• 63.3 false positive
• 34.4 true positive
• 31.2 methamphetamine
• 2.3 amphetamine
• (1) MDMA

AS 4760-2006
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Onsite test performance

• Cocaine
• lt1.0 of all referred non-negative samples
• 1 insufficient to confirm
• 4 false positive
• but (one) false negative

AS 4760-2006
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Common Drug-Testing MethodologiesOral Fluid
Conclusions

• A relatively new Standard not mature yet
• The on-site testing devices have some way to go
  before becoming reliable
• False and innocent positives are costly
• False negatives are worrying
• Need better feel for what the levels actually
  mean
• Need more experience re interferences
• Basically, this is a young field

AS 4760-2006
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Common Drug-Testing Methodologies

• Synthetic Cannabinoids
• Definition Substances which
• Are at least partially man-made
• Bind to CNS CB1 receptor with a medium to high
  affinity
• When binding to CB1, act as agonist
• Are commonly marketed so as to avoid detection of
  unlawful drug use

Toxicology
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Synthetic Cannabinoids

• Scope
• History
• Chemical nature
• Manufacture considerations
• Legality
• What does the Standard bring to bear?
• Analytical aspects

Toxicology
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Synthetic Cannabinoids

• History
• 1965 THC synthesised
• 1980 Cannabinoid receptors recognised
• 1984 John W Huffmans group commenced
  synthesising substances for medical use
• 2004 Spice herbal mixtures sold in Germany
• 2008 CP-47,497 JWH-018 identified in Spice

Toxicology
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Synthetic Cannabinoids

• History - Australia
• 2010 use increasing in WA mining industry
• January 2011 my first Australian enquiry
• 7 Australian laboratories offering testing
• Antibody screening test available early 2012

Toxicology
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Synthetic Cannabinoids

• Scope
• History
• Chemical nature
• Manufacture considerations
• Legality
• What does the Standard bring to bear?
• Analytical aspects

Toxicology
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Synthetic Cannabinoids

• Chemical nature The Classes
• Classical cannabinoids e.g. THC, HU-210
• Nonclassical cannabinoids e.g. CP-47,497
• Hybrid cannabinoids e.g. AM-4030
• Aminoalkylindoles e.g. JWH-018, JWH-073
• Eicosanoids e.g. methanandamide
• Others

Toxicology
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Synthetic Cannabinoids

• Chemical nature The Classes

Toxicology
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Synthetic Cannabinoids

• Scope
• History
• Chemical nature
• Manufacture considerations
• Legality
• What does the Standard bring to bear?
• Analytical aspects

Toxicology
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Synthetic Cannabinoids

• Manufacture and supply
• Impure substances imported
• Solution sprayed onto herbs
• Dried down, packaged and sold
• No quality control of dosage or distribution
• No continuity of composition manufacturer
  attempts to keep ahead of detection
• Concerns with manufacturing modifications

Toxicology
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Synthetic Cannabinoids

• Scope
• History
• Chemical nature
• Manufacture considerations
• Legal considerations
• What does the Standard bring to bear?
• Analytical aspects

Toxicology
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Synthetic Cannabinoids

• Legal considerations
• Worldwide variation in banning these
• In Australia

Toxicology
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Synthetic Cannabinoids

• Synthetic 'cannabis' gets nationwide ban - Aja
  Styles The Australian July 7, 2011
• Banned - Kronic and other synthetic cannabis-like
  substances moved to the prohibited substances
  list.
• Eight synthetic cannabis-like substances will be
  classified as prohibited substances throughout
  Australia from July 8, with plans to rule out any
  attempts to circumvent state bans on substances
  like Kronic.
• Parliamentary Secretary for Health and Ageing,
  Catherine King said the changes to classification
  of specific chemical compounds would enable a
  nationwide, uniform prohibition on these drugs.
• The chemicals to be prohibited ( using the common
  name) are AM-694, JWH 250, JWH 200, JWH
  073, JWH 122, JWH- 018, Cannabicyclohexanol, CP
  47,497 most of these can be found in retail
  products known as Kronic, Spice, Karma, Voodoo,
  Kaos and K2.
• "In response to calls for uniform restrictions on
  these types of substances, the Commonwealth has
  considered the matter and made a decision to
  prohibit eight of the most widely-used and abused
  synthetic cannabinoids."
• Yet broader restrictions are still being
  considered with advice on such restrictions being
  sought from Advisory Committee on Medicines
  Scheduling's meeting in October.

Toxicology
73
Synthetic Cannabinoids

• New synthetic cannabis dodges Aussie ban
• Fiona Willan, ninemsn- 1230 AEDT Wed Oct 12 2011
• Synthetic cannabis is still being sold in
  Australian stores, three months after a
  nationwide-ban was introduced.
• Authorities are now scrambling to outlaw a new
  strain of Kronic herbal smoking mixture, which a
  New Zealand company has released specifically for
  the Australian market.
• The company, Lightyears Ahead, has managed to
  dodge Australian laws by releasing a mixture that
  buyers claim is as potent as marijuana but does
  not contain any banned chemicals.

Toxicology
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Synthetic Cannabinoids

• Scope
• History
• Chemical nature
• Manufacture considerations
• Legal considerations
• What does the Standard bring to bear?
• Analytical aspects

Toxicology
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Synthetic Cannabinoids

• The Standard urine or saliva
• Collection and handling
• On site screening
• Within laboratory screening
• MS confirmation/characterisation/quantitation

Toxicology
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Synthetic Cannabinoids

• Analytical considerations On site screening
• Now at least 3 on site tests available or
  becoming available but
• No consistency with the metabolites sought
• No consistency with detection thresholds
• No certainty that confirmation laboratories are
  testing for the same substances

Toxicology
77
Synthetic Cannabinoids

• Analytical considerations on site screening
• All test for JWH-018 JWH-073 metabolites if no
  others
• The least sensitive detects 50 ug/L
• At this stage, none detect cannabis metabolites

Toxicology
78
Synthetic Cannabinoids

• Analytical considerations laboratory screening
• Now available

Toxicology
79
Synthetic Cannabinoids

• Analytical considerations MS confirmation
• At least 7 Australian laboratories offering MS
  detection and quantitation
• Apply considerations from AS/NZS 4308
• Standards expensive
• Standards were difficult to obtain
• Deuterated standards remain difficult to obtain
• Commercial controls not available yet

Toxicology
80
Synthetic Cannabinoids

• Analytical considerations MS confirmation
  (cont)
• Laboratories test for a limited number of
  substances range differs from lab to lab
• Sensitivities not defined in Standard -
  determined by individual laboratory decision
  which is based at least in part on analytical
  considerations
• Menu continually expanding

Toxicology
81
Synthetic Cannabinoids

• Analytical considerations what are we finding?
• WA lab - July 2011
• Testing for metabolites of JWH-018, JWH-073 and
  JWH-122 only at that time
• Initially average of 10 positive, up to 50 from
  some sites

Toxicology
82
Synthetic Cannabinoids

• Analytical considerations what is QML finding?
• Testing for JWH-018, JWH-073, JWH-122, JWH-200
  JWH-250 parent and metabolites
• Detection threshold 10 ug/L
• Positive finding in approx. 2 of samples
• JWH-018 metabolite and JWH-073 metabolite are the
  prevalent findings but a single JWH-122 and
  d9-THCA finding

Toxicology
83
Synthetic Cannabinoids

• Analytical considerations what are other labs
  doing?
• Testing for JWH-018 JWH-073 at least
• Up to 8 others but menu continuously expanding
• Detection thresholds vary from 50 ug/L to 0.1
  ug/L
• Positive rates vary from 1 to 10

Toxicology
84
Common Drug-Testing MethodologiesSynthetic
Cannabinoid Conclusions

• Future considerations where are we heading?
• No sign of diminishing requirement for testing
• No sign of falling use
• No court challenge to findings yet
• No challenge to action taken on positive finding
  yet

Toxicology
85
Common Drug-Testing MethodologiesSynthetic
Cannabinoids

• Future considerations whats missing?
• Detailed pharmacokinetics and detection
  characteristics
• Clinical toxicology
• Short term clinical effects
• Long term clinical effects
• Acute toxicity

Toxicology
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There are traps for the unwary
87
Errors have consequences