Drug Testing Overview

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Drug Testing Overview

• David J. Kuntz, PhD, DABFT, DFTCB
• Northwest Toxicology,
• now a part of Quest Diagnostics
• West Valley City, UT 84120
• Phone [phone]
• emaildavid.kuntz_at_nwtox.com

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Drug and Integrity Tests

• Drugs
• Amphetamines
• Cocaine
• Opiates
• Marijuana
• PCP
• Standard Integrity Tests
• Creatinine
• pH (acidity)
• Oxidants
• Generic test for multiple adulterants
• Specific Gravity

• Confirmation Tests for Adulterants
• Iodine
• Iodate
• Fluoride
• Chromium VI
• Nitrite
• Bleach
• Soap
• Glutaraldehyde
• Pyridine
• pH (addition of acids)

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Specimen Receipt and Accessioning

• Specimen receipt is performed in the most secure
  area of the laboratory
• Each specimen is handled one at a time
• Specimen information is entered into the computer
  system to allow tracking of the specimen from
  receipt to reporting
• Specimen bottles remain in this area or frozen
  storage at all times

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Initial Screening

• Often called the initial or immunoassay test
• All specimens are subjected to this test. It
  provides a rapid cost effective system to
  identify presumptive positive specimens
• This process requires 1 mL of urine to complete
  and will provide results for up to ten tests
  within 30 seconds
• Adulterants often target this process to change a
  positive screen to a negative test

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Confirmation Testing

• The first step is to separate the drug from other
  components of the urine (2-4 hours)
• Completed by a technique known as gas
  chromatography/mass spectrometry (GC/MS)
• The GC further separates the remaining urine
  components
• The MS identifies each drug through a chemical
  fingerprint which is unique - the identification
  is conclusive

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Records and Sample Retention Policies

• All analytical records for non-negative (e.g.,
  positives, adulterated, substituted samples) are
  maintained for seven years
• Positive sample bottles are isolated in the long
  term freezer and are extended from 1-year storage
  to 7-year storage for litigated samples
• Negative samples are stored for a week before
  destruction
• Litigation packages are prepared on request and
  normally shipped within ten days
• SOPs and other laboratory documents are stored
  indefinitely for discovery in arbitration/litigati
  on

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Lab Intervention in Adulteration

• For each sample, the lab conducts three chemical
  tests (pH, oxidants, creatinine), specific
  gravity (if the creatinine is less than 20 mg/dL)
  in addition to appearance, smell, and color
• The laboratory identifies approximately 2-3
  samples per thousand which are adulterated or are
  invalid
• Approximately 90 of adulterated specimens have
  drug identified in the urine sample
• If the adulterant can not be identified, it is
  reported as unsuitable

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Creatinine, Specific Gravity, pH and General
Oxidants

• Creatinine is a byproduct of protein metabolism
  and is related to muscle mass, exercise, and
  hydration
• Specific Gravity is only performed when
  creatinine is in the dilute or substituted
  categories
• pH is a measure of acidity and samples are
  typically acidic is the presence of adulterants
• The general oxidant test is generic test for
  oxidizing adulterants identification of the
  adulterant is the responsibility of the
  confirmation test. If the adulterant cannot be
  identified, the result is Invalid

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Nitrites

• One of the most popular adulterants several years
  and prevented the confirmation testing of
  marijuana
• Every sample is screened at 200 mcg/ml and
  confirmed with a second aliquot at 500 mcg/ml
• Nitrite is a normal constituent of urine,
  especially in urinary tract infections, but is
  only in low concentration (less than 100 mcg/mL)
• Samples exceeding 500 mcg/ml are reported as
  adulterated

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Chromium

• There are two types
• Chromium (6) is extremely toxic and corrosive
• Chromium (3) is the dietary form as chromium
  picolinate in vitamin supplements and does not
  interfere with testing nor is it identified in
  the testing
• Primarily effective against marijuana - works
  within minutes to destroy the presence of
  marijuana in the sample

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Bleach

• One of the few adulterants that can be detected
  by the collector through its odor
• Typically identified through odor at the time
  samples are aliquoted for the screening test
• Disappears from the urine over time and makes the
  confirmation for Lab B difficult

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Soap

• As with bleach, it has been used for decades to
  interfere with screening and confirmation tests
• Usually identified through excessive, long
  lasting bubbles and a flowery smell upon
  opening of the bottle
• The type of soap is not identified. Normally
  about a 1/2 teaspoonful is added

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Glutaraldehyde

• Became popular in 1992 as the first commercial
  adulterant
• It is used as a chemical sterilant and tissue
  fixative
• The presence of glutaraldehyde is indicative of
  intentional adulteration
• Screening tests provided ultra-negative
  immunoassay results screening by Schiffs test
  and full-scan GC/MS
• The use appears to be non-existent - but testing
  for this adulterant continues

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Iodine and Iodate

• Dietary iodine is converted to iodide in the body
  and transported to the thyroid for converting
  into proteins
• Iodide is normally found in the urine - NOT
  iodine
• Iodine can be purchased in adulterants or as a
  water treatment product
• If urine leaks from the container, it will darken
  the label and a drop on paper will turn the paper
  purple
• Iodate is the combination of iodine and oxygen
  and works slowly to destroy the drugs more
  difficulty for the Bottle B laboratory as the
  drug is gone and is unable to confirm the
  adulterant
• Iodine and Iodate are confirmed by separate
  methods - Amounts are very large and ignores
  dietary iodine

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Legal Issues and Arbitration

• Many cases involve adulteration and substitution
  and are more difficult to prosecute than drugs
• The laboratory staff is requested to provide
  testimony in about 75-100 cases per year
• November 1, 2004 the latest SVT regulations took
  place to adjust substitution numbers and set more
  guidance for adulteration testing and reporting
• Fewer issues regarding substitution with the
  lowering of the creatinine cutoff to 2 mg/dL
• Invalid pH samples on the rise with more rigorous
  standards in analysis seasonal variations with
  higher pH values in the summer with temperature
  elevation