You Can’t Fool the “Bladder Police” Effective Use of Urine Drug Screening
Wh Why Te Test? • Accountability • Create and maintain safe treatment environment • Compliance with licensing or policy
Collection • Supervised or unsupervised • When to collect • Staff training • Temperature monitored cups • Adulterant testing
In In-hou house se Te Testing ng • Cost • Staff training • Type of test kit • Staff issues • What to test for • Client privacy • When to test
Lab Testing • Prescription • Staff training • What to test for • Completing forms • When to test • Storage and pick up
Te Testing ing – Ho How w it Wo Works • Drug Testing Systems One Test Systems Use immunoassay (IA) to detect the presence of drugs and Are most often used for medical purposes in clinical and rehabilitation settings Two Test Systems Commonly use immunoassay as an initial test followed by a more specific confirmatory test using a different technology and Are used for results requiring a high level of certainty John M. Mitchell Immunoassays as an Initial Test in Drug Testing. Center for Forensic Sciences
Testing – How it Works What is an Immunoassay? • An immunoassay is a biochemical test that measures the concentration of a substance in a liquid (a portion of a biological specimen) using the reaction of an antibody or antibodies to its antigen (drug) John M. Mitchell Immunoassays as an Initial Test in Drug Testing. Center for Forensic Sciences
Te Testing ing – Ho How w it Wo Works What are Antibodies and Antigens? • Antibodies are a type of protein produced by the immune system in response to foreign substances (antigens) • Antibodies bind to the antigen responsible for their production John M. Mitchell Immunoassays as an Initial Test in Drug Testing. Center for Forensic Sciences
Testing – How it Works Immunoassay Principles I Y Common end Antibodies: • Usually harvested from sheep or rabbits • Usually IgG (represented as a “Y”) • Developed against classes of drugs • Recognize antigen (drug) by its shape Shape recognition end John M. Mitchell Immunoassays as an Initial Test in Drug Testing. Center for Forensic Sciences
Testing Te ing – Ho How w it Wo Works Immunoassay Principles II • Use Tagged Drug Targets Indicator (Tag) is bound to the target drug “Tag” may be an enzyme “ Tag ” a fluorophore a particle • Detection is based on competitive binding Antibodies bind with Drug in Sample OR with Tagged Drug Targets Drug John M. Mitchell Immunoassays as an Initial Test in Drug Testing. Center for Forensic Sciences
Testing – How it Works Immunoassay principles • Sample WITH drug in it • Add an antibody • Incubate Y John M. Mitchell Immunoassays as an Initial Test in Drug Testing. Center for Forensic Sciences
Te Testing ing – Ho How w it Wo Works Immunoassay Principles III • Antibody binds drug in the sample • Add tagged drug target • Little or no antibody binding of the tagged compound Y • Little or no change in signal John M. Mitchell Immunoassays as an Initial Test in Drug Testing. Center for Forensic Sciences
Testing – How it Works Immunoassay Principles IV • Sample WITHOUT drug in it • Add an antibody • Incubate • Add tagged drug target Y John M. Mitchell Immunoassays as an Initial Test in Drug Testing. Center for Forensic Sciences
Te Testing ing – Ho How w it Wo Works Immunoassay Principles • Antibody binds with the tagged compound • Binding causes change in signal produced John M. Mitchell Immunoassays as an Initial Test in Drug Testing. Center for Forensic Sciences
Testing – How it Works Testing with Immunoassays • Immunoassays are used to screen donor specimens for the possible presence of a drug or a class of drugs • These tests may be conducted on-site as part of the collection process or in a laboratory or other facility • On-site testing is normally conducted with a Point of Collection Test (POCT) device • Most testing is conducted in laboratories which have validated procedures and validated analytical instrumentation • Immunoassays allow some laboratories to test more than 10,000 donor specimens a day John M. Mitchell Immunoassays as an Initial Test in Drug Testing. Center for Forensic Sciences
Te Testing ing – Ho How w it Wo Works Immunoassay Specificity • Specificity is the affinity of an immunoassay for the target drug • Specificity is measured by cross reactivity: the response exhibited when an immunoassay reacts with a compound other than the target drug • Specificity limits the conclusions that can be drawn from immunoassay results John M. Mitchell Immunoassays as an Initial Test in Drug Testing. Center for Forensic Sciences
Testing – How it Works Low Specificity • An immunoassay with low specificity will react with many antigens (drugs) with similar structure • Example: One Amphetamine immunoassay with a cutoff of 300 ng/mL of D-Amphetamine gives a positive result with: D,L-Amphetamine (300 ng/mL), Phentermine (400 ng/mL), Tranylcypromine (500 ng/mL), Methamphetamine (1,000 ng/mL), Ephedrine (1,000 ng/mL), or Phenylpropanolamine (1,000 ng/mL) Therefore, a positive result from this immunoassay test would not prove use of amphetamine John M. Mitchell Immunoassays as an Initial Test in Drug Testing. Center for Forensic Sciences
Ta Tamp mper ering ng • Diluting • “Doping” • Substitution
Ta Tamp mper ering ng • Diluting Hyper saturating the body with fluids to dilute metabolites possibly below the 50 ng/mL threshold, depending on your metabolism. AZO Certo Niacin QCarbo Vinegar XXtra Clean Fiber pills Quick Flush Ready Clean pills Terminator Gold Rapid Cleanse Clear Choice Detox Tea MC1 Goldenseal Vale Triple Strength
Tamp Ta mper ering ng • “Doping” Adding different chemicals that defeat immunoglobulin/antigen binding Bleach (powdered) Liquid Soap Water Mary Jane’s SuperClean 13 Ammonia Purifyit Blood Sodium Nitrate Draino Table Salt Goldenseal Vinegar Hydrogen Peroxide Visine Lemon Juice WD 40
Ta Tamp mper ering ng • Substitution Concealed container Injection Catheterization Cigar containers/droppers
Ta Tamp mper ering ng - Co Coun unter ermea measures sures • Color • Temperature • Creatinine • pH • Specific gravity
False Positives Generic Name Brand Possible False Positive Efavirenz Sustiva Positive for Cannabinoids (THC) [Urinary metabolite(s) only; parent compound is non-reactive] Flunitrazepam Rohypnol Positive for Benzodiazepines (BZO) Lamotrigine Lamitcal Positive for Phencyclidine (PCP)
False Fa e Po Positives ives Generic Name Possible False Positive Brand l- Vick's Positive for Methamphetamine Inhaler Methamphetamine (mAMP) HCL Phenytoin Dilantin Possible Positive for Barbiturates (BAR) Urinary metabolite(s) only; parent compound is non-reactive
False Positives Generic Name Brand Possible False Positive Procaine Novocain Positive for Opiates (OPI, MOP) Ranitidine Pylorid, Zantac Positive for Methamphetamine (M-AMP) Urinary metabolite(s) only; parent compound is non- reactive
Fa False e Po Positives ives Generic Name Brand Possible False Positive Sertraline Zoloft Potential Positive for Benzodiazepines (BZO) Venlafaxine Effexor or Potential Positive for Effexor XL Phencyclidine (PCP)
False Positives • All positives require clinical intervention • Review clients medications before engaging in a clinical intervention • If a client reports taking a medication that may cause a false positive, a confirmatory test should be completed
Fa False e Ne Nega gatives ves • Time elapsed since use • Improperly obtained or secured specimen • Tampered sample
Detection Times Approximate Drug Detection Time Amphetamines 2-4 days Barbituates Short-Acting (Secobarbital) 1 day Long-Acting (Phenobarbital) 2-3 weeks Benzodiazepines 3-7 days
De Detec ection tion Ti Time mes Approximate Drug Detection Time Cannabinoids 3-30 days Cocaine 2-4 days Codeine 2-5 days Euphorics (MDMA, Psilocybin) 1-3 days
Detection Times Approximate Drug Detection Time LSD 1-4 days Methadone 3-5 days Methaqualone 14 days Opiates 2-4 days Phencyclidine (PCP) 2-4 days
De Detec ection tion Ti Time mes Approximate Drug Detection Time Phenobarbital 10-20 days Propoxyphene 6 hours to 2 days Steroids (Anabolic) Oral 14 days Parenterally 1 month
Clinical Interventions • Drug testing is a clinical intervention • Upon admission, always explain the role of drug testing • Drug testing may be scheduled, random, or suspicious • Prior to securing the urine, ask the client about changes in medication and if the client has used • Always explain the “why” of a particular drug test • If the drug test is “suspicious,” discuss the behaviors that brought about suspicion • Review test results with client immediately upon receipt, regardless of result
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