Drug Testing Basics

1. Drug Testing Basics Helen Harberts MA, JD Chief Probation Officer (Ret.) Prosecutor (Ret.) Porter93@msn.com

2. Internet wisdom… “Take a 5 hour energy bottle a clean sample a sunglasses bag with string put the bottle in bag tie the string to your belt buckle let it hang under your nuts put on 3 pairs of boxer briefs sum sweatpants and sum jeans this is what I'm going to try in a week. The only thing that can fail me is if they watch me pee it's for a job does anyone no if they watch”

3. This kind of comment just sets me free….. As long as no one is following you into the stall and watches you pee, then get a condom and fill it with warm water + a little bit of yellow food coloring. Hide scissors on you somewhere, and when you go take the test, cut the top on the condom (where you tied it off) and pour it into the cup. That's what I did when I was on probation and it worked.

4. We test to support recovery • We test to assist with refusal skills • We test to determine if treatment is working • We test to support incentive & sanction • We test to “help ya”, not to “catch ya”. Understand….

5. Your testing frequency should be assessment driven. • Persons who have severe substance abuse disorders (addicted) and who have been or are in treatment require frequent observed random drug testing of not less than twice a week for at least a full year after the completion of treatment, while on continued care. That means some folks will be testing for several years. Best practices

6. For persons who are high risk, low need (abusers or low to moderate users), they require frequent observed random drug testing in order to obtain compliance with the Court’s orders and to prevent the escalation of the disease or undesired behaviors. Best practices

7. Drugtestingis a guide, butisnotperfect. • Thisis a bigbusiness and a seriousbusiness • Drugtestingmust be done correctly, ortheresults are pointless. Understand…..

8. Quick Fix Whizzinator Pack One Whizzinator One Quick Fix • $149.95 Quick Fix http://www.quickfixurine.com/

9. Yes, itisicky. • Yes, itisuncomfortable • Yes, itpresentsuniquechallenges • Itismandatory. • Notmirrors, notprivacyscreens, only DIRECT OBSERVATION OBSERVED TESTING IS NOT AN OPTION

10. Scientifically valid • Proven methods and techniques • Accepted by all the science wonks • Therapeutically beneficial • Provides accurate profile of participants drug uses • Gives us rapid results for rapid response • Legally defensible • Able to withstand court challenge • Established court track record • Scrutinized legal & judicial review So what makes a good test?

11. urine - current specimen of choice • generally readily available - large quantities • contains high concentrations of drugs • good analytical specimen • provides both recent and past usage • EtS, EtG (Ethyl Sulfate and Ethyl Glucuronide • other specimens • Hair-know your limits. • sweat - patch test • saliva - oral fluids-better. • Eye scanning devices-ugh • Breath-for ETOH, lots of breath What do we test?

12. Impersonal, like a doctor’s office • Impeccable chain of evidence in both appearance and fact • Do it exactly the same way every time. You will need to testify from habit and custom. How to conduct at test:

13. Have you used any drugs or alcohol since I last saw you? • Is there anything I need to know before this test? • Will this test be clean? Basic Questions:Same every time

14. Get all of your paperwork ready WITH the client. You sign, they sign, everything. • CHECK Photo ID each time. Mark on form that you checked ID. • If possible design a urine testing room that works better than a standard room. • Removal of all outer clothing like coats. Get your stuff in order!

15. Wash hands before (and after) donation • Proper collection receptacle • Witness collection process. “I am sorry: I MUST see the urine leave your body and go directly into the cup” Always the same process:

16. Drop your drawers…all of them • Turn around 360 degrees • Women: squat and cough 3X • Men and women: start, stop, start. Actual testing:

17. “Tech Rawlinson instructed the defendant to squat to the ground with her knees and feet shoulder width apart, and to cough as hard as she could. Ms. Doe then squatted as instructed and coughed with her hand over her mouth. Tech Rawlinson heard a loud thumping sound on the floor immediately after Ms. Doe coughed. “ Squat and Cough….. Really?

18. You don’t do it…this is what gets past you.

19. Accept sample and inspect • Temperature strip/check (90-100 degrees F) • Color (note for lab) no color =? Inappropriate? • Odors (bleach, sour apples, aromatics, vinegar, etc.) • Solid stuff, or unusual particulates. • Visual line of sight, and label with probationer. Done?

20. Store the sample appropriately. • THIS IS EVIDENCE! • Develop detailed policy and train everyone on it! Cross train everyone. • Do quality control, interview, send fake donor. Double check and observe technique. Collection continued:

21. When does this disease sleep? Never! • Keep them guessing • Mix up testing schedules • Mix up specimen types (hair, urine, sweat, oral fluids) • It must be random • Limit time between notification and testing • Design drug specific regimens (cocaine) When should we test?

22. Use transdermal devices • Use remote monitiors such as ignition interlocks with photos. • PBT (presumptive breath tests) • Anything that will let you do immediate alcohol tests. • Check in group. Check after they use the bathroom. Watch for alcohol at all times. Assume alcohol

23. Poly substance is the rule, not the exception. • Watch for alcohol (especially with opiates and benzos and pot) • Switching drugs of choice is common. What are you testing for?

24. Amphetamines • Benzodiazepines • Cannabinoids • Cocaine • Opiates (organic) • PCP (?), MDMA(?) • Alcohol Remember: we test for the “usual suspects”, not everything!

25. EtG, EtS • Naltrexone, suboxone • Approved doses of medications • Antidepressants,etc. • Designer drugs • Synthetic opiates Other tests?

26. general estimates • urine: 1-7 days • excluding alcohol & THC • necessitates twice weekly screening • sweat (patch): 7 days Follow FDA exactly • saliva (oral fluids): up to 48-72 hours • hair: up to 90 days-but useless for other things • breathalyzer: few hours (.02 per hour) • EtG: up to 48 hours at 500 cut off. (EtS at ¼ of EtG) How long can we detect drugs by specimen?

27. Screening test-coarse test. Designed to separate negative samples from samples that are “presumptively” positive • Confirmation test- a follow up procedure designed to validate positive test results. • Distinctively different analytical technique • MUCH more specific and more sensitive. Two step approach

28. Each company will have information on the limits and cut offs of their products. • They are NOT all the same • Each company will have a list of interfering substances that may create a “false positive”. • Recall that the screen has a different cut-off! Remember: a screen is a crude test !

29. Gas chromatography-mass spectrometry, or (GC/MS) or other mass spec process • Drug molecules separated by physical characteristics • Identifies drugs based on chemical “fingerprint” • This is the gold standard. • Other chromatography techniques • Thin layer, etc. but you can confirm via GC/MS as needed. Confirmation Tests:

30. Negative, or none detected. • Positive • Dilute I got results. What do they mean?

31. Tells you no drugs or metabolites, that you tested for, were detected in the sample tested above cut off. • It does NOT mean, no drugs were present • Your participant may be clean….or,… None, or none detected

32. They may be using a drug you didn’t look for • Or, they may not be using enough of the drug • Or, they aren’t using it frequently enough • Or, you collected too long after use • Or, they tampered with the test • Or, the test isn’t sensitive enough • Could be they bought bad dope! Woman calls 911, says drug dealer gave her ‘bad weed’ 1:50 pm, April 5, 2014, Angelina Texas

33. If you think something else is going on, look closer! They might be beating the testing! • Change what you are doing! • Do a home visit, change samples, look closer! • Testing is a tool. It is only one tool. • You may be seeing relapse before the use happens. “second sense”

34. That the drug, or the metabolites, that you tested for, are detected in the sample • Their presence is above the “cut-off” level. • Your greatest confidence comes with confirmation. • BE CAREFUL about instant tests without an admission! Get confirmation as needed. (Due process concerns with higher error rate on these tests) “Positive” test results means….

35. a concentration, administratively established, to distinguish between negative and positive - “threshold” • established above the sensitivity limit • different for screening & confirmation • also referred to as threshold value • measured in ng/mL = ppb What is a “cutoff” level ?

36. It is important to understand and remember about cut-off levelson the various tests-you must understand this for many reasons. If you don’t understand this you may make a serious error.

37. Typical Cutoff Levelsscreening & confirmation • amphetamines * 500 ng/mL 250 ng/mL • benzodiazepines 300 ng/mL variable • cannabinoids * 20/50 ng/mL 15 ng/mL • cocaine (crack)* 150 ng/mL 100 ng/mL • opiates (heroin) * 300/2000 ng/mL variable • phencyclidine (PCP) * 25 ng/mL 25 ng/mL • alcohol 20 mg/dL 10 mg/dL • * SAMHSA (formerly NIDA) drugs

38. If you have a GC/MS confirmation grade positive test and a secure chain of evidence, the issue is settled via science. Remember that this is evidence and subject to due process.

39. Opiates: • Tests by CLASS of drug • Beware of synthetic opiates-they require separate panel and tests (demerol, darvon, methadone, fentanyl, etc. • Poppy seeds: they WILL interfere-no poppy seeds! • Sometimes folks legitimately need them, monitor closely and move off them ASAP • Detection time: up to 4 days. Specific drug test results

40. Drug specific assay • If it is positive, it is cocaine. • No interferences • Illicit use is the rule • Detection: up to 3 days, but 36 hours. • Negative test: may still be using coke. • Test aggressively • Watch for PAWS • Solarcaine? No • Benzocaine? No • Novacaine? No. • Nothing but cocaine tests positive for cocaine. Cocaine

41. Drug specific assay • No interferences • NO passive inhalation • Marinol or Sativex will test positive. • Critical issues: • Recent vs. non recent use • Cut off levels are critical: 50 ng/mL vs. 20 ng/mL • Detection: at 50 ng/mL • 10 days for heavy chronic use, • 1-3 for occasional use. Cannabis-

42. How do you discriminate between new drug exposure and continued elimination from previous use? (clean out time) • This issue only applies to cannabis. • “two negative test” rule-two back to back negative tests post clean out. Positive after that? New use! Recent vs. Non recent use:

43. Maybe, but not above the cut off levels! • Detection times: at 50 ng/mL cutoff • Up to 3 days for occasional use • Up to 10 days for heavy chronic use • Detection time at 20 ng/mL cutoff • Up to 7 days for occasional use • Up to 21 days for heavy chronic use. “But, it stays in the body for 30 days!”

44. That say it takes 30 days • Old, bad research • They did not ensure abstinence during study • They used very low cutoff levels • Used machines and methods no longer available with poor specificity. Yes, there are old studies

45. Try these instead! FACT SHEETS by Paul Cary www.ndci.org

46. Just say NO to “levels” “ The levels are falling! “ Do not guess! “Her levels are up over last week! “

47. 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 • drug concentrations or levels associated with urine testing are not useful for interpretation (i.e. distinguishing between recent use and continued elimination) • A confirmation test is positive or negative-there is no value to numeric levels.

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

49. 200 mg Wonderbarb @ 8:00 AM Collect urine 8:00 PM 12 hours later The Twins-by Paul Cary A B

50. The Twins - urine drug test results B A Wonderbarb = 638 ng/mL Wonderbarb = 3172 ng/mL