Testing for Drugs: In the Field & In Laboratories · DRUGGED DRIVING: WHAT WE KNOW AND WHAT WE...

DRUGGED DRIVING: WHAT WE KNOW AND WHAT WE NEED TO KNOW TRB Committee on Alcohol, Other Drugs and Transportation (ANB50)

Testing for Drugs: In the Field &In Laboratories

Barry K Logan

Christine M Moore

What do We Know?

Drug Testing Purposes in DUID

�Investigation�Prosecution�Intervention�Civil Litigation�Epidemiology

Associated Obligations

�Reliability�Forensic Defensibility�Sensitivity�Comprehensiveness�Uniformity

Prior Activity

�Survey Labs for current

practices.

�Provide Labs with more

consistent investigative

information.

�Integrate training of lab, court

and law enforcement personnel.

�Provide training in effects of

drugs on driving

�Make recommendations for drug

testing in DUID investigations.

2007 Guidelines

2007 Guidelines

�Provide prevalence data�Provide recommended list of analytes�Provide screening cut-offs�Provide confirmation cut-offs

�Blood

�Urine

�Oral Fluid

What do We Need to Know?

Questions?

�Who’s doing the Testing?�What technologies are they using?�What are they testing for?�What matrices are they testing in?�Are they in compliance with recommendations?�How could they be persuaded to comply?�How do users feel about the service?

Participant Information

� 96 Total Laboratories

� 45% State

� 16% County

� 13% Private

� Other – Regional, Hospital, Municipal or University laboratories

� 84 Laboratories Reported on Number of Analysts

� Range of 0-23

� Average of 8 analysts per laboratory

� Total of 644 analysts

Please indicate what methods are

routinely used for drug screening:

� 66 total participants� Multiple methods could be selected resulting in a total of 121

responses

13%

34%28%

17%

0%

8%

23%27% 29%

14%

1%6%5%

9%

2% 3%0%

82%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

EMIT ELISA GC-MS LC-MS LC-TOF Don't Test

Percentage of Respondents

Blood Urine Oral Fluid

Please indicate what methods are

routinely used for drug confirmation:

1% 0%

52%

36%

0%

11%

1% 0%

59%

33%

1%6%

2% 0%

11% 11%

0%

77%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

EMIT ELISA GC-MS LC-MS LC-TOF Don't Test

Percentage of Respondents

Blood Urine Oral Fluid

� 66 total participants� Multiple methods could be selected resulting in a total of 101

responses

Does your lab report unconfirmed screen results?

� Reasons for Reporting Unconfirmed Screen Results:

� Clients only request screen results

� Screening all classes of drugs

� Cases is closed before confirmation

� Insufficient sample volume

� Specimen screen when the lab does not provide a confirmatory analysis on drug/class

33%

67%

Yes No

Do you currently meet the guideline recommendations

for screening in each of these drugs in BLOOD?

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

% of Respondents

Yes - Below the Recommendation Yes - At the Recommendation

No - Above the Recommendation Currently DO NOT test

Do you currently meet the guideline recommendations

for screening in each of these drugs in BLOOD?

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Meet the recommendation Do NOT meet the recommendation

Do you currently meet the guideline recommendations

for screening in each of these drugs in BLOOD?

Drug (recommendation)Respondents that meet the

recommendation

Methadone (50 ng/mL) 77%

Nordiazepam (50 ng/mL) 74%

Benzoylecgonine (50 ng/mL) 72%

Oxazepam (50 ng/mL) 69%

Secobarbital (100 ng/mL) 67%

Phencyclidine (10 ng/mL) 63%

Carboxy-THC (10 ng/mL) 61%

Morphine (20 ng/mL) (free drug) 59%

MDA (20 ng/mL) 54%

THC (2 ng/mL) 50%

Methamphetamine (20 ng/mL) 50%

MDMA (20 ng/mL) 46%

Amphetamine (20 ng/mL) 44%

Propoxyphene (50 ng/mL) 43%

� Those that do not meet the recommendation reported one of the following: � They test above the

recommended

screening cutoff

� They do not test

� They do not know if

they meet the

recommendation

Do you currently meet the guideline recommendations

for confirming in each of these drugs in BLOOD?

0%

10%

20%

30%

40%

50%

60%

70%

80%

Benz

oyle

cgonine

(50 n

g/mL)

Oxaze

pam (50 n

g/mL)

Alp

razo

lam (10 n

g/mL)

Temaze

pam (50 n

g/mL)

Dia

zepam (20 n

g/mL)

Nord

iaze

pam (20 n

g/mL)

Carb

oxy-T

HC (5 n

g/mL)

6-a

cety

lmorp

hine

(10 n

g/mL)

Meth

amphe

tamine (20 n

g/mL)

Am

phe

tamine (20 n

g/mL)

Zolp

idem (20 n

g/mL)

Lora

zepam

(10 n

g/mL)

Hydro

codone

(10 n

g/mL)

Oxyco

done

(10 n

g/mL)

Phe

ncyclid

ine (10 n

g/mL)

MDM

A (20 n

g/mL)

Clo

naze

pam (10 n

g/mL)

Codeine (10 n

g/mL)

Hydro

morp

hone

(10 n

g/m

L)

Morp

hine

(10 n

g/mL)

MDA (20 n

g/mL)

Chlord

iaze

poxid

e (50 n

g/mL)

Pro

poxyphe

ne (50 n

g/mL)

Coca

ine (10 n

g/mL)

Coca

eth

yle

ne (10 n

g/mL)

Cariso

pro

dol (5

00 n

g/mL)

7-a

minoclona

zepam (10 n

g/mL)

Mepro

bamate

(500 n

g/mL)

Dextrometh

orp

han

(20 n

g/mL)

Am

itrip

tylin

e (25 n

g/mL)

Dip

henh

ydra

mine (25 n

g/mL)

Phe

nyto

in (500 n

g/mL)

Nortripty

line (25 n

g/mL)

Seco

barb

ital (1

00 n

g/m

L)

Carb

amaze

pine (500 n

g/mL)

Meth

adone

(10 n

g/mL)

But

alb

ital (1

00 n

g/m

L)

Topiramate

(1,0

00 n

g/mL)

Tramadol (2

0 n

g/mL)

Trazo

done

(25 n

g/mL)

Phe

nobarb

ital (1

00 n

g/m

L)

GHB (5,0

00 n

g/mL)

11-O

H-T

HC (2 n

g/mL)

% of Respondents

Percentage of respondents that meet the recommendation Do NOT meet the recommendation

Do you currently meet the guideline recommendations

for screening in each of these drugs in BLOOD?

Drug (recommendation)Percentage of respondents that

meet the recommendationDrug (recommendation)

Percentage of respondents that

meet the recommendation

Carboxy-THC (5 ng/mL) 56% Carisoprodol (500 ng/mL) 46%

11-OH-THC (2 ng/mL) 16% Meprobamate (500 ng/mL) 43%

Methamphetamine (20 ng/mL) 53% Zolpidem (20 ng/mL) 53%

Amphetamine (20 ng/mL) 53% Butalbital (100 ng/mL) 35%

Cocaine (10 ng/mL) 46% Phenobarbital (100 ng/mL) 32%

Benzoylecgonine (50 ng/mL) 70% Secobarbital (100 ng/mL) 38%

Cocaethylene (10 ng/mL) 46% Phenytoin (500 ng/mL) 39%

MDMA (20 ng/mL) 51% Carbamazepine (500 ng/mL) 37%

MDA (20 ng/mL) 49% Topiramate (1,000 ng/mL) 33%

Alprazolam (10 ng/mL) 61% GHB (5,000 ng/mL) 30%

Chlordiazepoxide (50 ng/mL) 48% Codeine (10 ng/mL) 51%

Clonazepam (10 ng/mL) 51% 6-acetylmorphine (10 ng/mL) 56%

7-aminoclonazepam (10 ng/mL) 43% Hydrocodone (10 ng/mL) 52%

Diazepam (20 ng/mL) 58% Hydromorphone (10 ng/mL) 51%

Nordiazepam (20 ng/mL) 58% Methadone (10 ng/mL) 37%

Lorazepam (10 ng/mL) 52% Morphine (10 ng/mL) 51%

Oxazepam (50 ng/mL) 61% Oxycodone (10 ng/mL) 52%

Temazepam (50 ng/mL) 59% Propoxyphene (50 ng/mL) 47%

Trazodone (25 ng/mL) 32% Tramadol (20 ng/mL) 33%

Amitriptyline (25 ng/mL) 41% Dextromethorphan (20 ng/mL) 42%

Nortriptyline (25 ng/mL) 38% Phencyclidine (10 ng/mL) 52%

Diphenhydramine (25 ng/mL) 41%

For drugs which you currently do not meet the

recommendations, please indicate the reasons:

0

5

10

15

20

25

We do notagree with

them

We lackstaffing

We lackinstrumentcapacity

We lackappropriateinstrumenttechnology

Our methodsare not

validated

Other

# of Respondents

� Free text responses (other)� Quantitative analysis performed only on a needed basis� They are only recommendations� DUID law only applies to scheduled substances (state)� Methods are currently being improved

� 57 total participants � Multiple

reasons could

be selected

What is the approximate turnaround time of your lab in

regards to DRUG analysis?

0 50 100 150 200 250 300 350 400 450 500 550

# of Days

� 62 toxicology laboratories represented

� Average – 26.7 days

� Median – 7 days

� Range 1- 75 days

� (excl. 90, 93, 124, 150, 186, 200, 279, 372, and 558 days)

DRE: What is the approximate turnaround time from

your toxicology lab in regards to DRUG analysis?

44%

33%

3%

3%

0%17%

Turnaround Time for Drug Analysis (Days)

1-30 Days

31-60 Days

61-90 Days

91-120Days

121-150 Days

151-180 Days

Fig. 24: Percentage of responses to the turnaround time from toxicology

labs for drug analysis in terms of days.

DRE: Satisfaction with drug analysis turnaround time

0

2

4

6

8

10

12

0 10 20 30 40 50 60

Sa

tisf

act

ion

Ra

tin

g

Turnaround Time (weeks)

Satisfaction Rating vs. Turnaround Time

Drug

Fig. 26: Correlation between turnaround times for drug analysis in terms

of weeks and the satisfaction ratings respective to the data set.

Analysis

Current State – Lack of Uniformity

�Why do Approaches to Drug Testing Vary?�Lack of enforceable national standards�Statutory consequences�Prosecution philosophy�Local policies�Technology�Resources

Current State – Consequences

�Undetected DUID�Incomplete death investigation�Inaccurate records�Ineffective deterrence�Lower priority for public policy

Standards for Other Kinds of Testing

�SAMHSA - Workplace�CLIA – Clinical testing�EPA – Environmental testing�WADA - Sports�AORC – Animal doping control�AOAC – Drugs, chemicals, trace elements�SWGTOX – Toxicology standards of practice

Factors Driving Compliance

�$$$�Federal Reimbursement�Civil Liability�Interstate commerce�Customers need to compare results�Commercial advantage�State legislation�Community pressure�Customer Education

What do We Need to Know?

What Do We Need to Do?

Future State

� Revise, update and promote recommendations

� Get buy-in from stakeholders� NHTSA, ONDCP, GHSA

� NSC CAOD, SWGTOX, AAFS/SOFT, IACT, ICADTS

� TRB, NDAA, NADCP, TSRP’s, IACP

� MADD, StopDUID.org,

� Promote per se Laws

� Technology& Field Testing