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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