David Martin, Ph.D.

25 Years of Drug Testingand its

Technical and Clinical Future

www.questdiagnostics.com

25 Years of Drug Testing and its Technical and Clinical Future

Drug Testing Emerging Technologies

20121992

12 MILLION DRUG TESTS

5 MILLION MANDATED DRUG TESTS

FRAGMENTED AND NON-CENTRALIZED IT

200+ MILLION DRUG TESTS

15 MILLION MANDATED DRUG TESTS

CONSOLIDATED AND CENTRALIZED IT

SalivaSaliva

Urine

Saliva-Urine-Hair Drug Tests Saliva-Urine-Hair Drug Tests

Time:Time:

Cut off

Hair

Hours Hours DaysDays Months

Hair Drug Testing

Instant Urine Drug Testing Kits Instant Urine Drug Testing Kits

ALERE TOXICOLGY SYSTEMS

PRINCETON BIOMEDICA (PBM)

SYVA RAPID TEST

ACCUSIGN

STATUS

ABI TESTCUP

BIO SITE TRIAGE

> 70 KITS ON MARKET

Saliva Drug Testing

SIMILAR TO BLOOD

IMPAIRMENT TESTING

INSTANT TESTING LABORATORY TESTING

Anti-Drug Testing Products

BREATH ALCOHOL TESTING

• Breathalyzer - Uses a chemical reaction involving alcohol that produces a color change

• Intoxilyzer - Detects alcohol by infrared (IR) spectroscopy

• Alcosensor III or IV - Detects a chemical reaction of alcohol in a fuel cell NHTSA

• Urine, Hair, Blood Spot –urine ETG/ETS for zero tolerance, PeTH binge monitoring,

SPORTS PRESCRIPTION DRUG ABUSE

“COCAINE PLUS” Additives

• PHENACETIN: a cancer causing pain reliever • DILTIAZEM: a cardiac medicine • ANFEPRAMONA: similar to amphetamine• BENZOCAINA: a local anesthetic• LIDOCAINA: a local anesthetic• LEVAMISOL: used to expel parasitic worms • HYDROXYZINE: an antihistamine

• “HEROIN PLUS”, “METH PLUS”, “MARIJUANA PLUS”……

11

EXTENDED 10 DRUG CLASS PANEL

• Amphetamines– Amphetamine– Methamphetamine– MDA– MDMA– MDEA

• Cocaine• Opiates

– Codeine– Morphine– Hydrocodone– Hydromorphone– 6-MAM

• Oxycodone– Oxymorphone

• PCP• Marijuana

• Barbiturates– Butabital– Amobarb– Pentobarb– Secobarb– Phenobarb

• Methadone• Propoxyphene

• Benzodiazepines– Oxazepam– Nordiazepam– Temazepam– Lorazepam– Flurazepam– Nitrazepam– Triazolam– Alprazolam– Flunitrazepam– Midazolam– Clonazepam

SUMMARY

• BEST PRACTICES: LAB ON ADMISSION, BAC

• HAIR, SALIVA AND URINE= DRUG HISTORY

• INSTANT IN TREATMENT, PASSES AND OUTPATIENT

• PRESCRIPTION MEDICATION, SYNTHETICS

• VARY THE DRUGS TESTED - LAB AND INSTANT

• NEW TECHNOLOGIES LC/MS/MS, NANO, CLOUD

• TREAT PATIENT NOT THE TEST