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PubMed1999

Quantitative posturagraphy as an alternative noninvasive tool for alcohol/drug/chemical testing--preliminary thoughts.

This article provides preliminary ideas regarding how the quantitative posturagraphy technique can be used as an alternative noninvasive tool to currently available blood/urine test for alcohol/drug/chemical exposure. It is argued that the urine or blood level of any chemical is highly dependent on the individual's metabolism without providing any insight into individual's task performance abilities under exposure to neurotoxic chemicals. On the other hand, the quantitative posturagraphy if carried out as proposed in this article will provide quantitative data regarding individual's ability to maintain "safe" upright balance while carrying out certain tasks. The proposed evaluation method is simple, portable, quick, and noninvasive and has been found to be sensitive to detecting low level solvent induced modifications in postural stability.

Ethanol↗

PubMedDate not supplied

Drug testing welfare recipients--false positives, false negatives, unanticipated opportunities.

Substance abuse and dependence are among the most common psychiatric disorders among pregnant and parenting women. These disorders among welfare recipients have attracted special concern. Chemical testing has been proposed to identify illicit drug use in this population. This analysis scrutinizes the potential value of drug testing, using recent data from the Women's Employment Study and the National Household Survey of Drug Abuse. One-fifth of recipients reported illicit substance use during the previous year. However, less than 5% satisfied diagnostic screening criteria for illicit drug dependence. Most recipients with psychiatric disorders or alcohol dependence reported no recent illicit drug use, and, thus, would not be detected through chemical tests. Although illicit drug users are rarely dependent, many face barriers to self-sufficiency. Screening and assessment programs should distinguish use from dependence, and should also identify alcohol dependence and psychiatric disorders. States should provide a range of treatment services to address these concerns.

Diagnosis, Dual (Psychiatry)↗

PubMed1990

Passive inhalation of cocaine by infants.

Cocaine abuse has increased greatly in recent years, creating important medical, legal, and social problems. Urine drug testing is used to diagnose cocaine ingestion. The presence of the cocaine metabolite benzoylecgonine (BZ) is commonly believed to be proof of recent cocaine intoxication. However, oral ingestion of even a minute quantity of cocaine can result in a positive test result. BZ was detected in the urine of four nonbreast-fed infants aged 6 weeks to 14 months who were admitted with diagnoses unrelated to cocaine poisoning. These infants were exposed to cocaine by passive inhalation of vapors generated by adult caretakers smoking "crack" cocaine. Two of the infants were retested 12 hours later and had no detectable BZ, strongly suggesting ingestion of a subpharmacologic amount of cocaine. Because passive inhalation of cocaine can produce measurable urine BZ concentrations, a positive urine screen does not necessarily indicate poisoning or intentional administration of the substance and therefore is not proof of child abuse or neglect.

Cocaine↗

PubMed2006

Hair analysis for drug detection.

Given the limitations of self-reports on drug use, testing for drugs of abuse is important for most clinical and forensic toxicological situations, both for assessing the reality of the intoxication and for evaluation of the level of drug impairment. It is generally accepted that chemical testing of biological fluids is the most objective means of diagnosis of drug use. The presence of a drug analyte in a biological specimen can be used to document exposure. The standard in drug testing is the immunoassay screen, followed by the gas chromatographic-mass spectrometric confirmation conducted on a urine sample. In recent years, remarkable advances in sensitive analytical techniques have enabled the analysis of drugs in unconventional biological specimens such as hair. The advantages of this sample over traditional media, like urine and blood, are obvious: collection is noninvasive, relatively easy to perform, and in forensic situations it may be achieved under close supervision of law enforcement officers to prevent adulteration or substitution. The window of drug detection is dramatically extended to weeks, months or even years when testing hair. It seems that the value of alternative specimen analysis for the identification of drug users is steadily gaining recognition. This can be seen from its growing use in preemployment screening, in forensic sciences, in clinical applications and for doping control. Hair analysis may be a useful adjunct to conventional drug testing in urine. Methods for evading urinalysis do not affect hair analysis. The aim of this review is to document toxicological applications of hair analysis in drug detection.

Alcoholism↗

PubMed1993

Screening mothers of young children for substance abuse.

Pediatricians have been urged to screen for parental substance abuse, but few screening instruments have been tested for mothers. We compared six screening questions for maternal alcohol and drug abuse with the Michigan Alcoholism Screening Test (MAST) and the Drug Abuse Screening Test (DAST). Questionnaires were completed by 507 mothers; most were Caucasian (78%) and married (75%). Eighteen percent were positive on the MAST, and 3% were positive on the DAST. The screening questions for drinking had a 90% sensitivity compared with the MAST; the questions about drug use had a sensitivity of 88% compared with the DAST. The MAST detected only 25% of mothers who reported physiologic tolerance to alcohol and 32% of those who reported binge drinking; the DAST failed to detect any mothers who reported using drugs in the previous 24 hours. The six screening questions about alcohol and drug use had good sensitivity, detected potential drinking problems and drug abuse missed by the MAST and DAST, and can be incorporated easily into a comprehensive psychosocial questionnaire.

Adult↗

PubMedDate not supplied

Drug use and associated factors among rural adolescents in Costa Rica.

The objectives of this study, carried out in 1995, were to assess both licit and illicit substance use among rural male and female Costa Rican adolescents, and associated health, psychological, and psychosocial problems. A sample of 304 students from rural schools was randomly selected. The mean age for females was 14.7 years (S.D. = 1.71), and for males was 14.4 years (S.D. = 1.62). The data were collected using the Latin-American version of Drug Use Screening Inventory (DUSI). Results showed a high prevalence of past-year alcohol use for both males and females (56.6% and 47.4%, respectively), and a lower prevalence of past-year tobacco use (44.0% and 7.7%). There results also showed a low level of use of solvent inhalants and benzodiazepines. In terms of illicit drugs, males preferred cocaine and marijuana, while females only reported amphetamine use. An analysis of adolescent functioning showed differences among alcohol users and nonusers in behavior patterns and peer relationships. However, no significant differences were found regarding rebellion, depression, and social isolation. The implications of these results are discussed, along with the importance of enhancing prevention, as well as early detection and intervention.

Adolescent↗

PubMed1993

[Forensic toxicological application of TOXI-LAB screening for biological specimens in autopsy cases and emergency cares].

Using the TOXI-LAB drug detection system, emergency toxicological screening was performed in autopsy cases and emergency cares. In 280 autopsy cases (male 182 cases 65%, female 98 cases 35%), drug positive cases were 28 cases of male (15%) and 24 cases of female (24%). The age groups which showed higher rate of drug positive cases were 10s-40s in male (approximately 20%) and 20s in female (67%). In the 238 cases of emergency care (male 129 cases 54%, female 104 cases 44%, unknown 5 cases 2%), drugs were positive in 29 cases of male (22%) and 32 cases of female (30%). The age groups which showed relatively higher rate of drug positive cases were 40s in male (64%), 20s (71%) and 30s (89%) in female. Forty-four different kinds of drugs were detected in TOXI-LAB positive cases, in which the psychotropic drugs and the sedative-hypnotic drugs amounted to approximately 70%. Methamphetamine and amphetamine, which were the main abused drugs showing a socially important problem, were detected in total 15 cases. TOXI-LAB was based on thin-layer chromatography (TLC); however, from the extraction to development, coloration and detection have been accelerated (about 50 min) and simplified. In order to perform the forensic toxicological practice in Japan, it becomes more useful that TOXI-LAB is used in autopsy cases and emergency cares, if the drugs, which have caused poisoning cares in Japan, are added to TOXI-LAB. The present study describes the advantage and problem of TOXI-LAB drug detection system through demonstrating the practical cases of autopsy cases and emergency cares.

Emergencies↗

PubMed2000

A GC-MS method for the detection of toluene and ethylbenzene in volatile substance abuse.

The interference of some substances with the gas chromatography-flame ionization detection and gas chromatography-Fourier transform infrared detection of toluene and ethylbenzene in volatile substance abuse poses problems. A gas chromatography-mass spectrometry (GC-MS) method that will overcome such interference has been developed for the detection of toluene and/or ethylbenzene in the headspace of preparations and products containing these substances and in the headspace of blood samples in the cases of volatile substance abuse. The method is based on converting toluene to benzoic acid via the formation of benzotrichloride. The latter compound was obtained upon the reaction of toluene with chlorine gas under direct sunlight conditions. In the presence of water, benzotrichloride was converted to benzoic acid. Ethylbenzene was converted to benzoic acid and two phenylethanols via the formation of side chain chloro-substituted phenylethanes followed by reaction with water. The chloro-substituted phenylethanes were obtained by the reaction of ethylbenzene with chlorine under direct sunlight conditions. The benzoic acid resulting from toluene and/or ethylbenzene and the two phenylethanols resulting from ethylbenzene were detected by GC-MS as their trimethylsilyl (TMS) derivatives. For the method to be viable for the detection of volatile substance abuse, the chlorination reactions were effected in the gaseous state.

Benzene Derivatives↗

PubMed1989

Urine screening for abused drugs in new admissions to a VA hospital.

The urine samples from two groups of Veteran's Administration patients newly admitted to general psychiatry units were screened in 1985 and in 1987-88 for abused drugs. The results were compared with urine samples from controls with similar age distributions admitted to an alcohol and drug abuse unit or to medical-surgical units. About 40% of all newly admitted patients were positive for one or more controlled drugs, but there were no significant differences among patient groups in the percentage of urine samples positive for these drugs. Marijuana and benzodiazepines were detected frequently in all patient groups and often in combination, although opiates also were frequently detected in the urine samples from the medical-surgical patients. There was a clear decrease in drug-positive samples with age in all patient groups, much of which could be accounted for by decreased marijuana detection.

Adult↗

PubMed1991

Detection of prenatal drug exposure in the pregnant women and her newborn infant.

Although urine testing remains the standard method for identifying and monitoring drug addicts, recent data suggest that it seriously underdiagnoses the prevalence of fetal exposure to various drugs. Results obtained with other body fluids and tissues (meconium and hair) are reviewed and the laboratory methodologies used to detect drugs are discussed in details.

Female↗

PubMed2000

On-site testing of saliva and sweat with Drugwipe and determination of concentrations of drugs of abuse in saliva, plasma and urine of suspected users.

Potential drug users participated voluntarily in a Belgian study on the usefulness of the non-instrumental immunoassay Drugwipe (Securetec, Germany) for the screening of cocaine, opiates, amphetamine and cannabinoids in saliva and sweat. If one of the screening assays (urine, oral fluid, sweat) showed a positive result, blood and saliva were collected. The on-site Drugwipe results were correlated with the Drugwipe results for saliva in the laboratory and with the GC/MS results of the corresponding saliva, plasma and urine samples and pharmacological effects at the time of sampling. The Drugwipe assay proved to be sufficiently sensitive for the detection of recent cocaine (n = 6) and amphetamine (n = 15) abuse, whether the device was wiped on the tongue or on the surface of the body, or when a saliva sample was applied to the wiping part. In five of the six potential cocaine users, the saliva concentrations of cocaine exceeded 1,000 ng/ml. In the amphetamine group, the saliva concentrations of amphetamine, MDMA or both were high (> 1,000 ng/ml) in 13 subjects. For cocaine and amphetamine, the positive scores for Drugwipe matched the GC/MS results for the three body fluids. Recent heroin abuse (n = 5) could be demonstrated to some extent with Drugwipe on samples from the tongue but only the two subjects with the highest saliva concentrations of MAM (> 500 ng/ml) and morphine (> 500 ng/ml) were positive. If the legal cut-off value for driving under the influence of opiates in Belgium (20 ng/ml of free morphine in plasma) was taken into account, only three subjects would have been legally positive. For cannabinoids (n = 15), false negatives and even some false positives were observed. Saliva can be considered as a useful analytical matrix for the detection of drugs of abuse after recent abuse when analysed with GC/MS.

Automobile Driving↗

PubMed1997

[Dependence producing substances in the practice of the Insitute of Forensic Experts in Krakow].

Different pieces of evidence connected with drug addiction have been used as material for studies carried out at the institute of Forensic Research in Kraków since the end of the sixties. The number of expert's opinions concerning these questions is constantly on the increase. Work done by the institute in this field has led to the creation of a list of dependence producing substances and their substitutes used by addicts, the methods of illicit production, and the ways and usable forms in which they are introduced into the system. The author describes the most popular drugs and their substitutes used in Poland. The number of these substitutes is big. Among them are: different medicines (e.g. Parkopan, Aviomarin) and solvents (toluene), various vegetable raw materials (e.g. Folium Stramonli, Pallocybe semilanceata). At the same time the use of genuine narcotics like morphine derivatives originating from Papaver somniferum and Cannabis sativa products, obtained by unusual methods of domestic production, was observed. The number of cases involving amphetamine and its analogues increased last year. The presence of opium alkaloids (morphine, codeine, papaverine, thebaine and narcotine as well as acetyl derivatives of morphine (heroine, 3-monoacetylmorphine, 6-monoacetylmorphine) and codeine (acetylcodeine) was detected in "kompot" by means of TLC, HPLC and GC/MS methods. The author also presents, from the analyst's point of view, analytical and interpretational problems of drugs of abuse, and regulations connected with drug addiction and with road traffic offences.

Forensic Medicine↗

PubMedDate not supplied

Drug testing in Canadian jails: to what end?

Since 1995, Corrections Services Canada (CSC) has conducted randomized urinalysis screening of a minimum of 5% of the federal inmate population on a monthly basis. Urine samples are screened for a broad range of psychoactive substances. The stated purpose of such screening is to reduce substance use in federal jails. Analysis of data provided by CSC for testing between 1994 and 1998 reveals small but statistically significant increases in the percentage of all urine samples that tested positive over that time. Analysis of the results of screening for opiates, cocaine and THC from data provided by CSC for the same time period, shows steady rates of opiate and cocaine detection at maximum and medium levels of security, decreases in opiate and cocaine detection in minimum security, and statistically significant increases in THC detection at all levels of security. The implications of these findings are discussed.

Canada↗

PubMed2003

An evaluation of rapid point-of-collection oral fluid drug-testing devices.

New technology is currently being marketed to rapidly test oral fluids for drugs of abuse at the point of collection (POC). There are no nationally accepted standards or cutoff concentrations for detecting drugs in oral fluids and for most analytes there are significant differences in cutoff concentrations across devices. Four devices were evaluated (OralLab), RapiScan, Drugwipe, and SalivaScreen) for their ability to meet manufacturers claims, and proposed federal standards for criminal justice and workplace programs. Human oral fluid fortified with known quantities of drug [drug(s) or metabolite(s)] was used to test these devices. Overall, the performance of these rapid POC oral fluid drug-testing devices was quite variable. Some devices performed well for the analysis of some drug classes but poorly for others. In general, most devices performed well for the detection of methamphetamine and opiates, but all performed poorly for the detection of cannabinoids. The ability to accurately and reliably detect cocaine and amphetamine was dependent on the individual device.

Equipment Design↗

PubMed1992

Efficacy of urinalysis in monitoring heroin and cocaine abuse patterns: implications in clinical trials for treatment of drug dependence.

Urinalysis can be used as an objective criterion for monitoring the outcome of a treatment program or a clinical trial. Important factors to consider when implementing a drug testing program include standardization of assay technology and cutoffs between participating centers and selection of identical testing schedules. Also, it is vitally important to minimize the amount of safe time (time that drug use can go undetected) occurring in a testing schedule. The detection times for cocaine and heroin have been shown to vary with selection of cutoff and with the drug dose. Obviously, the selection of cutoffs is under program control, whereas the amount of illicit drug use is under subject control. Fortunately, changes in the illicit drug dose by the subject demonstrate a log-linear relationship to detection time. Hence, a higher drug dose by the subject only extends the detection time slightly (and improves the probability of detection) without greatly increasing the risks of drug carryover from one urine test to another. The most efficient testing schedule for judging the outcome of clinical trials for cocaine and heroin appears to be a 3-days-a-week schedule (Monday, Wednesday, Friday or Tuesday, Thursday, Saturday). When different schedules were challenged by simulating random times at which cocaine use might occur during the week, the 3-days-per-week schedule was the most efficient without the risk of carryover. The 3-days-per-week schedule also performed better than 1-day-per-week when multiple random drug use was simulated. Overall, the 3-days-per-week testing schedule with specified assay technology and cutoffs was the best compromise for maximizing detection of drug use, minimizing carryover, and providing a standardized methodology for outcome comparison between programs.

Clinical Trials as Topic↗

PubMed2000

Presence of illegal drugs in drivers involved in fatal road traffic accidents in Spain.

This study investigated the presence of illegal drugs in the blood of 285 fatally injured drivers in Spain. Illegal drugs were detected in 10.2% of all samples. Illicit drugs alone were detected in 2.5% and together with other substances in 7.7%. Cocaine was the most common drug detected. The mean number (+/- S.D.) of substances detected was 2.6 +/- 1.2: consisting of 46 illegal drugs, 14 alcohol cases and 16 medicines. Three concentration levels of the different substances have been established: low, medium and high-toxic. In 68.9% of the samples in which an illegal drug was detected, a substance was also found at the high-toxic level. The results show that illegal drugs are commonly detected in road accident victims.

Accidents, Traffic↗

PubMed2006

Results of hair analyses for drugs of abuse and comparison with self-reports and urine tests.

Urine as well as head and pubic hair samples from drug abusers were analysed for opiates, cocaine and its metabolites, amphetamines, methadone and cannabinoids. Urine immunoassay results and the results of hair tests by means of gas chromatography-mass spectrometry were compared to the self-reported data of the patients in an interview protocol. With regard to the study group, opiate abuse was claimed from the majority in self-reports (89%), followed by cannabinoids (55%), cocaine (38%), and methadone (32%). Except for opiates the comparison between self-reported drug use and urinalysis at admission showed a low correlation. In contrast to urinalysis, hair tests revealed consumption in more cases. There was also a good agreement between self-reports of patients taking part in an official methadone maintenance program and urine test results concerning methadone. However, hair test results demonstrated that methadone abuse in general was under-reported by people who did not participate in a substitution program. Comparing self-reports and the results of hair analyses drug use was dramatically under-reported, especially cocaine. Cocaine hair tests appeared to be highly sensitive and specific in identifying past cocaine use even in settings of negative urine tests. In contrast to cocaine, hair lacks sensitivity as a detection agent for cannabinoids and a proof of cannabis use by means of hair analysis should include the sensitive detection of the metabolite THC carboxylic acid in the lower picogram range.

Adult↗

PubMed2006

Drugs of abuse testing in meconium.

Prenatal substance abuse is an ongoing concern with significant impact on neonatal health and development across socioeconomic lines. Meconium, passed by neonates during their first post-natal bowel movements, is a matrix unique to the developing fetus and contains a long history of prenatal metabolism. Over the last two decades, the use of meconium as a matrix for assessing prenatal exposure to drugs of abuse has yielded methods exhibiting higher sensitivity, easier collection, and a larger window of detection than traditional matrices. Recently, a method has been developed for the analysis of fatty acid ethyl esters in meconium as a biomarker of fetal alcohol exposure, potentially facilitating the future diagnosis of Fetal Alcohol Spectrum Disorder in situations where gestational alcohol consumption history is unknown. Screening for prenatal exposure to illicit and abused licit drugs in meconium is possible by use of a variety of immunoassay methods with conformational analysis usually occurring by GCMS or LCMS. In spite of increased sample preparation time relative to blood and urine, the long metabolic history, coupled with the ease and wide window of collection of meconium make it the ideal matrix for determining fetal drug exposure.

Female↗