By Joseph Salerno
The need for opiate and drug testing has grown in the last three decades. 2.4 million people in the United States abused opioid pain relievers in 1985, the year before President Ronald Reagan announced his Federal Drug-Free Workplace Program.1 That number swelled to 4.9 million - a 104% increase - by 2012.2 During that same time, the population of the United States grew only 32%.
The original opiate testing panel created in 1986 is an incomplete tool for today's drug testing needs. No other category of drugs has evolved as much as opiates and opioids. Addiction to high strength pain relievers and newer opioid compounds has eclipsed codeine, morphine, and heroin addiction addressed by the original 1986 five-panel drug test.
Based on the most recent data on emergency department visits related to illicit substance abuse, it is clear that opiate and opioid abuse has shifted dramatically. Screening for opiate abuse using only 1986 drug testing guidelines for the opiate drug class misses the past 30 years of pharmaceutical and drug testing advancements.3
1. United States Department of Health and Human Services. National Institutes of Health. National Institute on Drug Abuse. National Household Survey on Drug Abuse, 1985. ICPSR06844-v3. Ann Arbor, MI: Inter-university Consortium for Political and Social Research [distributor], 2013-06-19.
2. Substance Abuse and Mental Health Services Administration, Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-46, HHS Publication No. (SMA) 13-4795. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013.
3. Substance Abuse and Mental Health Services Administration, Drug Abuse Warning Network, 2011: National Estimates of Drug-Related Emergency Department Visits. HHS Publication No. (SMA) 13-4760 Series D-39. Rockville, MD: Substance Abuse and Mental Health Services Admin., 2013.http://www.usdtl.com/blog/shifting-landscape
When a child is exposed to illegal substance abuse they often also face other coexisting obstacles to a normal life - neglect, abuse, violence, and other vulnerabilities. Substance abuse is a disease, one that often prevents adults from doing what is in a child's best interests. Our environmental exposure test for children can help.
Our hair environmental exposure test is the only drug test designed to detect passive exposure to drugs and detect both native drugs and drug metabolites in the hair specimen. Drug metabolites are produced in the body only if drugs have been ingested. Children in drug exposed environments are most often not drug users themselves, so drug metabolites are typically absent in child specimens. However, the hair, like a sponge, can absorb non-metabolized drug (native drug) if it is exposed through things such as touching or being in contact with drugs or drug users.
Standard hair tests with other labs will only report a positive exposure result if drug metabolites are detected, even when the native drug is in the child's hair specimen. Our hair environmental exposure test reports a positive result if either native drugs or drug metabolites are detected.
A hair exposure test can provide evidence of drugs in a child's environment for the past 3 months. A positive test result suggests that the child has experienced one or more of the following: passive inhalation of drug smoke, contact with drug smoke, contact with sweat or sebum (skin oil) of a drug user, contact with the actual drug, or accidental or intentional ingestion of illegal drugs.
ChildGuard® is the only child hair test designed to detect exposure to native drugs and drug metabolites.
By Joseph Salerno
The movement and location of physical evidence from the time it is obtained until the time it is presented in court is the legal definition of chain of custody. The results of any newborn alcohol or substance of abuse test performed at USDTL may eventually be presented as evidence in a court of law, and this is why USDTL maintains universal chain of custody regardless of the client source of testing specimens. A court can exclude the results of a test if a chain of custody for the newborn sample was not maintained by the hospital and USDTL.
Chain of custody for specimens sent to USDTL is maintained as a chronological paper trail of collection and transfers of specimens throughout the testing process. The paper trail is signed and dated by each person who handles the specimen, both when they receive the specimen into their own hands, and when they hand it off to the next person in the process. Less transfers of a specimen that need to be documented is better for the chain of custody overall. A well maintained and legal chain of custody begins at the time of specimen collection and continues uninterrupted until test results have been presented in court, if necessary.
There are several key elements of the chain of custody for alcohol and drug test samples that must be present when samples arrive at USDTL. First, the specimen container must be sealed with an intact security seal. Next, the sample must be accompanied by a Chain of Custody and Control Form with an identification number matching the number on the specimen container. The Chain of Custody and Control Form is the first piece of the chain of custody paper trail. Thirdly, the Chain of Custody and Control Form must be signed and dated by an authorized agent from the client. If one or more of these elements are missing, USDTL must return the sample to the client.
An unbroken chain of custody ensures sample integrity in several ways that preserve the legal usefulness of alcohol and drug testing results.
Chain of custody ensures that the original sample is the same as the one that is tested and ensures that the integrity of the sample is preserved during transport. Tampering, substitution, or alteration of the sample prior to being tested is prevented by the chain of custody process, which ensures thatit has been handled only by the donor, a qualified collector, and lab testing personnel.
Maintaining chain of custody for newborn samples destined for alcohol and drug testing is a simple process, but all those who handle a drug testing specimen need to be vigilant about the process nonetheless. Diligent maintenance of chain of custody is always in the child’s best interest. Unfortunately, it is only when the legal impact of an improperly maintained chain of custody is realized, that the full value of a well maintained chain of custody is understood. Ultimately, chain of custody protects the institution that is collecting the specimen, as well as the newborn whose health and well-being may rely on the results of a USDTL alcohol or drug test.
Reference: Giannelli, P. (1996). Forensic Science: Chain of Custody. Criminal Law Bulletin, 32(5), 447-465.http://www.usdtl.com/blog/maintaining-chain-of-custody-protects-health-institutions-and-newborns
Celebrating 10 Years of Forensic Toxicology Innovation Using LCMSMS Technology
By Joseph Jones, MS, NRCC-FTC
Ten years ago, USDTL, Inc. was a much different laboratory than it is today. Back then, we still had yet to develop fingernail, umbilical cord, or dried blood spot phosphatidylethanol (PEth) testing. We weren't even testing ethyl glucuronide (EtG) in urine or hair, our most common form of alcohol testing today. But, as it turns out, ten years ago was right at the turning point for us, that moment of tremendous innovation and acceleration that has pushed us to the forefront of forensic toxicology we are at now. One of our biggest leaps forward at that time was adopting liquid chromatography (LC) technology into our methodology and moving from a solely gas chromatography (GC) focused laboratory to an integrated GC/LC facility. We've never looked back.
Our first LC instrument was generically dubbed machine Number 7, and it was a gamble for us. We had very little experience with LC methodologies, and we were not actively looking to adopt that technology at that time. In 2005 we were approached by the analytical technology company AB Sciex, who were looking to increase their competitive share of the forensic testing field, specifically with their liquid chromatography tandem mass spectrometry (LCMSMS) instruments. They made us an offer we couldn't refuse - a new LCMSMS instrument in our lab, assistance in developing a new EtG/EtS urine assay, and six months to develop our market. After six months, they would let us decide whether or not we wanted to buy the instrument, or take a pass and send it back. What growing laboratory would ever say no to that?
As soon as assay development was complete, we starting receiving requests for urine EtG/EtS testing from all over the country. Major labs such as LabCorp and Witham labs relied on us to do all of their EtG/EtS testing. Six months came and went, and not only could we afford to keep Number 7, but we had built enough business to occupy two machines, and Number 9 was purchased as well. Number 9 passed on to new owners just a few years ago, but good ol' Number 7 is still chugging away in our lab, having processed well over 100,000 samples in those 10 years. It's a well-loved work horse to this day.
That offer from AB Sciex came out of the blue without warning, and for us, it was a major shake-up. We could have said “no thank you,” but we didn't. Even with the generous offer made by AB Sciex, this course of action was a big risk for us. We took a chance on an opportunity to extend our innovation, as well as build a fantastic partnership that has endured these ten years. The net result was a powerful expansion of our instrumental capabilities that has allowed us to bring major innovations to the forensic testing world, such as umbilical cord testing, dramatically improved sensitivity in cannabinoid testing, PEth testing in dried blood spots, and more. Incorporating LCMSMS technology into our methodologies has allowed us to leverage our expertise to create what was previously not possible. It is a key factor in making USDTL first in newborn toxicology and without question the best hair and fingernail testing lab in the U.S.
Ten years on, we raise our glass to good ol' Number 7, to the past 10 years of pushing the boundaries of forensic toxicology, and to another 10 years and beyond of making a difference in the world around us.