USDTL is honored to announce that our Assistant Laboratory Director of Research, Aileen Baldwin, Ph.D., MPH is a recent coauthor of two published peer-reviewed articles focused on the increased prevalence of prenatal alcohol exposure (PAE).

“Limitations of Nail and Hair Ethyl Glucuronide (EtG) Levels to Assess Maternal Alcohol Use,” was published in the Journal of Drug Dependence and Addiction in July 2019. The study was conducted at a maternity hospital in Montevideo, Uruguay between 2016-2017 in efforts to determine Ethyl Glucuronide (EtG) levels in nail and hair samples collected at the time of delivery in comparison to Phosphatidylethanol (PEth) levels. The research obtained from this analysis finds that EtG levels are of limited value for the assessment of maternal alcohol use during the third trimester of pregnancy or in determining a newborn’s risk for Fetal Alcohol Syndrome Disorder (FASD). This report also suggests PEth is the preferred method to detect alcohol use during the later stages of pregnancy.

In January 2020, “Prevalence of alcohol use in late pregnancy,” was published in Pediatric Research. The study highlights the increased prevalence of prenatal alcohol exposure (PAE) specifically in the state of West Virginia (WV) and identifies risk factors associated with PAE including smoking, preterm birth, lower gestational birth weight, and a reduction in breastfeeding. The findings from this study demonstrate that the detection of PEth in residual dried blood spots is an effective surveillance screening tool to improve methods for detection of prevalence estimate of PAE.  The use of PEth screening can provide accurate and timely estimates of PAE, which is vital to inform public health workers, policymakers, researchers, and clinicians to develop and promote effective prevention strategies to lower PAE prevalence and provide targeted interventions and treatment services for infants affected by PAE.   

Congratulations to Aileen and all of our research collaborators on your continued success in research development!

To read more, click on the publication links below:

• Limitations of Nail and Hair Ethyl Glucuronide (Etg) Levels to Assess Maternal Alcohol Use
• Prevalence of alcohol use in late pregnancy

Alcohol abuse, a historical public health concern, is gaining increased interest among medical professionals and analysts. Developing assessments are unveiling the significance of our country’s alcohol crisis despite overshadowing drug epidemics.

An estimated 88,000 people die from alcohol-related causes annually, which makes alcohol the third leading preventable cause of death in the United States.¹ The prevalence of alcohol in our society is generating alarming statistics of abuse and death that can’t be ignored. According to the 2015 National Survey on Drug Abuse and Health, 15 million adults over the age of 18 and 600,000 of 12-17-year-olds have an alcohol use disorder.¹

Alcohol Use Disorder (AUD) is a chronic relapsing brain disease characterized by compulsive alcohol use, loss of control over alcohol intake, and a negative emotional state when not using.² AUD diagnosis is outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and its severity is categorized from mild to moderate, or severe. In efforts to identify an individual suffering from AUD the following symptoms may be present:

• Inability to limit the amount of alcohol consumed
• An increased time limit for drinking, getting alcohol, or recovering from alcohol use.
• Feeling a strong craving or urge to drink alcohol.
• Failing to fulfill major obligations at work, school, or home due to repeated alcohol use.
• Eliminating or reducing social and work activities, or hobbies
• Developing a tolerance to alcohol, causing an increased need for more to feel its effect or experiencing a reduced effect from the same amount.
• Subjected to withdrawal symptoms—such as nausea, sweating, and shaking when not drinking and often drinking to avoid these symptoms.³

AUD is more prone to develop during an individual’s early to mid-adult life, although the onset of the disorder can begin at any age. Certain risk factors can generate hazardous drinking behaviors including:

• Steady Drinking-drinking too much on a regular basis
• A Premature Introduction to Alcohol-putting individuals at a higher risk for AUD
• Family History-influenced genetic variables
• Mental Health-disorders including anxiety, depression, schizophrenia, or biopolar³

The identification process of AUD is an initial step in addressing a multi-faceted disorder—untreated AUD can lead to long-term health complications ranging from:

• liver disease, digestive, and heart problems
• diabetes complications
• sexual function and menstruation issues
• eye problems
• birth defects
• bone damage
• neurological complications
• weakened immune system
• increased risk of cancer
• medical and alcohol interactions³

Alcohol is currently a regulated and licit substance in the United States; therefore, it is imperative to adhere to the safe drinking recommendations put forth by health organizations monitoring its usage. According to the Center for Disease Control (CDC), the recommended consumption of alcohol for women is up to 1 drink a day and for men, up to 2 drinks a day.⁴ If you are under the age of 21, may be pregnant, or have other health problems —abstaining from drinking is strongly advised. In efforts to elaborate on moderating your drinking, understanding what constitutes a “drink” is crucial.

Defining A “Drink”

• 12-ounces of beer (5% alcohol content)
• 8-ounces of malt liquor (7% alcohol content)
• 5-ounces of wine (12% alcohol content)
• 1.5-ounces of 80 proof (40% alcohol content) distilled spirits or liquor (e.g., gin, rum, vodka, whiskey)⁴

Binge Drinking

Binge drinking is defined as a pattern of drinking that brings a person’s blood alcohol concentration (BAC) to 0.08 grams percent or above. This type of intoxication generally occurs when men consume 5 or more drinks or women consume 4 or more drinks in 2 hrs.⁵

Heavy Drinking

Heavy alcohol use is defined as binge drinking on 5 or more days within a month period.⁵

An Alcohol Epidemic

The depth of AUD in comparison to other national emergency drug epidemics has often gone underestimated, but in 2016, deaths caused by alcohol were more than double those involving opioids.⁶  The American Academy of Pediatrics (AAP), recommends adopting universal substance abuse screening, brief intervention, and referrals to treatment.⁶ Identifying adolescents who are at high risk for developing AUD by utilizing screening tools can help accurately predict problematic drinking behaviors. The National Institute on Alcohol Abuse and Alcoholism (NIAAA), have recently developed a two-question alcohol screening designed for middle school and high school students asking the following:

Middle School

1. Do you have any friends who drank beer, wine, or any alcohol in the past year?
2. How about you? In the past year how many days have you had more than a few sips of beer, wine, or any drink containing alcohol?

High School:

1. In the past year, on how many days have you had more than a few sips of beer, wine, or any drink containing alcohol?
2. If your friends drink, how many drinks do they drink on an occasion?⁷

The Importance of Utilizing Alcohol Assessment Tools

Administering evaluative tools in efforts to properly assess risky drinking behaviors can be a useful tactic. However, self-report reliability can become questionable –utilizing additional evidence-based measurements can assist in depicting the true magnitude of one’s drinking behaviors. Several studies have reported difficulties in measuring alcohol-related dependence using self-reporting tools, due to misinterpretation by respondents, lack of specificity, and misperception of AUD symptoms such as after-effects and acute intoxication.⁸ As a leading forensic toxicology laboratory, we provide alcohol biomarker testing to assist in identifying at-risk drinking behaviors. Our laboratory offers alcohol biomarkers in several specimen types including:

Newborn:

• Meconium-Fatty Acid Ethyl Ester (FAEE)-window of detection up to approximately 20 weeks prior to collection. (i.e., Birth)
• Umbilical Cord-Ethyl Glucuronide (EtG)-window of detection up to approximately 20 weeks prior to collection. (i.e., Birth)
• Blood– Phosphatidylethanol (PEth)-window of detection is up to approximately 2-4 weeks prior to collection.

Adult/Child:

• Fingernail-Ethyl Glucuronide (EtG)-window of detection is up to approximately 3 months prior to collection.
• Hair-Ethyl Glucuronide (EtG)-window of detection is up to approximately 3 months prior to collection.
• Blood-Phosphatidylethanol (PEth)-window of detection is up to approximately 2-4 weeks prior to collection.
• Urine-Ethyl Glucuronide/Ethyl Sulfate (EtG/EtS) and ethanol-window of detection is up to approximately 2-3 days prior to collection.

An estimated 16 million people in the United States have AUD.² Incorporating detection methods to assist in identifying individuals exhibiting indicators of destructive drinking can create an effective awareness about AUD –a crisis that affects so many of us today.  

References:

1. “Alcohol Facts and Statistics.” (n.d.). Retrieved from https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-facts-and-statistics
2. “Alcohol Use Disorder.” (n.d.). Retrieved from https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/alcohol-use-disorders
3. “Alcohol use disorder.” (2018, July 11). Retrieved from https://www.mayoclinic.org/diseases-conditions/alcohol-use-disorder/symptoms-causes/syc-20369243
4. CDC – “Fact Sheets-Alcohol Use And Health” – Alcohol. (n.d.). Retrieved from https://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm
5. CDC – “Fact Sheets-Binge Drinking” – Alcohol. (n.d.). Retrieved from https://www.cdc.gov/alcohol/fact-sheets/binge-drinking.htm
6. Hadland, S. E., Knight, J. R., & Harris, S. K. (2019, March 01). “Alcohol Use Disorder: A Pediatric-Onset Condition Needing Early Detection and Intervention.” Retrieved from https://pediatrics.aappublications.org/content/143/3/e20183654
7. Spirito, A., Bromberg, J. R., Casper, C., Chun, T. H., Mello, M. J., Dean, M., & Linakis, J. G. (2016, September 22). “Reliability and Validity of a Two-Question Alcohol Screen in the Pediatric Emergency Department.” Retrieved April 3, 2019, from https://pediatrics.aappublications.org/content/pediatrics/138/6/e20160691.full.pdf
8. Iglesias, K., Sporkert, F., Daeppen, J., Gmel, G. and Baggio, S. (2018). Comparison of self-reported measures of alcohol-related dependence among young Swiss men: a study protocol for a cross-sectional controlled sample. [online] Available at: https://bmjopen.bmj.com/content/8/7/e023632 [Accessed 3 Feb. 2020].

In 1996, California became the first state to pass legislation condoning the use of marijuana for medicinal purposes, and since the onset of that law, a powerful trend was set. Over 33 other states, including the District of Columbia, have now adopted various statutes for the permittance of recreational and medicinal marijuana. Although many government entities have sided that the benefits of the cannabis plant outweigh the risks, others are anxious that the ease of accessibility may cause an influx of misleading notions regarding the plant. Its exposure to vulnerable populations, including adolescents, those pregnant, or individuals suffering from preexisting psychiatric disorders continues to be a significant concern among communities.   

The Impact of Legalization on Local Communities

In a cross-sectional marijuana dispensary density study from 2001-2012 in California, associations between marijuana abuse/dependence hospitalizations disclosed that an additional one dispensary per square mile was associated with a 6.8% increase in the number of marijuana hospitalizations. The study’s findings concluded that increased availability of marijuana in zip codes with a higher density of dispensaries continues to be a probable correlation to the increased hospitalizations in dispensary-dense areas.¹

Despite this study and others, a recent CBS News Poll found that support for marijuana legalization has risen among groups that have historically opposed it. More than half of Republicans (56 percent) now think marijuana use should be legal due to reasons such as marijuana being less harmful than alcohol and believing it is less harmful than other drugs.² However, increases in marijuana potency is triggering a valid fear that the levels of THC in today’s plants are more toxic than therapeutic.

Increased Potency, Increased Risks

As highly potent cannabis increases in availability, scientists who study marijuana and the effects it has to the human body are becoming disturbed with the increasingly high rates of potency in delta-9-tetrahydrocannabinol (THC)–the main compound responsible for the drug’s psychoactive effects. According to a U.S. Drug Enforcement Administration seize, the potency of marijuana has increased from about 4% THC in 1995 to about 12% in 2014. By 2017 marijuana samples were up to 17.1% THC, totaling an increase of more than 300% from 1995-2017. Concentrated cannabis products known as hash and hash oil are also reaching potency levels as high as 80-90% THC.³

Nora Volkow, Director of the National Institute on Drug Abuse (NIDA) states, “The notion that it is a completely safe drug is incorrect when you start to address the consequences of this very high content of Delta-9-THC.”

The levels of THC within cannabis is imperative when factoring the effects it can have on the body when consumed. Low THC levels have been known to have less adverse effects compared to high THC levels.  

Low THC Content:

• Decreases Anxiety
• Treats Nausea
• Relaxation³

High THC Content:

• Panic Attacks
• Psychosis
• Paranoia
• Cannabinoid Hyperemesis Syndrome³

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) of the American Psychiatric Association now includes Cannabis Use Disorder (CUD) as a substance use disorder (SUD) diagnosis. Not all cannabis users develop CUD, however it is becoming more common than we think and can be serious. Normalizing use and reducing perception of harm can increase the development of CUD.⁴

DSM-5 Cannabis Withdrawal Symptoms:

• Anxiety, restlessness
• Depression, irritability
• Insomnia/odd dreams
• Physical symptoms, e.g.Tremors
• Decreased appetite⁴

In a longitudinal study published in Addiction, CUD was found to be significantly associated with psychotic and depressive symptoms.⁵

The Association Between Cannabis Use and Psychiatric Comorbidity

Cannabis use is recognized as a contributing factor for developing a psychotic disorder, children and teens with a family history of psychosis are most vulnerable.⁴

In a long-term prospective study, 1265 children born in Christchurch, New Zealand in 1977 were assessed repeatedly for psychosis symptoms due to daily exposure of cannabis in utero, which contributed to psychotic symptoms portrayed in these children at between the ages of 18-25. There was a significant correlation between cannabis use and later development of psychosis.⁴

A study conducted by Lancet Psychiatry found that three European cities­­–London, Paris, and Amsterdam, where high-potency weed is most prevalent, also have the highest rates of new cases of psychosis. The study indicates that daily pot users are three times more likely to endure a psychotic episode compared to an individual who has abstained from the substance.⁴

High potency forms of marijuana known as wax, butane hash oil, dabs, or shatter are growing in popularity and are more likely to induce psychotic states. The principal psychoactive component of cannabis is THC, which binds to cannabinoid-1 (CB-1) receptors found throughout the central nervous system. Studies specify that pure THC and CB1 agonists can produce psychotic symptoms including suspiciousness, paranoia, thought disorganization, and derealization.⁷

Marta Di Forti, lead author from the Institute of Psychiatry, Psychology, and Neuroscience at King’s College London says, “As the legal status of cannabis change in many countries and states, and as we consider the medicinal properties of some types of cannabis, it is of vital public health importance that we also consider the potential adverse effects that are associated with daily cannabis use, especially high potency varieties.”⁶

Maternal Marijuana Use

The adverse effects of marijuana can become extremely dangerous when the substance is used among those pregnant. According to the National Survey on Drug Use and Health, nearly 4% of pregnant women in 2007 and 2012 used marijuana in the past 30 days. Long-term neurobehavioral studies have shown that negative consequences have been found in children exposed to marijuana in utero such as altered neural functioning, behavioral deficits, emotional deficits, low academic achievement, and increased risk of adolescent substance use initiation.⁸ 

The uptick of marijuana legalization has generated a significant concern among obstetricians, gynecologists, and neonatal practitioners who are combating misleading claims that marijuana use during pregnancy is safe. According to the Center for Disease Control and Prevention (CDC), about 1 in 25 women in the U.S. report using marijuana while pregnant, despite the fact that marijuana use during pregnancy may increase the baby’s risk of developmental problems and low birth weight.⁹ The American College of Obstetricians and Gynecologists (ACOG) recommends that obstetrician-gynecologists counsel women against using marijuana while trying to get pregnant, during pregnancy, and while breastfeeding.¹⁰ Studies have found that cannabinoid receptors appear in the fetal brain around the 14^th week of gestation and are located in areas where cognitive and behavioral functioning develop.¹¹

According to a qualitative study, women reported that although they were consistently seeking prenatal care throughout their pregnancy, information and resources regarding maternal marijuana use was either not helpful or non-existent, resulting in the assumption that marijuana did not pose a significant threat to a developing fetus.¹² The study concludes that absenteeism of perinatal marijuana education can lead to an increase of use among pregnant women.¹²

Testing for Abuse

Cannabis is not a harmless substance. It has been found to have addictive properties, which can lead to impairments and cause serious health risks. Our tests are designed to identify the detection of short-term and long-term marijuana usage. Each available specimen type provides a unique window of detection.

• Hair: Up to approximately 3 months prior to collection.
• Nail: Up to approximately 3-6 months prior to collection.
• Umbilical Cord: Up to approximately 20 weeks prior to birth.
• Meconium: Up to approximately 20 weeks prior to birth.
• Urine: Up to approximately 2-3 days prior to collection.

We believe that to remain at the forefront of toxicology, it is imperative to offer testing services for all substances that may pose an increased risk for abuse and dependence. Our continued investment in developing and implementing testing for drug ingestion and exposure helps us address substances that most concern you.

References:

1. Mair, C., Freisthler, B., Ponicki, W. R., & Gaidus, A. (2015, September 01). “The impacts of marijuana dispensary density and neighborhood ecology on marijuana abuse and dependence.” Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4536157/
2. “Support for marijuana legalization hits new high, CBS News poll finds.” (n.d.). Retrieved from https://www.cbsnews.com/news/support-for-marijuana-legalization-hits-new-high-cbs-news-poll-finds/
3. Chatterjee, R. (2019, May 15). “Highly Potent Weed Has Swept The Market, Raising Concerns About Health Risks.” Retrieved from https://www.npr.org/sections/health-shots/2019/05/15/723656629/highly-potent-weed-has-swept-the-market-raising-concerns-about-health-risks
4. Hasin, D. S. (2018, January). “US Epidemiology of Cannabis Use and Associated Problems.” Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5719106/
5. Pond, E. (2019, January 28). “Cannabis Use, Cannabis Use Disorder Linked to Psychotic, Depressive Symptoms.” Retrieved from https://www.psychiatryadvisor.com/home/topics/addiction/cannabis-use-cannabis-use-disorder-linked-to-psychotic-depressive-symptoms/
6. Robinson, J. (2019, March 20). “Daily use of high-potency cannabis increases risk of psychosis by four times, study finds.” Retrieved from https://www.pharmaceutical-journal.com/news-and-analysis/news/daily-use-of-high-potency-cannabis-increases-risk-of-psychosis-by-four-times-study-finds/20206308.article?firstPass=false
7. Corey J. Keller, Evan C. Chen, Kimberly Brodsky & Jong H. Yoon(2016)“A case of butane hash oil (marijuana wax)–induced psychosis, Substance Abuse”, 37:3, 384-386, DOI: 10.1080/08897077.2016.1141153
8. Jones, J. (2018).“Medical Marijuana Laws and Maternal Marijuana Use.” Des Plaines, IL: Archives of Women Health and Care.
9. “What You Need to Know About Marijuana Use and Pregnancy” | Fact Sheets | CDC. (n.d.). Retrieved from https://www.cdc.gov/marijuana/factsheets/pregnancy.htm
10. National Institute on Drug Abuse. (n.d.).“Can marijuana use during and after pregnancy harm the baby?” Retrieved from https://www.drugabuse.gov/publications/research-reports/marijuana/can-marijuana-use-during-pregnancy-harm-baby
11. Day, N. L., Goldschmidt, L., Day, R., Larkby, C., & Richardson, G. A. (2015, June). “Prenatal marijuana exposure, age of marijuana initiation, and the development of psychotic symptoms in young adults.” Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/25534593
12. Jarlenski, M., Tarr, J. A., Holland, C. L., Farrell, D., & Chang, J. C. (2016). “Pregnant Women’s Access to Information About Perinatal Marijuana Use: A Qualitative Study.” Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/27131908

Congratulations to Michelle Pilkington for joining the Board of Directors for the Chicago Chapter of the Clinical Laboratory Management Association. CLMA is a community that brings together clinical laboratory professionals from laboratories of all sizes. Clinical laboratory managers and leaders, clinical technicians, consultants, marketers and military staff can connect and share their collective knowledge. To learn more click here. Michelle said “Having a seat at the table, representing USDTL, gives us an opportunity to be face to face with some of our regional clients and make a difference.”

At the 2019 annual business meeting of the Society of Forensic Toxicologists (SOFT) on October 17, 2019, Andre Sukta was elected by the membership to be on the Board of Directors.  The Board of Directors are tasked with representing the members at large and providing mission-based leadership, strategic governance and leadership continuity.  The mission of SOFT is to be an organization composed of practicing forensic toxicologists and those interested in the discipline for the purpose of promoting and developing forensic toxicology.  “It is an honor that my professional colleges have entrusted me with this responsibility and I look forward to continuing and honoring the legacy of this organization” Andre said. Please join USDTL in congratulating Andre for such an incredible achievement!

By: Kelly Hack, Content Writer

There are many variables regarding the analyses of substance abuse testing. Clients will often ask about specifics pertaining to the determination of time, dose and frequency when detecting substance(s) of abuse.

When testing a reservoir matrix- a material or substance, which can accumulate and retain drug and alcohol biomarkers (eg., urine, blood, hair, nail, umbilical cord, or meconium, etc.), the reported quantitation of a drug or its metabolite cannot be used to determine when/if a specific substance was used, how much of a substance was used or how often a substance was used. Test results show only if a substance was detected or not detected.

A specimen’s window of detection provides an estimated timeframe for detecting substance(s) of abuse. Based on extensive research studies, the generally accepted windows of detection for specimens used in our testing are as follows:

• Scalp Hair- Up to approximately 3 months prior to collection.
• Fingernail- Up to approximately 3-6 months prior to collection.
• Umbilical Cord- Up to approximately 20 weeks prior to birth.
• Meconium- Up to approximately 20 weeks prior to birth.
• Urine- Up to approximately 2-3 days prior to collection.
• Blood (PEth)-May be up to approximately 2-4 weeks prior to collection.

It is important to know that the interpretation of drug testing results may be determined by a Medical Review Officer (MRO). A Medical Review Officer is a licensed physician (MD or DO) who has knowledge of substance abuse disorders and has appropriate medical training to interpret and evaluate an individual’s positive test result together with his or her medical history and any other relevant biomedical information.¹This is an incredibly important aspect of drug testing. A laboratory can detect substances, but a MRO may be used to interpret what that detection means.

1.Journal of Occupational and Environmental Medicine: (January 2003-Volume 45-Issue 1-p 102-103) Quaifications of medical Review Officers (MRO’s) in Regulated and Nonregulated Drug Testing. Departments: ACOEM Consensus Opinion Statement

By: Kelly Hack, Content Writer

According to the Centers for Disease Control and Prevention (CDC), fentanyl-related overdose deaths in the United States have increased by more than 1,000 percent from 2011 through 2016.¹ The increased availability of illicitly manufactured fentanyl has contributed to the prevalence of neonatal abstinence syndrome (NAS) or neonatal opioid withdrawal syndrome (NOWS) throughout the United States. There was a greater than five-fold increase in the proportion of babies born with NAS from 2004 to 2014, when an estimated 32,000 infants were born with NAS/NOWS —equivalent to one baby suffering from opioid withdrawal born approximately every 15 minutes.²

In response to an ongoing opioid epidemic, medical professionals and advocates are invested in providing education, resources, testing, and preventative care in efforts to combat one of the most powerful opioids in the world —Fentanyl. This synthetic, opioid is extremely addictive and when used while pregnant can cause devastating outcomes to the fetus including neural tube defects, congenital heart defects, gastroschisis, stillbirth, and pre-term delivery.³

Newborns are often diagnosed with NAS/NOWS as a direct result of a sudden interruption of fetal exposure to prescription and illicit substances that were used or abused by the mother. Diagnosing an infant with NAS/NOWS is often assessed by identifying the following symptoms: tremors, jitteriness, irritability, excessive crying, and diarrhea. These indicators have been determined in the medical field as the standards for identifying a compromised central nervous system. Prenatal use & abuse of fentanyl can increase an infant’s risk for developing NAS/NOWS.

What Makes Fentanyl So Dangerous?

According to the United States Drug Enforcement Administration (DEA), fentanyl is approximately 100 times more potent than morphine and 50 times more potent than heroin.⁴ Its initial development was intended as a licit intravenous anesthetic; however, it has now become a public health threat as pharmaceutical products are subjected to theft, fraudulent prescriptions and illicit or less regulated distribution and manufacturing. The drug is often abused by injecting, snorting / sniffing, oral tablets / pills or removing the gel on fentanyl patches and then injecting or ingesting. The popularity of fentanyl within drug addicted communities derive from the addictive effects the drug produces —relaxation, euphoria, pain relief, and sedation. However, abused fentanyl also produces fatal side effects including: confusion, dizziness, nausea, vomiting, urinary retention, pupillary constriction, and respiratory depression.

Fentanyl’s Long-Term Effects on Fetus

Prenatal substance abuse can lead to long-term, irreversible damage to a developing fetus. In relation to fentanyl, these effects can consist of the following when associated with NAS/NOWS:⁵

• Cognitive and motor development deficiencies
• Infections
• Vision complications
• Sudden Infant Death Syndrome (SIDS)
• Susceptible to future substance abuse

Fentanyl and Toxicology Confirmation

According to the American Academy of Pediatrics, NAS/NOWS is a clinical diagnosis, however toxicological confirmation is necessary to identify the exact type of substance that the mother was using or abusing and to confirm or rule out the use of other licit or illicit substances during pregnancy.⁶

Due to the recent increase of cases regarding pregnant women and fentanyl exposure, it is critical to utilize testing that can help detect the latest drugs of abuse. Through internal research and strategic analysis, our laboratory is combating the growing epidemic of fentanyl use among pregnant women and those of childbearing age, with the development of testing for fentanyl in both umbilical cord tissue and meconium. As the first and only laboratory to offer fentanyl testing utilizing both advanced newborn specimens, our partnerships are provided with the opportunity to proactively and effectively address the alarming rates of prenatal fentanyl use. Both meconium and umbilical cord tissue belong to the baby, therefore maternal consent is not needed to proceed in testing.

Umbilical Cord Tissue

The umbilical cord tissue is available immediately for 100 percent of births and requires only 1 collection by 1 collector. This specimen’s look back provides detection up to approximately 20 weeks prior to birth, the most advanced newborn specimen on the market.

Meconium

Meconium has been recognized for decades as the “gold standard” for the detection of substances. It is the first stool of an infant produced in utero, consisting of epithelial cells, bile, mucous, and is odorless with a very dark, tar-like appearance. Meconium is uniquely developed during gestation with exclusive capabilities of preserving substances exposed prenatally up to approximately 20 weeks prior to birth. The average start of a meconium passage after birth occurs within 24-48 hrs., in most newborns it is generally passed in the first day or so of life.

Turnaround Time:

Our methodology and advanced instrumentation contribute to our laboratory’s efficient turnaround time. Generally, the standard turnaround time for reporting negative screening test results is the next business day, with an additional 1-2 business days for specimens that require confirmatory testing. Turnaround time begins from receipt of the valid specimen–accompanied by a properly documented valid order– into the laboratory. Some tests require additional time to process and will fall outside the standard turnaround time window.

As one of the only laboratories in the nation focusing exclusively on substance abuse testing, we are consistently adapting our services to meet the needs of our clients and communities. The validity of newborn toxicology results has never been more imperative. Through our partnership and services, we can customize a flexible comprehensive drug testing program based on your population health needs. Today’s substance abuse landscape is drastically different than it used to be-collaboration is vital in supporting our mission of protecting and enriching lives. 

References

1. Spencer, M.P.H., M., Warner, Ph.D, M., Bastian, B.S., B., Trinidad, M.P.H., M.S., J. and Hedegaard, M.D., M.S.P.H., H. (2019). “National Vital Statistics Reports.” [online] Cdc.gov. Available at: https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_03-508.pdf [Accessed 17 Sep. 2019].
2. Drugabuse.gov. (2019). “Dramatic Increases in Maternal Opioid Use and Neonatal Abstinence Syndrome.” [online] Available at: https://www.drugabuse.gov/related-topics/trends-statistics/infographics/dramatic-increases-in-maternal-opioid-use-neonatal-abstinence-syndrome [Accessed 17 Sep. 2019].
3. Center for Disease Control and Prevention, U. (n.d.). “Pregnancy and Opioid Pain Medications.” Retrieved from https://www.cdc.gov/drugoverdose/pdf/pregnancy_opioid_pain_factsheet-a.pdf.
4. Department of Education, U. (n.d.). “Drugs of Abuse Guide” (2017)(pp. 40-41) (United States).
5. “Long-Term Outcomes of Infants With Neonatal Abstinence Syndrome.” (n.d.). Retrieved from https://www.seattlechildrens.org/healthcare-professionals/education/continuing-medical-nursing-education/neonatal-nursing-education-briefs/long-term-outcomes-of-infants-with-nas/
6. Kocherlakota, P. (2014, August 01). “Neonatal Abstinence Syndrome.” Retrieved from http://pediatrics.aappublications.org/content/134/2/e547