You Cant Fool the Bladder Police Effective Use of Urine Drug - - PowerPoint PPT Presentation

You Can’t Fool the “Bladder Police”

Effective Use of Urine Drug Screening

Wh Why Te Test?

• Accountability
• Create and maintain safe treatment

environment

• Compliance with licensing or policy

Collection

• Supervised or unsupervised
• When to collect
• Staff training
• Temperature monitored cups
• Adulterant testing

In In-hou house se Te Testing ng

• Cost
• Type of test kit
• What to test for
• When to test
• Staff training
• Staff issues
• Client privacy

Lab Testing

• Prescription
• What to test for
• When to test
• Staff training
• Completing forms
• Storage and pick

up

Te Testing ing – Ho How w it Wo Works

• Drug Testing Systems
• One Test Systems

Use immunoassay (IA) to detect the presence

• f drugs and

Are most often used for medical purposes in clinical and rehabilitation settings

• Two Test Systems

Commonly use immunoassay as an initial test followed by a more specific confirmatory test using a different technology and Are used for results requiring a high level of certainty

John M. Mitchell Immunoassays as an Initial Test in Drug

• Testing. Center for Forensic Sciences

Testing – How it Works

What is an Immunoassay?

• An immunoassay is a biochemical test that

measures the concentration of a substance in a liquid (a portion of a biological specimen) using the reaction of an antibody

• r antibodies to its antigen (drug)

John M. Mitchell Immunoassays as an Initial Test in Drug

• Testing. Center for Forensic Sciences

Te Testing ing – Ho How w it Wo Works

What are Antibodies and Antigens?

• Antibodies are a type of protein produced

by the immune system in response to foreign substances (antigens)

• Antibodies bind to the antigen responsible

for their production

John M. Mitchell Immunoassays as an Initial Test in Drug

• Testing. Center for Forensic Sciences

Testing – How it Works

Immunoassay Principles I

Antibodies:

• Usually harvested from

sheep or rabbits

• Usually IgG (represented

as a “Y”)

• Developed against classes
• f drugs
• Recognize antigen (drug)

by its shape

Common end Shape recognition end

Y

John M. Mitchell Immunoassays as an Initial Test in Drug

• Testing. Center for Forensic Sciences

Te Testing ing – Ho How w it Wo Works

Immunoassay Principles II

• Use Tagged Drug Targets
• Indicator (Tag) is bound to the target drug
• “Tag” may be

 an enzyme  a fluorophore  a particle

• Detection is based on competitive binding
• Antibodies bind with Drug in Sample OR

with Tagged Drug Targets

Drug “Tag”

John M. Mitchell Immunoassays as an Initial Test in Drug

• Testing. Center for Forensic Sciences

Testing – How it Works

Immunoassay principles

• Sample WITH drug in it
• Add an antibody
• Incubate

Y

John M. Mitchell Immunoassays as an Initial Test in Drug

• Testing. Center for Forensic Sciences

Te Testing ing – Ho How w it Wo Works

Immunoassay Principles III

• Antibody binds drug in

the sample

• Add tagged drug target
• Little or no antibody

binding of the tagged compound

• Little or no change in

signal

Y

John M. Mitchell Immunoassays as an Initial Test in Drug

• Testing. Center for Forensic Sciences

Testing – How it Works

Immunoassay Principles IV

• Sample WITHOUT drug in it
• Add an antibody
• Incubate
• Add tagged drug target

Y

John M. Mitchell Immunoassays as an Initial Test in Drug

• Testing. Center for Forensic Sciences

Te Testing ing – Ho How w it Wo Works

Immunoassay Principles

• Antibody binds with the tagged

compound

• Binding causes change in signal

produced

John M. Mitchell Immunoassays as an Initial Test in Drug

• Testing. Center for Forensic Sciences

Testing – How it Works

Testing with Immunoassays

• Immunoassays are used to screen donor specimens for the

possible presence of a drug or a class of drugs

• These tests may be conducted on-site as part of the collection

process or in a laboratory or other facility

• On-site testing is normally conducted with a Point of Collection

Test (POCT) device

• Most testing is conducted in laboratories which have validated

procedures and validated analytical instrumentation

• Immunoassays allow some laboratories to test more than

10,000 donor specimens a day

John M. Mitchell Immunoassays as an Initial Test in Drug

• Testing. Center for Forensic Sciences

Te Testing ing – Ho How w it Wo Works

Immunoassay Specificity

• Specificity is the affinity of an immunoassay for the

target drug

• Specificity is measured by cross reactivity:
• the response exhibited when an immunoassay

reacts with a compound other than the target drug

• Specificity limits the conclusions that can be drawn

from immunoassay results

John M. Mitchell Immunoassays as an Initial Test in Drug

• Testing. Center for Forensic Sciences

Testing – How it Works

Low Specificity

• An immunoassay with low specificity will react with

many antigens (drugs) with similar structure

• Example: One Amphetamine immunoassay with a

cutoff of 300 ng/mL of D-Amphetamine gives a positive result with:

• D,L-Amphetamine (300 ng/mL), Phentermine (400 ng/mL),

Tranylcypromine (500 ng/mL), Methamphetamine (1,000 ng/mL), Ephedrine (1,000 ng/mL), or Phenylpropanolamine (1,000 ng/mL)

• Therefore, a positive result from this immunoassay test

would not prove use of amphetamine

John M. Mitchell Immunoassays as an Initial Test in Drug

• Testing. Center for Forensic Sciences

Ta Tamp mper ering ng

• Diluting
• “Doping”
• Substitution

Ta Tamp mper ering ng

 AZO  Niacin  Vinegar  Fiber pills  Ready Clean pills  Rapid Cleanse  Detox Tea  Goldenseal  Certo  QCarbo  XXtra Clean  Quick Flush  Terminator Gold  Clear Choice  MC1  Vale Triple Strength

• Diluting
• Hyper saturating the body with fluids to dilute metabolites

possibly below the 50 ng/mL threshold, depending on your metabolism.

Ta Tamp mper ering ng

• “Doping”
• Adding different chemicals that defeat

immunoglobulin/antigen binding  Bleach (powdered)  Water  Ammonia  Blood  Draino  Goldenseal  Hydrogen Peroxide  Lemon Juice  Liquid Soap  Mary Jane’s SuperClean 13  Purifyit  Sodium Nitrate  Table Salt  Vinegar  Visine  WD 40

Ta Tamp mper ering ng

• Substitution
• Concealed container
• Injection
• Catheterization
• Cigar containers/droppers

Ta Tamp mper ering ng - Co Coun unter ermea measures sures

• Color
• Temperature
• Creatinine
• pH
• Specific gravity

False Positives

Generic Name Brand Possible False Positive Efavirenz Sustiva Positive for Cannabinoids (THC) [Urinary metabolite(s) only; parent compound is non-reactive] Flunitrazepam Rohypnol Positive for Benzodiazepines (BZO) Lamotrigine Lamitcal Positive for Phencyclidine (PCP)

Fa False e Po Positives ives

Generic Name Brand Possible False Positive l- Methamphetamine HCL Vick's Inhaler Positive for Methamphetamine (mAMP) Phenytoin Dilantin Possible Positive for Barbiturates (BAR) Urinary metabolite(s) only; parent compound is non-reactive

False Positives

Generic Name Brand Possible False Positive Procaine Novocain Positive for Opiates (OPI, MOP) Ranitidine Pylorid, Zantac Positive for Methamphetamine (M-AMP) Urinary metabolite(s) only; parent compound is non- reactive

Fa False e Po Positives ives

Generic Name Brand Possible False Positive Sertraline Zoloft Potential Positive for Benzodiazepines (BZO) Venlafaxine Effexor or Effexor XL Potential Positive for Phencyclidine (PCP)

False Positives

• All positives require clinical intervention
• Review clients medications before

engaging in a clinical intervention

• If a client reports taking a medication

that may cause a false positive, a confirmatory test should be completed

Fa False e Ne Nega gatives ves

• Time elapsed since use
• Improperly obtained or secured

specimen

• Tampered sample

Detection Times

Drug Approximate Detection Time Amphetamines 2-4 days Barbituates Short-Acting (Secobarbital) 1 day Long-Acting (Phenobarbital) 2-3 weeks Benzodiazepines 3-7 days

De Detec ection tion Ti Time mes

Drug Approximate Detection Time Cannabinoids 3-30 days Cocaine 2-4 days Codeine 2-5 days Euphorics (MDMA, Psilocybin) 1-3 days

Detection Times

Drug Approximate Detection Time LSD 1-4 days Methadone 3-5 days Methaqualone 14 days Opiates 2-4 days Phencyclidine (PCP) 2-4 days

De Detec ection tion Ti Time mes

Drug Approximate Detection Time Phenobarbital 10-20 days Propoxyphene 6 hours to 2 days Steroids (Anabolic) Oral 14 days Parenterally 1 month

Clinical Interventions

• Drug testing is a clinical intervention
• Upon admission, always explain the role of drug testing
• Drug testing may be scheduled, random, or suspicious
• Prior to securing the urine, ask the client about changes in

medication and if the client has used

• Always explain the “why” of a particular drug test
• If the drug test is “suspicious,” discuss the behaviors that

brought about suspicion

• Review test results with client immediately upon receipt,

regardless of result

Clinical Interventions

• Negative drug screen
• Congratulate the client
• Review what drugs were tested for
• Ask the client about use of drugs not tested
• Ask about issue/problems when the sample was secured

Clinical Interventions

• Positive drug screen
• Tell the client you have the results and ask if the client

has anything to share

• Review what drugs were tested for and indicate what

was positive

• Allow the client time to respond
• Ask the client about use of drugs not tested
• Ask about when the client used, the circumstances
• Review/discuss consequences
• If discharge, make appropriate referral
• If no discharge, develop relapse prevention plan

Re Resou

• urces

rces

Re Resou

• urces

rces

• Collins, Jennifer. Laboratory Perspective on Additional

Drug Testing and Associated Costs. MEDTOX Laboratories, Inc.

• Mitchell, John M. Immunoassays as an Initial Test in

Drug Testing. Center for Forensic Sciences . RTI International

• TROUBLESHOOTING GUIDE DRUGS OF ABUSE.

Innovacon, Inc. San Diego, CA

• http://www.drug-test-facts.com
• http://www.drugabuse.gov/nidahome.html
• http://www.drugdetection.net/drug.htm