Detox Drinks To Pass A Drug Test

Total Detox Friend

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Growth of Drug Testing

By the mid-1970s, the field of drug testing had begun to take root, as many young Americans, both military and civilian, experimented with illegal drugs such as marijuana (tetrahydrocannabinol, or THC), lysergic acid diethyl-amide (LSD), and cocaine. Most urine testing for illicit drugs was being done either by forensic laboratories or in methadone treatment programs. In these programs, patients undergoing methadone substitution therapy for heroin addiction were monitored for illicit drug use and compliance with the methadone therapy (4). A modest amount of drug testing was being conducted in the workplace by innovative companies that recognized the productivity value of promoting a drug-free work environment. Then on May 26, 1981, an event occurred that had tremendous repercussions on the drug-testing industry (5). There was a serious and deadly crash involving fighter aircraft on the carrier USS Nimitz, in the Atlantic Fleet. Fourteen servicemen died, 48 were injured, and 150...

Specimens for Drugsof Abuse Testing

A wide variety of body fluid specimens have been utilized for analysis for the presence of drugs of abuse. Urine has been and remains the most widely used body fluid specimen for routine testing for drugs of abuse, but several alternative specimens are establishing their place as suitable for drug testing. Hair, sweat, and oral fluid have reached a sufficient level of scientific credibility to be considered for use in the federally regulated workplace drug-testing programs. Each specimen provides different information about time and extent of use and likelihood of impairment. Some of these specimens (e.g., urine and oral fluid) can even be analyzed with simple on-site, nonin-strumented testing devices, as well as through standard laboratory methods. These drug-testing tools, as objective pieces of information identifying drug use, have proven highly useful in addressing our society's ongoing substance abuse challenges. This chapter reviews the use of these various body fluid specimens...

Complications Introduced by Pointof Collection Drug Tests

The introduction of these products, however, created special concerns in workplace DOA testing applications. Pregnancy tests, designed for home use by patients, were ideal in their design for self-collection, interpretation, and receipt of the test results in the privacy of the home (8). For workplace DOA testing,

Changeable Bar Code Prelude to Digital Drug Testing

Confirmation laboratory can positively identify the drug. Removing the drug names from the cassette means that if all the color lines are present, as is the case with most strips, no drugs are detected in the specimen (i.e., the result is negative). If one or more color lines are absent from the series, the result is presumptively positive. It does not matter which drug is detected, because in every case, the outcome is the same. The specimen must be sent to a confirmation laboratory for further testing. From the bar code prospective, this argument presents a unique opportunity to translate the lines and spaces on the LFDOA test strips into a digital code, or a series of 0s and 1s. Consider the presence of a target line as indicated by a 1 and a space by a 0, then a five-drug test with one control line would be translated by a barcode reader into 10101010101 (six lines and five spaces) when the sample is negative and all six lines appear. If, for example, the THC test in the second...

The myeScreencom Portal

In the eScreen model, the digital information record begins when the employer orders a drug test online, schedules the event at the collection site via the portal at myeScreen.com, and the collection site has the complete donor information pre-accessioned. The donor's failure to appear within the prescribed time frame, usually 24 h, results in an e-mail to the employer, and a flag on the collection site record to cancel the collection. If the collection proceeds as scheduled, the laboratory, MRO, administrator, and employer have pre-accessioned data of the eScreen drug test, and know whether they should expect a specimen or result in the coming days. Exception reports can be generated to alert the service providers that the specimen or result has not been received when expected, before the customer calls looking for a missing result. myeScreen.com is a robust application service provider (ASP) software model, allowing employers to manage their drug-testing programs from beginning to...

Sample Adulteration in Urine DOA Testing

The instant DOA testing procedures are instituted, opposing forces are at work to develop methods to avoid detection of drug use. Initially, common household chemicals such as laundry bleach, table salt, toilet-bowl cleaner, hand soap, and vinegar were used. More recently, a variety of products became commercially available, which can be ordered through Internet sites and tollfree telephone numbers. Commercially available adulteration products can be classified into two broad categories. The first category consists of specific fluids or tablets, which when taken along with plenty of water, serve to flush out drugs and metabolites, resulting in diluted urine and reduced concentrations of drugs or metabolites. Examples of products in this category include Absolute Detox XXL drink, Absolute Carbo Drinks, Ready Clean Drug Detox Drink, Fast Flush Capsules, and Ready Clean Gel Capsules. All products are available from Internet sites. Root Clean is a hair-cleansing system targeting drug...

Adulteration of Hair and Saliva Specimens for Drug Testing

Hair and saliva specimens are alternatives to urine specimens for drug testing (see Chapter 11). Several products available through the Internet claim that washing hair with their shampoos can help pass a drug test. Clear Choice Hair Follicle Shampoo claims to remove all residues and toxins within 10 min of use. One application is sufficient for shoulder-length hair, and the effect can last for 8 h. Root Clean hair-cleansing system shampoo has also been commercially available. However, no systematic study has been reported to investigate the effect of using these products in a drug test. Saliva samples are also used for drug testing. The chances of adulteration of saliva specimen are very low to non-existent. However, the manufacturer of a commercially available mouthwash claims that by rinsing the mouth twice with this product, a person can beat saliva-based drug testing, which is a popular method of testing by insurance companies. The same company claims that its specially...

Key Stakeholders of Drug Courts 21 The Judge

Most drug courts utilize the services of the public defenders office to represent the participant in court and to ensure that their rights are protected. In a typical drug court, however, the participant is required to speak directly to the judge. The attorney, present as a part of the team, does not speak on behalf of the participant during the court proceeding. Defense attorneys in drug court adopt the principle that their clients are best served through a chance to face life drug-free and with the skills and opportunities necessary to be productive members of the community. tional model, treatment providers are active members of the team, participate in staffing of cases prior to the review hearings, recommend and enforce incentives and sanctions, share information concerning treatment compliance and drug-testing results with the court, and strive to educate the other members of the team on the basic aspects of addiction and how they affect the behavior of each participant.

Functional Significance of Drug Courts

Drug courts, through the cooperative efforts of all stakeholders, provide a comprehensive and efficient utilization of community resources and have proven very effective in reducing recidivism among program participants. According to a September 2003 report by the American University Drug Court Clearinghouse, the 1078 operational drug courts have collectively served more than 300,000 adults and 12,500 juveniles and graduated more than 73,000 adults and 4000 juveniles (2). The report further states that 75,000 of these offenders had been sentenced to periods of incarceration prior to their entering drug court and that despite this fact, drug courts consistently retain over 70 of those who enroll. A 2001 Columbia University National Center on Addiction and Substance Abuse (CASA) study concluded that, even though drug-court participants receive significantly more comprehensive and closer supervision than offenders participating in other forms of community supervision, drug use and...

Key Components of Drug Courts

In 1996, twelve drug-court practitioners and ancillary experts began the process of establishing a set of guidelines upon which drug courts around the country could base their own unique programs. Recognizing the need for cultural and jurisdictional diversity, this group set out to identify the fundamental similarities and standards of the few operational drug courts at that time. What resulted was the publication of Defining Drug Courts The Key Components (4). The following is simply a listing of these 10 key components of a drug court 1. Drug courts integrate alcohol and other drug treatment services with justice system case processing. Drug courts serve as a true partnership between drug and alcohol treatment professionals and the court system. The treatment team, which is comprised of all major stakeholders, meets regularly to discuss each participant's progress and to determine incentives, sanctions, and the future direction of the case plan. 3. Eligible participants are...

The Future of Drug Courts

To expand into other specialty courts dealing with issues other than primary substance abuse. Domestic violence, mental health, driving under the influence (DUI), tribal, university campus, child support, and re-entry courts were added to the growing number of adult, juvenile, and family drug courts. With an ever-increasing volume of evaluation data supporting the efficacy of these intensive intervention strategies, the model promises to expand into other special-population areas. Early prison release, prostitution, property offenses, impulse-related violent offenses, and parole or probation violations are all viable arenas for specialty courts. Even though most of these specialty courts do not deal with substance abuse as the primary issue, drug testing is still a very important component. Statistics shows that more than 80 of the crimes committed in the United States each year are drug-related (6). That means either the defendant was under the influence of drugs or alcohol at the...

The Results of the Roadside Drug Testing Assessment Project

The 21-mo Roadside Testing Assessment (ROSITA) project started in January 1999 and included a literature survey of drugs and medicines that have detrimental impacts on road users' performance, an inventory of the available roadside drug-testing equipment for urine, oral fluid, and sweat, an evaluation of the operational, user, and legal requirements for roadside testing equipment in the different European Union countries, and an extensive evaluation of several devices in eight countries. On-site immunoassays were used for the detection of drugs in urine, oral fluid, and or sweat in 2968 subjects. Police officers liked having the tools to detect drivers under the influence of drugs, and they were very creative in finding solutions to the practical and operational problems they encountered. On-site drug testing gave the police confidence, and saved time and money. Police officers had no major obj ections to collecting specimens of body fluids. In the majority of the participating...

Adulteration Remains a Challenge to Urine Drug Testing

Addicts to abused drugs have great incentives to try to defeat drug tests, and they often use adulteration products. Because of the high profit margin, great customer demand, low cost of entry, and wide accessibility via the Internet, there are many manufacturers in this market. Not only do some of them employ innovative chemists, they also provide informative educational materials on their Web sites, which help the abusers understand how the drug-testing system works and how to defeat the tests. Although legislators in many states have banned adulterant-product sales, and guidelines for detecting their presence have been established, adulteration will remain a challenge to urine drug testing (see Chapters 13 and 14).

The eScreen123 Software Runs the eScreen System

The eScreen system consists of a suite of hardware installed at the point of collection. The hardware suite consists of a Windows PC, monitor, eReader (Fig. 2), signature capture device, barcode reader, and laser printer. The PC is connected to the Internet, preferably via a broadband connection, and runs the eScreen123 (eScreen) software platform. The eScreen123 (Fig. 3) software is a Web-based application allowing each of the service providers e.g., the collection site, laboratory, MRO, and administrator to access their respective portion of the drug-testing record in real time throughout the drug-testing process. The collection site portal allows the collector to check in the donor, if not previously scheduled by the employer, based on a set of rules previously established by the system and embedded in the software. Collector screens guide the collector through the specimen-collection process, and require the completion of the custody and control form (CCF) elements. The date and...

Diluted Urine A Simple Way to Beat Drug Tests

A negative result for the presence of abused drugs in a urine specimen does not necessarily mean that no drug is present. It is also possible that the amount of drug was below the cut-off values used in the drug-testing protocol. Diluting urine is a simple way to beat an otherwise positive drug test if the original concentrations of drugs in the urine are just slightly above the cut-off values. To counteract this strategy, creatinine analysis in urine is an effective method to detect diluted urine. Neeedleman and Porvaznik considered a creatinine value of less than 10 mg dL as suggestive of replacement of urine specimen largely by water (4). Beck et al. (5) reported that 11 of all urine specimens submitted to their laboratory for DOA testing were diluted. The SAMHSA program currently does not allow analysis of dilute urine specimens at lower screening and confirmation cut-offs. However, in Canada, the Correction Services of Canada (CSA) program incorporates the following lower drugs...

The eCup

The eCup (eScreen) (Fig. 1) is a specimen-collecting device with an internal aliquoting pump to sequester an aliquot when the lid is closed onto the cup. The aliquot pump is a double-walled syringe designed to pump the sample aliquot up onto the two LFDOA test strips and adulteration strips. Adulteration strips (see Chapters 13 and 14), which contain tests for pH, creatinine, and nitrite, reside in the eCup lid in a third test-strip slot. The eCup has a unique patented lid label with an integrated tamper-evident seal. The label and seal are bar-coded with a unique specimen number. This is the specimen number used to create the electronic custody and control form, and to track the specimen and result throughout the testing process. Additional barcodes appear on the label to direct the eReader (eScreen) (discussed later) to decode certain coded information from the test-strip configurations, as well as lot numbers of cups and test strips. eCup test strips are integrated into the eCup...

The eScreen System

In view of the deficiencies associated with the conventional POCT and the perception that a digital drug test could be created, a system known as eScreen was developed. eScreen combines the benefits of point-of-collection specimen collection with recent advances in information technologies to create an instrumented POCT system. eScreen monitored the progress of LFDOA development closely. LFDOA clearly led the market as the analytical method of choice. Easy-to-use, low-cost, highly sensitive lateral-flow test strips could do everything that the lab-based immunoassay could do. eScreen did not compete in the manufacturing of LFDOA devices, but realized that commoditization would likely develop as tests got better and cheaper. eScreen uses the current Federal drug testing standards as a starting point, extracts the immunoassay screening procedure from the centralized laboratory, and shifts it to the point of collection. It keeps in place many of the safeguards already built into the...

Drug Testing Technologies and Applications

Over the past few decades, a remarkable gamut of increasingly sophisticated technologies has been employed for the development of drug-testing applications. Recent advancements in analytical instrumentation and computer technologies have further expanded the capabilities and dimensions for drug testing and toxicological analysis. Technologies of different chemical principles can be used sequentially or in combination to accomplish the specific goals and requirements of the drug analysis programs. Ligand-binding assays such as immunoassays are commonly used for screening. Separation techniques such as chromatography or electrophoresis, as well as their coupling with powerful detectors such as mass spectrometry, can be effectively used for confirmatory testing of preliminary positive results or systematic analysis of generally unknown toxic compounds. Each of these technology categories can be further broken down into multiple selections for instrumentations and methodologies. This...

The Antibody Component

By virtue of their high levels of specificity and binding affinities, antibodies are the ideal choice of agent for drug detection. Antibodies are produced by the immune system as weapons to eliminate invading pathogens (1). Antibodies to a specific DOA can be produced by immunizing animals with the selected DOA conjugated to a carrier protein. A carrier protein is necessary because small chemicals (DOAs) by themselves are usually not immunogenic enough (as a hapten) to elicit an antibody response (2-6). Common protein carriers for this purpose include bovine serum albumin (BSA) and keyhole limpet hemocyanin (KLH). However, this technique is not as simple as it sounds and is not for the amateur protein chemist. The type of linker used, the length of the linker used, the molar ratio of the drug to the carrier protein, and the type of carrier protein to be used are only some of the factors that must be carefully considered to achieve effective conjugation.

Pharmacokinetics and Pharmacodynamics

Nephron should still be able to cause a response. Alternatively, the finding of negligible amounts of these drugs in urine might simply mean that an as yet unidentified metabolite is the active species, and it behaves like the other loop diuretics with a lumen site of action, albeit with a more prolonged duration of effect. This appears to be the case with muzolimine. This drug has been withdrawn from study because of severe adverse neurologic effects.

Preliminary Screening Assays for Drugs of Abuse in Hair

Analysis for the presence of the drug opiates in hair was performed using RIA as early as 1979 (22). This was followed soon after with tests for phen-cyclidine (PCP) (23) and cocaine (24). In fact, it was the availability of RIA as an ultrasensitive analytical tool that initially prompted the pioneering testing of drugs in hair. As enzyme immunoassays develop greater sensitivity, nonradio-active immunoassays are increasingly being used for hair testing. A review of the immunological methods for testing drugs in hair from the early period to the year 2000 has been presented by Spiehler (25). MS confirmation methods took a few additional years to achieve the necessary sensitivities.

The Analytical Goal of a Drug Screening Assay

The goal of a drugs-of-abuse screening immunoassay is simpler than that of a clinical assay, which must accurately quantify normal serum components or abnormal markers over a range of concentrations. In forensic drug testing, there is usually just one standard reference, which contains the cut-off concentration of drug. Samples containing less than the cut-off drug concentration are considered negative, with no further testing required. Certain issues, such as cross-reactivity with related drugs or metabolites, which would produce unacceptable error in diagnostic clinical assays, are tolerable for workplace or other forensic screening because a second and more specific confirmatory test will be performed on the sample. precision of the signal measurement, and (3) the level of nonspecific binding. Because hair-testing laboratories often purchase well-characterized immuno-assay kits from vendors, the selection of the antibody is usually not a factor. The job of the laboratory is to...

Applications of Hair Analysis in Criminal Justice and Rehabilitation Settings

Mieczkowski et al. (57) have reported on use of hair testing as an objective measure of drug treatment outcome in a criminal justice diversionary treatment program for first-time, nonviolent offenders. Violations of the program conditions, including drug use, result in dismissal from the program. Hair samples were taken at intake to the program and at approx 2-mo intervals during the program, with random urine testing also being employed. Hair analysis at intake showed 50 of the 91 subjects positive for cocaine, 35 for marijuana, 3 for opiates, 1 for PCP, and none for amphetamines. Urinalysis done at the same time showed 12 positive for cocaine, 24 for marijuana, 1 for opiates, and none for PCP or amphetamines. These results highlight the diagnostic value of hair analysis in assessing the status of subjects as they enter a rehabilitation setting. The effectiveness of hair as a diagnostic tool in drug treatment has been discussed by Brewer (60), who noted a good correlation between...

Medical Applications of Hair Analysis

A number of investigators have applied hair testing to detect prenatal drug exposure (61-70). The retrospective power of hair analysis allows, at the time of birth of an infant, an assessment of drug intake for as long a portion of the gestation period as the length of the mother's hair specimen permits. The first example of determining prenatal drug exposure by hair analysis, reported in 1987, was that of a mother who had ingested PCP during her pregnancy (61). This study and that of Grant et al. (66) demonstrated that determining the pattern of drug usage over the term of the pregnancy by segmental hair analysis may be especially useful in evaluating effects on neurodevelopmental outcomes of varying levels of drug use during specific trimesters. Callahan et al. (67), in comparing hair, meconium, and urine analyses for identifying cocaine use in mothers, found hair and meconium (when performed by GC-MS) to be about equivalent, whereas urine was about half as effective. The Hospital...

To The Point Of Collection

In the laboratory-centric model of DOA testing, the testing process of negative and positive results is essentially indiscernible by all except those deeply engaged within the confirmation laboratory. Although the screening and confirmation laboratory are under one roof in a centralized laboratory facility, they are actually distinct in their objectives. The object of the screening laboratory is to identify which samples are negative (i.e., contain no drugs). The object of the confirmation laboratory is to identify which samples are positive (i.e., contain drugs). Nearly all laboratories utilize immunoassay testing, an inexpensive yet highly sensitive screening method capable of detecting nanogram quantities of drug analytes in a milliliter of urine. This highly sensitive method of screening, combined with automation and robotics in the laboratory, cost-effectively eliminates more than 93 of all specimens from further testing in normal workplace demographics. Criminal justice testing,...

Detection of Mitotic Cells

There are a number of potential applications for this methodology. It can be used to identify mitotic cells for the estimation of mitotic index (MI) in populations of cells growing exponentially or treated with drugs. It also can be used in stathmokinetic experiments in which the cells are arrested in mitosis and the rate of cell entrance to M (cell birth rate), emptying of the G1 compartment, and many other kinetic parameters can be estimated. Furthermore, the immunocytochemical detection of H3-P provides new opportunities for studying the role of H3 phosphorylation in chromatin condensation during mitosis. In particular, it may be helpful in identification of the kinase(s) and or protein phosphatase(s) involved in H3 phosphorylation and dephosphorylation. Since these enzymes are a potential target for development of new antitumor drugs designed to target the G2 to M transition, the possibility of immunocytochemical detection of the activity of one or more of them may be of great...

Benefits of a Closed Information System

Historically, in the laboratory-centric model, drug testing has been an open information system. The MRO receives laboratory data when then lab completes the specimen testing. The MRO doesn't know what they will be receiving until they receive it. The same is true for the laboratory. The laboratory receives samples each day sent from the collection site, not knowing what they will be receiving. There is no feedback loop in an open system, and the result is a lack of anticipated information and an arduous task of tracking missing specimens or results, starting at the end of process and moving forward until the problem has been identified. In the eScreen closed-loop information model, each of the parties to the transaction communicates via the Web to a common server. The donor, employer, collector, eReader, laboratory, and MRO each have access to the drug-test record in real time. Any party can access their respective portion of the record, sharing common file elements. Pre-accession...

Household Chemicals as Urine Adulterants

Simple household chemicals are found to be effective adulterants of urine drug tests. These include table salt, vinegar, liquid laundry bleach, concentrated lemon juice, and Visine eye drops (8,9). The effectiveness of these chemicals on specific drug tests is summarized below. Amphetamines sodium chloride at a concentration of 75 gm L of urine caused a false-negative drug test in a urine specimen containing 1420 ng mL of amphetamine. Similarly, Drano (bleach SC Johnson & Son) at a concentration of 18 mL L masked a urine specimen containing 1800 ng mL of amphetamines by EMIT assay. Benzodiazepines Visine, hand soap, and Drano caused false-negative tests with benzodiazepines at concentrations less than 6500 ng mL. authors tested these adulterating agents at 10 by volume concentration of urine. Out of six drugs tested (cocaine metabolite, amphetamines, opiates, phencyclidine, cannabinoid, and barbiturates), it was found that the cannabinoid test was the most susceptible to...

Pyridinium Chlorochromate As a Urine Adulterant

Besides simple household chemicals, more sophisticated substances are advertised commercially as adulterants for urine drug tests. Wu et al. (13) reported that the active ingredient of Urine Luck is 200 mmol L of pyridinium chlorochromate (PCC). The authors reported that Urine Luck caused a decrease in response rate for all EMIT II drug screens and for the Abuscreen morphine and THC assays. In contrast, Abuscreen amphetamine assay produced a higher response rate, and no effect was observed on the results of BE and PCP. This adulteration of urine did not alter GC-MS confirmation of methamphetamine, BE, and PCP. However, apparent concentrations of opiates and THC were reduced.

Chemical Adulteration

Chemical adulteration is the process of adding exogenous chemicals to the urine sample to prevent proper identification of the drug. A wide range of commercial products is available. These adulterants, often comprised of corrosive and toxic chemicals, are advertised as being able to prevent laboratories from detecting drugs or their metabolites in urine. Usually, the product consists of one or two small vials, which can be easily hidden. During collection, the user would mix the vial content with the urine sample. Many of these products offer 200 money back guarantee if they fail to beat the drug tests. Although product formulations are frequently changed to foil detection, recently developed adulterants are mostly oxidants (examples include nitrite, pyridinium chlorochromate PCC , hydrogen peroxide, and iodine). Brands like Urine Luck , Stealth , and ADD-It-ive are most popular.

Control Of Bile Acid Transport And Metabolism

An important mechanism toward controlling bile acid levels within cells is to adjust the cellular uptake or efflux of bile acids by regulating the expression and or activity of uptake and efflux proteins, as discussed in detail below. It should be noted, however, that additional mechanisms are also operational in preventing intracellular bile acid concentrations from reaching toxic levels. One such mechanism is to regulate the de novo synthesis of bile acids according to the existing intracellular bile acid content. To reduce bile acid synthesis, the expression levels of the key CYP enzymes involved in de novo bile acid synthesis (i.e., CYP7A1, CYP8B1, and CYP27A1) are suppressed.42 Furthermore, expression levels of several phase II enzymes that in addition to their role in drug detoxification may convert bile acids into less toxic and more hydrophilic derivatives are induced in response to elevated levels of bile acids.43 These metabolizing enzymes include uridine 5'...

Nuclear Receptors As Transcriptional Regulators Of Bile Acid Homeostasis

Receptor that typically utilizes drugs and xenobiotics as its ligands.66 In response to these ligands, PXR induces the expression of genes encoding proteins involved in drug detoxification and elimination pathways. In addition to xenobiotics, certain bile acids, such as the highly toxic LCA, can serve as agonistic ligands for PXR.67-68 Indeed, activation of PXR can protect mouse livers against LCA-mediated injury.67 Doubleknockout mice lacking both FXR and PXR exhibit more severe disturbances of bile acid metabolism than mice lacking only one of the nuclear receptors, demonstrating that both contribute to bile acid homeostasis.69 PXR is a master regulator of the gene encoding the CYP3A4 enzyme,70 which, in addition to its role in detoxifying xeno-biotics, also metabolizes bile acids to less toxic and more easily excreted derivatives. Thus, by being both activators of the CYP3A4 gene and substrates of the CYP3A4 enzyme, bile acids can initiate a hepatoprotective feedforward loop via...

Adulterant Effects on Positive Drug Specimens Over Time

The kinetics of adulterant effects were studied by Tse and Bogema (20). In these experiments, urine controls containing two times the cut-off levels of THC, MOR, AMP, PCP, and cocaine (COC) were set up. The samples were divided into three groups. To the first group, Urine Luck Formula 6.3 was added according to the manufacturer's instructions. To the second group, Stealth was added. The third group served as positive control, with no adulterants added. Within 5 min after the addition of adulterants, samples from each group were taken and simultaneously tested for presence of drugs and adulterants. The tests were repeated at 30 min and at 1,2, 3, 5, 8, 24, and 30 h after addition of adulterants. Detection of drugs was performed using Monitect, whereas adulterants were detected using Intect 7. Results of the drug tests with Monitect were as expected. Urine Luck and Stealth were found to be potent adulterants for THC and MOR, but were only marginally effective for AMP, PCP, and COC. For...

Marriage Made in Court John N Marr

The establishment of drug courts, coupled with their judicial leadership, constitutes one of the most monumental changes in social justice in this country since World War II. Since the development of specialized drug courts in 1989, the drug court movement in the United States has swept through the criminal justice system, revolutionizing the way many court systems process drug, domestic violence, driving under the influence (DUI) driving while intoxicated (DWI), juvenile, re-entry, and mental health cases. The movement has grown from one experimental court in Miami, Florida, to more than 1000 specialty courts in operation and another 500 in some stage of planning. The federal government, through the Bureau of Justice Assistance, provided more than 45 million in direct funding for drug courts in the United States during 2003. The Office of Justice Programs initial funding proposal for drug courts during fiscal year 2004 was 68 million. Why did they do this Because drug courts work....

Drug Court Testing Protocol

Owing to the impact of drug-test results in a drug-court system, it is imperative that the testing results be accurate and timely. Because cost is the major factor in the design of most drug court testing protocols, programs utilize the most comprehensive testing protocol possible based on available resources. Protocols are designed and followed to minimize these attempts to invalidate the drug-testing portion of the drug-court program. A basic tenet of drug courts is the necessity of providing immediate responses to both negative and positive drug tests. Participants appear before the drug-court judge on a regular basis so that their progress in treatment can be reviewed, their compliance with other programs and community supervision conditions can be monitored, and their behavior can be rewarded or sanctioned. Drug-test results are vital to this process. Research has shown consistently that rapid response is more effective than delayed response where any meaningful behavior change...

Drug Testing Methodologies and Technology

As a result of the above-mentioned issues of cost and immediacy, drug courts have experimented with most of the testing methodologies in an effort to discover the most efficient means to achieve their testing agenda. Based upon the high concentration of drug metabolites present in urine, the basic ease of urine sample collection, the accuracy of urine testing, and the relatively low cost of testing a urine sample, urinalysis has become the primary choice of most drug courts. Drug courts have experimented with other matrices, such as hair, saliva, sweat, breath, and ocular scans. All of these methodologies have specific, limited value within a typical drug court. Because courts test multiple times per week and are concerned about new use, long-term methods such as sweat patches and hair testing have only minimal relevance in specific situations. Untimeliness of results, lack of long-term validity studies, and high cost have minimized the acceptance of saliva tests. Ocular scans have...

Drug Testing Volume and Cost A Mathematical Perspective

How important is drug testing to the overall drug-court experience As stated earlier, drug testing provides the objective standard by which to measure a participant's progress and level of compliance. A December 2003 report by the Bureau of Justice Assistance Drug Court Clearinghouse at American University (5) stated that 1098 drug courts were operational at that time. A 2001 Drug Court Clearinghouse study (6) reported a moving total of nearly 80,000 active participants at any given time. Using the standard model of three drug tests per week during the first 3 mo in the program, two tests per week during the next 3 mo, and once per week during the final 6 mo, the average drug-court participant is drug tested 84 times during the first 12 mo in drug court. This does not take into account that many participants do not complete Pphase I in the minimum 3-mo period and that subsequent relapses result in a return to Phase I and its more frequent testing schedule. Length of stay in drug court...

Market Volume Across Europe

In terms of market development and test utilities, the overall European market for DOA testing is still considered to be approx 10 yr behind the US market. It is believed that whereas certain European markets have been slow to accept DAT, others have shown much more enthusiasm (3,4). Data indicate that there is a noticeable discrepancy in the level of test adoption in Europe in the form of a North-South divide, as illustrated in Fig. 1. Thus, cultural differences may be one of the factors responsible for holding back the development of the European DAT market (4). Spain and France are the countries currently exhibiting the highest level of resistance to drug testing. In Spain, drug testing is viewed with caution, in both health care and non-health care environments (4). Owing to the lack of legislation and national guidelines, doctors in Spain are reluctant to carry out a DAT, unless obligatory, for fear of being implicated in legal proceedings. In France, people involved in road...

Immediate and Long Term Roles for Medicinal Chemistry

Figure 2.5 Future drug discovery and development paradigm. This model portrays interactions with U.S. regulatory agencies and uses terms related to those interactions for steps 11 to 17. Future implies about 50 to 75 years into the new millennium. The most striking feature of this paradigm compared to Figs. 2.1 and 2.2 is the considerable number of decisions that will be made from virtual constructs rather than from experimental results. Confidence in the virtual decisions will be directly proportional to the level of knowledge that is learned from the huge amounts of drug screening data being amassed during the first 25 to 50 years of the new millennium, coupled with the overall ability to predict clinical outcomes. Step 1 is likely to be associated with some type of genomic and or proteomic derived notion that intends to amplify or attenuate one or more specific biological mechanisms so as either to return some pathophysiology to an overall state of homeostasis or to modify some...

Oral Fluid and Saliva Tests

In the 2003 European Workplace Drug Testing Society (EWDTS) Symposium, held in Barcelona, the merits of oral fluid, oral mucosal transudate, and saliva as DAT matrices were debated. Although the use of oral fluid-based assays remains low, their demand is definitely on the increase in Europe (4). For example, the original British Rail Alcohol and Drug Policy recommended use of urine tests for standard DOA screening. However, at least one rail operator has already switched to using oral fluids instead, because it is more acceptable among its staff. Less invasive and intrusive than either blood or urine, testing of oral fluid may be performed under direct visual supervision. Furthermore, by eliminating the need to send the sample for laboratory analysis, less time is taken to obtain the results (12). Presence of DOA in oral-fluid samples is also more indicative of recent consumption. At present, however, the levels of sensitivity and specificity of the current generation of oral-fluid...

Potential Therapeutics

Currently, there is no therapy that cures SMA. However, active investigations are underway, and new therapeutic approaches will likely emerge in the near future. Potential therapeutic approaches (reviewed in Refs. 11,19 ) are 1) to increase full-length mRNA from SMN2 by an in vivo alteration in the splicing pattern of SMN2 exon 7 through activation of trans-acting factors, or antisense RNA molecules 2) to increase the overall transcription level of SMN mRNA by activating the SMN promoter 3) to stabilize the SMN protein 4) to repair degenerated motor neurons 5) to replace degenerated motor neurons by stem cell therapy and 6) to target modifying factors other than SMN2. A high throughput drug screening for the identification of compounds that up-regulate full-length SMN protein is underway.

Adulteration Test Products Become a Necessity

With the spread of adulteration knowledge via the Internet, use of adulterants has increased . Hence, adulteration testing has become a necessity for guaranteeing the integrity of the drug-test process. However, laboratory-based adulterant test systems may not sufficiently detect all of the adulteration products in submitted specimens, because of the time delay involved in shipping and the quick dissemination of many newer-generation adulterants. Hence, the importance of on-site adulterant tests will increase (an example is discussed in Chapter 14). With the incorporation of adulterant test panels into lateral-flow drug test devices like the test cup, specimen integrity is established while the drug testing is being performed (an example is discussed in Chapter 12). This type of test product will become the device of choice.

Peroxidase Activities in Urine Adulteration

Stealth is an adulterant advertised as an effective way to beat a urine drug test. Stealth consists of two vials, one containing a powder (peroxidase) and a second one containing a liquid (peroxide). Combining the contents of both vials results in a strong oxidizing potential capable of oxidizing several drugs and metabolites. Stealth can mask detection of marijuana metabolite, LSD, and opiate (morphine) at 125-150 of cut-off values assayed by Roche OnLine and Microgenic's CEDIA immunoassay (16). Low concentration of morphine (2500 ng mL) could be effectively masked by Stealth, but not higher concentrations (6000 ng mL). Stealth also affects the GC-MS confirmation step. Cody et al. (17) reported that results of GC-MS analysis of Stealth-adulterated urine using standard procedures proved unsuccessful in several cases, and in 4 out of 12 cases, neither the drug nor the internal standard was recovered. Addition of sodium disulfite prior to extraction allowed recovery of both drugs and...

Glutaraldehyde As a Urine Adulterant

Glutaraldehyde has also been used as an adulterant to mask urine drug tests (18). This product is available under the trade name of UrinAid. Each kit contains 4-5 mL solution of glutaraldehyde, which is to be added to 50-60 mL of urine. Glutaraldehyde solutions are readily available in hospitals and clinics as a cleaning and sterilizing agent. A 10 solution of glutaraldehyde is also available from pharmacies as over-the-counter medication for treatment of warts. The addition of glutaraldehyde at a concentration of 0.75 volume to urine can lead to false-negative drug-screening results for cannabinoid tests using EMIT II immunoassays. Amphetamine, methadone, benzodiazepine, opiate, and cocaine metabolite tests can be affected at glutaraldehyde concentrations of between 1 and 2 using the EMIT screen. At a glutaraldehyde concentration of 2 by volume, Braith-waite (18) found that the assay of cocaine metabolite was significantly affected, with an apparent loss of 90 of assay sensitivity. A...

Concerns About Accuracy of Analysis

Further complicating POCT is the shift in analysis from the laboratory to the point of collection. Decentralizing the analytical process of DOA testing places the burden of responsibility for analytical interpretation on the collector and potentially unskilled personnel. Visually read endpoints of test results, although quite simple in most pregnancy tests, is dramatically more complicated in DOA testing. Most DOA tests contain multiple analyses, testing for cannabinoid (tetrahydrocannabinol THC), cocaine, amphetamine, morphine, and phencyclidine (PCP) on one or more lateral-flow strips. Included on each lateral-flow strip is a control, ensuring that the sample has migrated across the test area. A five-drug test will have one target zone for each drug analyte and one target control zone for each strip. Hence, a two-strip, five-drug panel will have a total of seven target zones. Most competitive binding assays produce a color indicator in the absence of the analyte. However, some tests...

Concerns About Necessity of Specimen Aliquoting

Manually performed DOA tests introduce several complications to the standard model of laboratory-centric testing. The first complication in the process of testing for drugs at the point of collection is aliquoting the specimen. Although aliquoting the specimen is standard procedure in the laboratory, there are standard operating procedures (SOP) and supervisory controls to reduce the potential for contamination of the forensic specimens. In the decentralized, point-of-collection model of DOA testing, there is little standardization in the method and procedures for aliquoting or handling of the original specimen. The sealed specimen must have its tamper-evident seal broken, and the specimen exposed to allow for the introduction of the aliquoting device. The introduction of a foreign object, such as a pipet, to obtain the aliquot in an uncontrolled environment, creates a potential legal challenge to the integrity of the specimen. This concern led to the invention of the testing cup,...

Hepatitis Viruses

Since HCV and HBV are major causes of morbidity and mortality in the world, there are significant efforts to develop more effective therapies. IFNs are immunomodulators, and one approach in phase III studies is the combination of IFNs with thymosin Qi (Zadaxin) for treatment of HCV and also for HBV. Although early in the drug discovery and development process, much research effort is now focused on the HCV protease NPTase helicase as an antiviral target. The HCV serine protease is essential for virus replication and is associated with an NPTase domain which activates the protease, and a helicase domain that preferentialy unwinds double-stranded RNA. The three-dimensional structure has been determined and drug screening programs are underway in several laboratories to identify potent inhibitors.

Oral Fluid

Steroids, hormones, enzymes, antibodies, DNA typing, therapeutic drugs, and drugs of abuse. From the earliest days of immunoassay development for drug testing in the early 1970s, saliva has been considered a suitable specimen. In fact, one of the first papers published on the use of homogeneous immuno-assays for the detection of drugs (a spin immunoassay developed by Syva Company, called free radical assay technique FRAT , a forerunner of the now well-established enzyme-multiplied immunoassay technique EMIT assay), specified in the title the use of both urine and saliva for morphine testing (16). The key advantage of oral fluid for drugs-of-abuse testing is the ease of specimen collection, without invoking privacy or gender concerns. Oral fluid for drug testing offers great promise for roadside driving-under-the-influence scenarios, which prove prohibitive for the collection of a urine specimen (see Chapters 8 and 17). Furthermore, there is the potential for immediate test results...

Conclusions

The two-stage drug-testing strategy requires the use of analytical methodologies with different chemical principles. Analytical methodologies for drug testing can be grouped into three major categories. Each of these technology categories can be further broken down into multiple selections for instrumentations and methods. Bio-affinity-based binding assays such as immunoassays are commonly used for screening. Separation techniques such as chromatography or electrophoresis, as well as their coupling with powerful detectors such as mass spectrometers, can be effectively used for confirmatory testing of preliminary positive results or systematic analysis of generally unknown toxic compounds. The analytical technologies afford a powerful means toward the detection, identification, and quantification of the presence of abused drugs in biological specimens. Nevertheless, measurement uncertainties and experimental variations always exist. Therefore, the interpretation of analytical results...

Raphael C Wong

Oral fluids have been generating increased interest as a matrix for abused drug testing. The present chapter describes an oral-fluid on-site detection device, Oratect , which screens for six drugs simultaneously. Oratect integrates collection, testing, and confirmation sampling into a single device. The collection process is simple, and test results can be obtained within 5 to 6 min. The data collected so far suggest that it is a viable screening test. Recently, the testing has been extended to alcohol, so that a simultaneous determination of drugs and alcohol is possible. Oral fluids offer an attractive alternative matrix for drug testing as a result of several factors including (a) reduced chances for adulteration (b) accessibility (c) non-invasiveness and (d) better correlation with serum drug levels compared to urine. These factors contribute to the increasing acceptability of oral-fluid drug testing as a valid indicator of drug usage (1-3). As a result, guidelines for performing...

Mass Spectrometry

Simple EI, a single-quadrupole mass analyzer, has been the cornerstone of identification in forensic urine drug-testing facilities. However, in most cases, this method is totally inadequate for determining the lower concentrations of drugs and their metabolites found in hair. Because of this fact and matrix effects seen with hair analysis, more sensitive and more specific MS technology has been developed. Psychemedics, the authors' laboratory and one which performs the most commercial hair analysis, presently uses the Finnigan TSQ 7000 MS analyzers operating in negative ion chemical ionization (NICI) GC-MS-MS for the determination of marijuana in drug samples, detecting the tetrahydro-cannabinol (THC) metabolite carboxyTHC (cTHC), which is also the target ana-lyte monitored in forensic urine drug testing. All confirmation procedures need to go through vigorous validation studies. Psychemedics also uses positive ion chemical ionization (PICI) LC-MS-MS for the determination of cocaine,...

Murray Lappe

New federal regulations proposed by the Department of Health and Human Services for drug testing of federal employees includes the addition of alternative specimens as well as the addition of alternative technologies for screening samples at the point of collection. Alternative technologies called point-of-collection tests (POCT) may use urine or oral fluids, and are either visually read or instrumented. eScreen (eScreen, Inc.) is an instrumented urine POCT with an integrated SVT, adulteration assay, Web-based information management system, and paperless chain of custody form. eScreen's instrumented system eliminates many potential areas of concern when testing samples at the point of collection. Safeguards that are present in a laboratory-based drug-testing environment are duplicated in eScreen's decentralized point-of-collection drug-testing model. The key to eScreen's robust point-of-collection model lies in the use of an extensive installed base of Internet-enabled eReaders and...

Specificity

The same UV spectrum as the parent compound. Therefore, specificity testing should be confirmed by analyzing accuracy samples with a selective analysis mode such as LC. If the capsule shell interferes with the bulk drug detection, the USP allows for a correction for the capsule shell interference. Corrections greater than 25 of labeled content are unacceptable 18 .

The eReader

Lighting conditions on the test strip are standardized and enhanced with white and green light-emitting diodes (LEDs) to improve the contrast between the background and test lines. Software was written to measure the optical activity of the CCD and produce a digital output in the form of translating the series of bars and spaces into 1s and 0s, as previously described. Thresholds were calibrated according to the strip manufacturer's specifications and the Substance Abuse and Mental Health Services Administration (SAMHSA) cutoff levels. The eReader has essentially only one moving part, the plunger mechanism. The plunger bracket is attached to an integrated light shield lowered onto the eCup lid to block ambient light from the camera. Once the eCup is inserted into the reader and the eScreen Web-based CCF is completed, an instruction is sent to the reader to begin the test. The plunger locks the eCup into the reader during the testing process and proceeds with the imaging and analysis...

Amitava Dasgupta

Persons abusing drugs attempt to adulterate urine specimens in order to beat drug testing. Dilution of urine in vivo by consuming excess fluid and various detoxifying agents available through the Internet is a common practice. Household chemicals such as bleach, acid, table salt, laundry detergent, toilet-bowl cleaner, vinegar, lemon juice, and Visine (Pfizer) eye drops are also used for adulterating urine specimens. Most of these adulterants except Visine eye drops can be detected by routine specimen integrity tests (creatinine, pH, temperature, and specific gravity). However, certain adulterants, such as Klear , Whizzies, Urine Luck , and Stealth , cannot be detected by using routine specimen integrity testing. These adulterants can successfully mask drug testing if the concentrations of certain abused drugs are moderate. Several spot tests have been described in the literature to detect the presence of such adulterants in urine. More recently, urine dipsticks are commercially...

Substitution

Substitution refers to the process of substituting a user's dirty urine with clean urine from another person or an animal, or with synthetic urine. Earlier substitution methods included collecting a clean person's or a pet's urine in a container and then dispensing it into the collection cup discreetly. However, the freshness of the urine became a problem. Further, it was difficult to constantly stash a volume of this urine in preparation for random testing. Recently, synthetic urine kits with long shelf life have become available. A typical kit consists of a pouch of liquid or lyophilized synthetic urine with temperature indicator, disposable heating pad, a strap to hold the pouch, and tubing with clamp to deliver the synthetic urine.

Probation

Probation officers are an integral part of any post-plea drug court. Not only do they provide community supervision at a level not possible for other members of the team, but in many jurisdictions probation may also provide case management, house arrest, and or drug testing. Probation also works with law enforcement to be the eyes and ears of the drug court when program participants are outside of the direct supervision of the other team members. Probation departments have learned that drug courts are a very cost-effective alternative to incarceration for persons found guilty of a technical violation of probation. This is especially true for those persons who test positive on probation-administered drug screens.

Prisons

Interventions such as drug testing are thought to have a positive effect in the reduction of drug-related crime. As a result, DATs have become an increasingly important weapon at all levels of the criminal justice systems, particularly across northern Europe. DATs are not restricted to offenders officers may also be randomly tested for drug abuse owing to their potential contact with drugs. As a result, prospective candidates looking to join the prison service or police force may also be subjected to a drug screen as part of their pre-employment assessment. population in 2002 had admitted to consuming drugs while in prison. Prisons in Germany and Spain were believed to have the highest rates of drug abuse. In contrast, in countries like the United Kingdom, where mandatory drug testing (MDT) is carried out in conjunction with cell searches, a significantly lower rate of drug abuse has been recorded. Nevertheless, detecting drug abuse among inmates remains difficult and time-consuming.

Other Specimens

Semen has been demonstrated to have measurable levels of drug after drug use. It is occasionally proposed as a basis to explain positive drug tests as a result of exposure to drugs through sexual relations. However, the absolute amount of drug present in semen is very low and could not account for significant exposure (61). A wide variety of body fluid specimens have been analyzed for the presence of drugs of abuse. The analytical methods are sound and well developed. Each specimen provides different information about time and extent of use and likelihood of impairment. However, the interpretation of test results from each of these types of specimen offers its own challenges. Formal regulatory criteria have been established for several of these specimens, and case law addressing their admissibility and probative value has been developed for some. These drug-testing tools, as an objective piece of information identifying drug use, have proven highly useful in addressing the ongoing...