Dr. Closson's Forensic Drug Testing Discussion

Alcohol: "Joe can really hold his liquor"

2009-09-25T12:45:00.002-04:00

We all know somebody who can "hold his liquor." These individuals can apparently drink significant quantities of alcohol and appear unaffected (or minimally affected). The key phrase here is "appear unaffected." Individuals who are experienced drinkers and usually consume alcohol on a regular basis become practiced at functioning under the influence of alcohol; they are used to performing simple tasks while intoxicated and give an outward appearance of being minimally intoxicated. But that view is deceptive. These experienced drinkers have developed the ability, through regular exposure to alcohol, to mask the outward appearance of intoxication. These individuals are just as affected as naive drinkers when it comes to the internal effects (those that are not easily observed) of alcohol. These effects include, among others, impaired vision, narrowing of the field of vision (tunnel vision), prolonged perception-reaction time, impaired hearing and most importantly, a serious degradation in the ability to perform divided attention tasks (driving a vehicle). So when you see someone who can "hold his liquor" be aware that he may be intoxicated and incapable of safely driving......drive him home, don't let him get behind the wheel of his car.

Should We Give Addicts the Drug They're Abusing?

2009-08-21T12:21:00.003-04:00

Recent research conducted in Canada has shown that giving heroin to heroin abusers who are not successful in conventional treatment has allowed for better treatment outcomes than continuing the failed treatment approach. The researchers followed 226 heroin addicts who had been abusing heroin for many years. These individuals had failed to improve by following conventional treatment. After one year 88% of the addicts who were given heroin were still in the study, compared to 54% of the addicts in the control group who had received methadone (one of the most popular treatment regimens). One caveat, those take heroin injections suffered more side effects including serious overdoses.

The U.S. government estimates that there are approximately 663,000 heroin abusers in the United States with approximately 15% of those individuals considered candidates for heroin prescription treatment. This can't happen overnight though. In the U.S. heroin is classified as a Schedule I substance which defines it as a substance that has a high potential for abuse and serves no legitimate medical purpose.

So we won't see this treatment modality anytime soon in the United States.

ref: NY Times August 20, 2009

Specimen Quality and the Chain-of-Custody

2009-08-07T11:57:00.002-04:00

It can't be emphasized enough that the quality of drug testing and the ability of a laboratory to detect drugs in a specimen is dependent of the quality of the sample provided. This starts with the collection of the sample at the collection site and the handling of the sample from that point forward through the analysis and long term storage.

The first step in the testing process is the collection of the sample. This should ideally be accomplished by an observed collection in which the collector actually witnesses the sample coming from the donor's body. This is easily accomplished when hair and oral fluid samples are utilized but can be more problematic when urine samples are collected. Collectors most often have to rely on the condition of the urine sample (temperature, color, etc.) to deterimine the acceptability of the urine provided. This is not an issue when the collector can personally cut a donor's hair or collect an oral fluid sample.

Most forensic toxicologists recommend that a digital photograph be taken of the donor and include this photo in the laboratory report.

A chain-of-custody should be initiated at the time of specimen collection in which the collector and donor certify the integrity of the sample and the actual handling of the sample. This chain-of-custody document is secured along with the sample and forwarded to the laboratory.

In the laboratory, the chain-of-custody documentation is maintained throughout the testing and storage of the sample.

By following this protocol the collector and laboratory can certify the integrity of the sample handling from collection to reporting and disposal. This information is critical should the need to support test findings in a court of law become required.

Important News from the FDA

2009-07-29T11:27:00.002-04:00

Anabolic Steroids and Steroid-Like Substances

The following FDA advisory crossed my desk today. It illustrates, again, that consumers must be vigilant in determining the ingredients contained in over-the-counter products they consume. Anabolic steroids are substances that promote muscle growth and aid in recovery from strenuous activity but if self-administered, without the advice and monitoring of a physician, they may cause lasting adverse consequences:

Public Health Advisory: The FDA recommends that consumers should not use body building products marketed as containing steroids or steroid-like substances
7/28/2009

The FDA is notifying the public about new safety information concerning products marketed for body building and increasing muscle mass. The FDA has sent a Warning Letter to a manufacturer of body building supplements that claim to contain steroid-like ingredients, but in fact contain synthetic steroids. The products named in the Warning Letter are marketed by American Cellular Laboratories, Inc., and include “TREN-Xtreme,” “MASS Xtreme,” “ESTRO Xtreme,” “AH-89-Xtreme,” “HMG Xtreme,” “MMA-3 Xtreme,” “VNS-9 Xtreme,” and “TT-40-Xtreme.”
The FDA has received reports of serious adverse events associated with the use of these products and other similar products. Products like these are frequently marketed as alternatives to anabolic steroids for increasing muscle mass and strength and are sold both online and in retail stores. They are often promoted to athletes to improve sports performance and to aid in recovery from training and sporting events. Although products containing synthetic steroids are frequently marketed as dietary supplements, they are NOT dietary supplements, but instead are unapproved new drugs that have not been reviewed by the FDA for safety and effectiveness.
Adverse event reports received by the FDA for body building products that are labeled to contain steroids or steroid alternatives involve men (ages 22-55) and include cases of serious liver injury, stroke, kidney failure and pulmonary embolism (blockage of an artery in the lung).
Due to the potentially serious health risks associated with using these types of products, the FDA recommends that consumers immediately stop using all body building products that claim to contain steroids or steroid-like substances. Consumers should consult their health care professional if they are experiencing symptoms possibly associated with these products, particularly nausea, weakness or fatigue, fever, abdominal pain, chest pain, shortness of breath, jaundice (yellowing of the skin or whites of the eyes) or brown/discolored urine. The FDA also recommends that consumers talk with their health care professional about any body building supplements they are taking or planning to take, particularly if they are uncertain about a product’s ingredients.
Health care professionals are advised to ask their patients about any over-the-counter products they may be using, including products marketed as dietary supplements. Additionally, health care professionals should be alert to patients presenting with the warning signs that may be associated with the use of steroids or steroid-like substances, including liver injury, kidney failure, stroke, and hormone-associated adverse effects, such as blood clots, including pulmonary embolism and deep vein thrombosis.
Health care professionals and consumers are encouraged to report any adverse events related to the use of these products to FDA's MedWatch Adverse Event Reporting program, either online, by regular mail or by fax, using the contact information at the bottom of this page.
For more details about these products see FDA’s Consumer Information piece (Consumer Update)Warning on Body Building Products Marketed as Containing Steroids or Steroid-Like Substances.

For questions or comments: drclosson@drclosson.com

Urine Adulteration, other substances

2009-07-23T15:53:00.003-04:00

In addition to the actions taken by individuals and the chemicals already discussed, we will conclude our discussion of ways to beat a urine drug test with the measurement of urinary pH as an indicator of tampering and the detection of oxidizing agents:

pH tests for the presence of acidic or alkaline adulterants in urine. Normal pH levels should be in the range of 4.0 to 9.0 (a range of 3.0 to 11.0 is used to indicate urine substitution; urine sample with pH values below this range or above this range are considered physiologically unlikely). Values outside of this range may indicate the sample has been altered. This test is an indicator of urine sample tampering but does not prove that tampering occurred. In addition, this test does not identify a potential substance used to mask drug use.

Oxidants/PCC (Pyridinium Chlorochromate) tests for the presence of oxidizing agents such as bleach and hydrogen peroxide. Pyridinium chlorochromate (sold under the brand name UrineLuck) is a commonly used adulterant . Normal human urine should not contain oxidants or PCC.

If you have any questions or would like to comment on this series please send your questions or comments to: drclosson@drclosson.com

Important News

2009-07-17T11:20:00.002-04:00

An interesting and important news item appeared in my in-box this morning.

Nature & Health Co. supplement products: LibieXtreme, Y-4ever, Libimax X Liquid, Powermania Liquid and Capsule, Herbal Disiac
July 16, 2009

Nature & Health Co., announced a voluntary nationwide recall of the company's supplement products sold under the following names: LibieXtreme, Y-4ever, Libimax X Liquid, Powermania Liquid and Capsule, Herbal Disiac. Lab analysis by FDA of these products found they contain either tadalafil, an active ingredient of an FDA-approved drug for erectile dysfunction (ED), its analog aminotadalafil, or the analog of sildenafil, an active ingredient of another FDA-approved ED drug, making these products unapproved drugs. The undeclared ingredients may interact with nitrates found in some prescription drugs such as nitroglycerin and may lower blood pressure to dangerous levels. Customers who have these products in their possession should stop using it immediately and contact their physician if they have experienced any problems that may be related to taking these products.

Because it is timely, and represents an issue that complicates drug testing and the interpretation of drug testing results, we will interrupt our discussion of Urine Drug Testing Adulterants for today.

This recall, because of ingredients that are contained in over-the-counter products that are unlisted on the bottle (and are regulated by the FDA), illustrates the difficulty toxicologists, physicians and counsellors have in interpreting the results of a drug test. Individuals may be exposed to substances and drugs, unknowingly, through the use of over-the-counter products.

This issue should always be discussed with the individual undergoing drug testing if an unexplained drug is detected. Utilize the expertise of a toxicologist to assist you in this endeavor.

If you have any questions or would like to comment please contact me at drclosson@drclosson.com

Urine Adulteration, Part 3

2009-07-14T12:52:00.003-04:00

We have been discussing the ways individuals, who are motivated to beat a drug test, can prevent detection of drugs in their urine sample. Today we will discuss the use of GLUTARALDEHYDE containing products. Glutaraldehyde is a toxic substance, used in pathology laboratories to fix (preserve) tissues that are undergoing pathologic examination. It is also used as a disinfectant. Glutaraldehyde works by binding to proteins and preventing them from accomplishing their biologic function. This substance is used as a masking agent in urine drug testing by preventing the detection of drugs by interfering with the immunoassay that is used in the screening portion of the test. The product is added to the urine sample after voiding (glutaraldehyde is a toxic substance and cannot be consumed). The laboratory has various means at it's disposal to detect the presence of glutaraldehyde in an adulterated sample. Glutaraldehyde is not a normal constituent of urine and it's presence is proof of specimen tampering. Glutaraldehyde containing products are readily available on the internet for the purpose of hiding drug use.

If you have any questions or comment please contact me at drclosson@drclosson.com .

Urine Adulteration, Part 2

2009-07-09T12:43:00.003-04:00

In our last conversation we discussed the ability of an individual to prevent the detection of drug use by simply diluting his or her urine. Today we will discuss NITRITE, one of a group of chemicals that have been used to beat a urine drug test.

Nitrite containing products are available on the Internet for the express purpose of masking drug use. Products such as Klear and Whizzies contain nitrite. Nitrite, in high enough concentrations, such as those seen following the addition of Klear or Whizzies to a urine sample, will interfere with both the initial immunoassay test used in the drug screen and also with the confirmatory GC/MS test, causing a false negative result. In the confirmatory test the nitrite actually causes the decomposition of the drug, rendering it undetectable. These effects are most apparent at masking marijuana use but nitrite also interferes with the ability to detect other drug classes in urine.

Nitrite is a normal constituent of urine, but normally occurring levels are much lower than those obtained following the addition of these nitrite-containing adulteration products. No effect on drug testing occurs at these normally occurring levels.

If you have any questions or comments please contact me at drclosson@drclosson.com

Urine Dilution-A Way To Beat The Test

2009-07-07T13:41:00.002-04:00

Urine Dilution....A Way to Beat the Test

In the previous post we discussed the issue of urine drug test tampering, either by consuming fluids or by adding substances to the urine sample. Today we will discuss an approach to hiding drug use that is inexpensive and may be the most effective.

The simple activity of consuming fluids may have a profound effect on the dilution of urine that is produced. Anyone involved in the supervision and/or collection of urine samples from donors undergoing drug testing has seen urine that "looks like water." Urine samples that are virtually clear are very dilute. By consuming excess fluids a donor can dilute his or her urine sample by a factor of 10 or 20 times. What this means is that anything dissolved in that urine, including drugs and drug metabolites, will exist in this diluted urine at concentrations 10-20 times LESS then they would in a normal urine. This may effectively lower the concentration of drugs and metabolites to levels that prevent detection......the donor has just beaten the urine drug test.

What can be done to prevent this occurence? Not much! While we can determine, after the fact, that a urine is dilute, retesting is required to ascertain potential drug abuse (and this testing will not be representatitive of the individual's condition during the first test).

Testing of other sample types, not prone to the effects of dilution, may be appropriate.

2009-07-03T09:52:00.002-04:00

In my last posting I referred to the significant problem of drug test adulteration undertaken by individuals who want to hide their use of unauthorized drugs. This is a major problem for laboratories, forensic toxicologists, courts and organizations charged with the responsibility of interpreting these tests. This problem is most pronounced when urine is the specimen collected. Over the next few postings I will discuss this problem in detatil and review the products used and the approaches taken by forensic toxicologists to detect this cheating.

Have a Happy and Safe 4th.

2009-07-02T11:09:00.002-04:00

Why Family Courts Prefer Hair Drug Testing
Most Judges and Attorneys working in child custody matters and other matters in Family Court recognize the distinct advantages that hair drug testing has over urine drug testing. An individual who is using a drug will incorporate that drug into the hair that is being formed at the time of use. Once incorporated, the drug remains in that portion of hair and serves as an historical record of drug use. The time period of this drug use record is only limited by the length of the donor's hair (each inch of hair represents a 2 month record of drug use). This record may be contrasted with the "detection window" of drug use obtained from a urine sample which is normally only 3-4 days after drug use. In addition, there are many ways that an individual can do something to his or her body or voided urine sample that will prevent detection of drug use. Products sold on the internet or through retail outlets are successful at masking the presence of drugs in a urine sample. Even the simple act of drinking excess water may prevent the detection of drug use in a urine drug test. Hair drug testing is not affected by these products and is a much more reliable testing modality.

In addition, hair samples may be segmented into several sections to provide information about when drugs were used.

2009-07-01T14:05:00.003-04:00

Welcome to all readers of my blog.

I hope to present a forum in which we can discuss any and all issues relating to drug testing. As you know, there are many types of drug tests administered in many different settings. Drug tests may be conducted by law enforcement, in court settings, as a requirement of employment and for medical evaluations (to name a few). I hope to present issues of interest to people in all walks of life and answer questions, to the best of my ability, that I routinely receive in my practice of forensic toxicology.

To start , I would like to outline some of the common types of tests so you can become familiar with the terminology:

ELISA (Enzyme Labeled ImmunoSorbent Assay) is the screening technology used for hair drug testing and oral fluid drug testing. This technique involves the mixing of specifically developed antibodies with the patient’s sample. These antibodies are designed to attach specifically to drugs or drug metabolites. The specific antibodies selectively will attach to drugs present in the patient’s hair or oral fluid. Automated instrumentation is used to detect this attachment of antibody to drug. If this specific attachment occurs the specimen is considered positive for the drug detected.

EMIT (Enzyme Multiplied Immunoassay Technique) is the screening technology used for urine drug testing. This technique utilizes essentially the same principles as the ELISA testing.

GC/MS (Gas Chromatograph/Mass Spectrometry) is considered a confirmatory testing technique. It is universally considered the “Gold Standard” in drug testing. This procedure involves the purification of a specimen (Hair, oral fluid or urine) by the gas chromatograph and the positive identification of the purified drug by the mass spectrometer. The mass spectrometer produces the mass spectrum of the drug undergoing confirmation. The mass spectrum is as unique to a drug as a fingerprint is to an individual. The GC/MS technique provides absolute information about drugs and drug metabolites in biological specimens.

Whereas drug screening, by either ELISA or EMIT, is an extremely reliable indicator of drug use, no screening test provides 100% accuracy. Only GC/MS testing can approach this level of accuracy.

If you have any questions about the topics covered you may email me at drclosson@drclosson.com or visit my website: drclosson.com