Technical – Accuracy


1920 Substance Abuse Testing

1921 Definitions Related to Substance Abuse

1921.1 Chain of Custody

CPS June 2010

The chronological documentation confirming that a drug specimen belongs to the person who was tested and the specimen has not been tampered with en route to the laboratory.

1921.2 Drug Confirmation

CPS June 2010

A drug confirmation is the measurement of the metabolization of a drug by a person’s body using a specimen collected from the person. If the drug is present in the person’s body at levels high enough to be metabolized, the possibility of accidental or second-hand exposure is ruled out. The confirmation also rules out false positives.

1921.3 Drug Screen

CPS June 2010

A drug screen is any test – whether performed by a caseworker, laboratory, or other facility that conducts screenings – to confirm the existence of a drug in a person’s system. A drug screen does not show the level at which a drug is present and therefore cannot be relied on to rule out the possibility of second-hand or accidental exposure.

1921.4 Instant Test (Oral Swab)

CPS June 2010

An instant swab test is a test of a client’s oral fluids performed by a caseworker to determine whether the client has used drugs recently. The results may be confirmed by a laboratory, if possible. The results mustbe confirmed by a laboratory before being presented as evidence in a court hearing.

1922 Eligibility for Substance Abuse Testing

CPS June 2010

Guiding Principle

If a worker has cause to believe, based on credible evidence, that a parent or someone who has direct access to the child has a substance abuse problem, including the abuse of alcohol or marijuana, and that problem threatens the child’s safety, the worker must request a drug test for the client.

To request a drug test, see 1951 Children and Adolescents Who Smoke Marijuana, Use Other Drugs, or Drink Alcohol.

Requesting a Drug Test

A worker may request substance abuse testing:

•  when the worker has cause to believe that a client has a substance abuse problem, based on credible evidence from an intake report, an investigation, comments from collateral sources (such as teachers, neighbors, and family doctors), child safety and risk assessments, family assessments, a drug screening, self-admission from the client, or on-going case monitoring;

•  when a court orders the testing;

•  when a safety plan that relates to substance abuse issues is about to end because it no longer appears necessary;

•  to allow or re-assess family reunification, if the parent has an active substance abuse problem;

•  to provide motivation for a parent to remain abstinent; or

•  to encourage participation in substance abuse treatment or aftercare.

The table below shows the tests that may be conducted or ordered for a client by the caseworker or accepted from other sources, and the staff who may approve the orders.

Each region may develop more stringent approval requirements.

Tests Allowed or Accepted

Approving Staff Level

Oral fluid (instant swab test, instant swab test with confirmation, or instant test lab confirmation).

Caseworker or per regional protocol.

Urine

Supervisor or per regional protocol.

(Caseworkers are not permitted to collect urine specimens.)

Hair

Program director or per regional protocol.

Meconium

DFPS does not conduct or purchase meconium tests.

DFPS accepts:

•  the results of a Hospital Meconium test on a newborn; and

•  the results of tests conducted in a hospital on the mother of the newborn. (The usual test on the mother is a urine analysis.)

1922.1 Determining Eligibility for Substance Abuse Testing Conducted by a Contracted Laboratory

CPS June 2010

The following clients are eligible for substance abuse testing that is conducted by a laboratory under contract:

Clients Eligible for Testing

Additional Details

Children in open CPS cases, including children in DFPS conservatorship and children who are being placed for adoption, when these services are needed.

Children must not be tested by DFPS caseworkers, unless the child is 10 years old or older and is being investigated as an alleged perpetrator.

The testing of child as an alleged child-perpetrator must be referred to a laboratory.

The parent in open CPS cases, excluding a foster or adoptive parent.

A parent may also be administered an instant swab test by a DFPS caseworker.

Caregivers or kinship family members being assessed to care for a child who is being placed voluntary by the parents rather than by court order (that is, as part of a parental child safety placement).

See:

6322.13 Definitions Related to Kinship Care

2234.4 Parental Child Safety Placement Initiated by the Family

A caregiver or kinship family member may also be administered an instant swab test by a DFPS caseworker.

The testing is paid for by submitting Form 2054 Service Authorization (located in the IMPACT system).

If child is in DFPS conservatorship, Medicaid does not pay for the testing of the caregiver, family member, or kin.

1922.2 Identifying the Substances That Are Eligible for Testing

CPS June 2010

Laboratory tests are ordered to test for the following substances:

•  Alcohol

•  Amphetamines

•  Cocaine

•  Opiates

•  Phencyclidine (PCP)

•  Cannabinoids (Marijuana)

•  Barbiturates

•  Benzodiazepines

•  Methaqualone (Quaalude; a depressant)

•  Methadone

•  Propoxyphene (Darvon; an opioid)

The following drugs are detected in saliva (instant swab tests):

•  Alcohol

•  Amphetamine

•  Cocaine

•  Codeine

•  Hydrocodone

•  Marijuana

•  Methamphetamine

•  Morphine

•  PCP

1922.3 Identifying Laboratory Services for Substance Abuse Testing

CPS June 2010

The laboratory substance abuse tests available by contract must include at least one of the following services:

•  Urinalysis testing

•  Hair testing

•  Oral fluid testing

A caseworker may collect oral fluid from a client in order to perform an instant swab test. The caseworker may be the sole witness to the oral collection and may be part of the chain of custody for instant swab tests only. (See 1921.1 Chain of Custody.)

The laboratory must provide the results of a drug test to DFPS staff only. The lab may not contact clients directly to obtain information or provide results.

1922.4 Referring Clients for Substance Abuse Testing

CPS June 2010

For complete referral instructions, see 8161.1 Active Cases – Authorizing, Extending, or Terminating Direct Services, as referenced in 1922.6 Adding, Extending, Reauthorizing, or Terminating Substance Abuse Services.

1922.5 Authorizing Substance Abuse Testing in IMPACT

CPS June 2010

To authorize substance abuse testing, workers must enter the following details into the IMPACT case management system.

In the IMPACT field …

the caseworker enters …

Category …

Substance Abuse

Service, Service Code

(as applicable) …

79A   (Drug Testing-Urine Analysis)

79B   (Drug Testing-Oral Fluids)

79C   (Drug Testing-Hair Testing)

79D   (Drug Testing-Confirm All Tests)

Unit of Service

One time

Limitations

The caseworker may not submit IMPACT Form 2054 Service Authorization more than once a week for each client.

Stages

The services (tests) listed in the chart above may be provided in the following stages:

•  Investigation (INV)

•  Family Preservation (FPR)

•  Substitute Care (SUB)

•  Family Substitute Care (FSU)

•  Family Reunification (FRE)

•  Adoption (ADO)

1922.6 Adding, Extending, Reauthorizing, or Terminating Substance Abuse Services

CPS June 2010

Workers must follow the procedures in 8161.1 Active Cases – Authorizing, Extending, or Terminating Direct Services:

•  to authorize additional units of service, or extend or reauthorize substance abuse testing; or

•  to terminate substance abuse testing before the end date noted on Form 2054 Service Authorization, located in the IMPACT system.

http://www.navigent3.com

Advanced Oral Fluid Drug Screening for the Workplace

via 1920 Substance Abuse Testing; 1921 Definitions Related to Substance Abuse; 1921.1 Chain of Custody; 1921.2 Drug Confirmation; 1921.3 Drug Screen; 1921.4 Instant Test Oral Swab; 1922 Eligibility for Substance Abuse Testing; 1922.1 Determining Eligibility for Substance Abuse Testing Conducted by a Contracted Laboratory; 1922.2 Identifying the Substances That Are Eligible for Testing; 1922.3 Identifying Laboratory Services for Substance Abuse Testing; 1922.4 Referring Clients for Substance Abuse Testing; 1922.5 Authorizing Substance Abuse Testing in IMPACT; 1922.6 Adding, Extending, Reauthorizing, or Terminating Substance Abuse Services.

Characteristic
Definition
   
Sensitivity The ability of a method to detect the presence of drugs or classes of drugs.
Speed The time from start to end of the analytical process using a method.
Simplicity Usually related to the speed of a method, the requirement for little training for technicians and often associated with highly automated procedures.
Reliability The dependability of a method. Its ability to reproduce accurate and precise results day-to-day.
Accuarcy The degree to which a method produces results consistent with actual values.
Precision The consistency with which a method reproduces results when measuring the same sample.
Economy/Cost Economic considerations include time of analysis, number of samples processed in a single run, degree of training required of personnel, price of obtaining (and maintaining) instrumentation, price of chemicals and other reagents used in analytical procedure, and overhead of analytical laboratory or other facility.
Safety The degree to which personnel using a procedure are exposed to risk of injury or long-term toxicity associated with chemicals required by a method.

Drug abuse as always continues to threaten the health and safety of millions of people in the workplace and in our schools.

While there is a growing awareness and concerned about the consequences of drug abuse among employees, students, and parents, there a need for better education in how to combat substance misuse, as well as what substances are most prevalent.  Substance misuse ranges alcohol to prescription drugs to meth and  heroin.

Managing substance misuse requires detection and deterrence as well as education and assistance.   These drugs can be detected using urine, hair or oral fluid  samples, with random testing being the most effective method by far.   While each specimen type has its pros and cons, all specimen collections must be directly observed as substance abuses will “cheat” the tests via substitution or adulteration.

The below is the brief description of the drugs abused and their testing methods.

Marijuana:
While marijuana is generally considered to be the most commonly abused drug, this is rapidly changing due to the rapid increase in the abuse of prescription drugs.  There were 15.2 million abusers aged 12 or above in 2008. Marijuana abusers can be detected between 3 to 5 days using urine and up to a maximum of 24 hours using oral fluid.   The impairment period for marijuana is generally considered to be one hour.

Prescription drugs:
There were nearly 6.2 million people aged 12 or older who abused prescription drug non-medically in 2008.  The most commonly abused prescription drugs include opioids such as oxycodone (Oxycontin, Percoset) and hydrocodone(Lortab, Vicodin).  Most urine tests, such as DOT or SAMSHA or NIDA 5-panel tests do not yield positive results for oxycodone or hydrocodone and therefore do not provide adequate safety protection.

Methamphetamine:
Methamphetamine is highly addictive stimulant with toxic effects on the central nervous system. Studies state that there were 314,000 Methamphetamine abusers in 2008.

Ecstasy:
Ecstasy (MDMA) is a drug of abuse with stimulant and psychodelic properties. There were nearly 555,000 ecstasy abusers in 2008.

Cocaine:
Cocaine is highly addictive stimulant drug of abuse. Studies show that there were 722,000 persons aged 12 years or above in 2008, who used cocaine for the first time in the past year averaging approximately 2,000 initiates per day.
Heroin:
Heroin is an addictive opiate drug, synthesized from morphine. In 2008, there were 114,000 persons aged 12 years or above who had used heroin for the first time within the past one year.   The abuse of prescription pain relieves has been linked to heroin abuse.
Steroids:
Athletes mostly use steroids to enhance performance and physical appearance. Steroid abuse can lead to serious health problems.

Drug misuse is prevalent and with the advent of prescription drug abuse, worse than ever.

Drug abuse can be detected and deterred by using reliable on-site oral fluid drug screening and laboratory-based testing methods.   In addition to oral fluid / saliva,  urine, hair, blood, and sweat specimens can be used for detecting certain drugs, however, factors such the convenience to detect the elevated levels of the substance abused and ability to perform observed specimen collection should be considered.

http://www.orapoint.com

Drug Alcohol Depend. 2003 Dec 11;72(3):265-9.

Is oral fluid analysis as accurate as urinalysis in detecting drug use in a treatment setting?

Bennett GA, Davies E, Thomas P.

Addictions Service, Sedman Unit, Dorset HealthCare NHS Trust, 16-18 Tower Road, Bournemouth BH1 4LP, UK. gerals.bennett@dorsethc-tr.swest.nhs.uk

BACKGROUND: Technology for testing oral fluid (OF) for the presence of drugs is available for treatment services and is more attractive than urinalysis: its validity is not well established. AIMS: Compare the accuracy of methods of on-site testing of OF and urine.

DESIGN: Comparison of the sensitivity and specificity of on-site testing of samples of OF and urine collected on the same occasion, using subsequent blind laboratory analysis of the same urine samples as the standard. SETTING: British addiction treatment service.

PARTICIPANTS: 157 drug dependent persons, 89% with evidence of opiates, 73% male, and 85% aged between 20 and 35 years.

MEASUREMENTS: Assessment of presence of four drugs using SYVA ETS urinalysis and Cozart Rapiscan OF Drug Test systems. Laboratory urinalysis using microplate enzyme-immunoassay technique.

RESULTS: The sensitivity of OF tests and urinalysis were, respectively, for opiates 91 and 91%, methadone 91 and 94%, and benzodiazepines 6 and 72%. The specificity of OF tests and urinalysis were, respectively, for opiates 78 and 67%, methadone 90 and 95%, and benzodiazepines 95 and 96%. Amphetamine usage was rare.

CONCLUSIONS: OF testing is as accurate as urinalysis in detecting the presence of opiates and methadone, and the absence of methadone and benzodiazepines.

Orapoint Advance Oral Fluid Drug Screening Technology http://www.navigent3.com

via Is oral fluid analysis as accurate as urinalysis i… [Drug Alcohol Depend. 2003] – PubMed result.

Study Finds Oral Fluid Drug Test Results Comparable to Urine Testing
December 2008

According to a recent large-scale study, laboratory-based oral fluid drug testing results are comparable to urine drug testing positive rates for the same classes of drugs. Results of the study, which was sponsored by the U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration, were presented by J. Michael Walsh, Ph.D., on October 29 at the annual meeting of the Society of Forensic Toxicologists in Phoenix.

THC Detection

First and forement, devices / techniques must screen for THC-delta-9 in oral fluid NOT THC-COOH and/or delta-11, etc. The latter is a metabolite found only in urine at any level that can be commonly detected, the former is the active ingreadient of marijuna and found in oral fluid.

Detection of THC-delta-9 in oral fluid has repeatedly been demonstrated to be possible from connsumption… up to 24 hours post consumption.

The following is one of several references available on this topic:

Relationship of (9)-tetrahydrocannabinol concentrations in oral fluid and plasma after controlled administration of smoked cannabis byHuestis MA, Cone EJ.Intramural Research Program,National Institute on Drug Abuse, National Institutes of Health,Baltimore, Maryland 21224. J Anal Toxicol. 2004 Sep;28(6):394-9

ABSTRACT
Understanding the relationship of (9)-tetrahydrocannabinol (THC) concentrations in oral fluid and plasma is important in interpretation of oral fluid test results. Current evidence suggests that THC is deposited in the oral cavity during cannabis smoking. This “depot” represents the primary or sole source of THC found when oral fluid is collected and analyzed. In this research, oral fluid and plasma specimens were collected from six subjects following smoking of cannabis cigarettes containing 1.75% and 3.55% THC. There was at least one week between each cannabis administration. Plasma specimens were analyzed by gas chromatography-mass spectrometry (GC-MS) and paired oral fluid specimens were analyzed by radioimmunoassay (RIA). In addition, one individual’s oral fluid specimens were also analyzed by GC-MS. These data are unique in that they represent simultaneous or near simultaneous collection of oral fluid and plasma specimens in subjects following controlled cannabis dosing. The first oral fluid specimen, collected from one subject at 0.2 h following initiation of smoking, contained a THC concentration of 5800 ng/mL (GC-MS). The similarity in oral fluid and plasma THC concentrations following the dissipation of the initial “contamination” indicates the likelihood of a physiological link between these specimens. Recent studies have shown that sublingual or transmucosal administration of pure THC results in direct absorption of intact THC into the bloodstream, thereby bypassing the gastrointestinal tract. The current study demonstrates that THC is deposited in the oral cavity and remains for up to 24 h following cannabis smoking. The decline in THC oral fluid concentration over this time suggests that there may be absorption of THC into blood as previously shown with pure THC. Passive cannabis exposure studies appear to indicate that positive oral fluid tests for THC can occur shortly after cannabis smoke exposure, but results were negative within 1 h. Consequently, when very recent passive exposure to cannabis smoke can be ruled out, it is concluded that a positive oral fluid test provides credible evidence of active cannabis use.

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