Drug Free Workplace Policy & Program - KnowledgeBase

Drug Abuse Epidemic in Massachusetts – The Boston Globe

pcholakis — Sun, 08 Nov 2009 01:54:58 +0000

Drug use called epidemic in Mass.

OxyContin, heroin imperil public health.

November 6, 2009

Abuse of OxyContin and heroin in Massachusetts has reached epidemic levels and must be attacked with the same fervor now being directed toward controlling the H1N1 flu virus, a special state commission said yesterday.

“The Commonwealth is in the midst of a serious and dangerous epidemic,’’ the panel, known formally as the Massachusetts OxyContin and Heroin Commission, said in a 71-page report released yesterday at the State House.

“The Commonwealth is losing men and women on its streets at a rate of 42 to 1, compared to what the state is losing in two wars overseas,’’ the panel said in its executive summary.

“Addiction is a medical disorder, and we have a public health epidemic on our hands that is larger than the flu pandemic.’’

The report compared the number of US service men and women from Massachusetts killed in Iraq or Afghanistan and the number who died from overdosing on one or both of the drugs between 2002 and 2007. During those years, 78 service people lost their lives while 3,265 died from drug-related causes, the panel found.“We have a health crisis here,’’ said state Senator Steven Tolman, who chaired the commission.

“None of them [addicts] want to be sick. You could have a son or a daughter who was brought up properly with all the morals and values, and, when they get hooked on the stuff, it doesn’t matter; it’s all out the window.’’

Berkshire District Attorney David F. Capeless, a commission member, said prosecutors believe that fighting substance abuse will reduce crime.

“The district attorneys realize that those who suffer from substance abuse need treatment,’’ Capeless said in a telephone interview. “But those who would propagate it in hopes of profiting from it, the dealers, need treatment of a different sort. They get incarceration.’’

The panel made 20 recommendations, including:

■Strengthen the existing prescription-monitoring program so that public health officials learn more quickly about patients collecting multiple prescriptions for the same drug and about doctors who appear to be writing more prescriptions than necessary.

■ Limit criminal sanctions against substance abusers who seek medical help for using illegal drugs and create a Good Samaritan law to shield anyone helping drug users in trouble get to a hospital before they die.

■Increase support for the three “recovery high schools,’’ where teenage substance abusers recover in a supportive educational, age-appropriate environment. The schools are in Boston, Beverly, and Springfield.

■Invest in substance abuse diversion programs that steer the addicted away from costly prisons into less expensive recovery programs.

“If the H1N1 virus killed 3,000 people in a five-year period in Massachusetts, the crisis would be center stage,’’ the commission found. “Because of the stigma surrounding substance abuse, this epidemic is left in the shadows.’’

Speaking for Governor Deval Patrick’s administration, Michael Botticelli of the Department of Public Health said the agency is planning to launch a pilot jail diversion program this year.

“What we are anticipating is that this would actually be cost effective for the Commonwealth,’’ he said. It costs $45,000 a year to incarcerate someone, he said. “The cost of treatment is dramatically lower.’’

In 2007, there were 105,552 admissions to DPH-funded substance abuse programs in Massachusetts, and the total spent during fiscal 2005 on substance abuse and addiction in the justice system was $1.084 billion, equal to 5.3 percent of the state budget, the commission said.

Capeless said he and other commission members know that increasing public support for noncriminal solutions to prescription and heroin drug abuse will not be easy.

“But it can happen to anybody, to any family, whether a big city, or rural, whatever economic status, region, or socioeconomic status,’’ he said. “We’ve heard from people from all walks of life.

“And unfortunately, they tell the same sad story,’’ Capeless said. “We are hoping to reach people before it happens.’’

ORAPOINT ADVANCED ORAL FLUID DRUG SCREENING TECHNOLOGY WWW.NAVIGENT3.COM

via Drug use called epidemic in Mass. – The Boston Globe.

Oral Fluid Confirmatory Testing – Proficiency Testing

pcholakis — Sat, 07 Nov 2009 01:09:50 +0000

ConclusionThis is the first external quality assessment scheme for drugs of abuse testing in oral fluid, which employs unstimulated oral fluid, treated only with sodium azide and acidic buffer.Looking at the global results obtained in this proficiency testing for drugs of abuse in oral fluid, a satisfactory performance of laboratories has been obtained taking into account that some of the laboratories participating in ORALVEQ are not specifically experienced in analyzing oral fluid. Nevertheless, they should be prepared to apply also to oral fluid the analytical methods developed and validated for the screening and confirmation of drugs of abuse in other matrices.In the screening tests, no false-negative results were reported and the false-positives could be related to the interference of the diluted oral fluid with one of the immunoassays used. With respect to confirmation analyses, the number of false-positive was considerable but they were reported by a reduced number of laboratories. Finally, concerning quantitative results, the scatter of results was quite high but this was due primarily to the few outlying values which were included since applying robust statistics.

via ScienceDirect – Forensic Science International : ORALVEQ: External quality assessment scheme of drugs of abuse in oral fluid : : Results obtained in the first round performed in 2007 .

ORALVEQ: External quality assessment scheme of drugs of abuse in oral fluid: Results obtained in the first round performed in 2007

M. Ventura^a^,^b, R. Ventura^a^,^c, S. Pichini^d^,^,, S. Leal^a, P. Zuccaro^d, R. Pacifici^d, K. Langohr^e^,^f and R. de la Torre^c^,^e

^aGrup de Recerca en Bioanàlisi i Serveis Analítics, Programa de Recerca en Neuropsicofarmacologia, IMIM-Hospital del Mar, Barcelona, Spain

^bUDIMAS, Universitat Autónoma de Barcelona, Barcelona, Spain

^cCEXS, Universitat Pompeu Fabra, Barcelona, Spain

^dDepartment of Drug Research and Medicine Evaluation, Istituto Superiore di Sanità, V.le Regina Elena 299, 00161 Rome, Italy

^eGrup de Recerca Clínica en Farmacologia Humana i Neurociències, Programa de Recerca en Neuropsicofarmacologia, IMIM-Hospital del Mar, Barcelona, Spain

^fDepartament d’Estadística i Investigació Operativa, Universitat Politècnica de Catalunya, Spain

Received 14 August 2008;

revised 22 September 2008;

accepted 23 September 2008.

Available online 11 November 2008.

Abstract

The Institut Municipal d’Investigació Mèdica IMIM-Hospital del Mar (Barcelona, Spain) in cooperation with the Istituto Superiore di Sanità (Rome, Italy) organized an external quality assessment scheme to assess the reliability of analytical laboratories when analyzing drugs of abuse in oral fluid (ORALVEQ). For the first round of ORALVEQ, performed in February 2007, three different samples (S1, S2 and S3) were sent to 21 participating international laboratories. S1 was a blank sample and S2 and S3 were prepared by addition of drugs at known concentrations to pre-screened drug-free oral fluid (containing sodium azide) and diluted up to 50% with acidic buffer. S2 contained 6-monoacetyl morphine, morphine, cocaine and benzoylecgonine and S3 contained 3,4-methylendioxymethamphetamine and 3,4-methylendioxyamphetamine. Results were evaluated from a qualitative and quantitative point of view. Whereas only half laboratories performed screening analysis, all of them reported a quantitative result for almost all analytes. Eighteen false-positive and 3 false-negative results were reported by 8 (from a total of 21) laboratories. The quantitative evaluation was performed measuring dispersion (% coefficient of variation, CV%) and accuracy (% error, ERR%) of results and calculating the z-score values (using robust statistics). ERR% between 2% and 20% and CVs% around 40% were obtained for all analytes. In terms of z-score, a high percentage of adequate results (between 85 and 95%) was obtained. In general, the participating laboratories had a satisfactory performance. The number of false-negatives reported was very low, the false-positives were reported by a reduced number of laboratories and the scatter in the quantitative results was principally due to a few outlying values; since applying robust statistics, there was no rejection of outliers.

Keywords: Oral fluid; Drugs of abuse; External quality assessment scheme

Article Outline

1. Introduction
2. Experiments 2.1. Materials 2.2. Methods
3. Results
4. Discussion
5. Conclusion
Acknowledgements
References

1. Introduction

Oral fluid is a promising biological matrix for the analysis of drugs of abuse and, together with hair and sweat, a non-invasive specimen alternative, to blood and urine [1]. Oral fluid has several advantages over conventional biological fluids: its collection is simple and non-invasive and can be done under direct supervision to prevent sample adulteration, substitution and dilution. For this reason, in the last years, oral fluid has become an important analytical tool in clinical and forensic toxicology. A large number of studies have been conducted on the key issues in oral fluid drug testing [2], [3] and [4], including the improvement and refinement of collection devices [5], [6], [7] and [8] and the development of more sensitive analytical techniques for onsite detection of drugs of abuse and subsequent confirmation by chromatographic techniques [9] and [10]. Furthermore, oral fluid testing for drugs of abuse has been proposed in Federal Workplace Drug Testing Programs Guidelines by the Substance Abuse and Mental Health Services Administration (SAMHSA) in the U.S. [11] and in Driving Under the Influence of Drugs (DUID) International Laws [12]. Subsequently, the number of international analytical laboratories routinely using oral fluid testing for drugs of abuse has increased in the last years.

Results provided by these laboratories need to be error-free since they can be used to take clinical and/or medical legal decisions. Hence, quality assurance of the results must be the prime objective of any analytical laboratory and the evaluation of laboratory performance through external quality assessment schemes (EQAS or proficiency testing) is recommended [13]. The guidelines issued by SAMHSA, among initial mandatory requirements for a laboratory applicant to Workplace Drug Testing Programs, include the participation to EQAS [11].

To our knowledge, only one EQAS was organized in 2005 with samples collected with the Intercept oral fluid collection device [14].

During 2007, the Institut Municipal d’Investigació Mèdica IMIM-Hospital del Mar (Barcelona, Spain) in cooperation with the Istituto Superiore di Sanità (Rome, Italy) organized an external quality assessment scheme for drugs of abuse testing in oral fluid (ORALVEQ) to assess the reliability of analytical laboratories when analyzing drugs of abuse in oral fluid and the applied methodological approaches. Twenty-one laboratories (seventeen European and four American) participated in ORALVEQ, and the results reported are detailed and discussed in this paper.

2. Experiments

2.1. Materials

Three different samples (S1, S2 and S3) were prepared and sent to the participating laboratories. Samples were prepared with unstimulated oral fluid collected from healthy volunteers, pooled after centrifugation to remove the mucous part and analyzed to verify the absence of interfering substances using standardized methodologies [15]and [16]. S1 was a blank sample and S2 and S3 were prepared by addition of drugs at known concentrations to drug-free oral fluid. S2 contained 300 ng/ml of 6-monoacetyl morphine (6-MAM), 800 ng/ml of morphine (MOR), 200 ng/ml of cocaine (COC) and 150 ng/ml of benzoylecgonine (BZE) and S3 contained 800 ng/ml of 3,4-methylendioxymethamphetamine (MDMA) and 150 ng/ml of 3,4-methylendioxyamphetamine (MDA). The analytes and their concentration present in the samples were selected according to oral fluid concentrations previously found in authentic samples from potentially intoxicated drivers [17]. The samples were prepared by spiking drug-free oral fluid (containing 0.1% sodium azide as preservative) with the analytes and diluted up to 50% with acidic buffer (0.1 M citric acid, 0.1 M sodium citrate, water, 33:17:50, v/v/v) at pH 4 [18]. The samples were mixed and distributed in 4 ml aliquots in Nunc-cryotubes TM (Nange Nunc International, Rochester, NY). For sample S2 and S3, two aliquots of eight tubes taken at the beginning, in the middle and at the end of the aliquoting procedure were analyzed using validated gas-chromatographic mass-spectrometric techniques [15] and [16] to verify samples’ content and homogeneity, and were found to be homogeneous. The rest of the tubes were stored at −20 °C until sending them to the ORALVEQ laboratories at room temperature [18]. Three international reference laboratories verified samples content; they also found the different aliquots coming from tubes taken at the beginning, in the middle and at the end of the aliquoting procedure to be homogeneous for all analytes contained in S2 and S3.

2.2. Methods

Participating laboratories were informed about the groups of substances that could possibly be present in the samples (amphetamine (AMP)/methamphetamine (MA), MDMA/MDA, COC/BZE and/or MOR/6-MAM) and were suggested to apply the cut-off concentrations for oral fluid specimens recommended by SAMHSA [11].

Results were evaluated from a qualitative and quantitative point of view. The qualitative evaluation was done calculating false-negative and false-positive findings. The quantitative performance of each laboratory was carried out calculating the z-score value such as: z-score = (x − X)/σ, where x was the individual laboratory’s value, X was the robust mean obtained by participating laboratories and σ the robust standard deviation obtained by participating laboratories. Robust mean and robust standard deviation were calculated following the International Standard ISO 13528: Statistical methods for use in proficiency testing by interlaboratory comparisons [19]. Criteria for classifying quantitative results on the basis of their z-score, were as follows: |z| ≤ 2 for satisfactory results, 2 < |z| < 3 for uncertain results and |z| ≥ 3 for unsatisfactory results. For each analyte, dispersion and accuracy of the results reported by participating laboratories were also measured. Dispersion was expressed as coefficient of variation (CV%) calculated using robust mean and robust standard deviation of participating laboratories and accuracy was measured as a standard error (ERR%) referred to the concentration reported by the reference laboratories.

3. Results

Twenty-one (seventeen European and four American) laboratories (including the three reference laboratories) participated in the first round of ORALVEQ. Regarding the analytical approach applied by laboratories, only 13 of the 21 laboratories (62%) performed screening of the samples using immunological methods. Enzyme-Linked Immunosorbent Assay—ELISA was the immunological method most applied by laboratories for all groups of substances (around 60%), followed by Cloned Enzyme Donor Immunoassay—CEDIA (around 30% for amphetamines and opiates and 23% for cocaine), Fluorescence Polarization Immunoassay—FPIA (around 8%) and Enzyme Multiplied Immunoassay—EMIT (around 8% for opiates and cocaine and not use for amphetamines). Approximately half of these laboratories used the screening cut-off concentrations recommended by SAMHSA [11], while the others applied either cut-off values suggested by assay manufacturer for urine samples or cut-off values established previously in their own laboratories during method development. All the 21 laboratories reported quantitative results for 6-MAM, MOR and COC, 19 laboratories for MDMA and BZE and 18 laboratories for MDA. One laboratory reported two values for each analyte using two different methodologies, rendering a total of 22 values for some analytes.

Summary of the analytical approaches applied by the participating laboratories in the confirmation (identification/quantification) analysis is reported in Table 1.

Table 1.

Summary of analytical approach applied by ORALVEQ laboratories in the confirmation (identification/quantification) analyses.

	Internal standard (% labs)			Extraction (% labs)			Analytical technique (% labs)			Cut-off concentration (% labs)
	No	Deuterated	Non-deuterated	No	L-L ^a	SPE ^b	GC–MS	LC–MS	LC–MS/MS	<^c	SAMHSA Recommended ^d	>^e
Amphetamine	5	65	30	10	50	40	67	5	28	30	70	–
Methamphetamine	5	65	30	10	50	40	67	5	28	30	70	–
MDMA	5	65	30	10	50	40	67	5	28	30	70	–
MDA	5	65	30	10	50	40	67	5	28	30	70	–

6-MAM	–	64	36	9	18	73	65	4	31	29	47	24
Morphine	–	64	36	9	18	73	65	4	31	38	62	–

Cocaine	–	59	41	9	23	68	65	4	31	33	48	19
Benzoylecgonine	–	59	41	9	23	68	65	4	31	29	42	29

Full-size table

^a Liquid/liquid extraction.
^b Solid/liquid extraction.
^c % of laboratories using a cut-off concentration below the one recommended by SAMHSA.
^d % of laboratories using the SAMHSA recommended cut-off concentration.
^e % of laboratories using a cut-off concentration above the one recommended by SAMHSA.

Internal standards (deuterated analogues in 60% of the cases) were always used to quantify 6-MAM, MOR, COC and BZE. For amphetamines, all the participants except one used internal standard when analyzed the samples and 65% used the deuterated analogues of the analytes. Seventy percent of the labs used the SAMHSA cut-off concentrations to confirm amphetamines and around 50% for the rest of the analytes [11]. For both 6-MAM/MOR and COC/BZE approximately 70% of the labs used solid phase extraction (SPE), and 40% for amphetamines. 10% of the participating laboratories did not report the applied extraction procedure. Gas chromatography coupled to mass spectrometry (GC–MS) was the most used analytical technique (approximately 70% of the labs), followed by liquid chromatography coupled to tandem mass spectrometry (LC–MS/MS) (approximately 30% of the labs) and liquid chromatography–mass spectrometry (LC–MS, 5% of the labs).

Some erroneous qualitative results were reported in the screening and confirmation analyses of the samples (Table 2). In the screening tests, performed by 13 laboratories, no false-negatives were found and a total of 10 false-positive results were reported by 2 laboratories: 5 false-positive results for S1 (the blank sample), 2 for S2 and 3 for S3. Regarding the confirmation tests, a total of 3 false-negative and 8 false-positive results were reported: 2 false-negatives in S2 and 1 in S3, 4 false-positives in S1 and 4 in S3 and of note, the 8 false-positive results were reported by 3 of the 21 laboratories (14%).

Table 2.

Qualitative composition of samples and false-negative and false-positive findings.

Sample	Qualitative content	AMPHETAMINE CLASS					OPIATES			COCAINE			TOTAL
		SCR ^a	AP	MA	MDMA	MDA	SCR ^a	6-MAM	MOR	SCR ^a	COC	BZE	SCR ^a	CONF ^b
False-negative findings
S1	–	–	–	–	–	–	–	–	–	–	–	–	–	–
S2	6-MAM, MOR, COC, BZE	–	–	–	–	–	0	0	0	0	0	2	0	2
S3	MDMA, MDA	0	–	–	0	1	–	–	–	–	–	–	0	1

False-positive findings
S1	–	2	0	0	0	0	1	2	0	2	1	1	5	4
S2	6-MAM, MOR, COC, BZE	2	0	0	0	0	–	–	–	–	–	–	2	0
S3	MDMA, MDA	–	0	0	–	–	1	0	1	2	1	2	3	4

Full-size table

–: Not applicable.

^a SCR: screening analysis.
^b CONF: confirmation analysis: identification/quantification.

False-negative and false-positive results came from a total of 5 laboratories, with one laboratory giving either FN and FP results, other two laboratories false-negatives and the last two the false-positive results.

The majority of laboratories reported quantitative results (Table 3). ERR%, measured with respect to the concentration reported by reference laboratories, were approximately 5% for MOR and MDA and approximately 20% for 6-MAM, COC, BZE and MDMA. CVs% of participating laboratories, calculated using robust mean and robust standard deviation, were around 40% for all the analytes studied. In case of reference laboratories (n = 3) the CVs were below 10% for all analytes except for BZE (12.9%).

Table 3.

Summary of quantitative results reported by ORALVEQ laboratories in S2 and S3.

	6-MAM		MOR		COC		BZE		MDMA		MDA
	Reference ^a	Participant ^b	Reference ^a	Participant ^b	Reference ^a	Participant ^b	Reference ^a	Participant ^b	Reference ^a	Participant ^b	Reference ^a	Participant ^b
Mean ^c	281.0	221.9	692.4	709.2	188.1	226.3	163.7	132.2	800.5	960.7	147.6	156.0
CV%^d	6.3	53.2	2.7	41.1	5.5	44.9	12.9	48.9	8.9	44.4	4.9	39.3
ERR%^e	–	21.0	–	2.4	–	20.3	–	19.2	–	20.0	–	5.7
N ^f	3	19	3	19	3	19	3	17	3	17	3	16
Satisfactory results ^g	–	95	–	95	–	89	–	88	–	88	–	94

Full-size table

^a Reference laboratories.
^b Participating laboratories.
^c Robust mean.
^d Coefficient of variation (%) = (robust S.D./robust mean) × 100.
^e Standard error (%) = ((robust mean − reference laboratories mean)/reference laboratories mean) × 100.
^f Number of quantitative results.
^g Percentage of satisfying results in terms of z-score (z ≤ 2).

A high percentage (between 85 and 95%) of satisfactory results, in terms of z-score, was obtained for all analytes and no differences were observed between the global trend of the quantitative results obtained by laboratories using GC–MS and those using LC–MS/MS.

Concentrations reported by ORALVEQ laboratories (reference and participating laboratories) for 6-MAM and MOR, for COC and BZE and for MDMA and MDA are presented in Fig. 1, Fig. 2 and Fig. 3, respectively.

Full-size image (38K)

Fig. 1. Oral fluid concentrations reported by ORALVEQ laboratories for 6-MAM (A) and MOR (B) in S2 joined by analytical techniques (LC–MS, LC–MS/MS and GC–MS). Mean of reference laboratories indicated by a black line.

Full-size image (40K)

Fig. 2. Oral fluid concentrations reported by ORALVEQ laboratories for COC (A) and BZE (B) in S2 joined by analytical techniques (LC–MS, LC–MS/MS and GC–MS). Mean of reference laboratories indicated by a black line.

Full-size image (39K)

Fig. 3. Oral fluid concentrations reported by ORALVEQ laboratories for MDMA (A) and MDA (B) in S3 joined by analytical techniques (LC–MS, LC–MS/MS and GC–MS). Mean of reference laboratories indicated by a black line.

4. Discussion

An important achievement of this first ORALVEQ round was that all the participating laboratories sent back the results. Of note, some of these laboratories do not routinely analyze oral fluid samples and had to re-apply to oral fluid and re-validate analytical methods developed and validated for screening and confirmation (identification/quantification) of drugs of abuse in other matrices, e.g. hair.

Only half of the laboratories performed screening tests prior to applying confirmatory analytical methods. This was probably caused by two factors: participating laboratories had been informed of the groups of substances that could be present in the samples and, at present time, the immunological methods available for the screening of drugs of abuse in oral fluid are scarce. This latter finding was also observed in the external quality assessment scheme (HAIRVEQ) we organized for drugs of abuse testing in hair [20].

All laboratories used cut-off concentrations to assess the presence or absence of a drug both in screening and in confirmation analyses; even if the cut-off concentrations recommended by SAMHSA were not applied for the all analytes [11], the cut-off values established by local medical commissions or internally by laboratory itself were applied instead.

In the confirmation analyses, all laboratories used chromatographic techniques coupled to mass spectrometry. Inadequate methodologies, implying other than mass spectrometric detection reported for HAIRVEQ [21], were not used by ORALVEQ laboratories.

While the number of false-negatives reported was very low (only 3 false-negatives), it has to be recognized that a significant number of false-positive results was reported: 10 false-positives in screening tests and 8 in confirmation analysis. One possible explanation for the false-positive results reported in screening tests, as suggested by one of the reference Laboratories, could have been the interference of the acidic pH used to dilute oral fluid samples with the performance of one of the used immunoassay. The dilution with acidic buffer was necessary to avoid the hydrolysis of the ester bonds of cocaine and 6-MAM to benzoylecgonine and morphine, respectively [18] and [22]. The number of false-positive results in the confirmatory tests was quite high as well, but on a positive note, those erroneous results were reported by a reduced number of laboratories (3 out of 21). Both in case of false-negative and false-positive results, of note, these were reported by laboratories commonly engaged in drug testing in conventional and non-conventional matrices for clinical and medicolegal purposes. Moreover, before the starting of ORALVEQ first round, participating laboratories were specifically asked if they were prepared to analyze oral fluid samples.

A high number of laboratories reported quantitative results for all the analytes present in the samples. The accuracy of results was quite good (ERR% never above 20%), but at the same time the dispersion was quite high (CV% always around 40%), probably due the presence of outliers; since applying robust statistics, no outliers were rejected but as an alternative to rejection they were given less weight. Indeed, CV% of reference laboratories were quite low for all analytes. Nevertheless, CV% obtained in this first round of ORALVEQ were similar to the ones found by Clarke and Wilson in the EQAS organized in 2005 with both oral fluid samples collected with the Intercept oral fluid collection device and samples prepared by dilution with the Intercept negative calibrator for oral fluid testing [14].

On the other hand, when comparing the accuracy and dispersion found for ORALVEQ samples with the ones obtained in proficiency testing programs for the analysis of drugs of abuse in another alternative matrix such as hair [21] and [23], the ERR% and the CV% found in ORALVEQ are much better. This is an expected, logical outcome taking into account that hair analyses require a more complex sample preparation (washing and digestion) than oral fluid.

Concerning z-score values, the high percentage of satisfactory results maybe due to the use of robust statistics, which takes into consideration all the results including outliers (even though with less weight), in the calculation of mean and S.D. [19].

Drug Abuse is Iowa 2010 Study

pcholakis — Tue, 03 Nov 2009 14:03:19 +0000

Advanced OraPoint Drug Screening Technology www.navigent3.com via IowaPolitics.com.

The 2010 Iowa Drug Control Strategy shows marijuana and methamphetamine are the two most abused illicit drugs in the State. Overall, alcohol, which is legal for Iowans over the age of 21, continues to be the substance most frequently abused by Iowans. The report also says medicine abuse appears to be on the rise.

“Based on primary substance abuse treatment admission data from the Iowa Department of Public Health, alcohol accounts for about 61 percent of all clients, followed by 23 percent who are there primarily for marijuana and almost eight percent mainly for meth,” said Gary Kendell, Iowa’s Drug Policy Coordinator and Director of the Governor’s Office of Drug Control Policy. “All available evidence indicates more Iowans are abusing prescription and over-the-counter drugs too.”

Kendell presented Iowa’s new drug control strategy Monday to White House Office of National Drug Control Policy Director R. Gil Kerlikowske, during a Roundtable discussion with officials at the Iowa Capitol in Des Moines. Kerlikowske is in Iowa, gathering input for the Obama Administration’s first National Drug Control Strategy, due to be released early next year.

“Coordination at all levels and across borders is required to reduce drug abuse and related issues such as crime, and I’m pleased Director Kerlikowske has come to Iowa to listen as state and local officials share experiences that may relate to the national drug control plan,” said Kendell.

Iowa’s strategy, developed in coordination with the State’s Drug Policy Advisory Council, calls for a balance of substance abuse prevention and treatment programming, and drug enforcement.

Medicine abuse continues to emerge as Iowa’s fastest growing form of substance abuse, based on reports from treatment centers and others. The Iowa Division of Narcotics Enforcement opened 243 percent more pharmaceutical cases and seized 412 percent more pharmaceutical units last year, compared to the year before when it reported large increases from the previous year. Another indicator of the growth in medicine abuse is the 1,225 percent increase since 2002 in public calls to the Statewide Poison Control Center to identify Hydrocodone and Oxycodone pain pills.

via IowaPolitics.com.

Kentucky Ranks No. 1 In Drug Abuse

pcholakis — Tue, 03 Nov 2009 13:59:53 +0000

From Orapoint Advanced Oral Fluid Drug Testing Technology www.navigent3.com via WLKY Investigates: Why Ky. Ranks No. 1 In Drug Abuse – Louisville News Story – WLKY Louisville.

The Commonwealth leads the nation in prescription drug use for non-medical purposes.

Last week, an investigation into interstate pill smuggling led to hundreds of arrests in Kentucky.

Prescription drug abuse leads to crime. Just ask Pat Fogarty.

“It’s been about a 10-year battle for me,” said Fogarty, a recovering drug abuser.

A judge ordered Fogarty to get help at Louisville’s Healing Place. Fogarty has spent time in jail for theft and other crimes related to his prescription drug abuse.

“I’ve stolen from my mom numerous times. She’d think I got sober, let me back in her life and I’d keep doing it. It didn’t matter. I did whatever it took to get money,” explained Fogarty.

Fogarty said he’s been clean for a year. He explained the various ways prescription drugs are readily available. He said some abusers doctor shop, or go from physician to physician to get painkillers. Others, he said, buy them on the streets.

The figures for Kentucky back up his claim.

“Thirty-two counties all across the state saw a 20 percent increase in the amount of drugs prescribed,” said Van Ingram from the Kentucky Office of Drug Control Policy.

The counties with the highest increase in prescription drugs from 2005 to 2007 were Carroll County, with nearly 42 percent, and Hancock County, with just over 54 percent.

Jefferson County jumped 18.5 percent during that time.

Arrests more than doubled during that time period. Metro police make prescription drug busts on a weekly basis. People call in phony prescriptions, steal prescription blanks, or change ones they get from doctors.

Last month, Martha Rowland was given a two-year prison sentence on a 2008 prescription drug case. Six weeks before her sentencing, she was arrested again on prescription fraud charges.

Prescription drugs are also the chief reason unintentional overdose deaths doubled over a five-year period in Kentucky.

“You know, we had 485 overdose deaths in Kentucky in 2008,” said Ingram.

Some of them were young people who got the drugs at home.

“People really need to be aware that their prescriptions can be pilfered in their own home,” said pharmacist Art Jacob.

That’s why authorities say drug toss events like one held in October are important.

“No. 1, just remove the access and ability for them to be diverted to the illegal market,” said Louisville Metro Police Department Sgt. John McGuire.

Fogarty said because the addiction is strong, so is the drive to feed the habit.

“Addicted for a decade and I’m pretty strong-willed person. I consider myself pretty strong-willed. The drive took over. It became my god,” said Fogarty.

Fogarty is now trying to help others kick their habit.

The First Line Of Defense

Kentucky has a state of the art system for tracking prescription drugs, especially controlled substances.

Last week, law enforcement authorities fanned out across eastern Kentucky searching for hundreds of people in a major investigation into interstate pill smuggling.

State police said many illegally obtained prescription drugs are coming from Florida.

It’s just one pipeline to the Commonwealth authorities are trying to plug.

“These pain killers are very powerful,” said Ingram.

“It’s not a drug like crack cocaine you can get on a street corner. But, you get to know certain people and network,” said Fogarty.

The addicts and suppliers come from all walks of life. Laura Ford is a nurse practitioner. Last month she was arrested on charges she forged prescriptions. Police said she was attempting to get Lortab.

Most young people, who died from drug overdoses in Kentucky last year did so with prescription drugs. That’s why its important to keep track of what you have in the medicine cabinet.

Hydrocodone drugs like Lortab, Lorcet, and Vicodin made up 46 percent of all controlled substances prescribed in Kentucky in the second quarter of this year.

Oxycodone drugs made up 16 percent.

“The only thing a doctor is, is a licensed drug dealer as simple as that and that has to be stopped,” said family practitioner Dr. Praveen Arla.

Arla said all physicians should be using KASPER, the Kentucky All Schedule Prescription Reporting System. All pharmacies in the state input information in the system.

“In a matter of minutes we can get a report on KASPER on a patient we suspect has been using drugs,” said Jacob.

“Out of 14,000 prescribers in Kentucky, only 26 percent of them have KASPER accounts to even access the data,” said Ingram.

Ingram said with KASPER, physicians can easily tell if their patients have been doctor shopping.

Guidelines won’t let police get on KASPER unless they have an active investigation.

Arla and his son, a physician, are teaming up with Bullitt County authorities to help, especially when it comes to youngsters.

“Right now as you look everyone is working as individuals and not together. I think the concept of the doctor and sheriff is really to get inside and help each other,” said Arla.

Doctor recalls journey through painkiller addiction

pcholakis — Mon, 02 Nov 2009 00:25:29 +0000

According to the U.S. Drug Enforcement Administration, opioid pain relievers, such as hydrocodone and oxycodone, cause more overdoses than cocaine and heroin combined.

When Michael Metzger forged himself prescriptions for the painkiller OxyContin, he was working more than 65 hours a week as a doctor, caring for patients who were often suffering from the chronic pain such drugs are meant to soothe.

“I was self-medicating, being overwhelmed both physically and emotionally with work. I think that’s what happens with most people. They’re not planning on becoming an addict,” Metzger said.

Over a period of years, self-medicating with prescription painkillers had become Metzger’s only method of coping with the long hours and stress of patient care. But the painkillers left him in anguish, unbearably alone and trapped in a dangerous dependence.

“The worst moment is when I think you realize that you are emotionally, physically and chemically addicted. There’s the feeling of not being able to survive without the drug, and physically you really can’t,” Metzger said.

In 2008, Metzger found an escape from his addiction when he was caught and charged with the felony offense of prescription fraud for forging another doctor’s signature on prescriptions.

He was lucky. That deeply embarrassing intervention is perhaps the only reason he’s now clean and alive – unlike at least 321 Montanans last year whose deaths were associated with the abuse of prescription drugs.

“My knowledge of people with addiction is that they won’t stop,” Metzger said. “It’s not something they will voluntarily stop. They will only stop if there’s a crisis.”

Last year’s death toll from prescription drug overdoses is a 30 percent jump from 240 in 2007, with the figures covering fatalities related to 19 prescription drugs.

OraPoint Advanced Oral Fluid Drug Testing Technology www.navigent3.com

via Doctor recalls journey through painkiller addiction.

Jacksonville 39 out of 40 in safety – Jacksonville Business Journal:

pcholakis — Sat, 31 Oct 2009 17:02:46 +0000

Jacksonville was second-to-last in a ranking of the safety of the 40 largest cities in the country by Forbes magazine. Only Miami was more dangerous.

The rankings are based on a city’s levels of violent crime, workplace fatality rates, traffic death rates and natural disaster risk.

The Jacksonville metro area ranked 30th in natural disaster risk, and that was the best showing in any of the four categories. The area was 35th for workplace fatalities, 37th for violent crime and 39th for traffic death rates.

Minneapolis-St. Paul ranked No. 1 scoring high in all categories. Portland, Ore., ranked third, and Boston and Seattle tied for fourth in Forbes’ rankings.

OraPoint Advanced Oral Fluid Drug Tests www.navigent3.com

via Jacksonville 39 out of 40 in safety – Jacksonville Business Journal: .

Dept. of Labor: Workplace accidents, deaths, on the rise

pcholakis — Sat, 31 Oct 2009 17:01:05 +0000

Dept. of Labor: Workplace accidents, deaths, on the rise

by JESSICA MACHETTA on OCTOBER 30, 2009

in BUSINESS

An average of nine Missourians are killed on the job per month. In September, that number jumped to 15. The Department of Labor is pointing to tough economic times as the reason for the increase.

The Department says the majority of workplace fatalities are in the construction and agricultural industries.

Amid a recent spike in injuries and deaths, the department is urging businesses to take advantage of its Safety and Health Achievement Recognition Program — or SHARP — which offers safety consultants at no cost.

Junior Dietzel, owner of Bee Seen Signs in Central Missouri, says losing a friend to a fall in Springfield hit home. That’s when he started writing safety programs and getting involved with SHARP in the early ’90s.

“We wanted to retain quality people, and a safe work environment is part of what it takes to do that,” he says.

Dietzel says the SHARP program has also helped reduce workers’ compensation premiums and general liability insurance.

“That savings goes a long way, especially for a small business like ours,” Dietzel says.

The Department of Labor says the manufacturing industry is considered a high-risk industry when it comes to workplace safety. It is typical for workers to suffer eye injuries, cuts from sharp edges, contusions from objects falling, back injhuries and a lot of slips, tripsand falls if the employer does not take the steps necessary to protect the employees from injuries. In 2009, more than 12,517 injuries and 15 deaths were reported to the Department from the manufacturing industry.

Recent deaths have been linked to transportation and public utilities, to retail trade and construction.

Advanced OraPoint Oral Fluid Drug Tests www.navigent3.com

via Dept. of Labor: Workplace accidents, deaths, on the rise.

Treatment is Key to Drug Abuse

pcholakis — Sat, 31 Oct 2009 14:16:25 +0000

Addiction is a major contributor to the Oklahoma criminal justice system. The top two crimes resulting in incarceration are distribution of drugs (16.2 percent of inmates) and possession of drugs (11.6 percent). More than half of the state’s prisoners are incarcerated for nonviolent offenses. Most of the violent crimes in Oklahoma are committed by those under the influence of drugs and alcohol.

This wasn’t the first time the Legislature’s been advised of the economic and social benefits of investing in treatment. State Secretary of Health Terry White, also director of the Department of Mental Health and Substance Abuse Services, has long extolled the benefits of investment in treatment.

In this economic downturn state officials may believe that investing in more treatment for drug addiction is an extraneous expense. It’s not. Such investments actually save money. Cox is right on the money.

OraPoint Advanced Oral Fluid Drug Tests deliver deterrence and detection www.navigent3.com

via Tulsa World: Strategy .

London Drug Problem 2009I

pcholakis — Sat, 31 Oct 2009 14:13:03 +0000

LONDON Reuters Life! -

“HIGHEST COCAINE USE IN EU

The Home Office interior ministry says that Britain has the highest reported cocaine use of any country in the European Union, official figures reporting that 12,354 adults were now receiving treatment for cocaine use.

Drug problems among workers in Londons financial district have rocketed in the last year because of stresses caused by the recession, according to the founder of a rehabilitation center.Don Serratt, chief executive of Life Works, said they had seen about a 25 percent increase in the number of people from the City seeking treatment for alcohol and cocaine abuse in the last few months.

“It has a lot to do with the current economic environment,” said Serratt, himself a former alcoholic and addict.

“Either they have been made redundant or they have fears around being made redundant or fears around lowered income because many of these people have high personal overheads,” he told Reuters.

“Even if you keep your job but you are looking at making a fraction of what you made, it adds quite a bit of stress.

“On Tuesday, Dr Neil Brener, medical director at Londons Priory Clinic which has treated many celebrities for drug issues, said City workers were those most likely to suffer cocaine problems.”Certainly people working in the financial industry are more likely to run into problems,” he told members of parliament MPs on the Home Affairs Select Committee.”They have a very high pressure job and they often start using it, not so much as a reward system but as a system to try and keep themselves going in highly pressured situations.

OraPoint Advanced Oral Fluid Drug Tests – www.navigent3.com

via Big rise in London City workers drug problems| Lifestyle| Reuters.

Northwest Herald | Prescription  drug abuse is  a local problem

pcholakis — Fri, 30 Oct 2009 23:51:17 +0000

By BRIAN SLUPSKI – bslupski@nwherald.com

Diazepam. Nordiazepam. Oxycodone. Amiodipine. Oxazepam. Temazepam. Hydromorphone. Oxymorphone.

The list of drugs seems like it should be the inventory of a pharmacy.

But the list represents the toxicology results of just one of 18 drug overdose deaths in McHenry County so far this year. In the vast majority of the deaths, prescription drugs played a role. Of the 18 deaths, 14 are considered to have been accidental, three were suicides and in one the cause has not been determined.

“A lot of people who get addicted think that because it came from a doctor, it can’t hurt [them],” said Chris Gleason, director of substance abuse services for Family Service & Community Mental Health Center for McHenry County.

The death of Michael Jackson and subsequent investigation of his doctor, Conrad Murray, once again has thrust the topic of prescription drug abuse into national headlines. Although the results of Jackson’s toxicology report still is pending, there have been multiple reports that the pop singer had a prescription drug problem.

The Jackson story stirred public interest, but some who treat drug addiction worry that it is more spectacle than a serious discussion of a real problem. Generally, there are two kinds of people who abuse prescription medications: People who were legitimately prescribed medication and become addicted, and people who are just looking to get high. The latter category often involves young adults and teenagers.

In February 2007, the Office of National Drug Control Policy issued a report that found, “Among young people ages 12-17, prescription drugs have become the second most abused illegal drug, behind marijuana.” The report also found that “there are troubling signs that teens view abusing prescription drugs as safer than illegal drugs and parents are unaware of the problem.”

via Northwest Herald | Prescription  drug abuse is  a local problem.

Drug Free Workplace Policy & Program - KnowledgeBase

Drug Abuse Epidemic in Massachusetts – The Boston Globe

Oral Fluid Confirmatory Testing – Proficiency Testing

Abstract

Article Outline

1. Introduction

2. Experiments

2.1. Materials

2.2. Methods

3. Results

4. Discussion

Drug Abuse is Iowa 2010 Study

Kentucky Ranks No. 1 In Drug Abuse

The First Line Of Defense

Doctor recalls journey through painkiller addiction

Jacksonville 39 out of 40 in safety – Jacksonville Business Journal:

Dept. of Labor: Workplace accidents, deaths, on the rise

Treatment is Key to Drug Abuse

London Drug Problem 2009I

Northwest Herald | Prescription drug abuse is a local problem

Northwest Herald | Prescription  drug abuse is  a local problem