Oral Fluid Drug Testing

2/23/2015
Oral Fluid Drug Testing
March 23rd, 2015
Drug Testing Options
Breath Blood Meconium
Vitreous
Hair
Sweat
Urine
Oral Drug Testing Options
Oral Fluid and Blood and Breath Actual levels (immediate use, up to four days) *
Urine
Measures metabolites /past use (several hours after use, up to four/five days) *
Meconium
Chronic drug consumption in the last trimester of pregnancy *
Hair
Indication of chronic use only, 1.5 inches of hair = 90 days *
* Peer reviewed papers available 1
2/23/2015
Window of Detection
Window of Detection
Oral Fluid Testing
Non invasive, easily obtained, fast collection time, no facilities needed or specialize personnel, preserves dignity Drug concentrations in saliva are proportional to drug concentrations in plasma/blood
If observed correctly, eliminates cheating
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Oral Fluid Testing
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Oral fluid has a number of advantages: 1.
OF is well proven as accurate, effective and robust. OF has been used for many years in Europe and the rest of the world in both clinical and criminal justice marketplaces and actively for the past 10 years here in the US. 2.
A drug detected in OF is the active (parent) drug component as well as any metabolite(s). 3.
The passive diffusion rate of a drug from the blood to oral fluid is governed by the free drug fraction in the circulation. This gives the distinct advantage that there is a direct relationship between blood levels of a drug and the presence of the drug found in saliva. 4.
As the presence of drugs in oral fluid is related to the amount of drug in the blood stream, oral fluid testing may serve as a better real time indicator of the presence and level of active drug in the patient, thus measures impairment.
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Blood flow to the 5 glands, in the mouth, is rapid. Drug transfer occurs relatively quickly after drug dose. Drug transfer to oral fluid will continue as long as there is drug in the circulatory system. 7.
Toxic, lethal levels, and Steady‐state ONLY FROM ORAL FLUID
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Oral Fluid detects 67% more positive Heroin than Urine.
Oral Fluid Lab Testing
Screening Assays and LC/MS/MS Testing
Technology
Screening
Confirmation
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Screening
5 panel example:
AMPHETAMINE (Adderall, Vyvanse, MDA/Adam, Phentermine/Adipex)
METHAMPHETAMINE (MDMA/Ecstacy, Methcathinone)
OPIATES (Heroin/6MAM, Morphine, Codeine, Hydrocodone)
COCAINE (Cocaine, Benzoylecgonine, Ecgonine methyl ester, Cocaethylene)
THC (delta 9 THC) Screening
Why Is a “Screen” a Screen?
PCP – Dextromethorphan
Opiates ‐ Hydrocodone, Oxycodone, Oxymorphone, Hydromorphone (not measured)
Naproxen, NSAIDs – THC
Benzodiazepines ‐ Alprazolam, other antidepressants
Barbiturates – Phenobarbital not always measured
Screening
(±)‐Amphetamine
(±)‐Methamphetamine
Ephedrine
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Confirmation
What does LCMSMS mean?
Liquid Chromatography, Tandem Mass Spectrometry
It identifies drugs by their “fingerprint”
Each drug has a unique structure
LC/MS/MS
• Liquid Chromatography/Tandem Mass Spectrometry
(LC/MS/MS).
LC/MS/MS or “Confirmation testing” is analytically
precise and extremely accurate, by measuring the
specific molecular mass, and the concentration
(amount) of any drug(s), in a sample. The testing
identifies not only the parent drug but also its
metabolites. Thus providing data on the exact drug and
amount of drug found.
LC/MS/MS
Marijuana
Chocolate
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Metabolism Chart
Oral Fluid Drug List
Drug List
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Marijuana
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Amphetamine (Adderall, Vyvanse) Adam (MDA)
Ecstacy (MDMA)
Methamphetamine Methcathinone *Chlorpheniramine *Ephedrine
*Phenylpropanolamine •
Delta 9‐THC •
*Cold pills that screen positive for Meth/Amp
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Amphetamines
Date Rape Drugs
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GHB Ketamine Nicotine
Cotinine
Alcohol Monitoring
Cocaine
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Cocaine Benzoylecgonine
Ecgonine methyl ester
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EtG (Ethyl glucuronide)
Disulfiram (Antabuse) 6
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Drug List
Opiate Antagonists
Opiates
6‐Acetylmorphine (Heroin) Codeine (Tylenol 3) Hydrocodone (Vicodin, Lortab, Lorcet,
Hycodan, Norco, Xodol, Vicoprofen)
Hydromorphone (Dilaudid)
Morphine (Kadian, Oramorph, Avinza, MSIR, MS Contin, MSI, MSER) Oxycodone (Percocet, Endocet) Oxymorphone (Numorphan, Opana) Fentanyl Pentazocine (Talwin) Meperidine (Demerol) Propoxyphene (Darvon) Dextromethorphan
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Naloxone (Narcan) Naltrexone (Depade)
Methadone (Dolophine) EDDP
Buprenorphine (Suboxone, Subose) Norbuprenorphine
Antipsychotics
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Risperidone (Risperdal)
Quetiapine fumarate (Seroquel)
Aripiprazole (Abilify) Olanzapine (Zyprexa)
Haloperidol (Haldol)
Thiothixene (Navane)
Fluphenazine (Prolixin)
Ziprasidone (Geodon) Drug List
Benzodiazepines
Tricyclic Antidepressants
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Amitriptyline (Elavil) Desipramine (Norpramin)
Doxepin (Sinequan)
Imipramine (Tofranil)
Maprotiline (Ludiomil)
Nortriptyline (Aventyl, Pamelor)
Trimipramine (Surmontil)
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SSRIs
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Paroxetine (Paxil)
Citalopram (Celexa)
Sertraline (Zoloft)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Fluvoxamine (Luvox) Alprazolam (Xanax) Bromazepam (Lexotan)
Chlordiazepoxide (Librium)
Clonazepam (Klonopin) Diazepam (Valium) Estrazolam (Doral) Flunitrazepam (Rohypol “Roofies”)
Flurazepam (Dalman)
Lorazepam (Ativan)
Lormetazepam (Loramet)
Midazolam (Versed)
Nitrazepam (Mogadom)
Nordiazepam
Oxazepam (Serax)
Prazepam (Centrax)
Temazepam (Restoril)
Triazolam (Halcion)
Drug List
Therapeutic Drugs
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Topiramate (Topomax) new
Divalproex sodium/valproic acid (Depakote)
Gabapentin (Neurontin)
Carbamazepine (Tegretol)
Bupropion (Wellbutrin)
Venlafaxine (Effexor) new
Mirtazapine (Remeron)
Trazodone (Desyrel)
Buspirone (Buspar)
Propranolol (Inderal)
Benzytopine mesylate (Cogentin)
Duloxetine (Cymbalta) new
Zolpidem (Ambien)
Lamotrigine (Lamictal)
Tramadol (Ultracet, Ultram)
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Carisoprodol (Soma) Meprobamate
Methylphenidate (Ritalin, Concerta)
Clonidine
Strattera
Special Request
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PCP & LSD
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Psilocin (Mushrooms)
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Methaqualone (Qualudes)
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Salvinorin A
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Bisacodyl (Dulcolax)
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Phentermine (“Phen‐Phen”)
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Atropine
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Scopolamine
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Synthetic Marijuana
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Bath Salts
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Kratom and Krocodil
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Sample Collection
Sample Collection | Chain of Custody
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Lab Report
• Simple – Easy – Fast ‐ Painless method for measuring drug levels
• Turn around time
Same day we receive the samples (meconium too!)
• Knowledgeable Customer Service Department
Your questions are answered either immediately or go directly to the Toxicologist and those questions are answered within hours
• Number of drugs detected (we can detect over 130 compounds)
• LC/MS/MS
More sensitive instrument – lower levels of detection reduces incidence of
false negatives
THANK YOU
Email [email protected] for more information
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