Drug Testing 101 Trust No One!
Drug Testing 101 Trust No One! Drug Testing Helen Harberts MA, MA JD Austin Texas 2011 My name is…and I’m an addict ddi t My brain tells me to keep using at all costs I take drugs to feel “less less bad”. bad . I get lonely and scared; drugs help that II’ve ve worked really hard, and need a vacation I have two days y until the next test…myy brain says I can use and you won’t know…. You just called me to test and I’m scared My “friends” tell me that all I have to do is Eatt some creatine E ti ffrom GNC GNC. Take some stuff from the head shop Drink lots off water and take vitamins Drink mild bleach drink vinegar Sneak in some clean urine Why y we test: Like a thermometer-it thermometer it measures possible continued infection It supports recovery It frames our treatment plan It frames sanctions and incentives It helps support the growth of refusal skills. Our participants understand…. #1 Comment from failures “IF ONLY YOU TESTED ME MORE” MORE Drugs of Abuse Testing Discussion some basic b i concepts t about b t drug d ttesting ti challenging collection strategies drug testing methods interpreting drug testing results questions & myths about drug testing specimen i ttampering i The “How to Beat a Drug Test Business” New stuff to irritate us even more Drug Testing Basics Characteristics of a Good Drug Test: scientifically valid therapeutically beneficial employs proven methods & techniques accepted by the scientific community provides accurate profile of client’s drug use provides rapid results for appropriate response legally defensible able bl to t withstand ith t d challenge h ll established court track record scrutinized by legal/judicial review PO test Message #1451 posted by hempafied (Info) November 21, 2001 10:34:16 ET I had not smoked weed in three months and then....I smoked one to two hits on Oct 12,13,18,24,25,30 waited a week and a half and smoked about four hits on Nov 10 and two bongs hits on Nov 11. I had a UA last evening (nov 19) at about 5 pm for probation. I am 5'7'' 135 p pounds average g metabolism. From Nov 11 to yesterday y y I drank white grape juice, cranberry juice, and large amounts of water. I took a home test on Thursday the 15 and passed with a faint line. Yesterday I took 4 aspirin four hours before my test, and drank 32 oz of gatorade mixed with a pouch of certo two hours before my test....I took B12 to color and ate a hamburger for creatine.......SOOOOO, what do you experts think???? Drug Testing Reality: While planning, implementing and administering drug testing assume that your clients know more about drug testing than you! It is their full time job….you have another job and other clients. They only have 1 probation officer (hopefully). Goals of Drug g Testing: g Why y do it? acts as a deterrent to future drug g use identify participants who are maintaining abstinence id if participants identify i i who h h have relapsed l d rapid intervention efficient utilization of limited resources provides incentive, support and accountability for participants adjunct to treatment & frames sanction decisions Because it is part of the court’s court s order.. order Drug g Testing g Specimens p urine - current specimen of choice generally readily available - large quantities contains high concentrations of drugs good analytical g y specimen p provides both recent and past usage EtS, EtG other specimens hair sweat - patch test saliva - oral fluids Eye scanning devices-ugh Breath-for ETOH, lots of breath How to do a drug test Monitor your vendors, and probation. This is NOT OPTIONAL How to conduct a urine test This is a medical process. It should be consistent objective consistent, objective, impersonal impersonal, and like a doctor’s office. Chain Ch i off evidence id and db both th th the appearance and factual existence of fairness must m st be present present. Officer & Staff safety first! Do not lock yourself in the room with a drug addict! No additional clothes clothes, purses purses, etc in the room with you! Utilize Utili universal i l precautions ti att allll times. Urine Sample Collection: pre-collection pre collection site preparation selection minimize access to water sources use an area with a scant floor plan find fi d privacy i & security it gather removal supplies beforehand of outer clothing complete custody & control form Sample Collection: ( (continued) ti d) wash hands prior to donation provide proper collection receptacle “witness” “ it ” collection ll ti additional clothing removal body b d iinspection i squat and cough Start, St t stop, t start t t use of the “wand” Sample Collection: (continued) acceptt sample l & inspect i t temperature (90-100˚ F) color (no color inappropriate) odor (bleach, sour apples, aromatics, vinegar, i etc.)) solids or other unusual particulates maintain visual line-of-sight label sample p correctly!!! y Sample Collection: (continued) security seal complete p custody y & control form store sample appropriately develop p detailed written p policy y quality control collection process don’t assume collection p procedures are being g done correctly exit interviews-if they laugh….. sending through a fake donor Test for alcohol & drugs! •Poly-substance abuse is common. •Your drug g of choice may y be alcohol…or your drug of choice may be at the bottom of yyour first beer… •Switching to other substances in early recovery y is common to avoid detection •Opiate cross-overs are common with alcohol. With alcohol, technology is your friend! Trans-dermal detection devices Presumptive Alcohol Sensors/PBT Home electronic monitoring with alcohol testing Local police/jail/Sheriff testing devices Kiosks with identification verification Ignition interlocks GPS systems systems-safe safe start type Nextel/cell phone to communicate with TX When to Test? KEEP ‘EM GUESSING ! test as often as possible - twice weekly or more effective drug testing must be random limit time between notification & testing consider use se of m multiple ltiple specimens (hair (hair, sali saliva, a ssweat) eat) design drug-specific testing regimes (cocaine test more q y) frequently) Understand, and do not underestimate, the power and nature of the addicted mind. Remember: THAT you are going i to test is not a surprise: but WHEN y you test should be a total surprise. Keep it random and do field testing! The “witnessed” collection (for urine) single most important aspect of effective drug testing program urine collections not witnessed are of little or no assessment value denial component of substance abuse requires “direct observation” collections of participants Squat and Cough….. “Tech Rawlinson instructed the defendant to squat to the ground with her knees and feet shoulder width apart, and to cough as hard as she could. Ms. Doe then squatted as instructed and coughed with her hand over her mouth mouth. Tech Rawlinson heard a loud thumping sound on the floor immediately after Ms Ms. Doe coughed. “ You don’t do it… this is what gets past you. Ask someone who knows…. here's a tip to all of you who give supervised UAs to female clients; Make them use a "hat" (a device that fits over the toilet seat to catch the urine) and keep both hands up in the air. I faked pee tests myself for 2 years at a major outpatient treatment facility by inserting a small bottle of clean pee into my vagina with the opening of the bottle covered by a single layer of aluminum foil wrapped on tightly by a rubber band. I would then puncture a hole through g the foil with one finger g as I held the cup allowing the urine to drain into it so it would sound just as if I were actually peeing. Help people hold themselves accountable. Use a hat. I told the treatment center eventually that I was faking every test and I told them how to make that impossible for me to continue doing too, too but they still don't use hats still to this day. I hold myself accountable nowadays, but sometimes I really wish I didn't know I had that option of faking a test still. Sample p collection: who,, quality, q y, conflict ttreatment, t t probation, b ti law l enforcement, f t case manager probation vs. outside collectors (contract service) quality assurance? specimen type (i.e. urine, hair, sweat) frequency of collection gender issues training t i i iissues The chemical testing process & interpretation of results We don’t test for all drugs-limited universe testing! amphetamines h t i ((speed) d) barbiturates,, benzodiazepines p cannabinoids (THC, marijuana) cocaine (crack) opiates (heroin) phencyclidine (PCP) alcohol Drug Detection Times - by Specimen g general estimates urine: 1-7 days sweat (patch): 7-14 days excluding g alcohol & THC necessitates twice weekly screening depending on product used saliva (oral fluids): up to 24 hours hair: up to 90 days breathalyzer: few hours EtG: up to 48 hours at 500 cut off. Drug Testing Methods Two Step Testing Approach Two-Step screening test – designed to separate negative samples from samples that are “presumptively” positive confirmation test – follow follow-up up procedure designed to validate positive test results distinctly y different analytical y technique q more specific and more sensitive Confirmation tests gas chromatography-mass spectrometry (GC/MS) drug molecules separated by physical characteristics identified based on chemical “finger-print” considered “gold standard” other chromatographic techniques Interpreting Drug Test Results N Negative ti or N None D Detected t t dR Results lt indicates that no drugs or breakdown products ((metabolites), p ), tested for,, were detected in the sample tested does not mean NO drugs present the probationer may be clean, or…. Negative/None Detected Interpretation donor is not using a drug that can be detected by the test OR donor not using enough drug donor donor’s s drug use is too infrequent collection too long after drug use urine rine is tampered test being used not sensitive enough “second second sense” sense If you think something else is going on, look closer! Testing is no more than a good tool. Change g up p the testing, g, do a home visit,, do what it takes to detect the problem. You may be seeing the first stage of relapse before the use happens. Positive Test Result Interpretation indicates i di t th thatt d drug(s) ( ) or b breakdown kd products (metabolites), tested for, were detected in the sample tested drug presence is above the “cutoff” cutoff level greatest t t confidence fid achieved hi d with ith confirmation What is a “cutoff” level ? a concentration, administratively established to distinguish between established, negative and positive - “threshold” established t bli h d above b th the sensitivity iti it lilimit it different for screening g & confirmation also referred to as threshold value measured d iin ng/mL / L = ppb b Typical yp Cutoff Levels screening & confirmation amphetamines * benzodiazepines cannabinoids bi id * cocaine (crack)* opiates (heroin) * phencyclidine (PCP) * alcohol 1000 ng/mL 300 ng/mL 20/50 ng/mL / L 300 ng/mL 300/2000 ng/mL 25 ng/mL 20 mg/dL g * SAMHSA (formerly NIDA) drugs 500 ng/mL variable 15 ng/mL / L 150 ng/mL variable 25 ng/mL 10 mg/dL g Specific S ifi d drugs and drug classes Alcohol - Results Interpretation screening tests specific for ethanol, ethyl alcohol positive results indicate presence alcohol alcohol is rapidly cleared from the body negative results don’t necessarily document abstinence detection time = hours example - person intoxicated at 11:00 PM, collect second urine sample of next day (11:00 AM), most likely test negative for alcohol EtG EtS EtG…EtS EtG [Ethyl [Eth l glucuronide] gl c ronide] is here. here Detects a metabolite of ethyl alcohol that remains in the system between two and five days days. Requires different lab equipment and processesdetects use when standard tests do not not. Highly sensitive, and very effective. Cut off: 500 –reveals reveals use for 48 hour window SAMHSA Advisory EtS should h ld come in i att ¼ the th EtG. EtG SAMHSA advisory Cautious use of EtG is required. Incidental or non-consumption non consumption exposure is possible Cut-offs are still being developed and clarified. Best recommendation: get an admission of use with the test results as a tool. Opiates - Results Interpretation screening tests - drug class assays positive results indicate presence of opiates most assays not reactive toward synthetic narcotic analgesics; meperidine (Demerol), propoxyphene (Darvon), methadone, pentazocine (Talwin), f t fentanyl l (Sublimaze) (S bli ) poppy seed interference- NO POPPY SEEDS! difficult to separate legitimate use from abuse detection time: up to 4 days following therapeutic use off codeine d i or morphine hi Cocaine - Results Interpretation drug specific assays positive results indicate presence of cocaine metabolites virtually i t ll no iinterferences-if t f if it comes b back k positive, iti it’s coke. positive results almost always associated with illicit drug use unless there is very recent ear, nose, throat surgery! detection time: up to 3 days maximum negative result may not be clear indication of non-use Cannabinoids - Results Interpretation drug specific assays cutoff levels: 50 ng/mL & 20 ng/mL positive results indicate presence of cannabinoids - virtually no interferences difficult to separate recent from non-recent use due to lipophilic properties detection time: up to 10 days for heavy chronic use; 1 - 3 days for occasional use no passive inhalation Marinol® usage Recent Use versus Nonrecent use (double sanction issue): How do you discriminate between new drug exposure and continued elimination from previous (chronic) use ? only drug that poses concern is Cannabinoids “two negative test” rule – two back-to-back negative drug tests post clean out Detection e ec o times es depend depe d o on cu cut o off levels! 30-day detection window often exaggerates duration •detection time: at 50 ng/mL cutoff • up to 3 days for occasional use • up to 10 days for heavy chronic use •detection time: at 20 ng/mL cutoff • up to 7 days for f occasional use • up to 21 days for heavy chronic use Many of the early cannabinoid studies often cited as p proof of 30+ dayy detection periods p suffered from . .. older research practices unable to ensure abstinence during the study detection cutoffs used very low used testing methods no longer available - poor specificity ifi it Just say NO to “levels” levels Drug Tests are Qualitative screening/monitoring dr drug g tests are designed to determine the presence or absence of drugs - NOT their concentration drug tests are NOT quantitative drug concentrations or levels associated with urine testing are not useful for interpretation (i.e. distinguishing g g between recent use and continued elimination) A confirmation test is p positive or negative-there g is no value to numeric levels. Drug concentrations or levels associated with urine testing g are,, for the most part, USELESS ! cocaine metabolite opiates i t cannabinoids amphetamines 517 ng/mL negative ti negative negative The Twins 200 mg Wonderbarb @ 8:00 AM A B Collect urine 8:00 PM 12 hours later The Twins - urine drug test results lt A Wonderbarb = 638 ng/mL B Wonderbarb = 3172 ng/mL The Twins - urine drug test results lt physiological make up exactt amountt d drug consumed d exact time of ingestion exact time between drug exposure and urine collection AND YET . . . . . A B The Twins - urine drug test results lt Twin B’s urine drug level is 5 times higher than Twin A A Wonderbarb = 638 ng/mL B Wonderbarb = 3172 ng/mL Why the difference in urine drug concentrations between twins? Twin A ate and drank normally during the day consumed foods and liquids diluted urine pool Twin B fasted - urine more concentrated = high drug level reduced d d variables i bl associated i t d with ith ttwins i tto near zero, still could not use urine drug levels d ’t kknow nearly don’t l as much h iinformation f ti about b t our own clients regarding drug use “But the levels of THC are falling!...” Simple rule to help you remember: You are either pregnant…or you’re you re not You are either dirty for detectable drugs…or you’re not. What the heck is creatinine and why should I care ? What is creatinine ? creatinine is derived from the non-enzymatic dehydration of creatine in skeletal muscle creatinine is produced by the body at a relatively constant rate throughout the day creatinine is a compound that is unique to biological material (i.e. urine, other body fluids) creatinine can be measured to determine the “strength” or concentration of a urine sample How are creatinine measurements used ? normall h human creatinine ti i llevels l will ill vary d during i the day based upon fluid intake - healthy individuals will rarely produce urine samples with creatinines of less than 20 mg/dL urines with a creatinines of less than 20 mg/dL are considered “dilute” and may not reflect an accurate picture of recent drug use urines with a creatinines of less than 5 mg/dL are considered “substituted” samples - not consistent with normal human urine But u what a about a ou normalized o a ed creatinine? Interesting…yes Possibly P ibl iinstructive….yes t ti Error rate: too high for my taste to sanction Why would you build resistance? Creatinine Facts incidence of creatinines less than 20 mg/dL in a “normal” population is approximately 1% some diseases that produce low urinary creatinines i id incidence off llow creatinines ti i iin a population l ti undergoing random drug testing is 3 - 5 times greater than a non-drug g g tested p population p any fluid intake dilutes the concentration of drugs in urine (along with the creatinine) More Creatinine F t Facts rapid intake of 2 quarts of fluid routinely produces low creatinines & negative urine drug tests within one hour rapid intake of 4 quarts of fluid almost always produces low creatinines and negative urine drug t t within tests ithi one h hour recovery time of urine creatinine and drug concentrations can take up to 10 hours incidence of drugs in urine of diluted specimens is over 5 times g greater than in samples p with normal creatinine levels Bottom Line: Dilute tests are a sign of a problem and need to be taken very seriously! So, what to do? Begin altering your schedule schedule-double double back Conduct a surprise field visit Check your testing regimen to be certain folks are being observed…and not being given too long to report for testing. First void in the AM Refer to a physician Offer catheter in lieu of water for shy bladder Questions i & Myths h S Surrounding di D Drug T ti Testing Myth #1 Passive inhalation of marijuana smoke can cause a “positive” drug test result. NO - nott if standard t d d cutoffs t ff are used d THC (cannabinoid) assay uses variable cutoffs (20, 50, 100 ng/mL) p passive inhalation research indicates less than 10 ng/mL in volunteer urines Shotgunning and hot box is not passive no passive inhalation for “crack” Myth #2 Advil ® (ibuprofen) causes “falsepositive” drug tests for marijuana positive NO! ® problem with EMIT method corrected 15 yyears ago g Myth #3 Consuming gp poppy ppy seeds causes “false-positive” p drug tests for heroin NO! - but? poppy seeds contain trace amounts of both codeine and morphine can causes “positive” “ iti ” d drug ttestt results lt ffor “opiate” class confirm positive opiates Avoid the discussion: simply add “no poppy seeds” to yyour orders…There is NO constitutional right to poppy seeds! Myth #4 Drinking vinegar or cranberry juice will produce a “negative” urine drug test. NO! theory is to cause a “pH shift”, making the urine sample acidic - altering the chemistry of immunoassay tests in reality - the body detoxifies the acid & physiological y g p pH dilutes to p But lots of fluid CAN create a dilute test Myth # 5 It takes 30 days to clean out the pot! NO-NO-a thousand times….NO! – contact NDCI and download How to “Beat” Beat a Drug Test You must understand the disease of addiction T understand To d t d this, thi Basics of Specimen Tampering - The Three Approaches dilution dil ti adulteration substitution Yes, I occasionally do research… Yes, It is the 7 step method to “Boobstitution”! * Google search it! This involves two Visine bottles-you can use your imagination to figure it out out. It speaks to OBSERVED testing. There are a variety of products on the market which take cruel advantage of the illness that h attacked has tt k d our clients li t Urine Specimen Dilution most common form of tampering pre collection dilution (hydration (hydration, water loading, diuretics) post collection dilution ( add water or fluid)) creatinine measurement is critical dilution dil i d detection i ((validity lidi checks) h k ) Pre-Collection Pre Collection Dilution high-volume ingestion of fluids (water loading, flushing, hydrating, etc.) may be in conjunction with products designed to “enhance” drug elimination or removal of drugs ((Gold Seal,, Clean ‘n Clear,, Test-Free,, Naturallyy Klean, etc.) no evidence these products have any additional effect ff t on drug d elimination li i ti use of diuretics P t C ll ti Post-Collection Dilution Dil ti agents added after sample collection ll ti d designed i d tto dil dilute t or “thin” drug g concentration in urine diluting agents (water, clean urine, other th fluids) fl id ) Urine Specimen Adulteration addition of foreign substances designed to “mask” drug presence post-collection tampering p p g low-tech adulterants that cause “pH shift” (lime, vinegar, g , bleach,, ammonia,, lemon,, drano)) low-tech adulterants that disrupt testing chemistry (salt, methanol, detergent) five common “high-tech” adulterants Specimen Validity Tests (SVT) creatinine,, UUN specific gravity pH nitrites gluteraldehyde pyridine d chromium Request SVT from testing laboratory or use dip-stick SVT products for on-site testing Urine Specimen Substitution replacing donor urine sample with another drug-free specimen biological bi l i l substitution b tit ti - someone else’s l ’ “clean” urine non-biological non biological substitution - replacing urine with urine “look-a-like” sample (diet Mountain Dew, water with food coloring) non-biologicals can be detected with creatinine testing g Addiction makes folks do strange things things…..this, this of course is an example of attempted urine substitution. The Story of Designer Drugs Designer Drugs: drugs, which are created (or reformulated, f l t d if th the d drug already l d existed) to get around existing drug l laws (CSA) (CSA), usually ll b by modifying dif i th the molecular structures of existing drugs t varying to i d degrees Designer Drugs: “designer drug” was first coined by law enforcement in the 1980s second International Opium Convention in 1925 which specifically banned alternative esters of morphine 1960s - 1970s, new synthetic hallucinogens (modifications of LSD & PCP) 1980s - 1990s, design of MDMA (ecstasy) & methcathinone 2000 - 2005, 2005 derivatives of psilocybin & mescaline anabolic steroid Designer Drugs: most designer g drugs g have been: opioids hallucinogens g anabolic steroids 2005 005 - 2010 0 0 stimulants (DMAA) sedatives (methyl-methaqualone) ( y q ) Sildenafil citrate (designer Viagra) synthetic y cannabinoids What Drives the Production Designer Drugs ? consumer preferences f law enforcement control Spice/K2 and Synthetic Cannabinoids No! We’re not talking g about this! What’s in these “incense” products? “Listed” Listed Ingredients in Spice Canavalia rosea: commonly known as beach bean or bay bean - vine found in tropical and subtropical beach dunes Nymphaea caerulea: also known as Blue Egyptian water lily Scutellaria nana: perennial herb also known as Dwarf skullcap Pedicularis densiflora: known commonly as Indian warrior - a perennial herb Leonotis leonurus: also known as Lion's Tail and Wild Dagga - a perennial shrub native to southern Africa Zornia latifolia: is a perennial herb Nelumbo nucifera: known by a number of names including Indian Lotus, or simply Lotus - aquatic perennial commonly found in China Leonurus sibiricus: commonly called Honeyweed or Siberian motherwort, herbaceous plant native to Asia vanilla honey Preparation p of the “incense”: botanicals are sprayed with liquid preparations of: HU-210 HU-211 HU 211 CP 47,497 JWH-018 JWH 018 JWH-073 Where can these Wh th “i “incense” ” products d t be purchased? Sources of Incense Products: “head” head shops/alternative medicine stores internet/on-line sources (2004) 1-(800) phone ordering services individual distributors Internet Sources: Internet Sources: Internet Sources: Buy on ebay: How is herbal incense promoted? p The Benefits: More Directions: There is 1.5g of Natural Super Puff in each package. Super Puff incense is an ultra strong g aromatic incense, and is one of the world's strongest herbal incense blends available. It contains an extremely potent blend off h herbal b l resins, extracts, and d leaves. This incense is for botanical use only and is not for human consumption. consumption Terms: TERMSANDCONDITONS:ByentrigthewbsiteofandoreingfromIntesHerbs.comyu agre to urTemsofServic andusea xpres dbelow.Youalso firmand gre tohe fol wing:Thatyouare18yearsofageor lder.NOEXCPTIONS!That nyherbs,herbal blends,andorbulkherbsonthis tear legatoseland/orpuchaseinyourphysicalocatin orpintofrec iptofshipment.Youagre touseourpoductsfortheirnted purose only. 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NO EXCEPTIONS! You agree to use our products for their intended purposes only. l You Y waive i without ith t exception ti your right to hold Seller liable in any way for the misuse of Seller’s products. Buyer understands that all of Seller’s Seller s products are offered for scientific research purposes only and that these products are not intended for human consumption. Buyer understands that Seller’s products are not meant for oral p or inhalation of smoke/hot / consumption vapors. The Seller does NOT supply instructions on proper use of any product provided. They smoke it!! Warnings? What warnings??! g What’s the story behind these synthetic THC chemicals? Synthetic Cannabinoids HU-210 HU-211 CP 47,497 (and related chemicals) JWH-018 JWH-073 Origins of Synthetic Cannabinoids HU 210 & HU-211 HU-210 HU 211 - synthesized at Hebrew University, Israel in 1988. HU-210 is an antiinflammatory; HU-211 as an anesthetic CP 47,497 - developed by Pfizer in 1980 as an analgesic JWH 018 & JWH JWH-018 JWH-073 073 - synthesize th i b by a researcher h at Clemson (1995) for use in THC receptor research - John W. Huffman more than 100 different synthetic cannabinoids have been created Synthetic Cannabinoids Timeline: first appearance on the Internet 2004 Europe p was original g target g market by 2008 widespread in Europe 2008 introduced into US widespread in US by late 2008 - 2009 late 2008 University Hospital Freiburg Freiburg, Germany first analysis of incense first email Spring 2009 Pharmacological Effects of Synthetic Cannabinoids HU-210 CP 47 47,497 497 JWH-018 JWH-073 JWH 073 All act as THC agonists (mimics THC and causes similar bonding and reaction) An agonist is a chemical that binds to a receptor and triggers a response – often mimicking the action of a naturally occurring substance. CB Receptors: p CB1 and CB2 CB1 receptor influence mainly the brain (central nervous system, CNS), but there are also effects expressed in the lungs, liver and kidneys CB2 receptor effects mainly the immune system and in certain stem cells CB Receptors: Smoking Cannabinoids What does CB1 receptor control? BG: motor control, control learning Hippo: ppo memory, e o y, spat spatial a navigation CB: cognitive g functions attention, language, emotions Pharmacological Effects of Synthetic Cannabinoids are Similar to THC increase heart rate & blood pressure altered state of consciousness mild euphoria and relaxation perceptual alterations (time distortion) intensification of sensory experiences pronounced cognitive effects impaired short short-term term memory reduction in motor skill acuity increase in reaction times Dependence Syndrome Similar to Marijuana Reported Effects of Synthetic Cannabinoids are Different to THC production inconsistencies herbal incense blends are harsher to inhale effect on appetite is non-existent increased restlessness & aggressive behavior herbal incense produces a shorter “high” high (perceptual alterations & sensory effects are limited) doesn’t mix well with alcohol (hangovers) ( g ) incense costs more than marijuana What’s the legal status off synthetic cannabinoids? bi id ? Legal Status of Synthetic Cannabinoids (DEA) HU-210 - because it is structurally similar to THC Schedule 1 controlled substance THC, HU-211, CP 47,497, JWH-018 and JWH073 - nott currently tl controlled t ll d under d th the CSA Prevalence of Synthetic THC? no national statistics Louisiana: 9 clients “pre-selected” based upon suspicion 7 tested positive C l bi MO Columbia MO: 17 clients “pre-selected” based upon suspicion 12 tested positive 5 self-admissions Can synthetic THC C C chemicals h i l be b d t t d by detected b drug d testing? Drug Testing: NO on-site, rapid, instant tests NO laboratory-based screening tests Four laboratories employing LC/MS/MS technology $30 - $60 per sample many a yu unknowns o s regarding ega d g tthis s testing The Wild, Wild Wild West (Issues of Concern): What synthetic compounds (or metabolites) are being tested by these laboratories? no standardized urine cutoff levels no standardized methods (LC/MS/MS) no independent quality control materials no proficiency testing detection window unknown caveat emptor! Are Th A There Control C t l Strategies Other Than Testing? Alternative Alt ti Control C t l St t i Strategies: community supervision & seizure ((client contract)) (4 ( th A. waiver) search car home car, home, possessions Drug Court Court’s s Response: place specific synthetic y cannabinoid prohibition in your client contract establish a date certain testing date - inform client population l ti establish sanction severity select l t participants ti i t for f testing t ti where h there th are indications of herbal incense use identify positive participants in court & sanction openly to enhance deterrent effect provide opportunity p pp y for p participants p to self-report p Bath Salts: The term Th t bath b th salts lt refers f to t a range of water-soluble products designed to be added to a bath. They are said to i improve cleaning, l i iimprove th the experience of bathing, serve as a vehicle for cosmetic agents, and some even claim l i medical di l b benefits. fit Bath B th salts have been developed which mimic the properties of natural mineral b th or h baths hott springs. i Sold Under the Names: Ivory Wave Ivory Pure Ivory Coast Purple P l W Wave Vanilla Sky Health Hazard? What is Ivory Wave: Methylenedioxypyrovalerone (MDPV) is a psychoactive drug with stimulant properties which acts as both a norepinephrinedopamine reuptake inhibitor (NDRI) (NDRI). MDPV has four times the potency of Ritalin MDPV - no history of FDA approved medical use sold since 2007 as a research chemical MDPV: MDPV currently popular in Europe, UK & Australia is usually snorted - similar to cocaine considered extremely y addictive MDPV is “legal” adverse medical/psychiatric ramifications NO drug test available commercially Designer Drugs: Take home message: designer g drugs g are here to stay y evolutionary patterns testing will lag behind legal controls with be difficult build community supervison/expand search & seizure efforts New term of probation p You may not ingest any item marked “Not Not for Human Consumption” Preventing Specimen Tampering develop challenging collection strategy - ie. ie make the testing unannounced and RANDOM! directly observed collections is the most effective approach to preventing adulteration and substitution inspect sample - train collection staff keep abreast of tampering techniques take temperature measurements (90˚ (90 - 100 100˚ F) use laboratory that employs specimen validity checks & use with on-site on site devices SUMMARY (continued) ( ) drug test often ! confirm positive screening results whenever possible k keep abreast b t off tampering t i techniques t h i challenge your program - quality assurance develop a relationship with drug testing experts testing laboratory or on-site device vendor understand that drug testing is only one part of th overallll d the drug courtt supervision i i process Remember: This is not about “gotcha” It is about helping folks to resist cravings and work programs. It is about supporting recovery recovery. It is about objectively measuring the presence of disease disease. Questions? Helen H l H Harberts b t [email protected] Porter93@msn com
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