Afternoon Thanks for attending on this Friday Afternoon In the next 30 minutes I wish to talk to you about two alternatives to urine drug testing – hair drug testing and oral fluid or saliva drug testing. Tom Bassindale, was also meant to be presenting this afternoon but he left ESR in July 2011.
FIRSTLY some information – I work for ESR based in Porirua. ESR does a variety of things inclduing forensic (DNA) and stuides communicable diseases. At the Kenepuru site the toxicology group is based and is where the WORKPLACE DRUG TESTING LAB occurs
In the next 30minutes I want to cover the following topics Hair testing and some work we have done on children found in methamphetamine labs Oral fluid and some issues that have come about today. This will cover some of what is mentioned in the abstract but has been updated to include the latest overseas information. Feel free to ask questions through out the presentation
Drugs can be found in biological samples for different time frames. This graph illustrates an overall view of the three types used for workplace drug testing and the overlap between the windows of detection – they are not isolated subsets. Oral fluid should relate to the most recent drug use whereas hair yields information on the history of an individuals drug use.
Tom Bassindale, the primary researcher on this work at ESR was going to present this next section. But her left ESR in July this year to go back home to the UK
These are some of the headlines relating to children having been associated with methamphetamine laboratories in NZ In New Zealand many children have been removed from clandestine laboratories following police intervention I n the last few years it has become standard procedure that these children have hair samples collected and analysed for the presence of methamphetamine
In New Zealand methamphetamine is a Class A controlled drug, this is the highest classification indicating serious concerns with abuse and harm People abusing the drug can show a wide range of effects depending on how much they have taken, when they last used it, how used to the drug they may be, as well as individual reactions to the drug There are serious health concerns for children over exposure to both chemicals used during the manufacture and to the drug itself. Inhalation of the chemicals can cause respiratory irritation and distress. Contact with the chemicals can cause burns on the skin and the fumes can cause eye irritation Common effects reported when children exposed to the drug are treated at emergency departments include altered mental state, agitation, hallucination and confusion. Long term effects are not known
It is not a difficult drug to make. The recipe is easily accessed by the internet and the chemicals involved can be purchased fairly readily The manufacture of methamphetamine is associated with high levels of fumes and vapours which have an associated risk of explosion. The places where the drug is manufactured generally require extensive decontamination after the laboratory is dismantled Methamphetamine can be present in high amounts on surfaces, furniture and appliances and it is likely children living in these properties are exposed to the drug through touching these surfaces and breathing in any airborne drug
The number of methamphetamine manufacturing laboratories identified by the NZ police increased from 9 in 2000, to a peak in 2006 of over 200 labs. From 2006 there was a decrease in the number of labs found, down to 135 in 2009, but I was told that number of labs found was up again last year. In 2008 a third of these labs had children associated with them and of these many actually had children present at the time of the police raid. The proportion of labs that have children living at the premises has increased over the years . This may reflect a change in the type of people involved in the illicit manufacture and people overcoming the fear of the chemicals involved. They appear to be more willing to carry out the potentially dangerous operation in the family home
If children are found at the house when the Police find a P lab, a hair sample is collected as part of a medical examination carried out on the children. If the children are not at the house at the time of the raid, permission to take hair samples must be obtained, either from the parents or from the Child,Youth and Family advocate assigned to the case Presence of methamphetamine in the hair will provide evidence of exposure and link the children to the P lab
The sample collection kits provided ask that the hair be collected where possible from the posterior vertex, tied near the root end and transported to the laboratory For these P lab children we generally analyse three 2 centimeter segments cut starting from the root end so we are looking at the previous six months exposure
We carry out analyses on hair samples for more than just the P lab children. Most requests concerning methamphetamine use are for parents trying to get access to their children. They are required to prove they are drug free and hair analysis shows a longer period of abstinence than the days that might be shown by a urine test. Not as often we analyse hair in cases of sexual assault when the delay between the assault and the registration of a complaint is too long for blood or urine to be of any use. In coronial cases we may look at evidence of drug use in the hair if there is a question of tolerance to a drug, such as in the case of an opiate overdose Analysis for the workplace is more commonly carried out on urine or oral fluid.
Hair samples are cut into 1,2 or 6 cm lengths depending on the time period requested and then finely chopped. The samples are briefly washed with methanol three times, the washings are kept and analysed along side the extracted hair samples The hair is extracted by heating at 37 degrees C in a 0.1M HCl solution overnight. The sample is then cleaned up by solid phase extraction followed by analysis by LCMSMS
Over the years 2008, 2009 and 2010 hair was collected from children associated with P labs who were aged from 2 months to 16 years. 52 case samples were analysed, 46 were positive for methamphetamine Some P labs had several children associated with them. When children are found to have been exposed to methamphetamine charges such as child endangerment may be added to those associated with manufacturing a Class A controlled drug
The amount of methamphetamine detected in these children’s hair is not insignificant. The highest level of methamphetamine detected so far is 131 nanograms per milligram, higher than we have seen in adult users of the drug. Only 11% of the children’s hair samples tested had no detectable methamphetamine When compared with the levels found in hair taken from adults, the average level found in the children is only slightly lower than the adults. But these adult hair samples are not from the adults associated with the P labs These adult hair samples are generally being tested for child custody cases to prove to the court that the donor was not using the drug. The range of levels found in these hair samples is very similar to those reported in a recent paper published in the Journal of Chromatography by Joon Song et al. They reported regular users of methamphetamine had levels ranging from 0.38 to53 ng/mg with a mean of 6
This is an example of the types of situations involved. The house was raided by the armed offenders squad accompanied by the national clandestine laboratory remediation team which is a specially trained police team Two baby girls were taken from the house and had blood urine and hair sample taken as part of medical examination I would like to mention when dealing with these cases we like to distinguish between use of a drug and exposure to the drug.
Another family situation, I dont know how long after the removal of the children that the urine samples were taken The recommended cut off to separate active use from possible passive exposure is 0.05 ng/mg. These children had clearly been exposed at a high level or for a long period of time
Although children living in P labs are an example of passive exposure to the drug, this passive exposure is quite different to the passive exposure that may occur in a recreational drug use situation. There are three main modes of incorporation of drugs into hair : Blood circulating in and around the hair follicle, From the drug in sweat and sebum resting on the hair and From external passive contamination, smoked fumes or dirty hands touching the hair When interpreting the results of hair analysis steps are taken to separate possible passive exposure from active use. The first important step involves washing the hair prior to extraction to remove any drug resting on the external surface and comparing the amount of drug in the wash to that extracted from the hair. Another indictor of external contamination may be determined by the presence or absence of amphetamine, the metabolite of methamphetamine. Amphetamine present in the hair will generally indicate that methamphetamine has been processed by the body.
However we can not by our analyses determine the source of drug or effects exposure may have on the child
Oral fluid ie mouth fluid sometimes known as saliva. In the last 10 years, the testing of oral fluid (also referred to as saliva) for the presence of drugs has become a reality due to advances in technology. Oral fluid drug testing has been hailed as the next best thing and will supersede urine drug testing in the workpalce. Personally I see it as an alternative that compliments urine and hair drug testing. It is all about horses for courses.
The main reasons given for using oral fluid for drug testing are as follows: It is less intrusive to collect than a urine sample. Results should relate to drug use on the same day, whereas for urine results could relate to use that occurred a few days ago. Still does not relate to impairment, what is said as if recent is use then the person could be impaired but no direct correlation Concept simple but expensive Collection spit into a tube, wipe tongue, suck a cotton wool bit or suck a lollipop that swells up.
With a short detection window an application in the workplace drug testing is post accident/reasonable cause where a positive would more likely relate to recent use. One standard exists in Australia ( the revision of this should start next year) European guidelines for workplace came out this yeat and the Drug testing Advisory Board in the USA have started deliberations of a USA standard. But as I will illustrate later everyone is different and little commonality exists. But problems – buffer for collection or not – issues with drug stability Dry mouth – inconsistent production of oral fluid, poor oral hygiene Onsite devices on the whole are not there yet in terms of sensitivity – too high and you miss drug use altogether; time to get results too long – 10 minutes Cannabis what are you looking at in a result could it be passive, may you have missed it? This last issue is one I wish to go into more detail about
Firstly two court decisions Very important NZ oral fluid employment court decision available on the web This court case was heard in 2007 and experts from NZ and Australia testified. Among the findings was the fact that Cannabis use and resulting impairment is a prime concern of the employers. Although there may be a time lag of between 1 and 2 hours between smoking cannabis and when this is detectable in urine, it is very unlikely that this would result in a false negative test result.
AUSTRALIAN DECISION AUGUST 2008 The findings here were different, on-site testing was not considered The industrial relations commission found Oral fluid preferred for random drug testing Lab based testing only Issues No accredited labs/collectors in Australia – since rectified May not reflect when individual is still impaired, you can be impaired from cannabis 24 hours later (pilot study) No levels for drugs like sedatives Company to do urine in mean time while issues are sorted (not quick in all honesty) Australia does do road side drug testing using oral fluid but it is not done as per the standard and is for a deterrent (risk reducer) not elimination of the risk.
Focussing on cannabis this is a graph from a study we participated in looking at oral fluid levels after use. In oral fluid measure THC the parent active ingredient of cannabis. SMOKER A typical graph for one smoker The red line indicates 10 ng THC/mL of oral fluid which is the target concentration in AS4760:2006 standard The THC levels peaked at 0.25 hours and by 2 hours were less than 10 ng/mL .
Typical passive user from the same study 2008 All of the subjects had levels less than 10 ng/mL by 1 hour. THC could still be detected in 3 passive subjects at 7 hours but the levels were less than 2 ng/mL (our detection limit is 0.2 ng/mL)
Different cut-offs different detection times everyone has different cut-offs Cut-offs are administrative and are set by consideration of many factors such as drug metabolism, instrument capabilities, environmental consideration eg passive What can be seen is pick a cut-off pick a detection time but issues still abound too high miss users, too low and the detection time is the same as urine. Might think Australian level is good but is it too short? People can be a risk for more than 6 hours after use of cannabis (pilots 24 hours). A recent study of people studied people in a Amerstdam coffee shop. They found people positive more than 10 mg/mL so high cut-off alone does not get around problem So what biomarker can be used to prove is oral fluid and ok (equivalent to creatinine); what distinguishes passive from active (THC-Acid?); lack of research into detection time from controlled doses, and knowledge can you relate levels to impairment for all drugs
Overall there are more choices but you need to know the limitations and make the best choice for a situation. Oral fluid drug testing is in a state of flux – where to from here what is guaranteed is that it is not stable , changes in cut-offs etc can be expected and is could well extend the detection time to the same as urine. But what ever you choose and however you do it , the limitations should be known
New Choices in Workplace Drug Testing – Oral Fluid and Hair
New Choices in Workplace Drug Testing – Oral Fluid and Hair Dr Sarah Russell October 2011
TOPICS <ul><li>Hair testing - introduction and application to children found in “P” Labs </li></ul><ul><li>Oral Fluid- introduction </li></ul><ul><ul><ul><ul><ul><li>- what cut-off to pick? </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>- cannabis issues </li></ul></ul></ul></ul></ul><ul><li>Questions </li></ul>
Generalised Windows of Detection time Concentration Days -Weeks Days - Months Hours -Days Hair Urine Oral Fluid
Detection of methamphetamine in hair of children removed from clandestine laboratories Dr Tom Bassindale
<ul><li>Man jailed as daughter tests </li></ul><ul><li>positive for P (NZPA) </li></ul><ul><li>Three kids found in P-Lab </li></ul><ul><li>home (Bay of Plenty Times) </li></ul><ul><li>Dad “made meth for his kids” </li></ul><ul><li>Home detention for P producer </li></ul><ul><li>(Sunday News) </li></ul><ul><li>P-lab couple put kids at risk </li></ul><ul><li>- judge (Stuff.co.nz) </li></ul>
When is a sample collected? <ul><li>When a clan lab is raided and children found, medical exam proceeds (including collection of samples) </li></ul><ul><li>CYFS or parents need to consent if the children are not within the lab </li></ul><ul><li>Links children into lab and exposure to P </li></ul>
From years 2008 to 2010 <ul><li>Samples taken from 52 children </li></ul><ul><li>Ages from 2 months to 16 years </li></ul><ul><li>Many family groups (up to 8 children from one lab) </li></ul><ul><li>Evidence has been heard in District and High Court </li></ul>
Hair Results Cases Positive Range (ng/mg) Mean (ng/mg) Adult (varied cases) 92 34 % 0 - 92 6.7 Children (P lab cases) 52 89 % 0 - 131 5.8
Case Example – Family 1 <ul><li>House raided by AOS and NCLRT - materials for P manufacture found </li></ul><ul><li>Twin 16 month old girls removed </li></ul><ul><li>Medical samples collected (blood, urine, hair) </li></ul><ul><li>Blood and urine: no methamphetamine detected </li></ul><ul><li>Hair: child A – ~0.6 ng/mg </li></ul><ul><li>child B – ~0.2 ng/mg </li></ul>
Case Example <ul><li>Police executed a search warrant - materials for P manufacture found </li></ul><ul><li>Two children removed 6 and 8 years </li></ul><ul><li>Medical samples collected (urine, hair) </li></ul><ul><li>Urine: no methamphetamine detected </li></ul><ul><li>Hair: child A – ~2.4 ng/mg </li></ul><ul><li>child B – ~5.8 ng/mg </li></ul>
How has it got there? <ul><li>No published data on passive exposure </li></ul><ul><li>Likely to need high exposure over prolonged period or large environmental exposure </li></ul><ul><li>Incorporated into the hair </li></ul><ul><ul><li>Hair sample washed and the washes analysed </li></ul></ul><ul><ul><li>(Tsanaclis and Wicks, FSI, 2008) </li></ul></ul><ul><li>Likely to be circulating in the blood </li></ul><ul><ul><li>Metabolite amphetamine also seen </li></ul></ul>
Oral fluid <ul><li>Concept </li></ul><ul><ul><li>Is to equate oral fluid to blood </li></ul></ul><ul><ul><li>treat similarly? </li></ul></ul><ul><li>How? </li></ul><ul><ul><li>collect by spitting/wiping </li></ul></ul>
<ul><li>Collection devices – buffer or not </li></ul><ul><li>Dry mouth syndrome </li></ul><ul><li>Onsite devices not there yet </li></ul><ul><li>Cannabis – problem sensitivity/passive </li></ul><ul><li>When? Why? </li></ul><ul><ul><li>short time frame of use required (hours) </li></ul></ul><ul><ul><li>post accident/ reasonable cause </li></ul></ul><ul><li>How </li></ul><ul><li>Australian standard AS4760:2006 </li></ul><ul><li>European Guideline </li></ul><ul><li>USA- in progress </li></ul><ul><li>BUT </li></ul>
Court Decisions 1 <ul><li>Maritime Union of New Zealand Judgement; December 2007 </li></ul><ul><ul><ul><li>Oral fluid not there yet </li></ul></ul></ul><ul><ul><ul><li>Cannabis detection still the problem </li></ul></ul></ul><ul><ul><ul><li>On-site worse than laboratory testing </li></ul></ul></ul><ul><ul><ul><li>No relationship oral fluid and urine </li></ul></ul></ul>
Court Decisions 2 <ul><li>Australian Industrial Relations Commission August 2008 </li></ul><ul><li>Oral fluid preferred for random drug testing </li></ul><ul><li>Lab based testing </li></ul><ul><li>Issues then were </li></ul><ul><li>No accredited labs/collectors in Australia </li></ul><ul><li>May not reflect when individual is still impaired </li></ul><ul><li>No levels for drugs like sedatives </li></ul><ul><li>Company to do urine in mean time </li></ul>
Different cut-offs different detection times Standard Cut-off level Detection time Passive? AS4760:2006 10 ng/mL Up to 6 hours Probably not European (DRUID) 1 ng/mL days Issue? Studies show could be American thoughts 2 ng/mL Up to 28 days (chronic) Analyse for metabolite as well?
Drug Testing Paradigm <ul><li>Know the limitations of the test </li></ul><ul><li>Target testing to minimise bias results </li></ul><ul><ul><li>Frequency, work days, type of testing </li></ul></ul><ul><li>Awareness of drug trends </li></ul><ul><li>Education and rehabilitation </li></ul><ul><li>IT IS ALL ABOUT MAKING THE BEST CHOICE </li></ul>