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Developments in Toxicology Support for the DRE Community

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NMS Labs and Draeger Safety Diagnostics announce a partnership formed to deliver the Total Oral Fluid Drug Testing Solution.

Presented by Barry K. Logan PhD, DABFT, National Director of Forensic Services, NMS Labs - July 2011..

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Developments in Toxicology Support for the DRE Community

  1. 1. DEVELOPMENTS IN TOXICOLOGY SUPPORT FOR THE DRE COMMUNITY Barry K Logan PhD, DABFT National Director of Forensic Services NMS Labs
  2. 2. <ul><li>NMS Labs made a long term commitment to support the DRE program through the development of specially targeted tests, the most up-to-date test menu, and innovations in test design and service. </li></ul><ul><li>We are committed to quality and forensic defensibility through accreditation and analytical practices that exceed regulatory requirements. </li></ul>Welcome
  3. 3. Oral Fluid Drug Testing for DRE
  4. 4. <ul><li>NMS Labs and Dräger Safety Diagnostics are proud to announce a partnership formed to deliver the Total Oral Fluid Drug Testing Solution – comprising: </li></ul><ul><ul><li>Field OF Drug Screen </li></ul></ul><ul><ul><li>Sample Collection and Shipping Supplies </li></ul></ul><ul><ul><li>Targeted LCTOF Confirmation </li></ul></ul><ul><ul><li>Online Results </li></ul></ul><ul><ul><li>One Price, One Invoice </li></ul></ul>Welcome
  5. 5. <ul><li>Oral Fluid </li></ul><ul><ul><li>Least invasive collection. </li></ul></ul><ul><ul><li>No time delay for collection. </li></ul></ul><ul><ul><li>On-site testing capability. </li></ul></ul><ul><ul><li>Targeting parent drug for detection. </li></ul></ul><ul><ul><li>Drugs are stable at room temperature. </li></ul></ul><ul><ul><li>Well suited to DRE program or per se States. </li></ul></ul><ul><ul><li>Ideal for routine arrests, checkpoints, and emphasis patrols. </li></ul></ul>OF Drug Testing
  6. 6. <ul><li>2004 Australian states begin random roadside oral fluid testing. </li></ul><ul><li>2005 ROSITA II report issued. </li></ul><ul><ul><li>Not ready for forensic implementation </li></ul></ul><ul><ul><li>Limited sensitivity </li></ul></ul><ul><ul><li>Operator dependent </li></ul></ul><ul><ul><li>Poor QC in manufacturing </li></ul></ul>History of OF Drug Testing
  7. 7. <ul><li>2006 DRUID Project begins </li></ul><ul><li>2009 “ESTHER” report issued. </li></ul><ul><ul><li>Evaluation of oral fluid Screening devices by TISPOL to Harmonise European police Requirements. </li></ul></ul><ul><ul><li>16 Devices evaluated </li></ul></ul><ul><ul><li>The Dräger Drug Test 5000, was qualified as promising from a practical police perspective to be used during daily traffic law enforcement activities. </li></ul></ul><ul><ul><li>Suitable for use in police vehicles. </li></ul></ul>History of OF Drug Testing
  8. 8. DUID Oral Fluid Use Belgium: saliva screening, blood/saliva confirmation Australia: saliva screening (2x), saliva confirmation Germany: saliva/urine testing, blood confirmation UK: FST, blood sampling; no device being used France: saliva screening, blood confirmation Switzerland: Approved for use
  9. 9. DUID Oral Fluid Use OF Specifically Approved in: Alabama Arizona Colorado Indiana Kansas Louisiana Missouri New York North Carolina North Dakota Ohio Oregon South Dakota Utah
  10. 10. Making OF Testing work for DRE <ul><li>Reliable Roadside/Portable Test </li></ul><ul><ul><li>Targeted to DRE priority drugs </li></ul></ul><ul><ul><li>Sensitive </li></ul></ul><ul><ul><li>Non-subjective </li></ul></ul><ul><ul><li>Documentable </li></ul></ul><ul><li>Laboratory Confirmation </li></ul><ul><ul><li>Integrated with screen wrt scope and sensitivity </li></ul></ul><ul><ul><li>Validated for collection devices </li></ul></ul><ul><ul><li>Works well with limited sample volume </li></ul></ul>
  11. 11. <ul><li>Dräger Drug Test 5000 Field Test Included </li></ul><ul><ul><li>Amphetamine/Methamphetamine </li></ul></ul><ul><ul><li>Cocaine </li></ul></ul><ul><ul><li>Opiate </li></ul></ul><ul><ul><li>Cannabinoids </li></ul></ul><ul><ul><li>Benzodiazepines </li></ul></ul><ul><ul><li>Methadone </li></ul></ul><ul><li>Quantisal® Collection Device included </li></ul><ul><ul><li>Collects 1mL of OF in the field </li></ul></ul><ul><ul><li>Ships to NMS Labs </li></ul></ul>Total OF Drug Test Solution
  12. 12. Total OF Drug Test Solution <ul><li>NMS Labs LCTOF Confirmation Included </li></ul>Amps Benzos Opiates Cocaine Methadone Cannabs Amphetamine Diazepam Codeine Benzoylecgonine Methadone THC Methamphetamine Nordiazepam Morphine Cocaine EDDP THC-COOH MDMA Oxazepam Hydrocodone Cocaethylene MDA Temazepam 6-MAM Chlordiazepoxide Hydromorphone Lorazepam Oxycodone Clonazepam Oxymorphone Alprazolam Dihydrocodeine Midazolam
  13. 13. <ul><li>Comparing the Dräger scope to the positives from the DRE program, ~70% of the potentially impairing drug positives would cross-react. </li></ul><ul><li>Since many cases are polydrug, case positive rate will likely be higher. </li></ul><ul><li>Cut-offs targeted to match Dräger Drug Test 5000, and exceed proposed workplace guidelines. </li></ul>Total OF Drug Test Solution
  14. 14. <ul><li>Drugs missed would include PCP, and some prescription medications (tricyclic antidepressants, antihistamines, muscle relaxants, barbiturates). </li></ul><ul><li>Less significant misses: SSRIs. </li></ul><ul><li>With significant impairment and a negative field drug test, blood draw should be considered. </li></ul>Limitations and Solutions
  15. 15. Complements Existing NMS Labs Tests <ul><li>8070B (Blood) Drug Impaired Driving/DRE Toxicology Panel (with Alcohol) </li></ul><ul><li>8070U (Urine) Drug Impaired Driving/DRE Toxicology Panel (with Alcohol) </li></ul><ul><li>8071B (Blood) Drug Impaired Driving/DRE Toxicology Panel </li></ul><ul><li>8071U (Urine) Drug Impaired Driving/DRE Toxicology Panel </li></ul>
  16. 16. Complements Existing DRE Tests <ul><li>Fast TAT </li></ul><ul><li>Proactive Customer Support </li></ul><ul><li>Newly Revised Reference Comments </li></ul><ul><li>New Forensic Report Format </li></ul><ul><li>Fast Access to Results Reports Online </li></ul><ul><li>Quality Backed by ABFT and ISO accreditation </li></ul>
  17. 17. Complements Existing NMS Labs Tests <ul><li>Rx & Therapeutic Drugs or Metabolites </li></ul><ul><li>Hallucinogens </li></ul><ul><li>Inhalants </li></ul><ul><li>1,1 Difluoroethane (DFE) </li></ul><ul><li>Piperazine Designer Drugs Panel </li></ul><ul><li>Gamma-Hydroxybutyric Acid (GHB) </li></ul><ul><li>Salvinorin A & B </li></ul><ul><li>Synthetic Cannabinoids </li></ul><ul><li>Designer Stimulants (“Bath Salts”) </li></ul>
  18. 18. Designer Drugs and Synthetics
  19. 19. Designer Drugs “Bath Salts” <ul><li>“ Novelty Items” </li></ul><ul><li>“ Bath Salts” </li></ul><ul><ul><li>Water softening agents, epsom salts, sodium bicarbonate, sodium chloride, amino acid blend, naturally occuring trace elements and minerals. </li></ul></ul><ul><li>Mephedrone or MDPV </li></ul>
  20. 20. Available Designer Drug Tests <ul><li>2623B Mephedrone & MDPV Designer Stimulants, Blood </li></ul><ul><li>2623U Mephedrone & MDPV Designer Stimulants, Urine </li></ul>
  21. 21. Available Designer Drug Tests <ul><li>MBDB </li></ul><ul><li>2C-B </li></ul><ul><li>2C-I </li></ul><ul><li>2C-T-7 </li></ul><ul><li>BZP </li></ul><ul><li>TFMPP </li></ul><ul><li>Cathinone </li></ul><ul><li>Mephedrone </li></ul><ul><li>4-methylmethcathinone </li></ul><ul><li>Salvinorin B </li></ul><ul><li>AMT </li></ul><ul><li>DMT </li></ul><ul><li>5-MeO-DIPT </li></ul><ul><li>2-C-B-fly </li></ul><ul><li>bromo-dragon fly </li></ul>8755B/U Hallucinogens Panel (Expanded) includes: 30 more in development!
  22. 22. Available Designer Drug Tests <ul><li>2C-B </li></ul><ul><li>2C-D </li></ul><ul><li>2C-E </li></ul><ul><li>2C-H </li></ul><ul><li>2C-I </li></ul><ul><li>2C-N </li></ul><ul><li>2C-P </li></ul><ul><li>2C-T-2 </li></ul><ul><li>2C-T-4 </li></ul>As Special Request: <ul><li>Methcathinone </li></ul><ul><li>Buphedrone </li></ul><ul><li>Flephedrone </li></ul><ul><li>Methedrone </li></ul><ul><li>4-methylethcathinone </li></ul><ul><li>4-methylmethcathinone </li></ul><ul><li>3,4-DMMC </li></ul><ul><li>3-FMC </li></ul><ul><li>Methylone </li></ul><ul><li>Ethylone </li></ul><ul><li>Butylone </li></ul><ul><li>Pentylone </li></ul><ul><li>Pyrovalerone </li></ul><ul><li>α -Pyrrolidinopentiophenone </li></ul><ul><li>Naphyrone </li></ul>
  23. 23. Designer Synthetic Cannabinoids <ul><li>Cannabis-like effects. </li></ul><ul><li>With paranoia, hypertension, seizures, agitation, and psychosis. </li></ul><ul><li>First Wave: </li></ul><ul><ul><li>JWH-018 </li></ul></ul><ul><ul><li>JWH-073 </li></ul></ul><ul><ul><li>JWH-019 </li></ul></ul><ul><ul><li>JWH-250 </li></ul></ul><ul><li>9560B Synthetic Cannabinoids Screen, Blood (Forensic) Test </li></ul>JWH-018
  24. 24. Syn Cann: DRE Case State College, PA Driving Male, 21 yo Five hits “Mr Nice Guy Incense” two hours prior, in a blunt Admits 20mg Zyprexa one hour prior Minor one car crash into curb Toxicology (Blood) Behavioral Olanzapine JWH-018 10ng/mL 5ng/mL Subject has slurred speech, slow and low Unsteady on feet States he can hardly stand Fell asleep during evaluation Eyes rolled back in his head Poor coordination Cooperative DRE Opinion CNS Depressant/Cannabis
  25. 25. Syn Cann: DRE Case State College, PA Physiological Male, 21 yo Five hits “Mr Nice Guy Incense” two hours prior, in a blunt Admits 20mg Zyprexa one hour prior HGN VGN LOC Pulse BP Eyes Pupil size Temp. All six clues, immediate onset Present Present 86 BPM 108/54 Bloodshot Dilated 101 Toxicology (Blood) SFST Olanzapine JWH-018 10ng/mL 5ng/mL OLS Unable to perform WAT Unable to perform DRE Opinion CNS Depressant/Cannabis FTN Unable to perform
  26. 26. Designer Synthetic Cannabinoids <ul><li>Newly Expanded Scope! </li></ul><ul><li>9560B Synthetic Cannabinoids Screen, Blood (Forensic) Test </li></ul><ul><ul><li>JWH-018 </li></ul></ul><ul><ul><li>JWH-019 </li></ul></ul><ul><ul><li>JWH-073 </li></ul></ul><ul><ul><li>JWH-250 </li></ul></ul><ul><ul><li>JWH-081 </li></ul></ul><ul><ul><li>JWH-122 </li></ul></ul><ul><ul><li>JWH-200 </li></ul></ul><ul><ul><li>JWH-210 </li></ul></ul><ul><ul><li>RCS-4 </li></ul></ul><ul><ul><li>RCS-8 </li></ul></ul><ul><ul><li>AM-694 </li></ul></ul><ul><ul><li>AM-2201 </li></ul></ul>
  27. 27. Designer Synthetic Cannabinoids <ul><li>Urine Tests </li></ul><ul><li>NMS Labs first to announce true metabolites of: </li></ul><ul><ul><li>JWH-018 </li></ul></ul><ul><ul><li>JWH-073 </li></ul></ul><ul><ul><li>JWH-019 </li></ul></ul><ul><ul><li>JWH-250 </li></ul></ul><ul><ul><li>AM-2201 </li></ul></ul><ul><li>New Tests Coming Soon. </li></ul>
  28. 28. Thank You! www.NMSLabs.com www.draeger.com
  29. 29. DRE Immunoassay Panel For each of the immunoassay tests run, how often are they positive? Immunoassay Positivity Rate (%) (n=3810 cases) Amphetamines 5.3 Barbiturates 0.2 Benzodiazepines 21.4 Cocaine/Metabolites 11.0 Methadone 3.7 Opiates 13.7 PCP 1.2 Propoxyphene* 0.4 Cannabinoids 47.3
  30. 30. DRE Immunoassay Panel For each of the immunoassay test positives, how often are the confirmations negative? Reflex test All Negative Rate (%) Amphetamines 41.5 Barbiturates 14.5 Benzodiazepines 7.2 Cocaine/Metabolites 24.5 Methadone 8.8 Opiates 15.5 PCP 24.5 Propoxyphene* 23.2 Cannabinoids 42.1
  31. 31. DRE Immunoassay Panel For each of the immunoassay tests run, how often are they positive? Immunoassay Positivity Rate (%) (n=3810 cases) Amphetamines 5.3 Barbiturates 0.2 Benzodiazepines 21.4 Cocaine/Metabolites 11.0 Methadone 3.7 Opiates 13.7 PCP 1.2 Propoxyphene* 0.4 Cannabinoids 47.3
  32. 32. DRE Immunoassay Panel <ul><li>1. Of the DRE basic panel that is currently ordered: </li></ul><ul><li>What percentage are positive for each of the immunoassays run individually? </li></ul><ul><ul><li>See Slide </li></ul></ul><ul><li>What percentage are positive for any immunoassay run? </li></ul><ul><ul><li>Alcohol aside 83% screen positive for at least one drug. </li></ul></ul><ul><li>What are the average number of reflexes from the Immunoassay panel? </li></ul><ul><ul><li>Average number of reflexes is 1.4 for drug test. </li></ul></ul><ul><li>What is the positivity rate for each of the reflexes ordered from the Immunoassay. </li></ul><ul><ul><li>Cannot determine </li></ul></ul><ul><li>2. For the reflexes from the Immunoassay </li></ul><ul><li>Which and how many of each of the reflex tests are ordered? </li></ul><ul><ul><li>Done, not helpful </li></ul></ul><ul><li>b. What is the positivity rate for each of the reportable compounds? </li></ul><ul><li>3. For the GC Add-on on any of the DRE Acodes </li></ul><ul><li>a. What is the frequency and identity of all reportable compounds from the GC add on </li></ul><ul><li>b. What is the average number of reflex tests from the GC Add on </li></ul><ul><li>c. What is the identity and total number of instances of being reported for any drug reported from the GC add on? </li></ul><ul><li>4. Of all the DRE WO’s </li></ul><ul><li>a. How many cases end up being positive for at least one reportable drug? </li></ul><ul><li>b. How many are positive for 2,3,4,and 5 or more drugs? </li></ul>

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