DrugCheck Onsite DRUG TESTING TRAINING · · 2016-04-13• A screening test is an initial test...

DrugCheck® Onsite

DRUG TESTING TRAINING

A. Drugs of Abuse and Testing Overview

Trends in Drug Use1. Who’s using drug testing?2. Types of Testing: Screening, Confi rmation3. Detection Times and Cutoff Levels4. False Positives5. Adulteration of Samples6. Interpretation of Results7. Drug Screenings Offered by DrugCheck8. ®

B. DrugCheck® NxScan Cup Features/benefi ts1. Cup operation2.

C. DrugCheck® NxStep CupFeatures/benefi ts1. Cup operation2.

D. DrugCheck® Dip TestFeatures/benefi ts1. Dip operation2.

E. DrugCheck® Training Exam

CONTENTS

Trends in Drug UseAbout 19.5 million Americans or 8.3% of the population are current users of illicit drugs, meaning they use at least once per month, including approximately:

12.4 million employed Americans• 3.9 million dependent on illicit drugs• 15 million dependent on alcohol•

Total economic cost = $246 billion

DRUGS OF ABUSE AND TESTING

MarijuanaCocaineOpiatesAmphetaminesBarbituratesBenzodiazepinesAdultern/SubstitutePropoxypheneMethadonePCP

% Distribution of Positive Results

62.814.4

5.4

5.1

3.23.9

1.7

2.30.8 0.5

Who’s using drug testing?Workplaces with safety-sensitive environments• DOT vs. non-DOT• Manufacturing• Construction• Energy (oil, gas, utilities)• Retail• Gaming• Security• Government• Healthcare• Schools• Corrections: Probation/Parole•

CorporationsWal-Mart 1.2 million• McDonalds 364,000• GM 363,000• UPS 359,000• Ford 346,000• Sears 323,000• IBM 320,000• GE 313,000• Kroger 312,000• JC Penny/Eck. 265,000•


Types of Testing:Screening and Confi rmation

A screening test is an initial test for drugs. It can • be an onsite test like DrugCheck® or a test that is done on a chemistry analyzer. It is usually non-quantitative.

A confi rmation test is often more sensitive and • more specifi c (selective) than a screening test and is usually quantitative.

An example of a confi rmation assay is gas • chromatography/mass spectrometry (GC/MS).

Positive screening tests should be confi rmed by • GC/MS.


Types of Testing


Type Pros Cons Window of DetectionUrine Most reliable results•

Least expensive• Most fl exibility in testing different • drugs, alcohol & nicotineMost likely of all methods to withstand • legal challenge

Specimen can be adulterated, • substituted or dilutedLimited window of detection•

Typically 1 to 5 days, THC • may be longer

Hair Longer window of detection• Greater specimen stability• Can measure chronic use• Easy to ship and store• More diffi cult to adulterate than urine•

Most expensive• Test usually limited to basic 5 • drugsCannot detect alcohol use• Will not detect recent drug • use. (1 to 7 days prior to test)

Depends on length of hair. • Hair growth = half an inch per monthSpecimen shows 3 month • history

Oral Fluids Sample obtained under direct • observationMinimal risk of tampering and • collected in any environmentCan detect alcohol use• Refl ects recent drug use•

Less effi cient in detecting THC• Sample dries out, multiple • sample testing not practicalMore expensive than urine • testingDrugs and metabolites do not • remain in oral fl uids as long as in urine

Approx. 10 to 24 hours•

The “Cutoff Level” is the concentration level established as a breakpoint or threshold for labeling a result Positive or Negative (e.g. 50 ng/mL THC or 300 ng/mL Cocaine)

The concentration of a drug is expressed in nanograms (ng) per milliliters (mL), or ng/mL. One nanogram is equal to one billionth of a gram and 1 mL is equal to about 1/30 of a fl uid ounce.


Detection Times and Cutoff LevelsSAMHSA (Substance Abuse and Mental Health Services Administration) Cutoffs

Drug Type Detection Time Cutoff Levels (ng/mL)Screen GC/MS

Marijuana Up to 10 days (with heavy use up to 30 days)

50 15

Cocaine 2 to 4 days 300 150

Opiates2000 or 300 ng/mL

1 to 2 days 2000 2000

Amphetamine 2 to 4 days 1000 500

Methamphetamine 2 to 4 days 1000 500

Oxycodone 1 to 2 days 100 100

Barbiturates 1 or 2 days, Phenobarb1 or 2 weeks

300 200

Benzodiazepines (example: valium)

1 to 2 days: normal dosechronic use: weeks

300 200

Methadone 1 to 3 days 300 200

Ecstasy 1 to 3 days 500 parent drug

Propoxyphene 3 to 4 days 300 300

Buprenorphine 3 to 4 days 10 10


Detection Times and Cutoff Levels


Drugs of Abuse TableDRUG TYPE PHARMACEUTICAL

NAMEDETECTION TIME SIGNS OF USE

Amphetamine (AMP) Speed, Bennies, Dexies, Uppers, Footballs

Dexedrine, Benzedrine, Dextrostat, Adderall, Biphetamine

2-4 days; cutoff level: 1000 ng/mL Dilated pupils, decreased appetite; dry mouth & nose, bad breath; frequent lip licking, talkative, nervous; increase in heart rate & blood pressure

Methamphetamine (MET) Ice, Crystal, Meth, Doe Desoxyn, Methedrine 2-4 days; cutoff level: 1000 ng/mL Same as amphetamines; overdoses cause elevated body

temp.

Ecstasy (MDMA) XTC, E, Adam, Blue Lips, Blue Kisses, Disco Biscuits, X-ing, Doctor

None 1-3 days; cutoff level: 500 ng/mL Same as amphetamines; may grind teeth and clench jaw, sweating and increase in body temp.

MDA *

Eve, Love Pill None 1-3 days Same as amphetamines; hallucinations, increase in body temp.; tachycardia, agitation, very talkative

Cocaine (COC)

Coke, Crack, Snow, Flake, Rock, Nose Candy, Powder, Blow

None 2-4 days; cutoff level: 300 ng/mL Dilates pupils, increased heart rate and BP; anesthesia, euphoria, sensitive to sound; and touch, less need for food, cardiotoxic

Marijuana (THC)

Weed, Pot, Grass, Reefer, Hash, Mary Jane, Cannabis, Columbian, Acapulco Gold, Ganja, Bhang

Marinol 1-2 joints: 2-3 days; Oral Ingestion: 1-5 days; Moderate smoker: 5 days; Heavy smoker(daily): 10 days; Chronic smoker-5 joints per day: 14-18 days or as long as a month; cutoff level: 50 ng/mL

Increased appetite, altered perception, memory loss, bloodshot eyes, giggle frequently, trouble walking, disorientation; increased heart rate, vasodilation, dry mouth and throat, decreased respiratory rate, panic attacks, and paranoia


DRUG TYPE PHARMACEUTICAL NAME

DETECTION TIME SIGNS OF USE

Methadone (MTD)

Amidone, Fizzes Dolophine, Methadone, L-Polamidon, Physeptone

2-3 days; cutoff level: 300 ng/mL Similar to heroin but less intense; sedation analgesia, same as other opiates

Gamma Hydroxybutyric Acid (GHB) *

GHB, Cherry Meth, Easy Lay, Jib, Georgia Home Boy, Sleep 500, Soap, Vita G, Grievous Bodily Harm, Scoop, Goop, Fantasy, Everclear, Salty Water, Liquid X

None 1 day Users feel euphoric then sleepy; used as a date rape drug; slows breathing and heart rate

Phencyclidine (PCP)

Veterinary Anesthetic, Angel Dust, Hog, Killer Weed

Sernylan Up to 14 days; up to 30 days with chronic users; cutoff level: 25 ng/mL

Dissociative anesthetia-analgesia and amnesia, dissociated from environment but not asleep, pulse and BP elevated, coma

Ketamine *Veterinary Anesthetic, Kat, Special K, Vitamin K, K, Horse Tranquilizer

Ketalar Same as PCP Analgesia, amnesia, hallucinations, foul-tasting drip from nasal passages; users feel they are outside of their body, vomiting, seizures, dissociation

Opiates (OPI) (Heroin- and morphine-based drugs) Smack, H, Skag, Dope, Junk, Horse

Hydromorphone (Dilaudid), Codeine, Tylenol with Codeine, Morphine ( Avinza, Kadian, MS Contin, Oramorph SR, Hydrocodone (Vocodin): Pos. at 300 cutoff

1-2 days; cutoff level: 2000 ng/mL or 300 ng/mL

Pupils constricted, pulse and BP lowered, body temp. lowered, euphoria initially and then drowsy, respiratory depression, convulsions, constipation, coma


DRUG TYPE PHARM. NAME DETECTION TIME SIGNS OF USE

Oxycodone (OXY) OXY, OC,OX, Oxycotton, Hillbilly Heroin, Killer

OxyContin, Percodan, Percocet, Roxicodone, Tylox, OxyContin is a time-released form of Oxycodone

1-3 days; OxyContin longer detection times; cutoff level: 100 ng/mL

Same as opiates

Propoxyphene (PPX)

Yellow Footballs Darvon, Darvocet 3-4 days; cutoff level: 300 ng/mL Same as opiates

Barbiturates (BAR)

Barbs, Downers, Tranqs, Blue Dolls, Bluebirds, Rainbows, Yellows, Reds, Red Devils, M&Ms

Nembutal, Luminal, Seconal, Tuinal, Florinal, Neodorm, Immenoctal, Stadodorm

Short acting: 1 day (Seconal, Nembutal); Long acting: 2-3 weeks (Phenobarb); cutoff level: 300 ng/mL

Pupils normal, but reaction to light slow, pulse, BP and respiratory rate lowered, sedation, stupor, coma

Benzodiazepines (BZO)

Bennies, Rophies Librium, Valium, Ativan, Halicon, Vivol, Novopoxide, Remestan, Rohypnol, Xanax, Tranxene, Restoril, Versed, Clonopin, Rivotril, Dalamane, Serax

Normal dose: 2-3 days; Chronic use (1 or more yrs): 4-6 weeks; cutoff level: 300 ng/mL

Drowsiness, dizziness, muscle relaxtion, hangover effect after large dose, Rohynol used as rate rape drug

Tricyclic Antidepressants (TCA)

Weed, Pot, Grass, Reefer, Hash, Mary Jane, Cannabis, Columbian, Acapulco Gold, Ganja, Bhang

Amitriptyline (Elavil, Endep), Cyclobenzaprine (Flexeril, Clomipramine (Anafranil), Perphenazine (Triafon), Desipramine (Norpramin), Imipramine (Totranil), Nortriptyline (Pamelor), Protriptyline (Vivactil), Trimipramine (Surmontil), Promazine (Sparine), Nordoxepine, Doxepin (Sinequan)

Therapeutic dose: 3 days; Extended use: 4 weeks; cutoff: 1000 ng/mL

Elevated body temperature, elevated pulse and BP, pupils dilated, agitation, delirium, seizures, constipation, dry/fl ush skin


False Positives

POPPY SEED BAGELS Avg. bagel has 5 grams of poppy seeds yielding about 600 to 700 ng/mL of morphine concentration 24 hours after ingestion. New cutoff level is 2,000 not 300.

PROTON PUMP INHIBITORS, like Protonix, Prilosec, Prevacid, and Nexium, that treat GERD, may cause false positives with THC.

SUSTIVA (efavirenz) HIV antiviral causes false positive with THC. Over $282 million sold in 2003. New DrugCheck® THC does not cross-react.

EFFEXOR may cause a false positive with PCP. Over $2 billion sold in 2003.

ZOLOFT (sertraline) may cause a false positive for BZD. Over $2.5 billion sold in 2003.

PHENTERMINE (Pro-Fast, Teramine) may cause a positive result with Amphetamine.

DAYPRO (Oxaprozin) a popular medication for arthritis may cause a false positive for Benzodiazepines.

ADDERALL A treatment for ADHD, may cause a positive for amphetamines.


Drug Panel Cross React. Pharm. Name Brand Name Drug Use

In product insert Dextroamphet + amphet

Adderall Treatment of ADHD and narcolepsy

Amphetamines Potential Amantadine Amantadine Parkinson’s disease

Methamphet-amines

Potential Bupropion Wellbutrin & Zyban Antidepressant

Potential Chloroquine Aralen Treats malaria

Potential Chlorpromazine Thorazine, Largactil Treatment for psychotic disorders

Potential Desipramine Norpramin Antidepressant

Potential Dextroamphetamine Dexedrine Used for narcolepsy “sleep attacks”

Potential Ephedrine Ephedra and Ma Huang Amphetamines

Potential Fenfl uramine Fen Phen Fen Phen diet pill outlawed by FDA

Potential labetalol Labetalol Blood pressure

Potential Mexiletine Mexitil Cardiovascular - treat-ment for arrhythmia

Potential n-acetyl procain-amide

Procainmide Cardiovascular - treat-ment for arrhythmia

Potential Phentremine Adipex/Obenix/Oby-Trim

Diet pills

Does not cross Phenylephrine Neo-synephrine Nascal congestion & hypotension, ophthalmic solution

Potential Propranolol Inderal Cardiovascular-hyperten-sion, (beta blocker)

Does not cross Pseudoephedrine Claritin-D and other OTC cold medicines

Nasal congestion

Potential Quinacrine Atabrine, Mepacrine Protozoal infection of the intestinal tract

Does not cross Ranitidine ZANTAC Treatment for heartburn & duodenal ulcer

Potential Selegiline Selegiline Parkinson’s disease


Methamphet-amines cont.

Potential Trazodone Desyrel, Desyrel Dividose

Antidepressant medica-tion

Does not cross Tyramine Tyramine Headaches/blood pres-sure

In product insert d-Methamphetamine

In product insert d-Amphetamine

In product insert Chloroquine Aralen Treats malaria

In product insert Deoxyephedrine

In product insert MDMA Ecstasy

Methamphetamine Desoxyn ADHD with hyperactivity and obesity

Barbiturates Potential Phenytoin Dilantin Anticonvulsant - treat-ment for epilepsy

Potential Primidone Mysolin Anticonvulsant - treat-ment for epilepsy

In product insert Secobarbital Seconal Sedative

In product insert Alphenal

In product insert Amobarbital Short term treatment of insomnia

In product insert Aprobarbital Relieve anxiety/sleep

In product insert Barbital Induce unconsciousness

In product insert Butabarbital Short term treatment of insomnia

In product insert Butalbital Headaches

In product insert Pentobarbital Nembutal Sedative

In product insert Phenobarbital Epilepsy

Benzodiaz-epines

Potential Oxaprozin Daypro Nonsteroidal anti-infl am-matory - for arthritis

[ EXAMPLE ] Potential Sertraline Zoloft Treatment for depression

In product insert Oxazepam Serax Anti-anxiety

In product insert Alprazolam Xanax Anti-anxiety

Cross Reactivity



Benzodiaz-epines

In product insert Bromazepam Tenix Anti-anxiety

In product insert Chlordiazepoxide Libritabs, Librium Anti-anxiety

In product insert Clobazam Mystan Epilepsy

In product insert Clonazepam Klonopin Anti-anxiety

In product insert Diazepam Valium Treat for anxiety, epilepsy & muscle relaxant

In product insert Estazolam Prosum Sleeping pill/cousin to valium

In product insert Flunitrazepam Rohypnol Known as date rape drug; illegal in U.S.; legally sold elsewhere as short-term treatment for insomnia

In product insert Lorazepam Ativan Anti-anxiety

In product insert Nitrazepam Rhoxal Insomnia

In product insert Nordiazepam Diazepam Tranquilizer

In product insert Temazepam Restoril Relief of insomnia

In product insert Triazolam Halcion Short-term to assist sleep

Marijuana In product insert Dronabino Marinol Liquid THC, to increase appetite

Potential Efavirenz Sustiva AIDS

Potential Hemp Seed Oil Cannabis seed

[ EXAMPLE ] Potential Pantoerazole Protonix GERD acid refl ux

Potential Panpoloc (Canadian) GERD acid refl ux

Potential Nexium GERD acid refl ux

Potential Prilosec GERD acid refl ux

Cocaine Potential TAC Solution TAC Solution Topical cocaine for pain

In product insert Benzoylecgonine Cocaine toothache drops

In product insert Cocaine

In product insert Ecgonine Cocaine metabolites

In product insert Ecgonine Methyl Ester

Cocaine metabolites


Methadone In product insert None Common treatment for heroin/opiate addiction

Opiates Potential Fluoroquinolones Treatment for bacterial infections

Potential Ofl oxacin Floxin Ear Drops - antibiotic, treatment for PID

Potential Papaverine Erectile dysfunction

Potential Poppy Seeds Baking goods

Potential Rifampicin & Rifampin

Rimactine,Rifadin, Rofact

Antimicrobal, treatment for TB

In product insert Morphine Pain

In product insert 6-Acetylmorphine Pain

In product insert Codeine Pain

In product insert Ethyl morphine Pain

In product insert Hydromorphone Pain

In product insert Hydrocodone Vicodin Pain

Oxycodone In product insert Oxycodone OxyContin/Percolone/Roxicodone

Moderate to severe pain

In product insert Hydrocodone Vicodin Analgesic with acet-aminophen

In product insert Hydromorphone Dilaudid Pain management

In product insert Oxymorphone Numorphan Treatment for moderate to severe pain

In product insert Codeine Codeine Pain management / cough medicine

Phencyclidine (PCP)

Potential Dextromethorphan Dextromethorphan Treat cough

Potential Diphenhydramine Benadryl Allergies

Potential Thioridazine Mellaril Tranquilizer, for psychotic disorders

Potential Venlafaxine Effexor Antidepressant

In product insert Phencyclidine PCP

Cross Reactivity


Adulteration of Samples

Adulterant Drug Test Affected Adulteration Strip AffectedChlorine Bleach THC, OPI, AMP pH, SG, Oxid

Liquid Drain Cleaner OPI, AMP pH, SG

Vinegar AMP SG

Pyridinium Cl Cr (PCC) THC, COC, OPI, PCP, AMP SG, Oxid

Stealth THC, COC, PCP Oxid

Instant Clean THC, COC, PCP Oxid

UR’n Kleen THC, COC, OPI, PCP SG


Test for 4-panel AdulterationCREATININE Waste product from creatine metabolism that originates from skeletal muscles. Creatinine is excreted in the urine at a constant rate. Normal range: 20 mg/dl to 200 mg/dl.

pH Normal urine range from 6.0 to 7.0, but can vary from 4.5 to 8.0. High pH urines can be seen in UTIs or from diets high in vegetables and diary products. Low pH urines result from uremia, severe diarrhea, starvation and diets high in ascorbic acid or citric fruits.

SPECIFIC GRAVITY Measures urine concentration, or the amount of dissolved substances present in urine compared to distilled water. Normal range is from 1.002 to 1.030. High values are caused by dehydration, glycosuria, and radio-opaque dyes. Low values occur in diabetes insipidus, renal disease and diuretic use.

NITRITE Present in the urine from urinary bacterial infections with levels at 0.1 mg/dL to 5 mg/dL. The cutoff for adulterated samples is >15 mg/dL. The presence of bleach will give an abnormal result.

DC107 1007

2 3 4 5 7 9 ≥10

1.000 1.005 1.015 1.025 ≥1.030

0 0.1-0.2 0.5-5.0 ≥15mg/dl

Negative 10 20 50 100 200 mg/dl

ADULTERATION COLOR COMPARISON CHARTABNORMAL

(LOW)

pHImmediate

Specific Gravity (SG)45 seconds

Nitrite (NI)45 seconds

Creatinine (CR)45 seconds

ABNORMAL(HIGH)

NORMAL

Adulterant strip results should be read at 1 minute. Do not read results after 1 minute as pad color may change.


Test for 3-panel Adulteration

DC107C 0608

Adulteration Color Comparison ChartAbnormal

(Low)Test Strip TestReading Time

2 3 4 5 7 9 ≥10

pHImmediate

1.000 1.005 1.015 1.025 ≥1.030

SpecificGravity (SG)

45 seconds

PositiveNegative

Oxidants(OX)

30 seconds

Abnormal(High)

Normal

(example of strip as it may appear in cup)

OXIDANTS Tests for the presence of oxidants, such as bleach and peroxide, in the urine. Oxidants, when present in urine, will produce a blue or green color.

SPECIFIC GRAVITY Measures urine concentration, or the amount of dissolved substances present in urine compared to distilled water. Normal range is from 1.002 to 1.030. High values are caused by dehydration, glycosuria, and radio-opaque dyes. Low values occur in diabetes insipidus, renal disease and diuretic use.

pH Normal urine range from 6.0 to 7.0, but can vary from 4.5 to 8.0. High pH urines can be seen in UTIs or from diets high in vegetables and diary products. Low pH urines result from uremia, severe diarrhea, starvation and diets high in ascorbic acid or citric fruits.

Adulterant strip results should be read at 1 minute. Do not read results after1 minute as pad color may change.


DrugCheck® Urine Alcohol TestUrine alcohol will be positive up to 8 hours depending on amount of alcohol consumed. If alcohol strips are used, the results are obtained by direct comparison of the reacted pad to the color blocks on the Alcohol Color Chart.

Negative results are indicated by no color, or light yellow color, on the pad (0% pad reaction).

Positive results are indicated by a color reaction on the pad (light green to bluish green color). See Alcohol Color Chart for intensity.

Invalid results are indicated by color development only on the edges that might be ascribed to insuffi cient sampling. Sample should be retested.

Alcohol strip results should be read at 2 minutes. Do not read results after 2 minutes as pad color may change.

Alcohol Color Chart 0% 0.04% 0.08% 0.20%

DC121 0507


Interpretation of Results: Urine TestsNEGATIVE Two lines appear. One line visible in the control region (C), and another apparent line adjacent visible in the test region (T). This negative result indicates that the drug concentration is below the detectable level.

NOTE: The shade of color in the test line region (T) will vary, but it should be considered negative if a line is visible. There is no meaning attributed to the line color intensity or width.

POSITIVE One line appears in the control region (C). No line whatsoever appears in the test region (T). The lack of a line in the test region (T) indicates a preliminary positive result for the corresponding drug of that specifi c test region. Send this urine specimen to a certifi ed laboratory for a more specifi c confi rmation by GC/MS.

INVALID Control line fails to appear. Insuffi cient specimen volume or incorrect procedural techniques are the most likely reasons for control line failure. Review the procedure and repeat the test using a new test device. If the problem persists, contact your supplier for technical support.

C

T

C

T

C

T

C

T

C

T

C

T


Screenings Offered by DrugCheck®

Alcohol

Amphetamine(1000 ng/mL)

Barbiturates(300 ng/mL)

Buprenorphine

(10 ng/mL)

Benzodiazepines

(300 ng/mL)

Cocaine(300 ng/mL)

Ecstasy(500 ng/mL)

Methamphetamine(1000 ng/mL)

Methadone(300 ng/mL)

Opiates – OPI 2000(2000 ng/mL)

Opiates – OPI 300(300 ng/mL)

Oxycodone(100 ng/mL)

Phencyclidine(25 ng/mL)

Propoxyphene(300 ng/mL)

Tricyclic Antidepressants

(1000 ng/mL)

Marijuana(50 ng/mL)

Cotinine(200 ng/mL)

EDDP(100 ng/mL)

Fentanyl(10 ng/mL)

DrugCheck® Onsite

DRUG TESTING TRAINING

For more information, contact your distributor.

DrugCheck Onsite DRUG TESTING TRAINING · · 2016-04-13• A screening test is an initial test...

Documents

Transcript of DrugCheck Onsite DRUG TESTING TRAINING · · 2016-04-13• A screening test is an initial test...