Oral Fluid Drug Testing: Analytical Approaches, Issues and Interpretation of Results

2019 ◽  
Vol 43 (6) ◽  
pp. 415-443 ◽  
Author(s):  
Nathalie A Desrosiers ◽  
Marilyn A Huestis
Keyword(s):  
Analytical Methods ◽  
Drug Testing ◽  
Oral Fluid ◽  
Driving Under The Influence ◽  
Multiple Drug ◽  
Blood Concentrations ◽  
The Past ◽  
Drug Classes ◽  
Drug Concentrations ◽  
Analytical Approaches

AbstractWith advances in analytical technology and new research informing result interpretation, oral fluid (OF) testing has gained acceptance over the past decades as an alternative biological matrix for detecting drugs in forensic and clinical settings. OF testing offers simple, rapid, non-invasive, observed specimen collection. This article offers a review of the scientific literature covering analytical methods and interpretation published over the past two decades for amphetamines, cannabis, cocaine, opioids, and benzodiazepines. Several analytical methods have been published for individual drug classes and, increasingly, for multiple drug classes. The method of OF collection can have a significant impact on the resultant drug concentration. Drug concentrations for amphetamines, cannabis, cocaine, opioids, and benzodiazepines are reviewed in the context of the dosing condition and the collection method. Time of last detection is evaluated against several agencies' cutoffs, including the proposed Substance Abuse and Mental Health Services Administration, European Workplace Drug Testing Society and Driving Under the Influence of Drugs, Alcohol and Medicines cutoffs. A significant correlation was frequently observed between matrices (i.e., between OF and plasma or blood concentrations); however, high intra-subject and inter-subject variability precludes prediction of blood concentrations from OF concentrations. This article will assist individuals in understanding the relative merits and limitations of various methods of OF collection, analysis and interpretation.

scholarly journals Relationship Between Oral Fluid and Blood Concentrations of Drugs of Abuse in Drivers Suspected of Driving Under the Influence of Drugs

2009 ◽  
Vol 31 (4) ◽  
pp. 511-519 ◽  
Author(s):  
Sarah M R Wille ◽  
Elke Raes ◽  
Pirjo Lillsunde ◽  
Teemu Gunnar ◽  
Marleen Laloup ◽  
...  
Keyword(s):  
Oral Fluid ◽  
Drugs Of Abuse ◽  
Driving Under The Influence ◽  
Blood Concentrations

scholarly journals Using biological samples in epidemiological research on drugs of abuse

2011 ◽  
Vol 21 (1) ◽  
Author(s):  
Hallvard Gjerde ◽  
Elisabeth Leere Øiestad ◽  
Asbjørg S. Christophersen
Keyword(s):  
Drug Use ◽  
Drug Testing ◽  
Oral Fluid ◽  
Drugs Of Abuse ◽  
Drug Dose ◽  
Biological Matrices ◽  
Single Drug ◽  
Drug Concentrations ◽  
Frequency Of Use ◽  
Hair Samples

Blood, oral fluid (saliva), urine and hair are the most commonly used biological matrices for drug testing in epidemiological drug research. Other biological matrices may also be used for selected purposes. Blood reflects recent drug intake and may be used to assess impairment. Oral fluid reflects drug presence in blood and thereby also recent intake, but drug concentrations in this matrix cannot be used to accurately estimate concentrations in blood. Urine reflects drug use during the last few days and in some cases for a longer period, but does not indicate the dose size or frequency of use. Hair reflects drug use during several months, but is a poor matrix for detecting use of cannabis. If using a single drug dose, this can be detected in blood and urine if the sample is taken within the detection timeframes, in most cases also in oral fluid. Single drug use is most often insufficient for producing a positive test result in a sample of hair. For cocaine and amphetamine, weekly use may be needed, while for cannabis a positive result is not guaranteed even after daily use. Refusal rates are lowest for oral fluid and highest for blood and hair samples. The analytical costs are lowest for urine and highest for hair. Combined use of questionnaires/interviews and drug testing detects more drug use than when using only one of those methods and is therefore expected to give more accurate data.

Increasing Prevalence of Ketamine in Drivers in New York City Including the Identification of 2-Fluoro-Deschloroketamine

2021 ◽  
Author(s):  
Elba Arango ◽  
Allison Toriello ◽  
Zoila Rosario ◽  
Gail Cooper
Keyword(s):  
New York ◽  
Law Enforcement ◽  
Driving Under The Influence ◽  
Recreational Drug ◽  
Effective Management ◽  
Blood Concentrations ◽  
Predominantly Hispanic ◽  
Drug Classes ◽  
Increasing Trend ◽  
First Time

Abstract Ketamine is a dissociative anesthetic used in veterinary and human medicine since the 1970s. Its clinical use has expanded to control of seizures, pre-hospital emergency medical services (EMS), and is finding new purpose as an analgesic alternative and antidepressant. Ketamine brings hope for effective management of chronic pain in the absence of opioids, and decreasing suicidal ideations, however, its persistence as a recreational drug for its hallucinogenic properties remains. In the wake of expanding medicinal purposes, the diversity of New York City’s population was explored to better understand its misuse. This retrospective study looks at the prevalence of ketamine in driver fatalities over a period of 18 years (2003–2020) and cases involving suspected driving under the influence of drugs (DUID) over a period of 6 years (2015–2020). Ketamine was identified in 6 driver fatalities and in 47 DUID cases. None of the driver fatalities were suspected of ketamine misuse, due to administration either in hospital or EMS administration. In the DUID cases, an increasing trend was observed over the 6-year study period with 100% (N = 47) of the cases confirmed as non-hospital/non-EMS administered ketamine. Of the DUID cases, 94% were male, with the majority between the age of 21–39 years (85%) and were predominantly Hispanic (36%) and Asian (34%). Blood concentrations of ketamine ranged from 27 to > 2000 ng/mL with polydrug use prevalent. The most common drug classes detected in addition to ketamine were cannabinoids (38%), ethanol (32%), benzodiazepines (26%), cocaine (19%), and amphetamines/MDMA (15%). In 2019, 2-fluoro-deschloroketamine (2F-DCK) was identified in two cases for the first time. Despite its increased acceptance for mental health disorders, ketamine’s persistence and misuse as a recreational drug remains and should continue to be monitored by relevant toxicological, clinical, and law enforcement communities along with emerging illicit ketamine analogs.

A Single Method for 127 Recommended and Additional DUID Drugs in Blood and Urine by LC-MS/MS

2021 ◽  
Author(s):  
Megan Farley ◽  
Helena Tran ◽  
Steven Towler ◽  
Jirair Gevorkyan ◽  
Sue Pearring ◽  
...  
Keyword(s):  
Driving Under The Influence ◽  
Urine Samples ◽  
Multiple Drug ◽  
Tier 2 ◽  
Simple Method ◽  
Forensic Casework ◽  
Target Drug ◽  
Drug Classes ◽  
Blood And Urine Samples ◽  
Single Method

Abstract Driving under the influence of drugs (DUID) cases continue to challenge forensic toxicologists as both the volume and complexity of casework increases. Comprehensive DUID testing should also meet the drafted ASB/ANSI standard and the NSC-ADID recommendations. A simple method using protein precipitation followed by filtration extraction with an 8-minute run time by LC-MS/MS was developed, and a comprehensive ASB/ANSI validation performed. Assessed in blood quantitatively, and urine qualitatively, is 127 target drug and metabolite analytes including cannabinoids (12), amphetamines (11), cocaine and metabolites (6), benzodiazepines (36), Z-drugs (5), opioids (27), anticonvulsants (3), first-generation antihistamines (6), muscle relaxants (2), dissociatives and hallucinogens (6), barbiturates (10), and miscellaneous substances (3). Limits of detection are appropriate for DUID, and other forensic casework such as drug-facilitated crime (DFC) and postmortem investigations. To demonstrate applicability, 78 proficiency test blood and urine samples, and 1,645 blood and urine samples from authentic cases samples demonstrated effective detection of target analytes in forensic casework. By increasing the analytical scope of multiple drug classes via a single method, this technique detects drugs that may have previously gone undetected, such as flualprazolam, etizolam, mitragynine, gamma-hydroxybutyric acid, and psilocin, and improves laboratory efficiency by reducing the number of tests required. The described method is, to the authors’ best knowledge, the only published single procedure to meet all drugs listed in the drafted ASB/ANSI standard, and recommended Tier 1 and traditional drugs from Tier 2 for DUID screening, whilst also achieving many drugs recommended for DFC and postmortem testing.

Oral fluid testing for marijuana intoxication: enhancing objectivity for roadside DUI testing

2017 ◽  
Vol 24 (1) ◽  
pp. 78-80 ◽  
Author(s):  
Mitchell L Doucette ◽  
Shannon Frattaroli ◽  
Jon S Vernick
Keyword(s):  
Drug Testing ◽  
Oral Fluid ◽  
Motor Vehicle ◽  
District Of Columbia ◽  
Driving Under The Influence ◽  
Policy Makers ◽  
Us States ◽  
The Usa ◽  
Recreational Use ◽  
Marijuana Intoxication

Reducing marijuana-impaired driving is an important part of any strategy to prevent motor vehicle traffic injuries. In Colorado, the first of eight US states and the District of Columbia to legalise marijuana for recreational use, drivers with positive tests for the presence of marijuana accounted for a larger proportion of fatal MVCs after marijuana commercialisation. The use of blood tests to screen for marijuana intoxication, in Colorado and elsewhere in the USA, poses a number of challenges. Many high-income countries use oral fluid drug testing (OF) to provide roadside evidence of marijuana intoxication. A 2009 Belgium policy implementing OF roadside testing increased true positives and decreased false positives of suspected marijuana-related driving under the influence (DUI) arrests. US policy-makers should consider using roadside OF to increase objectivity and reliability for tests used in marijuana-related DUI arrests.

scholarly journals Drivers who tested positive for cannabis in oral fluid: a longitudinal analysis of administrative data for Spain between 2011 and 2016

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e026648 ◽  
Author(s):  
Francisco Herrera-Gómez ◽  
Mercedes García-Mingo ◽  
Mónica Colás ◽  
Juan Carlos González-Luque ◽  
F Javier Alvarez
Keyword(s):  
Administrative Data ◽  
Drug Testing ◽  
Oral Fluid ◽  
Driving Under The Influence ◽  
Secondary Outcome ◽  
Age And Gender ◽  
Polysubstance Use ◽  
Current Implementation ◽  
The Mean ◽  
And Gender

ObjectivesThis study aimed to assess the association between positive roadside tests for delta-9-tetrahydrocannabinol (THC) and other driving-impairing substances and THC concentrations and the age and gender of THC-positive drivers.DesignThis study is based on administrative data.Setting, participants and exposuresNational administrative data on drivers who tested positive in confirmation analysis of driving-impairing substances in oral fluid were assessed (2011–2016, 179 645 tests).Primary and secondary outcome measuresFrequencies of positivity for THC, THC alone and THC plus non-THC substances (stratification by age and gender in 2016) and THC concentration were obtained. Comparisons and univariate and multivariate regression analyses were performed.ResultsOf the 65 244 confirmed drug-positive tests, 51 869 were positive for THC (79.5%). In 50.8% of the THC-positive tests, cocaine and amphetamines were also detected. Positivity for THC and non-THC substances predominated among drivers with low THC concentrations and represented 58.6% of those with levels lower than 25 ng/mL. The mean±SD for age was 29.6±7.7 years (year 2016, n=24 941). Men accounted for 96.3% of all THC-positive drivers. With increasing age, positivity for THC decreased (OR 0.948; 95% CI 0.945 to 0.952; p<0.0001), and positivity for THC and non-THC substances increased (OR 1.021; 95% CI 1.017 to 1.024; p<0.0001). Men were associated with higher THC concentrations (OR 1.394; 95% CI 1.188 to 1.636; p<0.0001).ConclusionsCannabis positivity is frequent among drivers, and polysubstance use is common. Hence, focusing on younger drivers and those with low THC concentrations is encouraged. This study provides evidence on the current implementation of roadside drug testing in Spain and aims to characterise driving under the influence (DUI) of cannabis to increase the awareness of all involved to help them avoid DUI.

scholarly journals Recommendations for Toxicological Investigation of Drug-Impaired Driving and Motor Vehicle Fatalities – 2021 Update

2021 ◽  
Author(s):  
Amanda L D’Orazio ◽  
Amanda L A Mohr ◽  
Ayako Chan-Hosokawa ◽  
Curt Harper ◽  
Marilyn A Huestis ◽  
...  
Keyword(s):  
Traffic Safety ◽  
Drug Testing ◽  
Oral Fluid ◽  
Motor Vehicle ◽  
The United States ◽  
Driving Under The Influence ◽  
Tier Ii ◽  
Toxicological Investigation ◽  
Testing Practices ◽  
Tier I

ABSTRACT This report describes updates to the National Safety Council’s (NSC) Alcohol, Drugs, and Impairment Division’s (ADID) recommendations for drug testing in Driving Under the Influence of Drugs (DUID) cases and motor vehicle fatalities. The updates are based on a survey of drug testing practices in laboratories in the United States and Canada, a comprehensive review of the prior recommendations, and data and research on drugs most frequently detected in DUID cases. A consensus meeting was held with representative forensic science practitioners and the authors of this report to update recommendations. No changes were made to the Tier I scope; however, there were changes to cutoffs of some analytes for blood, urine and oral fluid. Due to increased prevalence in DUID cases, trazodone and difluoroethane were added to the Tier II scope. For clarification, Tier I cutoffs reflect free concentrations, and hydrolysis is recommended but not required. The consensus panel concluded that urine is an inferior matrix to blood and oral fluid as it may represent historical use or exposure unrelated to observed impairment; therefore, future iterations of these recommendations will not include urine as a recommended matrix. Laboratories currently testing urine should work with traffic safety partners to encourage the use of blood and oral fluid as more appropriate specimens and adjust their capabilities to provide that testing.

scholarly journals Utility of Oral Fluid in Compliance Monitoring of Opioid Medications

2014 ◽  
Vol 17;1 (1;17) ◽  
pp. 63-70 ◽  
Author(s):  
Till Conermann
Keyword(s):  
United States ◽  
Pain Management ◽  
Drug Testing ◽  
Oral Fluid ◽  
Drug Class ◽  
The United States ◽  
Compliance Monitoring ◽  
Detection Rates ◽  
Drug Classes ◽  
Opioid Medications

Background: Prescription drug abuse is the fastest growing drug problem in the United States, and the increase in unintentional drug overdose deaths has been driven by the increase in opioid analgesic use. Given the epidemic of non-medical prescription pain reliever use and the current medico-legal climate, it is increasingly important for the prescriber to monitor for medication compliance. Objectives: The purpose of this IRB approved study is to compare the results of oral fluid (OF) and routine urinalysis for monitoring compliance in a single academic pain management program in an urban setting in order to evaluate the utility of OF analysis in compliance monitoring when prescribing opioid medications. Study Design: Outcomes analysis of prospective, consecutive, paired comparison study with clinical implications. Setting: Single academic interventional pain management center in the United States. Methods: Paired OF and urine specimens were collected for each patient with signed informed consent, at the Institute for Pain Medicine, Western Pennsylvania Hospital, from patients who routinely donated urine on a random basis for compliance testing. A total of 153 paired specimens were analyzed. Demographic and prescription data were made available. Specimens were screened using immunoassay and presumptive positive findings were confirmed with liquid-chromatography and mass spectrometry. Although both matrices were tested for a wider range of medications, the data presented here are representative of analgesic opioids and benzodiazepine drug classes only. Results: Following exclusion criteria, of the 132 remaining specimen pairs that were positive for opioids or benzodiazepines in at least one matrix, 101 pairs showed exact drug class matches (76.5%). In an additional 21 pairs, at least one drug class was positive in both matrices (15.9%), giving an overall agreement of 92.4%. Overall, 191 positive results were found in urine averaging 1.4 drugs per specimen; 176 positives were detected using OF for an average of 1.3 drugs per specimen. Conclusions: In the setting of stable dosing of prescription opioids and/or concomitant illicit drug use, given comparable detection rates between urine and OF matrix qualitative results, the OF matrix for drug testing for compliance monitoring may serve as a useful and valid testing tool. The authors conclude that overall OF analysis produces comparable results to urine sample analysis with detection rates differing primarily due to differences in windows of detection for different drug classes. Limitations: The limitations include the study was performed in a single academic center in an urban community. Also, there is a paucity of literature regarding windows of detection for OF analysis compared to urine. IRB: APPROVED - Allegheny-Singer Research Institute West Penn Allegheny Heath System (ASRIWPAHS) - IRB Study #FWA00015120 Key Words: Urine drug testing, oral fluid drug testing, saliva, opioids, drug abuse, compliance, chronic pain, diversion

scholarly journals On-Site Test for Cannabinoids in Oral Fluid

2012 ◽  
Vol 58 (10) ◽  
pp. 1418-1425 ◽  
Author(s):  
Nathalie A Desrosiers ◽  
Dayong Lee ◽  
David M Schwope ◽  
Garry Milman ◽  
Allan J Barnes ◽  
...  
Keyword(s):  
Test Performance ◽  
Drug Testing ◽  
Oral Fluid ◽  
Diagnostic Sensitivity ◽  
Driving Under The Influence ◽  
Sample Collection ◽  
Institutional Review ◽  
Noninvasive Sample ◽  
Site Test ◽  
Workplace Drug Testing

Abstract BACKGROUND Oral fluid (OF) testing offers noninvasive sample collection for on-site drug testing; however, to date, test performance for Δ9-tetrahydrocannabinol (THC) detection has had unacceptable diagnostic sensitivity. On-site tests must accurately identify cannabis exposure because this drug accounts for the highest prevalence in workplace drug testing and driving under the influence of drugs (DUID) programs. METHODS Ten cannabis smokers (9 males, 1 female) provided written informed consent to participate in this institutional review board–approved study and smoked 1 6.8%-THC cigarette ad libitum. OF was collected with the Draeger DrugTest® 5000 test cassette and Quantisal™ device 0.5 h before and up to 22 h after smoking. Test cassettes were analyzed within 15 min (n = 66), and Quantisal GC-MS THC results obtained within 24 h. Final THC detection times and test performances were assessed at different cannabinoid cutoffs. RESULTS Diagnostic sensitivity, diagnostic specificity, and efficiency at DrugTest 5000's 5 μg/L screening cutoff and various THC confirmation cutoffs were 86.2–90.7, 75.0–77.8, and 84.8–87.9%, respectively. Last detection times were &gt;22 h, longer than previously suggested. Confirmation of 11-nor-9-carboxy-THC, absent in THC smoke, minimized the potential for passive OF contamination and still provided 22-h windows of detection, appropriate for workplace drug testing, whereas confirmation of cannabidiol, and/or cannabinol yielded shorter 6-h windows of detection, appropriate for DUID OF testing. CONCLUSIONS The DrugTest 5000 on-site device provided high diagnostic sensitivity for detection of cannabinoid exposure, and the selection of OF confirmation analytes and cutoffs provided appropriate windows of detection to meet the goals of different drug testing programs.

scholarly journals The Potential Role of Oral Fluid in Antidoping Testing

2014 ◽  
Vol 60 (2) ◽  
pp. 307-322 ◽  
Author(s):  
Sebastien Anizan ◽  
Marilyn A Huestis
Keyword(s):  
Oral Fluid ◽  
Potential Role ◽  
Driving Under The Influence ◽  
Doping Agent ◽  
Drug Classes ◽  
The World ◽  
World Anti Doping Agency ◽  
Urine Testing ◽  
Collection Methods

Abstract BACKGROUND Currently, urine and blood are the only matrices authorized for antidoping testing by the World Anti-Doping Agency (WADA). Although the usefulness of urine and blood is proven, issues remain for monitoring some drug classes and for drugs prohibited only in competition. The alternative matrix oral fluid (OF) may offer solutions to some of these issues. OF collection is easy, noninvasive, and sex neutral and is directly observed, limiting potential adulteration, a major problem for urine testing. OF is used to monitor drug intake in workplace, clinical toxicology, criminal justice, and driving under the influence of drugs programs and potentially could complement urine and blood for antidoping testing in sports. CONTENT This review outlines the present state of knowledge and the advantages and limitations of OF testing for each of the WADA drug classes and the research needed to advance OF testing as a viable alternative for antidoping testing. SUMMARY Doping agents are either prohibited at all times or prohibited in competition only. Few OF data from controlled drug administration studies are available for substances banned at all times, whereas for some agents prohibited only in competition, sufficient data may be available to suggest appropriate analytes and cutoffs (analytical threshold concentrations) to identify recent drug use. Additional research is needed to characterize the disposition of many banned substances into OF; OF collection methods and doping agent stability in OF also require investigation to allow the accurate interpretation of OF tests for antidoping monitoring.

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