Testing for Alcohol and Other Drugs

21. DRUID Project Evaluation of Oral Fluid (Saliva) Testing Devices for DUI Enforcement

"It is disturbing that the sensitivities of the cannabis and cocaine tests were all quite low, although further testing of the cocaine tests is desirable due to the low prevalences and the low concentrations encountered in this study. There are several countries in Central and Southern Europe for which these two substance classes are of special interest. On the other hand, it seems the sensitivities of the devices are generally better for amphetamines, a frequently encountered drug class among the DUI drivers in the Nordic countries. The suitability of the device for the intended national DUI population should also be considered, for example, PCP is rarely, if ever, found in Europe, therefore at the current time utilising a PCP test is unnecessary. Since the on-site tests are relatively expensive the suitability of all the individual substance tests incorporated in the device should be considered.
"The evaluation showed that none of the evaluated tests is on a desirable level (>80% for sensitivity, specificity and accuracy) for all of the separate tests that they comprised. However, there were tests that performed already on a promising level for one or more substance classes. The DrugTest 5000 had the best overall results. The next best device was Rapid STAT, which performed at a similar level, except for the cocaine test which was somewhat less sensitive. Clearly the best device in terms of sensitivity for amphetamines was the DrugWipe 5."

Tom Blencowe, Anna Pehrsson and Pirjo Lillsunde, Editors. "Analytical evaluation of oral fluid screening devices and preceding selection procedures." Project Funded by the European Commission under the Transport RTD Programme of the 6th Framework Program, Project No: TREN-05-FP6TR-S07.61320-518404-DRUID (National Institute For Health and Welfare, Finland, Sept. 2010), p. 95.

22. Accuracy of Certified Labs Not Verified

"The accuracy of certified labs has never been tested. Not a single study of the accuracy of HHS certified laboratories has ever been conducted. The National Academy of Sciences and other experts have urged HHS to conduct such tests,6 but HHS has never done so. Nor has HHS allowed independent researchers to see its data. HHS’ failure to conduct or allow accuracy studies of certified labs is especially troubling in light of the federal government’s assurances that the labs it used were reliable prior to the CDC study.
"The only relevant study actually indicates that certified labs are not reliable. In 2007, the United States General Accountability Office (GAO) studied 23 labs, all of whom were federally certified. The GAO found that not one of these labs consistently followed federally mandated procedures for lab accuracy.7"

Maltby, Lewis, "Latest Research Reveals New Problems with Drug Testing," National Workrights Institute (Princeton, NJ: March 2012), p. 2.

23. Drug Testing and Other Pre-Employment Screening Performed by Sheriff's Departments

"Nearly all officers were employed by a sheriff’s office that used criminal record checks (99%), personal interviews (98%), background investigations (98%), and driving record checks (95%) (figure 4). More than 4 in 5 officers were employed by an office that used medical exams (87%), and drug tests (85%). More than two-thirds were employed by one using psychological evaluations (72%) and credit checks (69%). More than half of officers worked in sheriffs' offices using written aptitude tests (58%) and physical agility tests (54%)."

Hickman, Matthew J. and Reaves, Brian A., "Sheriffs' Offices 2003" (Washington, DC: USDOJ, Bureau of Justice Statistics, May. 2006), NCJ 211361, p. 8.

24. Testing for Drug Use by Drivers

"Evidence-gathering technology for drugs is not as advanced in terms of ease of use and noninvasiveness as it is for alcohol. Until recently, no simple test police officers could administer to obtain an indication of drug use similar to the preliminary breath test for alcohol has been available. Rather, samples of urine or blood typically must be sent away for laboratory analysis to determine the presence of drugs and their quantification. Screening tests using urine, which can be used by officers in the police station, have been field tested by NHTSA. The technology is also developing for using saliva, sweat, and hair samples to detect drug use (Hersch, Crouch, & Cook, 2000).
"As said earlier, NHTSA has funded the Drug Evaluation and Classification (DEC) program, which equips specially trained officers, known as Drug Recognition Experts (DREs), to observe and record behavioral evidence of drug use to assess potential drug impairment among persons suspected of drug-impaired driving, and guide chemical testing and expert testimony for DUID trials. Currently, more than 40 States have officially adopted DEC programs to train DRE personnel."

Lacey, John, Brainard, Katharine, and Snitow, Samantha. (2010). Drug Per Se Laws: A Review of Their Use in States. (DOT HS 811 317). Washington, DC: National Highway Traffic Safety Administration, pp. 5-6.

25. Drug Tests Using Urine

"Urine is the most rigorously evaluated and most commonly used matrix for drug testing (Watson et al., 2006). All results are affected by laboratory test or point-of-care test (POCT) cutoff concentrations. Therefore, practitioners should always consult with laboratory staff when ordering laboratory tests or carefully read POCT package inserts before using the test. Numerous POCTs are available for urine drug testing.
"Window of Detection
"The window of detection for urine falls in the intermediate range, compared with the detection period or window for other matrices. Many factors influence the window of detection for a substance. Factors include, but are not limited to, the frequency of use (chronic or acute), amount taken, rate at which the substance is metabolized, cutoff concentration of the test, patient’s physical condition and, in many cases, body fat. Some hepatic, renal, endocrine, and other pathologies may extend the detection window."
"Drugs are present in urine from within minutes of use to several days after, depending on the substance; quantity ingested; the degree to which the bladder was filled with drug-free urine at the start of drug use; the patient’s hepatic, cardiac, and renal function; the patient’s state of hydration; and drug type. Drugs that are smoked or injected are detectable in urine samples almost immediately. Detection rates for drugs taken orally are slower, taking up to several hours and peaking at about 6 hours (Dolan et al., 2004).
"The window-of-detection estimates used in this chapter are from several sources: Cone (1997), Dasgupta (2008), Verstraete (2004), Warner (2003), White and Black (2007), Wolff et al. (1999), and Wong and Tse (2005).
"Many urine drug tests detect the drug metabolite, rather than the drug itself. As a general rule, drug metabolites remain in the body for a longer period than does the parent drug, allowing for a longer detection period. For example, when the test is for cocaine using urine, the target compound is usually the metabolite, benzoylecgonine, rather than the parent cocaine molecule."

"Clinical Drug Testing in Primary Care," Technical Assistance Publication (TAP) 32, Substance Abuse and Mental Health Services Administration, Clinical Drug Testing in Primary Care (Rockville, MD: U.S. Department of Health and Human Services, 2012), p. 51.

26. Urine Tests for Alcohol

"After years of research, Ethyl Glucuronide (EtG) was found to be a direct metabolite of the alcohol (ethanol). EtG has emerged as the marker of choice for alcohol and due to the advances in technologies is now routinely available. Its presence in urine may be used to detect recent alcohol consumption, even after ethanol is no longer measurable using the older methods. The presence of EtG in urine is a definitive indicator that alcohol was ingested. Other types of alcohol, such a stearyl, acetyl and dodecanol, metabolizes differently and will not cause a positive result on an EtG test.
"The EtG test has become known as the “80 hour test” for detecting any amount of consumed ethyl alcohol. This is not totally true. It is true that EtG can be detected in chronic drinkers for 80 hours or even up to 5 days. During this period of chronic use, the EtG level can exceed 100,000 ng/mL. Two primary factors to determine the window of detection is based on volume of alcohol consumed and the time between each drink. A person that consumes 3 drinks can only have a detectable level of EtG for approximately 20 to 24 hours and peaks at approximately 9 hours with an EtG level around 15,000 ng/mL.
"Therefore, the presence of EtG in urine indicates that ethanol was ingested. EtG is a more accurate indicator of recent consumption of alcohol than measuring for the presence of ethanol itself."

Turnage, Jim, "Innovations in Substance Abuse Testing," presented for the State Bar of Texas (Dallax, TX: Forensic DNA & Drug Testing Services, Inc., April 17, 2011), p. 17.

27. Evaluation of Draeger DrugTest 5000 for Detecting Drugs Through Oral Fluid

"DrugTest 5000 screening results were evaluated against Quantisal confirmation data to determine TP [True Positive], TN [True Negative], FP [False Positive], FN [False Negative], diagnostic sensitivity and specificity, and efficiency at various cutoffs (Tables 1 and 2). When compared to THC alone, the diagnostic sensitivity and specificity and efficiency were 86.2%–90.7%, 75.0%–77.8%, and 84.8%– 87.9% at the 5-μg/L cutoff and 75.9%–92.7%, 76.0%–100.0%, and 78.8%– 86.4% at the 10-μg/L DrugTest 5000 cutoffs. Overall, the DrugTest 5000 performed better with the 5-μg/L screening cutoff, with diagnostic sensitivity and efficiency above the DRUID-recommended 80%. There were few FP and FN tests, and when they occurred, concentrations were at or near the confirmation cut-off. A limitation of this study was the inclusion of a small number of TN samples, only 6 –12 with the 5-μg/L DrugTest 5000 and 1- and 2-μg/L confirmation cutoffs, to adequately evaluate diagnostic specificity. On the basis of previous reports, more TN samples were expected over the 22-h collection period. Detection rates were highest and windows of detection were longest when we confirmed for THC alone (Fig. 1 and 2). However, the recent report of THC concentrations in OF following 3 h of passive exposure to cannabis smoke advocate for the inclusion of THCCOOH in confirmation criteria, because this analyte is not present in cannabis smoke and was not found in any OF [Oral Fluid] samples following passive exposure (18)."

Nathalie A. Desrosiers, et al., "On-Site Test for Cannabinoids in Oral Fluid," Clinical Chemistry, Oct. 2012, 58(10):1418-25.

28. Drug Testing Using Hair

"Testing of hair rather than urine is often promoted because it is less invasive and can detect drug use over longer time periods. Hair tests cannot detect very recent drug use but do detect use that has occurred between (approximately) 10 and 90 days prior to the test (depending on the length of the hair). In addition to being more expensive than urine testing, however, hair testing raises several important concerns. As compared with urine drug tests, hair testing may more frequently result in positive results because of external (i.e. passive) exposure to drugs or chemicals. Hair treatments, such as coloring or straightening, can also affect the results of hair tests, making it more difficult to detect drug use. In addition, hair testing is not used in some Federal criminal justice proceedings because there is some evidence that naturally dark hair (e.g. that of African Americans and Asians) is more likely to test positive than lighter hair, leading to concerns of racial bias in the effects of testing programs."

"Drug Testing Welfare Recipients: Recent Proposals and Continuing Controversies," Office of the Assistant Secretary for Planning and Evaluation (Washington, DC: October 2011), p. 4.

29. Race, Hair Types, Equity, and Biased Results in Hair Testing

"Additional controversies exist about whether biophysical attributes affect hair analysis. Studies have shown that concentrations of drugs in hair can be affected by variations in hair structure, growth rate, melanin content, hygiene, and cosmetic hair treatments, such as bleaching (Dasgupta, 2008). Although there have been a limited number of human clinical controlled studies, data show that higher concentrations of some drugs (e.g., codeine, cocaine, amphetamine) are found in dark hair compared with concentrations found in blond or red hair (SAMHSA, 2004). Cone and Joseph (1996) reviewed several articles and found that hair testing may be biased toward some hair types. Drugs of abuse bind more readily to Africoid and Mongoloid types of hair compared with Caucasoid hair. Cosmetic hair treatments also affect the binding of drugs to hair. For example, bleaching of the hair can reduce drug content, but it also can damage the hair to the extent that bleaching may increase binding of the drug to the hair (Skopp, Pötsch, & Moeller, 1997). Some drugs (i.e., THC) do not differentially distribute into hair based on melanin content (Smeal, 2007). Therefore, hair testing may not be the most equitable drug testing matrix. Hair rinses, bleaches, and shampoos that claim to interfere with drug tests are advertised on the Internet and in magazines."

"Clinical Drug Testing in Primary Care," Technical Assistance Publication (TAP) 32, Substance Abuse and Mental Health Services Administration, Clinical Drug Testing in Primary Care (Rockville, MD: U.S. Departent of Health and Human Services, 2012), p. 22.

30. Hair Detection "Window"

"An advantage of drug testing with hair is the longer window of detection compared with other matrices (Boumba, Ziavrou, & Vougiouklakis, 2006). The detection period for hair is limited only by the length of the hair sample and the degree of deposition in the hair. Cannabinoids have been shown to deposit less readily than basic drugs in hair (Huestis et al., 2007). Some laboratories typically restrict analysis to a hair segment representing about 3 months of growth. However, this long window period is also a disadvantage; hair testing is not useful in substance abuse treatment or monitoring opioid pain or other addictive medications when frequent (weekly or monthly) drug testing is desired. Because the timing of the drug use is difficult to determine by testing hair, it is not very useful clinically."

"Clinical Drug Testing in Primary Care," Technical Assistance Publication (TAP) 32, Substance Abuse and Mental Health Services Administration, Clinical Drug Testing in Primary Care (Rockville, MD: U.S. Department of Health and Human Services, 2012), p. 22.