Testing for Alcohol and Other Drugs

31. Disadvantages for Drug Testing Using Hair

"Disadvantages for testing for drugs in hair are the high costs and the longer time needed to obtain results, compared with the time required by other matrices. Analysis of the hair specimen is a complex process that involves breaking down the hair to free the drugs trapped in it. This chemical process requires a longer time of analyses than other matrixes. It can be done only in a laboratory; no POCTs [Point Of Care Tests] are available for testing hair samples."

"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.
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32. Oral Fluid (Saliva) Testing

"The parent drug is usually found in oral fluids, although the metabolite(s) may be present and quite useful. The parent drug is generally found in higher concentrations in oral fluids than are drug metabolites. Compared with urine specimens, oral fluid specimens present fewer opportunities for adulteration or substitution (Dams, Choo, Lambert, Jones, & Huestis, 2007). Use of commercial adulterants or mouthwashes were not found to interfere with the immunoassay (Bosker & Huestis, 2009), or they did not affect test results if the products are used more than 30 minutes before specimen collection (Drummer, 2006; Niedbala, Kardos, & Fries, et al., 2001; Niedbala, Kardos, Fritch, Cannon & Davis, 2001). The window of detection for oral fluid is narrower than it is for urine, and drug concentrations are generally lower (Warner, 2003). In general, drug testing of oral fluids detects drug use during the previous 24–48 hours, regardless of the route of administration (Cone, 2006), although the selection of cutoffs plays an important role in the length of the detection window.
"Oral fluid collection devices vary, but the most common version is a swab or absorbent pad on a stick that is placed between the lower cheek and gums to collect fluid and is left in place for a few minutes. It is then inserted into a vial containing a buffer solution for shipment to the laboratory. POCTs [Point Of Care Tests] are also available for oral fluid testing."

"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. 20.
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33. Breath Testing for Other Drugs in DUI Enforcement

"The results of this investigation provide further support to the possibility of using exhaled breath as a readily available specimen for drugs of abuse testing. There is a possibility that exhaled breath will develop into a new matrix for routine drug testing and present an alternative to already used matrices like urine, blood, oral fluid, sweat and hair. Each matrix may have its specific advantages and disadvantages. Since exhaled breath may be as easy to collect as in alcohol breath testing, it may present a new, more accessible matrix than blood at the roadside and elsewhere when the sampling procedure is an obstacle. We previously observed that exhaled breath methadone increases after intake [2]. If a correlation to blood concentration can be shown for exhaled breath levels, it may become a substitute matrix for monitoring impairment. One advantage of exhaled breath may be the detection of 6-AM, which is problematic in blood."

Olof Beck, et al., "Detection of drugs of abuse in exhaled breath using a device for rapid collection: comparison with plasma, urine and self-reporting in 47 drug users," Journal of Breath Research, 7 (2013) 026006 (11pp), http://dx.doi.org/10.1088/1752...
http://iopscience.iop.org/1752...
http://iopscience.iop.org/1752...

34. Oral Fluid Test Evaluations 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+."

Driving under the Influence of Drugs, Alcohol and Medicines (DRUID Project) 6th Framework Programme, "Analytical evaluation of oral fluid screening devices and preceding selection procedures," Deliverable 3.2.2 (Finland: National Institute for Health and Welfare, March 30, 2010), p. 95.
http://www.druid-project.eu/Dr...

35. Testing for Alcohol Using Breath (Breathalyzer)

"The body metabolizes alcohol rapidly, but alcohol will be detectable in breath as long as it is present in blood. The detection period for ethyl alcohol itself is hours (not days) after the last alcohol use. The metabolism of alcohol varies considerably by the person’s gender, age, physical condition (especially the condition of the liver), and weight.
"Easily administered breath alcohol tests are available to confirm alcohol ingestion within the past several hours. When a breath alcohol analyzer test is conducted properly, it gives an accurate measurement of breath alcohol content (BrAC). The BrAC gives an estimate of blood alcohol level (BAL) (Watson et al., 2006). Body temperature and breathing patterns can affect breath alcohol test results. Compared with blood and urine tests, breath tests are less precise. Some evidence suggests that breath tests may underestimate BALs by approximately 8.5 percent (Garriott, 2008).
"The breath alcohol analyzer (such as the best-known version, Breathalyzer) is a device that gives an accurate BrAC."

"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. 23.
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36. Drug Testing Using Finger and Toe Nails

"Like hair, fingernails and toenails are composed of a hard protein called keratin. Drugs are incorporated into nails from the blood stream and remain locked in the nail as it grows. Nails grow in both length and thickness. Drugs enter the nail from the base (cuticle end) as the keratin is formed and via the nail bed that extends under the full length of nail.
"The distal end or free end of the fingernails and toenails are clipped for testing. If length does not allow, the surface can be shaved but is not the preferred sample. If the surface is scrapped using a razor blade (a medical device) then this one procedure probably requires the collector to follow HIPAA requirements. Nail polish and acrylic nails must be removed prior to collecting the nail sample.
"The method of screening for drug use in nail tests is the same as hair, Immunoassay. The nail is put in a chemical solution to remove external contaminants and then liquefied. All drugs found in the initial screen are confirmed by one of the methods previously explained.
"Drugs can be identified in nail clippings 2-4 weeks following ingestion and can be detected from 3 to 8 months or longer. The broad range is based on numerous factors. Fingernails grow (approximately .12 inches per month) faster than toenails (approximately .042 inches per month), longer fingers grow faster than short fingers, age and gender of the person, the time of year, the food the person eats, the dominant hand grows faster than the other hand, etc."

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. 16.
http://www.dallasbar.org/sites...

37. Drug Tests Using Sweat

"Several collection devices have been manufactured for collecting sweat specimens. The two most common are the patch and the swipe; however, the sweat patch is the only device approved by the U.S. Food and Drug Administration (FDA). The quantity of sweat collected is determined by the length of time the patch is worn and the physiology of the person wearing the patch. The patch should be worn for at least 3 days, but no longer than 7 days, although most drugs will have been excreted within the first 48 hours (Barnes et al., 2009; Huestis et al., 2008; Kacinko et al., 2005; Schwilke et al., 2006). This ensures that a sufficient amount of sweat is collected for testing. The sweat collected with the patch detects drug use that occurred shortly before the patch was applied and while the device remains on the skin."

"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. 21.
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38. Sweat Test Accuracy

"Because sweat can be collected only in limited quantities, there may not be sufficient specimen for repeat or confirmatory testing. Sweat is less susceptible to tampering or adulteration than is urine. The accuracy of sweat testing is not standardized. Its accuracy remains somewhat controversial (Watson et al., 2006). However, the sweat patch is used extensively in the criminal justice system, and its use to identify relapse or violations of conditions of probation has been upheld by the courts."

"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.
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39. Psychological Testing

"There is no psychological test that can reliably screen for substance abuse. The MAC-R Index on the Minnesota Multiphasic Personality Inventory 2 (MMPI-2) detects only addiction potential, not current use. If someone has been addicted in the past but is currently living a sober lifestyle, that person is still likely to test positive for addiction potential as this is more a personality style instead of a measure of current status (Friedman, Lewak, Nichols, & Webb, 2001). The idea behind the Substance Abuse Subtle Screening Inventory (SASSI) (Miller, 1994) is a good one. Essentially, it is an attempt to identify substance abuse through a self-report of symptoms that are associated with substance abuse without directly asking the central question. The Michigan Alcohol Screening Test (MAST) (Selzer, 197 1) is considerably less subtle, asking questions more directly. NCS also has an Alcohol Use Inventory (Horn, Wanberg, & Foster, 1987) that it markets."

Schleuderer, Claude and Campagna, Vicky, "Assessing Substance Abuse Questions in Child Custody Evaluations," Family Court Review (Madison, WI: Association of Family and Conciliation Courts, April 2004) Vol. 42, No. 2, p. 380.
http://207.56.97.118/2011_schl...

40. Drug Testing vs Impairment Testing

Impairment Testing

"Few employers have used impairment testing, and information concerning that experience is very limited and extremely difficult to obtain. The available information, however, indicates that impairment testing is not just a better answer on paper, but in practice as well. Employers who have used impairment testing consistently found that it reduced accidents and was accepted by employees. Moreover, these employers consistently found that it was superior to urine testing in achieving both of these objectives."

National Workrights Institute, "Impairment Testing: Does It Work?" (Princeton, NJ: NWI, undated).
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