2/23/2015 Oral Fluid Drug Testing March 23rd, 2015 Drug Testing Options Breath Blood Meconium Vitreous Hair Sweat Urine Oral Drug Testing Options Oral Fluid and Blood and Breath Actual levels (immediate use, up to four days) * Urine Measures metabolites /past use (several hours after use, up to four/five days) * Meconium Chronic drug consumption in the last trimester of pregnancy * Hair Indication of chronic use only, 1.5 inches of hair = 90 days * * Peer reviewed papers available 1 2/23/2015 Window of Detection Window of Detection Oral Fluid Testing Non invasive, easily obtained, fast collection time, no facilities needed or specialize personnel, preserves dignity Drug concentrations in saliva are proportional to drug concentrations in plasma/blood If observed correctly, eliminates cheating 2 2/23/2015 Oral Fluid Testing • Oral fluid has a number of advantages: 1. OF is well proven as accurate, effective and robust. OF has been used for many years in Europe and the rest of the world in both clinical and criminal justice marketplaces and actively for the past 10 years here in the US. 2. A drug detected in OF is the active (parent) drug component as well as any metabolite(s). 3. The passive diffusion rate of a drug from the blood to oral fluid is governed by the free drug fraction in the circulation. This gives the distinct advantage that there is a direct relationship between blood levels of a drug and the presence of the drug found in saliva. 4. As the presence of drugs in oral fluid is related to the amount of drug in the blood stream, oral fluid testing may serve as a better real time indicator of the presence and level of active drug in the patient, thus measures impairment. 6. Blood flow to the 5 glands, in the mouth, is rapid. Drug transfer occurs relatively quickly after drug dose. Drug transfer to oral fluid will continue as long as there is drug in the circulatory system. 7. Toxic, lethal levels, and Steady‐state ONLY FROM ORAL FLUID 8. Oral Fluid detects 67% more positive Heroin than Urine. Oral Fluid Lab Testing Screening Assays and LC/MS/MS Testing Technology Screening Confirmation 3 2/23/2015 Screening 5 panel example: AMPHETAMINE (Adderall, Vyvanse, MDA/Adam, Phentermine/Adipex) METHAMPHETAMINE (MDMA/Ecstacy, Methcathinone) OPIATES (Heroin/6MAM, Morphine, Codeine, Hydrocodone) COCAINE (Cocaine, Benzoylecgonine, Ecgonine methyl ester, Cocaethylene) THC (delta 9 THC) Screening Why Is a “Screen” a Screen? PCP – Dextromethorphan Opiates ‐ Hydrocodone, Oxycodone, Oxymorphone, Hydromorphone (not measured) Naproxen, NSAIDs – THC Benzodiazepines ‐ Alprazolam, other antidepressants Barbiturates – Phenobarbital not always measured Screening (±)‐Amphetamine (±)‐Methamphetamine Ephedrine 4 2/23/2015 Confirmation What does LCMSMS mean? Liquid Chromatography, Tandem Mass Spectrometry It identifies drugs by their “fingerprint” Each drug has a unique structure LC/MS/MS • Liquid Chromatography/Tandem Mass Spectrometry (LC/MS/MS). LC/MS/MS or “Confirmation testing” is analytically precise and extremely accurate, by measuring the specific molecular mass, and the concentration (amount) of any drug(s), in a sample. The testing identifies not only the parent drug but also its metabolites. Thus providing data on the exact drug and amount of drug found. LC/MS/MS Marijuana Chocolate 5 2/23/2015 Metabolism Chart Oral Fluid Drug List Drug List • Marijuana • • • • • • • • Amphetamine (Adderall, Vyvanse) Adam (MDA) Ecstacy (MDMA) Methamphetamine Methcathinone *Chlorpheniramine *Ephedrine *Phenylpropanolamine • Delta 9‐THC • *Cold pills that screen positive for Meth/Amp • Amphetamines Date Rape Drugs • • GHB Ketamine Nicotine Cotinine Alcohol Monitoring Cocaine • • • Cocaine Benzoylecgonine Ecgonine methyl ester • • EtG (Ethyl glucuronide) Disulfiram (Antabuse) 6 2/23/2015 Drug List Opiate Antagonists Opiates 6‐Acetylmorphine (Heroin) Codeine (Tylenol 3) Hydrocodone (Vicodin, Lortab, Lorcet, Hycodan, Norco, Xodol, Vicoprofen) Hydromorphone (Dilaudid) Morphine (Kadian, Oramorph, Avinza, MSIR, MS Contin, MSI, MSER) Oxycodone (Percocet, Endocet) Oxymorphone (Numorphan, Opana) Fentanyl Pentazocine (Talwin) Meperidine (Demerol) Propoxyphene (Darvon) Dextromethorphan • • • • • • • • • • • • • • • • • • • Naloxone (Narcan) Naltrexone (Depade) Methadone (Dolophine) EDDP Buprenorphine (Suboxone, Subose) Norbuprenorphine Antipsychotics • • • • • • • • Risperidone (Risperdal) Quetiapine fumarate (Seroquel) Aripiprazole (Abilify) Olanzapine (Zyprexa) Haloperidol (Haldol) Thiothixene (Navane) Fluphenazine (Prolixin) Ziprasidone (Geodon) Drug List Benzodiazepines Tricyclic Antidepressants • • • • • • • Amitriptyline (Elavil) Desipramine (Norpramin) Doxepin (Sinequan) Imipramine (Tofranil) Maprotiline (Ludiomil) Nortriptyline (Aventyl, Pamelor) Trimipramine (Surmontil) • • • • • • • • • • • • • • • • • SSRIs • • • • • • Paroxetine (Paxil) Citalopram (Celexa) Sertraline (Zoloft) Escitalopram (Lexapro) Fluoxetine (Prozac) Fluvoxamine (Luvox) Alprazolam (Xanax) Bromazepam (Lexotan) Chlordiazepoxide (Librium) Clonazepam (Klonopin) Diazepam (Valium) Estrazolam (Doral) Flunitrazepam (Rohypol “Roofies”) Flurazepam (Dalman) Lorazepam (Ativan) Lormetazepam (Loramet) Midazolam (Versed) Nitrazepam (Mogadom) Nordiazepam Oxazepam (Serax) Prazepam (Centrax) Temazepam (Restoril) Triazolam (Halcion) Drug List Therapeutic Drugs • • • • • • • • • • • • • • • Topiramate (Topomax) new Divalproex sodium/valproic acid (Depakote) Gabapentin (Neurontin) Carbamazepine (Tegretol) Bupropion (Wellbutrin) Venlafaxine (Effexor) new Mirtazapine (Remeron) Trazodone (Desyrel) Buspirone (Buspar) Propranolol (Inderal) Benzytopine mesylate (Cogentin) Duloxetine (Cymbalta) new Zolpidem (Ambien) Lamotrigine (Lamictal) Tramadol (Ultracet, Ultram) • • • • Carisoprodol (Soma) Meprobamate Methylphenidate (Ritalin, Concerta) Clonidine Strattera Special Request • PCP & LSD • Psilocin (Mushrooms) • Methaqualone (Qualudes) • Salvinorin A • Bisacodyl (Dulcolax) • Phentermine (“Phen‐Phen”) • Atropine • Scopolamine • Synthetic Marijuana • Bath Salts • Kratom and Krocodil 7 2/23/2015 Sample Collection Sample Collection | Chain of Custody 8 2/23/2015 Lab Report • Simple – Easy – Fast ‐ Painless method for measuring drug levels • Turn around time Same day we receive the samples (meconium too!) • Knowledgeable Customer Service Department Your questions are answered either immediately or go directly to the Toxicologist and those questions are answered within hours • Number of drugs detected (we can detect over 130 compounds) • LC/MS/MS More sensitive instrument – lower levels of detection reduces incidence of false negatives THANK YOU Email blemberg@forensicfluids.com for more information 9