A Word on Specimen Types

A Word on Specimen Types

Today we are going to discuss the different specimen types that can be used to test for drugs. We do offer testing for all the specimen types that I will cover. It is helpful to know what to expect from each specimen type in regard to window of detection (both onset and outset), susceptibility to adulteration, collection woes, and general benefits or shortcomings. So, take a few minutes to read and decide for yourself if you are testing the specimen type that works best for your program or facility.

 

Blood

Blood is probably one of our least favorite specimen types. Firstly, it is relatively hard to collect, requiring a trained medical practitioner at least. The second reason it is at the bottom of the list is its short window of detection; substances can only be detected when they are in the bloodstream (while the donor is under the influence). This is actually a plus when we are talking about workplace injuries (as an example) when we want to find out if someone is impaired at the time, but we (collectively) are more likely to be concerned with recent prior drug use. Lastly, there are essentially no onsite/instant tests for drugs of abuse that use blood as a specimen type. However, on the plus side, it is impossible to adulterate a blood specimen.

 

Hair Follicle

 

Hair follicle specimen are not as difficult to collect as blood; there is no medical knowledge necessary. Hair testing also has no gender concerns with witnessing collection. As with blood, however, it is only available as a laboratory test. Another shortcoming with hair is the limited number of drugs that are being tested (only tests: AMP, COC, THC, OPI, OXY, PCP). While hair provides a very long window of detection - detecting drugs for up to 90 day after use - it also has a long onset, meaning drugs will not begin to be detected until about 7 days after use. As for adulteration, there are many products on the internet that claim to “detoxify” your hair to remove any drugs that may be present, but I have not found any evidence that these products are effective. 

 

Sweat Patch

 

Sweat patch testing is a relatively new offering and it is somewhat unique in its window of detection. The patch is typically worn for 10 days (or more), and drugs take about 2-3 days to come to the surface of the skin, so if positive it would most likely be from use 2-3 days before the patch was applied, or used in the first 7 (out of 10) days the patch was worn. The downside here is that if a participant knows the patch is coming off Monday, they could use drugs Saturday or Sunday without the use being detected.  It is a very simple specimen to collect with no gender concerns as it is placed on the arm. There is no known method of adulteration for the sweat patch. As with hair, it is only available as a laboratory test, and also like hair, it is a limited range of drugs that are detected, adding only MET to the list of detectable hair substances.

 

Surface/Powder

 

This one is sort of the oddball here; it is not a test for drug use, it is a test to see what substance a person may have in their possession. It will also test surfaces for possible contamination by drugs (i.e. a person’s desktop or computer keyboard). This is most often used by law enforcement in the field (it is sometimes called a “field test”), perhaps testing a baggie found on a person or in their vehicle. It can also be helpful for corrections or any other residential facility where drug residue might be found in someone’s cell, or other space where only a limited number of people might have access. Much like a drug test, however, it must be a “target” substance – in other words you must use the right test to get a positive or negative hit on that particular substance. Since so many illicit (or misused) drugs can be a “white powder”, you might not happen to have tested for the correct white powder!

 

Saliva

 

Saliva testing has become more popular as the accuracy and precision of the instant/onsite saliva tests have improved immensely over the years. One appeal of saliva testing is that there are no gender concerns for witnessed collections, not even a bathroom is needed; it is also a fairly simple collection and testing procedure. However, while it is much easier to collect (and less invasive) than blood, it shares the same limitation of the window of detection; drugs will not be detectable in saliva for more than 24 hours after use. As with blood, this window of detection makes the most sense when impaired driving and workplace injuries are the concern.

 

Urine

 

Urine remains our favorite specimen type. While there are gender concerns for witnessed collections, and adulteration is more possible than with other specimen types. The window of detection, the huge number of substances able to be tested, and relatively lower cost still outweigh the negatives. Witnessed collections can be a challenge, but not one too challenging to be more than a mild inconvenience in most cases. Adulteration is a concern, but modern adulterant testing is thorough enough to be an excellent deterrent. On the other hand, the window of detection shows recent use, going back days (or weeks, depending on the substance), which fits almost universally with what we are trying to determine. There are instant tests available for more than 25 drugs of abuse and lab tests available for more than 40; this is a huge improvement over any of the other specimen types listed. Lastly, the cost is going to be the lowest out of all the specimen types, making it more feasible to follow a regular testing schedule.

Understanding the Limitations of Drug Testing

Identifying the limitations that are inherent in the world of drug testing will give you a better understanding of how drug tests are intended to perform and help with the day to day frustrations of operating a drug testing program. Join our Chief Product Officer, Eric Malis, for another great educational presentation that breaks down these limitations. Learn about different cross reactions between certain substances and how there are many other different factors that may affect the integrity of a test result.

 

The Great Poppy Seed Debate: A Quasi-Scientific Endeavor

The Great Poppy Seed Debate: A Quasi-Scientific Endeavor

Eric Malis

A Quasi-Scientific Hot Pastrami on a Kaiser Roll

There’s always been a lot of debate about poppy seeds and whether their ingestion can or will cause a positive result on an opiate panel; many of us have even seen the famous episode of the Seinfeld TV show where Elaine was almost fired due to a positive drug test caused by poppy muffins. There have been plenty of scientific papers published where sophisticated laboratory equipment is used to determine the opiate make-up of poppy seeds, and their concentrations. But what does really mean to those of us performing drug tests every day? Well, I wanted to take slightly-less-than scientific approach to see what this looks like in the real world. I did take some proper steps to ensure that my results were not completely unscientific (waiting a week between attempts as to not have any residual form the previous, for example).

So let’s see what I found…

 

Week 1: Poppy Seed Bagel (Local “Bronx-Style” Tuna Salad)

My first go was at a newer local NY Deli near the office that I’ve been meaning to try. I went for lunch and had a poppy bagel with tuna salad (lightly toasted, since you asked); there were not quite as many poppy seeds as on the Kaiser bun in the photo above. My first specimen was an hour after eating and came up negative on one of our MOP300 panels. The next specimen was 2 hours after that and was positive on the MOP panel. My next specimen was about 3 hours after that and was back to negative. The laboratory confirmatory results are as follows:

Specimen 1 Codeine: 154ng/mL Morphine: 331ng/mL Creatinine: 138mg/dL

As you can see, this is just barely above the cut-off for the Opiate panel. Both Codeine and Morphine present, more than likely not as metabolites, but as the parent alkaloids from the poppy seeds.

 

Week 2: Poppy Seed Kaiser Roll (Hot Pastrami with Spicy Mustard)

 

My second attempt was at a local favorite here, this one has been in town since 1974! The bottom of the bun had essentially no seeds, so just what you see pictured. My first specimen was 2 hours after eating and came up positive. My second specimen at 6 hours after eating was also positive. My third specimen at +9 hours was also positive. Unfortunately, that brought me to bedtime – next test will be in the morning so I can have a full 12+ hours awake after eating! Lab results for this group as follows:

Specimen 1 Codeine: Trace Morphine: Trace Creatinine: 184mg/dL
Specimen 2 Codeine: 133ng/mL Morphine: 51ng/mL Creatinine: 139.5mg/dL
Specimen 3 Codeine: Trace Morphine: Trace Creatinine: 71.3mg/dL

In this case, we see that the instant test can sometimes react even when the concentration is below the threshold. This is a common occurrence and is probably regarded as one of the biggest weaknesses of instant tests as a whole (be sure to attend my webinar next month for more on this). Looking at the Codeine/Morphine ratio, we can see that these poppy seeds have a different make-up then the ones from the previous week.

 

Week 3: Poppy Seed Bagel (With a “Schmear” of Cream Cheese)

 

My third round was at a national bagel chain (Einstein’s). I do like a lot of poppy seeds on my bagel, so I was familiar with their offerings. I made sure to eat this for breakfast this time, to give me more waking hours in which to provide specimens. Still only poppy seeds on the top, but they almost completely cover the surface of the top of the bagel; so probably nearly twice as many as you see in the picture of the bun. My first specimen was at about 90 minutes after eating and was positive. My second specimen was at about 4 hours after eating and it was also positive. My third specimen was at 6 hours after breakfast and still positive. My fourth specimen at 7.5 hours was still positive. I finally produced a negative specimen at the 10 hour mark. Lab results for this group as follows:

Specimen 1 Codeine: None Morphine: 286ng/mL Creatinine: 191.7mg/dL
Specimen 2 Codeine: None Morphine: 539ng/mL Creatinine: 144.4mg/dL
Specimen 3 Codeine: None Morphine: 183ng/mL Creatinine: 100.0mg/dL
Specimen 4 Codeine: None Morphine: 88ng/mL Creatinine: 79.7mg/dL

This one is interesting as once again the alkaloid make-up differs from either of the previous 2 weeks; in this case we don’t have any Codeine present. Also, we see again the instant test is giving a positive where the concentration is well below the cut-off. It is worth noting that the instant tests used for this entire experiment were not part of our standard catalog – we had a bunch of samples from other manufacturers that were probably going to expire if we didn’t make use of them, and this seemed a perfect opportunity!

 

So, we can clearly see that it does not take an inordinate amount of poppy seeds the trigger a positive test result. Also, contrary to popular belief, there would be no way for a laboratory to make the determination (at least on most of these results) that the positive was from poppy seeds versus Morphine and/or Codeine use. Many of my judicial customers (probation/parole, drug court, etc.) are able to have their participants sign something acknowledging that consumption of poppy seeds or other poppy foods constitutes a violation – this is to avoid any conflicts down the road. Some of my non-profit addiction treatment facilities who rely on food donations, must sadly decline any donations of poppy foods. So, there are ways to minimize the chances for this to become an issue, but it isn’t the same for everyone, and it isn’t always easy!

 

Some other things to consider:

  • Not just time should be a consideration, but also number of urinations. If I didn’t get up to pee twice in the middle of the night, my next void in the morning of week 2 would most likely have still been positive.
  • Not all poppy seeds are created equal. Some have higher concentrations of different opiates, some are “washed” better and contain less opiates over all.
  • I need to be better hydrated. Some of my Creatinine levels are a little higher than average for my age/gender. This also highlights the importance of considering specimen dilution/concentration when determining any drug test result.

 

CBD Products Causing THC Positives?

CBD Products Causing THC Positives?

Eric Malis

The question I am getting most frequently these days is whether CBD oil and other CBD products can cause a positive result on the THC panel. Let’s dig in a little to see what CBD is supposed to be, and what it often is.

 

What is CBD?

 

CBD, or Cannabidiol, is a non-psychoactive Cannabinoid – a substance that acts on the Cannabinoid receptors (the endocannabinoid system) in animals – one of more than 100 such Cannabinoids found in the Cannabis plant.  While medical research into CBD is still in its infancy, promising studies are being undertaken to see if it can be used to treat a myriad of ailments, including anxiety, chronic pain, autoimmune disease, and epilepsy, among others. The FDA has even approved a CBD-based medication called Epidiolex for epilepsy.

 

Regulation and Availability

 

CBD is “legal” in some states if it is derived from the hemp plant, which by definition may not contain more than 0.3% THC (the psychoactive substance in Cannabis); I use quotation marks because Federally, the DEA has stated “Just because we haven’t taken any enforcement action, doesn’t mean it’s okay.” Basically, the status of CBD is sort of in limbo, although it has already been excluded as both a dietary and food supplement. In the meantime, it is becoming ubiquitous – being sold everywhere from vitamin and health-food stores, to head shops and convenience stores; and in products from vaping oils and topical lotions, to tinctures and even snacks and soft drinks; there is even a huge market aimed at CBD products for pets! And because of the lax enforcement, it often is coming from less-than-reputable sources, its quality and ingredients list vary wildly. Reputable CBD producers will have their products verified by an external laboratory, and the contents clearly marked on the packaging.

 

Why Does This Matter to Us?

 

Getting back to the big question for us; will these products cause a positive on the THC panel on the instant test? The short answer is no: CBD use will not cause a positive result on a THC test; the THC panel is designed to react solely with THC and its metabolites. However, because of the laissez faire attitude by both enforcement authorities, and especially unscrupulous producers, many CBD products available “on the street” these days contain more than the allowable amount of THC. So, even in the best circumstances, many CBD products will contain trace amounts of THC (as allowable), but again, the lack of regulation and oversight means we are seeing too many products that contain unacceptable amounts of THC, which can be the cause of many THC test positives where the user claims to have only used CBD. Reputable CBD producers will have their products verified from an independent laboratory, and the contents clearly marked on the packaging.

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