Safer Alternative

Since March, as businesses and government agencies started closing and investigating safer alternative ways of testing procedures, more and more people have been inquiring about oral fluids testing for drugs of abuse. These are sometimes referred to as saliva tests or mouth swabs. So, let’s talk a little bit about what they are, how they work, and why the sudden spike in interest.

There are a couple of reasons for the impression that oral fluids testing allows for a safer collection protocol. Firstly, an oral fluids drug test can be performed remotely via video conferencing software. The administrator can watch the donor collect the specimen themselves, watch the collected specimen being inserted into the test, and watch the results develop without the device or donor leaving the camera view. Secondly, an oral fluids test can be performed in an outdoor setting while maintaining social distancing guidelines. Of course, the donor must remove their face covering to collect the specimen, but you should still be able to witness the entire process at a safe distance.

How They Work & Procedures

If you are unfamiliar with oral fluids test, there are basically two parts: the collector, which is a sponge attached to a plastic handle and the test device itself, where the collector (sponge) is inserted to direct the specimen into the well inside of the test where the test strips are located. The collection process can be a little tricky until you get the hang of it – for starters, an uncooperative donor can purposefully withhold collecting enough saliva to allow the test to function – but once the procedure is mastered, the test is as easy to perform and read as a urine drug test. One other tricky step with collecting a specimen is that the test requires more saliva than you might think. The instructions only mention the amount of time it should take until you have enough specimen, but it is not that black and white. The donor should compress the sponge against their cheek or tongue and allow the decompression to absorb the excess fluid. In the worst-case scenario, they can also expectorate directly into the test device, or into an external receptacle, which can then be poured into the test.

Progress

Oral fluids tests have come a long way in the past 12-15 years. If you had asked back then, I would have discouraged their use or at least give warning about their accuracy and other shortcomings. Today, however, they are just as accurate as the urine drug tests that we provide. Additionally, the number of substances that can be tested has significantly caught up to the options we have for urine testing. Add to this the fact that it is impossible to adulterate an oral fluids test, if the instructions are followed properly, making them an excellent tool to have at your disposal.

Shortcomings & Final Word

Perhaps the only shortcoming of oral fluids testing, especially for most of your purposes, would be the window of detection. As the toxicology of urine closely mirrors the toxicology of blood, drugs are only detectable while they are still in the bloodstream, much like a breathalyzer only detecting current intoxication as opposed to an EtG test offering detection for up to 80 hours after use. So, the best-case scenario for oral fluids testing would be detection of less than 24 hours after use. In some situations, such as injury at work, where the important factor is detecting current intoxication, oral fluids testing makes the most sense. However, this window of detection isn’t always as useful to someone when the need to detect recent and past drug use requires a detection window that goes back days or even weeks in some cases.

In summary, oral fluids testing is a great option for programs looking to detect recent drug use. Though there are some drawbacks with their window of detection, they can be administered safely and frequently, while adhering to COVID-19 guidelines. If you would like any additional information on this, or any other subject, please leave a comment below or reach out to us directly. Stay safe and be well.

What is EDDP?

I often get asked about EDDP – primarily, “what is EDDP?”, and “should I care about EDDP?”. EDDP – the abbreviation for the chemical compound 2-ethylidene-1, 5-dimethyl-3, 3-diphenylpyrrolidine – is a major metabolite of methadone. While methadone is not a widespread drug of abuse these days, it is certainly something you would not want to not test for. Hopefully, the information about EDDP in this blog post will help you decide if testing for EDDP would be beneficial.

As you may know, some drug tests are designed to react to the parent substance: in other words, the substance that was ingested, while some panels are designed to detect the metabolite: what the body changes that substance into as the body’s metabolism processes it into waste. As for substances, some are (at least partially) excreted in the exact same form that was ingested. For example, with methadone, in most cases, the body will excrete at least some methadone in the urine. Also, as with most substances, the body will excrete at least some amount of metabolite in the urine – in this case, we mean EDDP.

Should I Care About EDDP?

There are 3 primary reasons to care about, and test for, EDDP. Before we get there, it is important to note that there is a non-trivial percentage of people in the world who are “extensive metabolizers” of methadone; this means that while most people will excrete the parent compound in their urine, some will almost completely metabolize the methadone into EDDP. Since a standard methadone panel does not react to the EDDP, it gives us three risky scenarios: 1) You have a patient/participant using methadone illicitly and a simple methadone test is not detecting this. 2) You have a patient/participant who is supposed to be taking their methadone, but suspect they are instead spiking their specimen with methadone to give the illusion they are taking it, and 3) Same scenario as number two, except the patient/participant is taking their methadone as prescribed, yet is causing suspicion by producing a negative methadone test.

Another, lesser, benefit of testing EDDP, is that all methadone instant tests currently available will cross-react with Doxylamine – a substance found in the over-the-counter medications Nyquil and Unisom (amongst others). The EDDP panel has a much higher threshold for cross-reactivity for Doxylamine than the methadone panel.

So, EDDP may not necessarily be crucial to all programs, but it is good to know what it is, and if you should care about it. As always, please fell free to comment here or reach out to us should you have any questions or would like any additional information on the subject.

As many of us are looking toward going back to normal, or at least back to work, special considerations must be made if we are going to prevent a new spike in COVID-19 infections. In addition to some tips on keeping a clean workplace, we will also talk about some testing methods that help with social distancing. Of course, a lot of the tips here you’ve been hearing for months and are just common-sense precautions, but hopefully having everything compiled here together will be useful and even helpful!

Keep Yourself Clean

This one seems fairly obvious; it is well known that the first step in preventing the spread of coronavirus (or any virus, for that matter) is to keep your hands clean. Washing your hands thoroughly for 20 seconds with any bar or liquid hand soap is an excellent first step toward preventing the spread of viruses; handwashing should be done frequently. Another way to prevent infection is to avoid touching your face, especially openings like mouth and nose. Of course, hand shaking or other casual contact that we often take for granted should be avoided.

Keep Your Environment Clean

Another big help in preventing infection is to keep the air and area around you clean. The best way to do this is to wear a mask that covers both your nose and mouth. This is more about preventing your spreading infection than preventing your getting infected. While an N95 mask is probably the best as it catches 95% of airborne particles, a simple 3-layer surgical mask goes a long way in mitigating the risk of contagion. Even lesser-protective cloth masks and other homemade coverings are helpful…every little bit helps! Even with a mask on, it is still important to cough and sneeze into the crook of your elbow (this is always a good idea). Also, it is important to stay home or otherwise avoid contact with others if you are experiencing any symptoms of infection or fever. Lastly for your environment, good social distancing (keeping 6 feet away from others) will help greatly.

Keep Your Work Area Clean

As the coronavirus can live on surfaces (especially non-porous surfaces like desks, etc.), it is important to clean and disinfect surfaces regularly, including, but not limited to: desktops, keyboards, doorknobs, faucets (kitchen and bathroom), and any other commonly shared office equipment (printers,  photocopiers, and touchscreens, as examples). Floors and common areas should also receive extra cleaning and disinfecting. Some have suggested using disposable utensils if there is a shared break room/kitchen or other place it is common for coworkers to take meals or snacks.

Drug Testing

If you plan on continuing urine drug testing, it is even more important to follow the steps I’ve already outlined. Some have decided to switch to sweat path testing to minimize contact with their clients/participants, as the patch is worn continuously for 7-10 days. Some have chosen hair testing for this reason. Another popular method of testing during these times is oral fluids testing; oral fluids testing can be performed remotely via video-chat…from collection to results without the donor having an opportunity to substitute specimen or otherwise adulterate. Please take a moment to read our blog about specimen types for more information on how these differ from urine.

In summary: stay healthy! If not for yourself, stay healthy for your loved ones, and stay healthy the people who rely on you. Whatever the reason you are testing for drugs of abuse, the people you are testing rely on you to be there to help them navigate and get through it – stay healthy for them!

Testing for COVID-19 is an important step in tracking cases and contagion mapping. It also tells us who needs treatment and isolation. At some point, COVID-19 testing will be needed in order for us to get back to “business as usual” as a country (and as a planet!). That being said, there are many different types of tests out there, not all using the same specimen type, not all taking the same amount of time for results; it’s a lot to wade through and there is too much misinformation out there. I am going to (hopefully) help you make some sense of this by breaking down all of the currently available testing methods. Please keep in mind, this information is evolving rapidly (I had to make changes over the course of the few days this was written!), but this is the best information available at the time of publishing.

Laboratory Nasal Swab (Nasopharyngeal Culture) Test

This is a molecular test in that it tests for the RNA/DNA (genetic building blocks) of the SARS-CoV-2 (COVID-19) live virus. Since this detects the live virus, a positive test indicates that the body is currently infected with the virus. It’s doesn’t determine when in the timeline the infection is (onset, peak, or outset). Also, important to note: if there is live virus in your body, then you are contagious. The specimen for this test is mucous collected (most-commonly) from the posterior nasopharynx (the upper part of the nasal passage), and it collected by taking a cotton swab and inserting it to the back of the nasal passage. The specimen is processed at the lab with a process called RT-PCR (real-time polymerase chain reaction) which – in very basic terms – is a DNA replication/splicing to check compatibility. If the DNA is able to replicate, then it proves the presence of this particular coronavirus. While we have seen instances of false negative results, they are almost entirely due to poor or erroneous collection techniques. Aside from that, this is an extremely accurate way to detect it. Lastly, because this is a lab test, the results are not immediately available and can take days (or more, depending on the lab).

Instant Nasal Swab (Nasopharyngeal Culture) Test – “Abbott ID Now”

This one is relatively new, having only received its FDA EUA (emergency use authorization) on March 27th of this year. Like the laboratory test above, it is a molecular test. The specimen is also mucous, but instructions indicate it be collected from the nose, throat, nasopharynx, or oropharynx (back of the throat). The big difference between this and the lab test is that this is a standalone testing unit than can provide a near-instant result (5-13 minutes). The accuracy, while not quite as good as the lab test above, is still an impressive 95% per the manufacturer’s documentation. There are another 2 or 3 devices that are similar to this, and either FDA cleared (or close) that will have results within an hour; I focused on the Abbott device because many of you probably saw it on the news where President Trump had one out on the table during a press conference.

Instant Serology Immunoassay

Lastly, we have the newest test to be made available – an instant device that works much like the old pipette (eyedropper) style drug and pregnancy tests. Also, like most drug tests devices, the result is available within 15 minutes! It is a serology test, meaning the specimen needed is blood (whole blood, serum, or plasma). This test is different than the others above in that it is testing for the antibody that your body creates when exposed to the virus. This means it will detect whether you currently have or have had the virus; in other words, you may have already cleared the virus from your body and still trigger a positive on this test. As it is a screen, it is less accurate than the molecular tests, with most on the market between 82%-90% accuracy. There are more than 40 manufacturers who have either filed for an EUA (or have notified the FDA of their intent to do so), but as of this writing, only one has approved. There is some confusion as to the collection method for the blood specimen: it is being widely described as a finger stick test – finger stick being a minimally invasive method of pricking the fingertip to draw a bead of blood (diabetics do many times this daily). However, in an effort to discourage home use, any serology test that has been FDA cleared will clearly state that finger stick is not an acceptable method of collection. Unfortunately, there are no COVID-19 tests that are currently available for home use. Lastly, we do have these tests available, so please reach out to your consultant for more information or click here to fill out an order request form.

In Closing

I hope I have shed some light on the available tests that are out there. Again, since this is changing so fast, do not hesitate to check in with us if you need to take any steps based on the information here – just to be sure. Our next post will be about some tips and tricks on how to keep a clean and safe working environment as we start trying to get back to work or as some of you continue to do so already. If you have any tips or information on how you are performing testing in a world where social distancing is becoming the new norm please comment and share. The best thing we can do right now is work together in fighting this invisible enemy.

One question I am asked fairly often is regarding the primary metabolite of Heroin; known as 6-AM or 6-MAM. These are synonymous for 6-Acetylmorphine and 6-Monoacetylmorphine (actually all 4 mean exactly the same thing!). For the sake of brevity, in this post I will call it by its most popular moniker: 6-MAM.

Heroin itself has an extremely weak affinity to the μ-opioid receptors, meaning that Heroin itself will essentially not produce any euphoric or pain-relieving effects. However, once it enters the bloodstream, it is immediately metabolized into 6-MAM, which is what actually causes the effects of the drug. Heroin is also metabolized quickly into the less-active 3-Monoacetylmorphine (3-MAM), and less quickly into Morphine. Some forms of Heroin do contain some 6-MAM (most notable would be Black Tar Heroin), but for the most part it is only detectable once the Heroin has been metabolized in the body. As an aside: with regards to drug screening, we are really only concerned with active metabolites, since immunoassays rely on an active chemical reaction to function at all!

*Metabolization of Heroin to 6-MAM

Because 6-MAM is unique to Heroin, many are asking about the availability (as well as the quality and reliability) of an instant test for it so they can make sure they are detecting any Heroin use. While it is available, and the reliability and accuracy are outstanding on the 6-MAM instant test, I typically counsel against testing 6-MAM for a few reasons:

1. 6-MAM is only detectable in urine for a short time, with barely a 12-hour window of detection.
2. While 6-MAM has a very short window of detection, the Morphine that is also created as a metabolite takes much longer to purge from one’s system, giving us about a 3-day window of which it can be detected on a standard Opiate panel.
3. From what we are hearing, so much of the Heroin on the streets these days contains very little (if any) Heroin at all, and it is mostly Fentanyl mixed with other filler. 

So, if you absolutely need to know that the positive Opiate that you are seeing came from Heroin use (as opposed to Morphine or Codeine use), then the 6-MAM panel can provide that information. However, do realize that the window of detection is going to severely limit your ability to detect this substance.

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.