If you read this blog with any regularity, you know I try to keep my topics educational. However, sometimes something new and interesting on the horizon is worthy of its own announcement, if only to determine if anyone else is excited about the potential as we are. In fact, more than ever, we would love to have feedback from you on the potential usefulness of this new test.

Just landed on my desk is an early version of an instant test that uses hair follicle as the specimen!

In the past, hair testing was only available via laboratory testing. The lab testing for hair is generally expensive and limited in which substances it can detect. The potential to have an instant POC (point of care) hair test will counter both of these shortcomings. While we do not have a price-point for these yet, we anticipate a cost not much higher than oral fluids tests, far from the cost of the laboratory version. Also, while most laboratories who even offer hair testing are only testing for five basic drug classes or so; no Fentanyl, no Alcohol, not even Benzodiazepines are being offered for screening by most laboratories performing hair testing. Early information indicates that the instant version would have the potential to detect any substance where there is already a urine test version available.

There is one other reason hair follicle testing remains less-popular than urine testing, and that is the window of detection. To learn more about the different specimen types, please read my previous blog post on the topic here. I will summarize here: while in urine we detect substances used within the past few days or weeks, depending on the substance, substances in hair follicle specimens are detected for 10-90 days. In other words, it will take about 10 days for a substance to begin to be detected (onset) and will be detectable for about 90 days after (outset). This window of detection does not work well for every setting.

There are a few other benefits of hair testing. One being that there is no need for same-sex collectors or even a bathroom. Another would be that it is almost impossible to adulterate a hair specimen. No more “shy bladder” excuses for producing a specimen is also a bonus of hair testing.

In the coming weeks I will be testing the early version that I have here and will be documenting my process and my results, and will post a full report of the testing process from start to finish.

In the meantime, as I mentioned, we would love to hear from you: Is this something that would be useful or not? Please reach out to me or your consultant and share your thoughts.

If you’ve watched our “Understanding the Limitations of Drug Testing” webinar or have had conversations with me about that subject, you’ve heard me talk about substances that many people expect to be detected on the tests that they are using, but actually are not.  An excellent example of this that we are all hopefully familiar with is Fentanyl. This synthetic opioid, for a long time, was expected to be detected on an Opiate panel but in fact it is not. As Fentanyl became more problematic, we increased our efforts to ensure that we were giving our customers the knowledge and the tools needed to test for this dangerous substance. Today we will discuss Hydrocodone and Clonazepam. While not nearly as prevalent as Fentanyl, these are two commonly prescribed drugs that do have the potential for abuse and are worth knowing about.

Hydrocodone is an Opioid pain medication, with Vicodin being the most prominent brand name. If you’ve ever had any serious dental work, you have probably heard of this one. Since it is an Opioid, it has a high potential for misuse and addiction, so it is a substance that is important to test for. However, the misconception is that this substance would be detected on the standard Opiate panel, or at least the Oxycodone panel.  Because these substances share a similar molecular structure, there is a possibility that Hydrocodone could be detected on either of those panels. However, the concentration of Hydrocodone in the specimen would have to be much higher than the other substances being detected, and therefore neither of those panels will ever be reliable tools for detecting Hydrocodone. Fortunately, we do have a Hydrocodone specific test, both as separate single-panel dip tests, and also included in select multi-panel cup configurations.

Clonazepam is a Benzodiazepine commonly known by the brand name Klonopin. Benzodiazepines, or Benzos, also have a high potential for misuse and addiction and is also an important substance to test for. Also, like Hydrocodone, it is possible that Clonazepam will trigger a positive on the standard Benzodiazepine panel, but it will not be at all reliable. The Benzodiazepine panel was designed to detect the most common Benzodiazepines. So, a standard test will detect about 20 of the 50+ Benzodiazepines that exist in the world, but Clonazepam is different enough in both molecular structure, and in the way the human body metabolizes it, that it will not be reliably detected. For this reason, such as with Hydrocodone, we do offer a Clonazepam specific test in both a single-panel dip test, and as part of select multi-panel cup configurations.

The big takeaway here is that it is important to know what substances will be detected on the panels you are testing with. While the tests are engineered to detect as many drugs in a specific class as possible, sometimes differences in chemistry and biology make this impossible. Fortunately, in almost all cases, we have the tool available that will fill these “blind spots”.

As always, for additional information or discussion on this topic, please reach out to me or your consultant.

Today’s subject was sparked from a conversation that our sales consultants have fairly regularly. Usually this comes up in the context of us pressing to find out why a facility is using the specific tests that they are using. The answer we get more than any other is some variant of, “it’s just the way we’ve always done it.” If you’ve had any conversations with our sales team, you know they won’t simply let that answer stand alone. It is always our mission to understand the needs of each facility we work with, but sometimes this can entail explaining why some of the thought processes behind those needs might be misguided, outdated, or missing crucial bits of information.

For example, when inquiring why a facility is not testing for Fentanyl, when it is clearly the most concerning drug of abuse, we will often hear the previously mentioned, “it’s just the way we’ve always done it”, or, specific to Fentanyl, “we assumed that this would be detected on our Opiate panel”. This covers all three of the thought processes I described.

However, for this blog post, we are going to focus on the other side of this coin, substances that people have been testing for that may or may not be necessary. Keep in mind, I will never fault anyone for playing it safe and testing for everything that they can, but this doesn’t always work for facilities that need to keep costs down. I always recommend that people find a happy medium, and keeping our clients informed about substances that are of the highest concern at the time is incredibly important in helping such facilities try and find that happy medium.

Today we are going to look at Propoxyphene (PPX) and Tricyclic Antidepressants (TCA) with a nod to a couple of honorable mentions in Barbiturates (BAR) and Phencyclidine (PCP).

First, Propoxyphene, more commonly known by its brand names, Darvon and Darvocet, is a mild Opioid pain reliever. It dates back to 1954 and was developed, like most Opioids, as an attempt to create a non-addictive pain medication. Spoiler alert, it was still addictive! Being that it was a mild Opioid, it did have a slightly lower risk of addiction, but it was neither non-addictive nor totally safe, as such, this medication has been taken off the shelves in the US since 2010. Most other First World countries follow suit shortly thereafter. While it is still prescribed in other countries, albeit infrequently, it is not completely gone from the world. However, with many more commonly prescribed, and therefore more readily available Opioids, I have never in my 20+ years heard of a Propoxyphene positive result, nor any facilities having concerns with its misuse.

Next up is Tricyclic Antidepressants. Tricyclic Antidepressants are a class of antidepressants characterized by their chemical structure, which contains three rings of atoms. TCAs were also developed in the early 1950s during the early days of psychopharmacology (psychopharmacology being medications to treat mental disorders). TCAs are typically classified as, “mood elevators”, and the most commonly known is probably Elavil (Amitriptyline). These medications have not been pulled from shelves like Propoxyphene, but they are rarely prescribed these days in favor of the more modern class of antidepressants, such as SSRIs (Prozac and Celexa), SNRIs (Cymbalta and Effexor), and NRIs (Wellbutrin). Near obscurity aside, according to the US government classification of psychiatric medications, “TCAs are non-abusable”. While in slightly higher demand than testing for Propoxyphene, TCAs can be a good place to cut back on if you are trying to keep costs down.

Honorable mentions: Barbiturates (BAR) and Phencyclidine (PCP).

Please do not interpret this as my advising not to bother, or that you don’t need to test for these, but I wanted to include this in an attempt to point out how uncommon these substances have become in terms of drugs of abuse. Barbiturates have long since been replaced in most cases with Benzodiazepines (especially for sedation). However, we do see a small number of prescription medications that contain them. Fioricet, for example, is a common medication prescribed for migraines.

If you are testing BAR, I am going to guess that you probably have never seen a positive result. To a lesser extent than BAR is PCP. This dissociative anesthetic was used medically from 1956 to 1965 (1978 for veterinary medicine), until discontinued due to high rates of negative side effects. We typically see the better tolerated, Ketamine (KET), being used for anesthetic purposes in its place. While we do sometimes hear about geographic pockets of the country where this substance pops up from time to time, it is not nearly as widespread as it once was.

In summary, do not take this article as the final word on what tests are best for you or your facility to use, but take this to open up a conversation about whether or not, what you are testing for is really what you need to test for, or if it is just the way you’ve always done things.