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.