Intoxication,Drugs of Abuse Testing & Forensics A

Posted on October 8, 2008

PCP
Diazepam, as well considered in the state of some ingredients in cough medicines, Dextromethorphan.

Poppy seeds such as on a Burger King roll, bagel rolls (according to the Journal of Chemical Chemistry, Volume 33, #6, 1987), quantities of poppy seeds ingested in this study 25 and 40 grams, may be expected to be contained in 1 or 2 servings of poppy seed cake. Therefore, poppy seeds image a potentially serious source of falsely indubitable results in testing somniferous abuse. The paper in Clinical Chemistry also concludes: “”Not only is it difficult to distinguish heroine or morphia abuse from codeine, end dietary poppy seeds can give a strong positive results for urinary opiates for different days duration that is confirmed by GC/MS decomposition.””

The list of agents which have power to cause false positivity in the urine has also been described for endogenous excretion of enzymes in the urine. For cite, a study from Emory University by Dr. James Woodford, has shown that a percentage of persons of African origin, orientals and Pacific Islanders may be testing positive for marijuana subordinate to a mechanism which involves the paint melanin which protects the hide from sun, what one. approximates the molecular structure of the THC metabolite which causes laboratory cross reaction with marijuana.

What this ways and means is that if you have used any of these over-the-counter medications, you may be accused (arrested) based on a false positive urine test. If your expert does not pick out this up you may be in serious irreversible trouble.

Methodology of Drug Screening in Urine
There are various methods to detect drugs in the urine. The most frequent one is an enzyme immunoassay (EIA), or radioimmunoassay (RIA), and florescence polarization immunoassay (FPIA). There are additional more sophisticated methodologies which are performed on extract of urine what one. are performed using thin layer chromatography (TLC), aeriform fluid chromatography (GC) of great altitude action liquid chromatography (HPLC) and gas chromatography/mass spectrometry (GS/MS). The only accepted procedures based on the defining of the National Institute of Drug Abuse (NIDA), and the Department of Defense (DOD), are immunoassays followed by gas chromatography/mass spectrometry confirmation. The confirmation utilizing gas chromatography/mass spectrometry is required since the methodology of immunoassay be able to give false positive results due to cross reactivity. This is owing to the fact that this methodology cannot specifically identify the drug, but for better reason the antibodies recognize substances what one. may acquire the same constitution chemically, or immunologically or enzymologically, other than the drug of interest. Immunoassays for amphetamines will show reactivity with drugs structurally related to amphetamines, such over-the-counter sympatomedicoamines, phenylpropanolamine and ephedrine, over-the-counter legal medications used for nasal plethora, cold and appetite suppressant. Confirmation therefore is a must utilizing gas chromatography/mass spectrometry. The use of elastic fluid chromatography/bulk spectrometry provides an extremely high characteristic of reliableness when properly preformed and applied.

As far as gas chromatography/mass spectrometry, this is a superb methodology if transacted correctly. For instance, if the equipment has not been cleaned appropriately, the previous run from the previous testing direct contaminate the next sample, and will give erroneous, inaccurate and incorrect results. Therefore, it is preceptive to look into the methodology that the person used for specific results on gas chromatography/mass spectrometry at a given indicated case. (On many occasions a deposition of the lab technician will reveal that the sample was contaminated.)

What this means to you is that if your urine is tested utilizing the immunological method only, without establishment with GS/MS, there is a high probability that the result may be a false positive and irrelevant to your situation.

Forensic Accuracy of GS/MS
Gas chromatography/majority spectrometry is extremely and highly accurate granting that done correctly. A laboratory which performs the test must be NIDA certified or CAP (College of American Pathologists) certified. All of the labs that perform the gas chromatography/celebration of the lord’s supper spectrometry on site be possible to be NIDA certified. Labs that send samples to not the same laboratory for gas chromatography/mass spectrometry full investiture are ineligible, I recapitulate, ineligible, for NIDA certification. Therefore one must be very careful when looking at the test results to see whether the laboratory is NIDA/CAP certified. Furthermore, some labs do not suitably and thoroughly clean the GC/MS equipment. Some labs don’t even do GC/MS confirmation. Some labs use cheap alternative methods to increase profits and reduce expenses. Therefore you must be in a position to aggressively cross examine the laboratory director and technician.

Drug of Abuse and Hair Testing
Hair testing according to drug of abuse testing has change to extremely popular among employers. There have been several scientific forensic doubts about the use of this methodology for proof of satirize. For example, the Society of Forensic Toxicologists in 1990 stated: “”The use of hair analysis for employees in pre-employment drug testing is premature, and cannot be supported by the current complaint on hair analysis in spite of drugs of abuse.”” A 1997 study by the National Institute of Drug abuse reached a conclusion and indicated that significant ethnic propensity may be the result of test for cocaine positivity. Analytical Toxicology in its sending out in March/April 1998 indicated that removal of melanin from hair (a methodology used to remove the ethnic bias) “”does not eliminate the hair color bias when interpreting cocaine concentrations”” Public information available (Congressional records from May 14, 1999), indicated that the Department of the Army clerk raised questions about the Army’s use of hair testing in a specific case, and members of Congress were expressing their discomfort through the procedure’s reliability. Indeed, Representative, Cynthia McKinney, a Democrat of Georgia, and from Defense Secretary, William Cohen, that she is exploring feasible Legislative remedy to prohibit human hair testing for drugs in the military, given that the hair testing has been proven by forensic toxicologists to subsist racially biased. Indeed, the paper by means of Kintz, et. al. published in the Journal of Forensic Scientific International, January 1997, Volume 17, pages 84 to 123 and 151 to 156, indicated that false positives are found even at low concentrations. Tissue hair analysis in good hands with good laboratory technology may give an idea about habitual employment of some of the drugs; however, it is preferable that these should be combined with urinalysis utilizing either screening, or better confirmation methodology.

Practical Application to a Case Analysis
In order to summarize and make the too proud for data applicable, I will describe two case scenarios.

Case #1:
A 28-year-old worker pitiless off the roof, 2nd floor, while on the job. He suffered different bone fractures, head bruise and was taken to the emergency room. At the emergency room animal-water was sent to the lab for drug screening. Upon recovery from the injury the patient requested Workers Compensation benefits, and was denied since the urine drug screening utilizing EMIT methodology (immunological) detected opiates. In his deposition the patient testified that he has not used drugs, did not use drugs onward the epoch of injury either. On careful review of the medical records, it turned out that the physician on behalf of the employer had recommended denial of the Workers Compensation benefits, failed to review the paramedic ambulance notes which was called to the scene of the injury and had transferred the patient to the hospital. The emergency room notes sheet indicated that the long-suffering had received IV morphine from the medic driver to sedate him from his severe pain of bone fractures and skull concussion. The evaluating physician further failed to note that the urine sample was obtained 4 hours after the patient’sitting stay in the emergency room, and did not define whether that was a fresh piss sample, catheterized animal-water, and did not indicate the volume of the urine. The patient’s physician provided a report documenting that there is no story of drug carp at, there was no evidence that the patient was impaired from testimonies from his supervisors and coworkers on the date that the injury occurred, and has further supposing evidence that the urinalysis was taken several hours after the patient was administered IV morphine by paramedics at the emergency room, and therefore, the results were essentially erroneous and irrelevant to the patient’s cause of injury. This is an example of in what condition drug urine testing can subsist applied wrongfully, and cause unnecessary pain, anxiety, hindrance of benefits and major expenses to the insurance carrier and the citizens who end up paying these expenses out of their pocket.

Case #2:
This is a 32-year-old female patient, a driver of a vehicle who was involved in a car collision and suffered mental bleeding (ruptured spleen), and a fracture of a bone of the lower extremity. She had requested medical benefits from her insurance carrier for medical expenses as well as time lost from work, and has filed a suit in law since these were denied. The physician who examined the patient on behoof of the assurance carrier, and whose report was the groundwork for the denial, noted in his reports that upon initiation to the emergency room on the date of injury, urine screening test for science of poisons was done, and was positive for amphetamines. The physician who examined the patient on behalf of the insurance carrier failed to note the time of the testing, the time the urine was obtained from the patient, whether the assiduous was taking any medications which contain amphetamines, of the like kind as ephedrines or pseudoephedrines. The medical records examined carefully by the agency of the patient’s physician, found notes from the concern doctor who attended the patient at midnight adhering her admission. The home teacher took a good detailed story recorded in his handwriting which clearly fixed that the patient is an allergic individual, and has for the last pair weeks been using compounds which contain both ephedrine and pseudoephedrine. The physician who reported on behalf of the patient further was able to show in the medical records that all examining physicians clearly stated that the patient was alert x 4 on admission to the hospital, defiance her pain and notwithstanding medications received from the paramedics and emergency room physicians. There was no clinical evidence of impairment, there was no history of drug abuse, in that place was no evidence of drug impairment. The puzzle with this trial, is that the urine screening test was a false positive, because of the patient’s use of over-the-counter ephedrine and pseudoephedrine containing medications to treat a devoid of warmth and nasal congestion. Had a follow-up been accomplished on that sample with gas chromatography/mass spectrometry showing a specific type of amphetamine, the story main have been different if indeed the patient was a user (which is not the case here). This case further illustrate: 1. The need for a very in depth evaluation of the chart and notes, as far as to the patient’s mental capacity before and after the collision. 2. A detailed analysis of past and present prescription and over-the-counter medications. 3. The need to follow-up on piss screening test if it is positive for drugs of abuse in a case where such suspicion is indicated. Gas chromatography/mass spectrometry is the issue tool to eventually follow-up on such a suspicion.

In summary, while drug harm and intoxication is a problem, the diagnosis of Aintoxicated@ is a scientific one and cannot be based on Apersonal beliefs@ or Afeelings@ of a defense examiner.

About Dr. Brautbar
Dr. Brautbar is board-certified in internal remedy, forensic remedy, and nephrology, with a specialization in toxicology. Dr. Brautbar has provided expert medical notion and scientific spectacle in product liability, personal injury, medical & nursing home standards, and toxic tort cases throughout the United States. Dr. Brautbar is a Clinical Professor of Medicine at USC School of Medicine, Department of Medicine, and served as Chairman and Vice-Chairman of the Department of Medicine at the Queen of Angels/Hollywood Presbyterian Medical Center. He has published past 240 journal manuscripts, abstracts, and book chapters in the fields of internal medicine, toxicology, and nephrology. His resume includes past and present membership in 25 National and International Scientific Societies including the Collegium Ramazzini. Dr. Brautbar has been on the faculty of the National Judicial College and lectured to Judges on the issue of Scientific Evidence, and was a peer reviewer for the Federal Judicial Center (Reference Manual on Scientific Evidence, Second Edition, 2000). Dr. Brautbar has also been a peer-reviewer for the ATSDR.

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About the author:
Dr. Brautbar is writing article for www.environmentaldiseases.com,specializes in Internal Medicine, Nephrology, Toxicology, Pharmacology, and Occupational Medicine. He is a Clinical Professor of Medicine at the University of Southern California, School of Medicine, teaching medicine, and actively engaged in the exercise of medicine.

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