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Heide G, Jamt REG, Fainberg-Sandbu J, Øiestad ÅML, Høiseth G. Driving under the influence of cocaine and MDMA: Relationship between blood concentrations and results from clinical test of impairment. J Anal Toxicol 2024; 48:380-387. [PMID: 38613441 PMCID: PMC11165640 DOI: 10.1093/jat/bkae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 03/13/2024] [Accepted: 03/20/2024] [Indexed: 04/15/2024] Open
Abstract
The general use of cocaine is increasing in recent years, while the trend for 3,4-methylenedioxymethamphetamine (MDMA) is less clear. The relationship between blood concentrations and impairment is poorly understood, which complicates interpretation. The aims of this study were to report prevalence and blood concentrations of cocaine and MDMA in drugged drivers, and to investigate the relationship between blood concentrations and impairment. Samples of whole blood were collected from apprehended drivers in the period 2000-2022, and a clinical test of impairment (CTI) was simultaneously performed. The samples were initially analyzed for cocaine and MDMA using gas chromatography-mass spectrometry (until 2009 and 2012, respectively), and later using ultra-high-performance liquid chromatography-tandem mass spectrometry. Overall, cocaine was detected in 2,331 cases and MDMA in 2,569 cases. There were 377 and 85 mono cases of cocaine and MDMA, respectively. In the mono cases, the median cocaine concentration was 0.09 mg/L (range: 0.02-1.15 mg/L), and 54% of the drivers were clinically impaired. The median MDMA concentration was 0.19 mg/L (range: 0.04-1.36 mg/L), and 38% were clinically impaired. There was a statistically significant difference in the median cocaine concentration between drivers assessed as not impaired (0.07 mg/L) and drivers assessed as impaired (0.10 mg/L) (P = 0.009). There was also a significant effect of the blood concentration of cocaine (adjusted odds ratio [aOR] = 6.42, 95% confidence interval [CI] = 1.13-36.53, P = 0.036) and driving during the evening/night-time (aOR = 2.17, 95% CI = 1.34-3.51, P = 0.002) on the probability of being assessed as impaired on the CTI. No significant differences were found for MDMA. Many drivers are not assessed as impaired on a CTI following cocaine or especially MDMA use. For cocaine, a relationship between blood concentrations and impairment was demonstrated, but this could not be shown for MDMA.
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Affiliation(s)
- Gunhild Heide
- Department of Forensic Sciences, Oslo University Hospital, P.O. Box 4950 Nydalen, Oslo 0424, Norway
| | | | - Jonas Fainberg-Sandbu
- Department of Forensic Sciences, Oslo University Hospital, P.O. Box 4950 Nydalen, Oslo 0424, Norway
| | - Åse Marit Leere Øiestad
- Department of Forensic Sciences, Oslo University Hospital, P.O. Box 4950 Nydalen, Oslo 0424, Norway
| | - Gudrun Høiseth
- Department of Forensic Sciences, Oslo University Hospital, P.O. Box 4950 Nydalen, Oslo 0424, Norway
- Center for Psychopharmacology, Diakonhjemmet Hospital, Forskningsveien 13, Oslo 0373, Norway
- Norwegian Centre for Addiction Research, Institute of Clinical Medicine, University of Oslo, P.O. Box 1171 Blinderen, Oslo 0318, Norway
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Magura S, Lee-Easton MJ, Abu-Obaid R, Reed P, Allgaier B, Amaratunga P, Lorenz-Lemberg B, Levitas M, Achtyes ED. Comparing presumptive with direct-to-definitive drug testing in oral fluid vs. urine for a U.S. national sample of individuals misusing drugs. Drug Alcohol Depend 2023; 250:110894. [PMID: 37481872 PMCID: PMC10530259 DOI: 10.1016/j.drugalcdep.2023.110894] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 07/03/2023] [Accepted: 07/06/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND The aims are to compare the results of presumptive drug testing with confirmation of positives vs. direct-to-definitive drug testing, combined with investigation of urine vs. oral fluid as test matrices. METHODS Paired oral fluid and urine specimens were collected voluntarily and anonymously from 1098 individuals applying for methadone treatment in 11 clinics across 7 U.S. states. All specimens were analyzed by immunoassay (IA) and liquid chromatography-tandem mass spectrometry (LC-MS-MS). RESULTS Confirmed IA prevalences for urine were significantly higher than for oral fluid for 7 out of 10 drug classes - benzodiazepines, cannabis, cocaine, methadone, opiates, oxycodone and tramadol. Drug prevalences by direct-to-definitive LC-MS-MS were either the same or higher than prevalences by confirmed IA. Drug prevalences by LC-MS-MS were higher in urine for two drug classes (cocaine, methadone) and higher in oral fluid for two drug classes (buprenorphine, tramadol), but were equivalent in urine and oral fluid when averaged over all 10 drug classes. Certain drugs of special concern such as heroin and buprenorphine were more frequently detected in oral fluid than urine. CONCLUSIONS Urine analysis showed some technical advantage over oral fluid in sensitivity to several drug classes within a confirmed IA testing protocol, but this may be outweighed if there is reason to believe that tampering with urine specimens is a significant problem. Overall drug detection by direct-to-definitive testing was similar for oral fluid and urine, but one matrix may be preferable if there is a particular drug of clinical or epidemiological interest.
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Affiliation(s)
| | | | | | - Pete Reed
- Forensic Fluids Laboratories, Inc, USA
| | | | | | | | | | - Eric D Achtyes
- Western Michigan University Homer Stryker M.D. School of Medicine, USA
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Savage T, Sanders T, Pieters R, Miles A, Barkholtz H. Suitability of SoToxa® Oral Fluid Screening Over Time: Re-examination of Drugged Driving in Wisconsin. J Anal Toxicol 2022; 46:825-834. [PMID: 35767245 DOI: 10.1093/jat/bkac047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/11/2022] [Accepted: 06/28/2022] [Indexed: 11/15/2022] Open
Abstract
Drug impaired driver detection is a critical element of traffic safety. However, shifting drug use patterns over time and geography may limit long-term reliability of assay-based screening tools. In this work, we compare qualitative results from the Abbott SoToxa® oral fluid (OF) screening device to Quantisal™ OF and whole blood. Our objective was to examine these three qualitative toxicological approaches, scope applicability of OF collection at the roadside, and compare to a previous analysis of SoToxa® in Wisconsin. OF specimens were screened with the SoToxa® for six drugs or drug classes including amphetamine, benzodiazepines, cocaine, methamphetamine, opioids, and tetrahydrocannabinol (THC). OF and blood specimens were collected from 106 participants. Quantisal™ OF and blood specimens were screened for drugs on ultra-performance liquid chromatography coupled to quadrupole time-of-flight high-resolution mass spectrometry (UPLC-QToF-HRMS) using a data independent acquisition mode. UPLC-QToF-HRMS data was compared to comprehensive spectral libraries and drugs were qualitatively identified. Drug Recognition Expert evaluations were performed, and face sheets submitted for 21 participants in this work. In general, the SoToxa® results were consistent with the combined qualitative results observed in Quantisal™ OF specimens and whole blood specimens. Limitations were uncovered for benzodiazepines, opioids, and THC. The SoToxa® benzodiazepine assay has high cutoff concentrations for diazepam and clonazepam, limiting its sensitivity and positive predictive value when considering these drugs. SoToxa® opioid screening did not detect fentanyl, which is increasingly prevalent among drug users. Finally, ∆9-THC and its major metabolite 11-nor-9-carboxy-∆9-THC are lipophilic, limiting partitioning into oral fluid. Despite these limitations, the SoToxa® instrument may be useful in assisting law enforcement with identifying individuals driving under the influence of drugs and establishing probable cause at roadside for making impaired driving arrests. Furthermore, Quantisal™ OF may be useful as screening specimens due to their ease of collection and results consistent with whole blood.
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Affiliation(s)
- Theodore Savage
- University of Wisconsin-Madison, Wisconsin State Laboratory of Hygiene, Forensic Toxicology Section, 2601 Agriculture Drive, Madison, WI 53718, USA
| | - Therese Sanders
- Wisconsin Department of Transportation, Bureau of Transportation Safety and Technical Services, Chemical Testing Section, 3502 Kinsman Boulevard, Madison, WI 53704, USA
| | - Ryan Pieters
- University of Wisconsin-Madison, Wisconsin State Laboratory of Hygiene, Forensic Toxicology Section, 2601 Agriculture Drive, Madison, WI 53718, USA
| | - Amy Miles
- University of Wisconsin-Madison, Wisconsin State Laboratory of Hygiene, Forensic Toxicology Section, 2601 Agriculture Drive, Madison, WI 53718, USA
| | - Heather Barkholtz
- University of Wisconsin-Madison, Wisconsin State Laboratory of Hygiene, Forensic Toxicology Section, 2601 Agriculture Drive, Madison, WI 53718, USA.,Pharmaceutical Sciences Division, University of Wisconsin-Madison, School of Pharmacy, 777 Highland Avenue, Madison, WI 53705, USA
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Jang S, Son SU, Kang B, Kim J, Lim J, Seo S, Kang T, Jung J, Lee KS, Kim H, Lim EK. Electrospun Nanofibrous Membrane-Based Colorimetric Device for Rapid and Simple Screening of Amphetamine-Type Stimulants in Drinks. Anal Chem 2022; 94:3535-3542. [DOI: 10.1021/acs.analchem.1c04512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Soojin Jang
- BioNanotechnology Research Center, KRIBB, Daejeon 34141, South Korea
- Department of Nanobiotechnology, KRIBB School of Biotechnology, UST, Daejeon 34113, South Korea
| | - Seong Uk Son
- BioNanotechnology Research Center, KRIBB, Daejeon 34141, South Korea
- Department of Nanobiotechnology, KRIBB School of Biotechnology, UST, Daejeon 34113, South Korea
| | - Byunghoon Kang
- BioNanotechnology Research Center, KRIBB, Daejeon 34141, South Korea
| | - Junseok Kim
- Department of Chemistry, Incheon National University, Incheon 22012, South Korea
- Research Institute of Basic Sciences, Incheon National University, Incheon 22012, South Korea
| | - Jaewoo Lim
- BioNanotechnology Research Center, KRIBB, Daejeon 34141, South Korea
- Department of Nanobiotechnology, KRIBB School of Biotechnology, UST, Daejeon 34113, South Korea
| | - Seungbeom Seo
- BioNanotechnology Research Center, KRIBB, Daejeon 34141, South Korea
- Department of Cogno-Mechatronics Engineering, Pusan National University, Busan 46241, South Korea
| | - Taejoon Kang
- BioNanotechnology Research Center, KRIBB, Daejeon 34141, South Korea
| | - Juyeon Jung
- BioNanotechnology Research Center, KRIBB, Daejeon 34141, South Korea
- Department of Nanobiotechnology, KRIBB School of Biotechnology, UST, Daejeon 34113, South Korea
| | - Kyu-Sun Lee
- BioNanotechnology Research Center, KRIBB, Daejeon 34141, South Korea
| | - Hyungjun Kim
- Department of Chemistry, Incheon National University, Incheon 22012, South Korea
- Research Institute of Basic Sciences, Incheon National University, Incheon 22012, South Korea
| | - Eun-Kyung Lim
- BioNanotechnology Research Center, KRIBB, Daejeon 34141, South Korea
- Department of Nanobiotechnology, KRIBB School of Biotechnology, UST, Daejeon 34113, South Korea
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Nazerdeylami S, Ghasemi JB, Amiri A, Mohammadi Ziarani G, Badiei A. A highly sensitive fluorescence measurement of amphetamine using 8-hydroxyquinoline-β-cyclodextrin grafted on graphene oxide. DIAMOND AND RELATED MATERIALS 2020; 109:108032. [DOI: 10.1016/j.diamond.2020.108032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
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Desrosiers NA, Huestis MA. Oral Fluid Drug Testing: Analytical Approaches, Issues and Interpretation of Results. J Anal Toxicol 2019; 43:415-443. [DOI: 10.1093/jat/bkz048] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/12/2019] [Accepted: 05/23/2019] [Indexed: 12/19/2022] Open
Abstract
AbstractWith advances in analytical technology and new research informing result interpretation, oral fluid (OF) testing has gained acceptance over the past decades as an alternative biological matrix for detecting drugs in forensic and clinical settings. OF testing offers simple, rapid, non-invasive, observed specimen collection. This article offers a review of the scientific literature covering analytical methods and interpretation published over the past two decades for amphetamines, cannabis, cocaine, opioids, and benzodiazepines. Several analytical methods have been published for individual drug classes and, increasingly, for multiple drug classes. The method of OF collection can have a significant impact on the resultant drug concentration. Drug concentrations for amphetamines, cannabis, cocaine, opioids, and benzodiazepines are reviewed in the context of the dosing condition and the collection method. Time of last detection is evaluated against several agencies' cutoffs, including the proposed Substance Abuse and Mental Health Services Administration, European Workplace Drug Testing Society and Driving Under the Influence of Drugs, Alcohol and Medicines cutoffs. A significant correlation was frequently observed between matrices (i.e., between OF and plasma or blood concentrations); however, high intra-subject and inter-subject variability precludes prediction of blood concentrations from OF concentrations. This article will assist individuals in understanding the relative merits and limitations of various methods of OF collection, analysis and interpretation.
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Affiliation(s)
| | - Marilyn A Huestis
- Lambert Center for the Study of Medicinal Cannabis and Hemp, Institute of Emerging Health Professions, Thomas Jefferson University, Philadelphia, PA, USA
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Gjerde H, Gjersing L, Furuhaugen H, Bretteville-Jensen AL. Correspondence between Oral Fluid Drug Test Results and Self-Reported Illicit Drug Use among Music Festival Attendees. Subst Use Misuse 2019; 54:1337-1344. [PMID: 30860932 DOI: 10.1080/10826084.2019.1580295] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Use of illicit substances is often under-reported. Testing positive in oral fluid provides an objective confirmation of recent intake. OBJECTIVES To examine the agreement between oral fluid test results and self-reported substance use among music festival attendees, and factors associated with reporting past 48 h drug use among users identified by drug testing. METHODS One thousand three hundred nine participants were recruited from six music festivals in Norway (June-August 2016). They completed a questionnaire and provided oral fluid samples analyzed for amphetamines, MDMA, tetrahydrocannabinol (cannabis), and cocaine. Additionally, their blood alcohol levels were measured. RESULTS Overall, 5.5% reported use of amphetamines, cannabis, cocaine, and/or MDMA during past 48 h in the questionnaire, whereas 10.8% tested positive in oral fluid. Only 16.7% of identified cocaine users and 31.1% of identified MDMA users reported past 48 h cocaine or MDMA use, respectively. Higher proportions of identified cannabis and amphetamine users reported past 48 h use (53.8% and 55.6%, respectively). Multivariable logistic regression analysis showed that among participants who tested positive, those reporting weekly illicit substance use (Adjusted Odds Ratio [AOR] 30.6; 95% Confidence Interval [CI] 6.3-147.9), and using such substances when younger than 18 years (AOR 5.0; 95% CI 1.9-13.4) were more likely to report past 48 h use. Conclusions/Importance: Oral fluid testing appears to be an important tool when studying illicit substance use among music festival attendees, as significant under-reporting was observed. Among those testing positive, regular, and experienced users were more likely to report recent use, compared to less regular and experienced users.
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Affiliation(s)
- Hallvard Gjerde
- a Section of Drug Abuse Research, Department of Forensic Sciences , Oslo University Hospital , Oslo , Norway
| | - Linn Gjersing
- b Department of Alcohol, Tobacco and Drugs , Norwegian Institute of Public Health , Oslo , Norway
| | - Håvard Furuhaugen
- a Section of Drug Abuse Research, Department of Forensic Sciences , Oslo University Hospital , Oslo , Norway
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Interpreting oral fluid drug results in prisoners: monitoring current drug intake and detection times for drugs self-administered prior to detention. Forensic Toxicol 2018. [DOI: 10.1007/s11419-018-0434-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Edwards LD, Smith KL, Savage T. Drugged Driving in Wisconsin: Oral Fluid Versus Blood. J Anal Toxicol 2017; 41:523-529. [PMID: 28830121 DOI: 10.1093/jat/bkx051] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 06/23/2017] [Indexed: 01/06/2023] Open
Abstract
A pilot project was conducted in Dane County, Wisconsin, to evaluate the frequency of individuals driving under the influence of drugs (DUID). Evidentiary blood specimens, collected from subjects arrested for Operating While Intoxicated (OWI), were compared to oral fluid (OF) results obtained with the Alere DDS2®, a handheld screening device. The project objectives were to evaluate (i) the Alere DDS2® for use by police officers in the field, (ii) the frequency of individuals DUID and drugs combined with alcohol among OWI cases, (iii) the differences between detecting drugs in OF and in blood, and (iv) the effect of the laboratory drug testing cancellation policy (LCP) when the blood alcohol concentration (BAC) exceeds 0.100 g/100 mL. Following the arrest and collection of blood, subjects were asked to voluntarily participate in the project and provide an OF specimen. The OF was presumptively screened with the Alere DDS2® for six drug categories including (ng/mL) amphetamine (50), benzodiazepines (temazepam, 20), cocaine (benzoylecgonine, 30), methamphetamine (50), opioids (morphine, 40) and THC (delta-9-THC, 25). Results obtained with the OF screening instrument were not confirmed. A total of 104 subjects (22 female, 82 male), ages 18-72, were included in the project. Blood specimens were tested by gas chromatography-headspace (GCHS-FID) for volatiles, enzyme immunoassay (Siemens Viva-E Drug Testing System), and an alkaline basic drug screen with gas chromatography-mass spectrometry (GCMS) analysis. To compensate for differences between the EIA and the Alere DDS2® drug categories, results from the enzyme immunoassay and the alkaline basic drug screen were combined for purposes of comparing OF to blood. Seventy-six of 104 (73%) subjects arrested for OWI were driving under the influence of alcohol; 71 of the 76 had a BAC exceeding 0.10 g/100 mL. Subjects with a BAC exceeding the LCP, screened positive for drugs in both OF (n = 29) and blood (n = 28). Overall, one or more positive drug screening result was observed in 57 (55%) and 50 (48%) subjects for OF and blood specimens, respectively. THC was the most frequently detected drug category in both OF (n = 46) and whole blood (n = 44). Drug Recognition Expert (DRE) evaluations were performed on 18 subjects. In general, the Alere DDS2® results were consistent with the combined screening results observed in evidentiary blood specimens. This project was limited in scope as a second OF specimen was not collected for confirmation of drugs, however it did demonstrate that nearly 40% of the subjects with concentrations of alcohol exceeding 0.10 g/100 mL, screened positive for one or more drug categories in both OF and blood. The Alere DDS2® portable OF screening instrument may be useful in assisting law enforcement with identifying individuals driving under the influence of drugs and establishing probable cause at roadside for making DUID arrests.
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Affiliation(s)
- Lorrine D Edwards
- Wisconsin State Laboratory of Hygiene, Forensic Toxicology Section, School of Medicine and Public Health, UW-Madison, 2601 Agriculture Drive, Madison, WI, 53707, USA
| | - Katherine L Smith
- Wisconsin State Laboratory of Hygiene, Forensic Toxicology Section, School of Medicine and Public Health, UW-Madison, 2601 Agriculture Drive, Madison, WI, 53707, USA
| | - Theodore Savage
- Wisconsin State Laboratory of Hygiene, Forensic Toxicology Section, School of Medicine and Public Health, UW-Madison, 2601 Agriculture Drive, Madison, WI, 53707, USA
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Thevis M, Geyer H, Tretzel L, Schänzer W. Sports drug testing using complementary matrices: Advantages and limitations. J Pharm Biomed Anal 2016; 130:220-230. [DOI: 10.1016/j.jpba.2016.03.055] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 03/27/2016] [Indexed: 01/14/2023]
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Abstract
Oral fluid has become an important matrix for drugs of abuse analysis. These days the applicability is challenged by the fact that an increasing number of new psychoactive drugs are coming on the market. Synthetic cannabinoids and synthetic cathinones have been the main drug classes, but the diversity is increasing and other drugs like piperazines, phenethylamines, tryptamines, designer opioids and designer benzodiazepines are becoming more prevalent. Many of the substances are very potent, and low doses ingested will lead to low concentrations in biological media, including oral fluid. This review will highlight the phenomenon of new psychoactive substances and review methods for oral fluid drug testing analysis using on-site tests, immunoassays and chromatographic methods.
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