Positive Drug Test Research Articles

Urinary Pharmacokinetic Profile of Cannabinoids Following Administration of Vaporized and Oral Cannabidiol and Vaporized CBD-Dominant Cannabis.

Cannabis products in which cannabidiol (CBD) is the primary chemical constituent (CBD-dominant) are increasingly popular and widely available. The impact of CBD exposure on urine drug testing has not been well studied. This study characterized the urinary pharmacokinetic profile of 100-mg oral and vaporized CBD, vaporized CBD-dominant cannabis (100-mg CBD; 3.7-mg ∆9-THC) and placebo in healthy adults (n = 6) using a within-subjects crossover design. Urine specimens were collected before and for 5 days after drug administration. Immunoassay (IA) screening (cutoffs of 20, 50 and 100 ng/mL) and LC-MS-MS confirmatory tests (cutoff of 15 ng/mL) for 11-nor-9-carboxy-∆9-tetrahydrocannabinol (∆9-THCCOOH) were performed; urine was also analyzed for CBD and other cannabinoids. Urinary concentrations of CBD were higher after oral (mean Cmax: 776 ng/mL) versus vaporized CBD (mean Cmax: 261 ng/mL). CBD concentrations peaked 5 h after oral CBD ingestion and within 1 h after inhalation of vaporized CBD. After pure CBD administration, only 1 out of 218 urine specimens screened positive for ∆9-THCCOOH (20-ng/mL IA cutoff) and no specimens exceeded the 15-ng/mL confirmatory cutoff. After inhalation of CBD-dominant cannabis vapor, nine samples screened positive at the 20-ng/mL IA cutoff, and two of those samples screened positive at the 50-ng/mL IA cutoff. Four samples that screened positive (two at 20 ng/mL and two at 50 ng/mL) confirmed positive with concentrations of ∆9-THCCOOH exceeding 15 ng/mL. These data indicate that acute dosing of pure CBD will not result in a positive urine drug test using current federal workplace drug testing guidelines (50-ng/mL IA cutoff with 15-ng/mL confirmatory cutoff). However, CBD products that also contain ∆9-THC may produce positive urine results for ∆9-THCCOOH. Accurate labeling and regulation of ∆9-THC content in CBD/hemp products are needed to prevent unexpected positive drug tests and unintended drug effects.

Positive drug test trends in fatally-injured drivers in the United States from 2007 to 2017

BackgroundThe last two decades have seen tremendous changes in the U.S. environment surrounding drugs. Driving under the influence of drugs is a growing public health hazard. The present study examined trends in drug involvement in fatally-injured drivers in the U.S.MethodsData were drawn from the 2007–2017 Fatality Analysis Reporting System. Cochran–Armitage tests were performed to assess the statistical significance of changes in the yearly prevalence of positive drug tests in fatally-injured drivers over time. In addition, analyses were stratified by sex, race, and age.ResultsThe yearly prevalence of positive drug tests in fatally-injured drivers increased significantly from 20.7% in 2007 to 30.7% in 2017, with results showing a higher prevalence among males, those aged 21–44, and Whites. The gap between Blacks and Whites narrowed in 2017. There was a decline in the yearly prevalence in all age groups between 2016 and 2017, although the decrease in the 21–44 age group was much smaller than other age groups. Among drivers who tested positive for drugs, 34.6% had a blood alcohol concentration (BAC) above the threshold of per se evidence for impaired driving, and 63% had a BAC below the threshold.ConclusionsOur results indicate that the overall yearly prevalence of fatally-injured drivers who tested positive for drugs increased significantly from 2007 to 2017, with similar results found for subgroups. Findings further highlight that drugged driving remains a public health priority, and more action is needed to stem this disturbing trend.

Characteristics of deaths associated with kratom use.

Kratom (Mitragyna speciosa Korth) use has increased in Western countries, with a rising number of associated deaths. There is growing debate about the involvement of kratom in these events. This study details the characteristics of such fatalities and provides a 'state-of-the-art' review. UK cases were identified from mortality registers by searching with the terms 'kratom', 'mitragynine', etc. Databases and online media were searched using these terms and 'death', 'fatal*', 'overdose', 'poisoning', etc. to identify additional cases; details were obtained from relevant officials. Case characteristics were extracted into an Excel spreadsheet, and analysed employing descriptive statistics and thematic analysis. Typical case characteristics (n = 156): male (80%), mean age 32.3 years, White (100%), drug abuse history (95%); reasons for use included self-medication, recreation, relaxation, bodybuilding, and avoiding positive drug tests. Mitragynine alone was identified/implicated in 23% of cases. Poly substance use was common (87%), typically controlled/recreational drugs, therapeutic drugs, and alcohol. Death cause(s) included toxic effects of kratom ± other substances; underlying health issues. These findings add substantially to the knowledge base on kratom-associated deaths; these need systematic, accurate recording. Kratom's safety profile remains only partially understood; toxic and fatal levels require quantification.

Examining Predisposing Factors and Program Performance Indicators Associated With Program Completion: A Comparison of Opioid and Non-Opioid-Preferring Participants in Drug Court.

Opioid use and abuse, as well as criminal justice involvement, have increased dramatically in the past two decades. Drug court is a community-based rehabilitation program for individuals with substance abuse issues involved in the criminal justice system. Given unique treatment needs associated with opioids, the current study examined predisposing factors and program performance indicators associated with drug court completion based on individuals' opioid preference. Secondary data (i.e., participant assessment and drug court Management Information System) as well as conviction information from a statewide database were examined for a sample of drug court participants (N = 534). Data analyses compared opioid-preferring (n = 267) and non-opioid-preferring (n = 267) program participants. For non-opioid-preferring participants, a combination of predisposing characteristics, including both social/demographic characteristics and substance use (i.e., education, drug court site, lifetime benzodiazepine use), as well as program performance indicators (i.e., number of days in drug court, number of positive drug tests, and sanctions/therapeutic responses) influenced drug court completion. For opioid-preferring participants, only program performance indicators emerged as important for program completion, specifically number of days in drug court, number of positive drug tests, and sanctions/therapeutic responses. Findings for non-opioid-preferring participants are consistent with past research, suggesting that individual predisposing characteristics and program performance indicators are influential on program completion. However, findings suggesting that only program performance indicators are influential for opioid-preferring participants adds a unique contribution to the literature. This information may help provide more individualized program planning and ultimately more programmatic success.

Examining gender and factors associated with postprogram recidivism in a statewide drug court program

This study examined factors associated with postprogram recidivism for male and female drug court participants. Secondary data, including the drug court participant assessment and Management Information System, as well as official state records for arrests, convictions, and incarcerations, were examined for a stratified random sample of drug court participants (males: n = 322; females: n = 284). Examining two-year postprogram recidivism for males, three variables were associated with reduced odds of recidivism: age, marital status, and number of days in drug court. For males, one variable was associated with increased odds of recidivism: number of positive drug tests during drug court. Examining two-year postprogram recidivism for females, four variables were associated with reduced odds of recidivism: age, employment status, number of days in drug court, and receiving ancillary services during drug court. For females, two variables were associated with increased odds of recidivism: prior misdemeanor alcohol conviction and number of positive drug tests during drug court. Findings suggest some overlap in factors of influence for postprogram recidivism, yet also unique contributions by gender. Data suggest the importance of understanding risks and needs to properly match services to individuals.

Marijuana Legalization in Canada: Insights for Workplaces from Case Law Analysis

The legalization of marijuana in Canada is expected to have a significant impact on workplaces, requiring the development or updating of company drug-related policies and procedures. To help employment relations stakeholders with this change, recommendations are made based on an analysis of 93 past arbitration/tribunal/court cases involving marijuana-related policy violations, drawn from the Labour Source database. Issues addressed include language and communication of the work rule, reasonableness of drug tests, standard of proof, duty to accommodate, and mitigating factors. Based on the study of those 93 court cases, some recommendations can be formulated. First, employers need to clearly state their drug-related policies, taking into consideration safety-sensitivity and any substance abuse culture. This may include prohibition of possession, use, and distribution of drugs at the workplace or working under the influence, and the need to report any medical drug use that requires accommodation. Drug tests should only be done when there is a bona fide occupational requirement or where safety is a concern, such as post-incident or when there is reasonable suspicion of drug impairment. Also, it is important to understand that positive drug test results can only show past drug use but not the level of impairment or whether the drug was used while on a work shift. Therefore, to support an offence violation and discipline, corroborating evidence from multiple witnesses and sources are often necessary. Supervisors should be trained to identify the characteristics related to marijuana and drug impairment and the procedures to follow when an incident occurs. Employers must be cognizant of the duty to accommodate medical marijuana users or recreational users who are addicted, under human rights protection for disability. Such accommodation may include work reassignment or a leave of absence. In deciding on a penalty, other than past performance and disciplinary records and personal extenuating circumstances, arbitrators may consider rehabilitation situations to assess the prognosis and viability of the employment relationship. Employers and unions are advised to stay abreast of latest developments in the laws, drug test technologies and medical research related to marijuana use.

Ventricular Tachycardia Induced by Exercise Test as a Predictor of Coronary Artery Disease Development

A long-term clinical observation of the patient with ventricular tachycardia induced by exercise test but without myocardial ischemia and coronary artery atherosclerosis based on the results of angiography in the debut of the disease is described. However, arrhythmia reproducibility during stress tests, positive drug tests with nitroglycerin and beta-blocker, results of cardiac positron emission tomography with fatty acids revealed the ischemic genesis of arrhythmias, which was indirectly confirmed by a positive antiarrhythmic effect of the therapy with a metabolic drug (treatment with a beta-blocker was impossible because there was a sinus block). Coronary angiography was performed again after 7 years during the recurrence of ventricular arrhythmia with unstable angina. Stenosis of the left anterior descending artery was revealed. The antiarrhythmic effect of myocardial revascularization was continuously positive. Therefore, ventricular tachycardia induced by exercise test in patients with risk factors even in the absence of clinical and electrocardiographic criteria for myocardial ischemia could be an early debut of coronary artery disease.

Essential Features of Third-Party Certification Programs for Dietary Supplements: A Consensus Statement.

The presence of performance-enhancing drugs in dietary supplements poses serious anti-doping and health risks to athletes and military service members. A positive drug test, suboptimal health, or adverse event can ruin a career in either setting. These populations need to be certain in advance that a product is of high quality and free from performance-enhancing drugs and other banned substances. However, no regulatory authority conducts or mandates a quality review before dietary supplements are sold. Under the Food Drug and Cosmetic Act, the Food and Drug Administration does not have a role in the premarket safety review of dietary supplements. Due to the increasing demand for high-quality, properly labeled dietary supplements, multiple companies have stepped into this void by offering testing and quality review programs for dietary supplements. Each of these third-party programs has its own quality assurance program with varying testing components. It is difficult for consumers in the sport and military settings to assess whether a particular certification program reduces the risks enough so that they can use a product with confidence. This article puts forward the consensus of the authors on current best practices for third-party certification programs for dietary supplements consumed by athletes and military service members. Also discussed are important ways that third-party programs can develop in the future to improve access to safe, high-quality dietary supplements for these populations.

Detox shampoos for EtG and FAEE in hair – Results from in vitro experiments

In this study, we investigated if “detox” shampoos, which are sold online can have an impact on EtG or FAEE concentrations in hair. Recently, we showed, that prolonged washing with water can lead to significant washout of EtG in hair [1] . According to customer reviews, positive drug testing results could be avoided after long-term incubation with shampoo under a swimming cap. To evaluate the potential of four detox shampoos, we incubated distal hair samples from three subjects, obtained during a standard haircut, for 2.5, 5, 7.5 and 10 h. For EtG, three shampoos performed similar to deionized water. The fourth shampoo showed additional heavy washout effects with a decrease of up to 86% after 2.5 h. For the apolar FAEE, no washout was observed. Incubation with two shampoos resulted in increases in FAEE concentrations due to FAEE being present as shampoo ingredients. Further investigation of EtG washout in proximal forensic hair samples ( n = 9) with the most potent shampoo showed a mean decrease in deionized water of 23% ± 25%, and a decrease by the use of detox shampoo of 73% ± 12%, compared to non-incubated hair after 8 h. Detox shampoos proved to have the potential to alter EtG and FAEE concentrations in hair during in vitro experiments. Further in vivo studies need to be performed. Since several possibilities of manipulation (e.g., by heat, chemical treatment, washing-out) are known for hair – and dilution or adulteration are known for urine – but not for blood, further investigations of alcohol markers for abstinence monitoring should include phosphatidyl ethanol (PEth) in blood [2] , [3] . Especially for abstinence monitoring, one should not only rely on one marker in hair – as pointed out in the consensus: “A concentration < 7 pg/mg does not contradict self-reported abstinence of a person during the corresponding time period before sampling.” This statement implies that it is not a proof of abstinence. However, in practice of traffic medicine, the result (EtG < 7 pg/mg) is very often interpreted as a proof of abstinence.

First evaluation of the possibility of testing for drugged driving using exhaled breath sampling

Objective: Driving under the influence of psychoactive drugs causes an increased risk for accidents. In combating this, sobriety tests at the roadside are common practice in most countries. Sampling of blood and urine for forensic investigation cannot be done at the roadside and poses practical problems associated with costs and time. An alternative specimen for roadside testing is therefore warranted and the aerosol particles in exhaled breath are one such alternative.Methods: The present study investigated how the exhaled breath sample compared with the routine legal investigations of blood and urine collected from suspects of drugged driving at 2 locations in Sweden. Exhaled breath was collected using a simple filter collection device and analyzed with state-of-the-art mass spectrometry technique.Results: The total number of cases used for this investigation was 67. In 54 of these cases (81%) the results regarding a positive or negative drug test result agreed and in 13 they disagreed. Out of these, the report from the forensic investigation of blood/urine was negative in 21 cases. In 6 of these, analytical findings were made in exhaled breath and these cases were dominated by the detection of amphetamine. In 7 cases a positive drug test from the forensic investigation was not observed in the breath sample and these cases were dominated by detection of tetrahydrocannabinol in blood. In total, 45 samples were positive with breath testing and the number of positives with established forensic methods was 46.Conclusion: The promising results from this study provide support to exhaled breath as a viable specimen for testing of drugged driving. The rapid, easy, and convenient sampling procedure offers the possibility to collect a drug test specimen at the roadside. The analytical investigation must be done in a laboratory at present because of the need for a highly sensitive instrument, which is already in use in forensic laboratories. The analytical work is not more challenging than for blood or oral fluid and should not cause an increase in cost. However, more studies need to be done before exhaled breath drug testing can be applied routinely for drugged driving investigation.

Detox shampoos for EtG and FAEE in hair - Results from in vitro experiments.

The assessment of alcohol consumption behavior in hair is well established in forensic toxicology. The Society of Hair Testing (SoHT) recommends the direct alcohol markers ethyl glucuronide (EtG) and fatty acid ethyl esters (FAEE) for the detection of past alcohol consumption. In this study, we investigated if detox shampoos which are sold online can have an impact on EtG or FAEE concentrations in hair. According to customer reviews, positive drug testing results could be avoided after long-term incubation with shampoo under a swimming cap. To evaluate the potential of four detox shampoos, we incubated distal hair samples from three subjects, obtained during a standard haircut, for 2.5, 5, 7.5, and 10hours. For EtG, three shampoos performed similar to deionized water. The fourth shampoo showed additional heavy washout effects with a decrease of up to 86% after 2.5hours. For the apolar FAEE, no washout was observed. Incubation with two shampoos resulted in increases in FAEE concentrations due to FAEE being present as shampoo ingredients. Further investigation of EtG washout in proximal forensic hair samples (n=9) with the most potent shampoo showed a mean decrease in deionized water of 23%±25%, and a decrease by the use of detox shampoo of 73%±12%, compared to non-incubated hair after 8hours. In conclusion, detox shampoos proved to have the potential to alter EtG and FAEE concentrations in hair during in vitro experiments.

The prevalence of alcohol and illicit drug use among injured patients presenting to the emergency department of a national hospital in Tanzania: a prospective cohort study

BackgroundAlcohol and illicit drugs have been found to be major contributing factors leading to severe injuries in a variety of settings. In Tanzania, the use of these substances among injured patients has not been studied. We investigated the prevalence of positive tests for alcohol and illicit drug use among injured patients presenting to the emergency medicine department (ED) of Muhimbili National Hospital (MNH).MethodsThis was a prospective cohort study of a consecutive sample of patients > 18 years of age presenting to the ED-MNH with injury related complaints in October and November 2015. A structured data sheet was used to record demographic information, mechanism of injury, clinical presentation, alcohol and illicit drug test results, and ED disposition. Alcohol levels and illicit drug use were tested by breathalyser device or swab stick alcohol test and multidrug urine panel, respectively. Patients were followed up for 24 h and 30 days using medical chart reviews and phone calls. Descriptive statistics and relative risk were used to describe the results.ResultsWe screened 1011 patients and we enrolled all 143 (14.1%) patients who met inclusion criteria. 123 (86.0%) were male, the median age was 30 years (IQR: 23–36 years). The most frequent mechanism of injury was road traffic accidents (84.6%). 67/143 (46.9%) patients tested positive for alcohol and 44/122 (36.1%) patients tested positive for drugs. 29 (26.1%) tested positive for alcohol and drugs. The most frequently detected illicit drug was marijuana in 30/122 (24.5%) injured patients. 23/53 (43.4%) patients with positive alcohol testing self-reported alcohol use. 3/25 patients with positive illicit drug tests who were able to provide self-reports, self-reported drug use. At 30-day followup, 43 (64.2%) injured patients who tested positive for alcohol had undergone major surgery, 6 (9.0%) had died, and 36 (53.7%) had not yet returned to their baseline.ConclusionsThe prevalence of alcohol and illicit drugs is very high in patients presenting to the ED-MNH with injury. Further studies are needed to generalise the results in Tanzania. Public health initiatives to decrease drinking and/or illicit drug use and driving should be implemented.

Illegal substance use among 1,309 music festival attendees: An investigation using oral fluid sample drug tests, breathalysers and questionnaires.

Illegal substance use at music festivals is less documented than it is in nightlife and electronic dance music settings. This study investigated such use through questionnaires, breathalysers and oral fluid drug testing. We also examined the associations between testing positive for illegal substances and demographics, self-reported substance use and measured blood alcohol concentration levels. A cross-sectional study of 1,309 festival attendees from six Norwegian music festivals taking place between July and August 2016. Logistic regression models estimated the likelihood of a positive oral fluid drug test. Covariates were male, age, education, employment, smoking status, early age for alcohol intoxication, alcohol intoxication ⩾2 times a week, past-month and past-year illegal substance use, blood alcohol concentration levels and festivals. Overall, 12% reported illegal substance use in the past 30 days and 11% tested positive for illegal substances. Cannabis (6%), cocaine (3%) and MDMA/ecstasy (2%) were most commonly detected. One-third had a blood alcohol concentration ⩾0.10%. Of those with a positive test result ( n=146), 95% had detectable alcohol levels and 41% had a blood alcohol concentration above 0.10%. Those studying or working part-time were less likely to test positive compared to those who were not employed. Furthermore, those reporting daily smoking and past-year cannabis or MDMA/ecstasy use were more likely to test positive, compared to those not reporting such use. Illegal substance use was less prevalent than in previous nightlife and electronic dance music studies. Almost all those testing positive for illegal substances had detectable alcohol levels and 41% had a blood alcohol concentration greater than 0.10%, possibly indicating combined use.

High on drugs: Multi-institutional pilot study examining the effects of substance use on acute pain management

IntroductionSubstance use and abuse may have the significant, but unanticipated, consequence of lessening the efficacy of opioid analgesics for acute pain management. We hypothesized that pre-injury substance use increases opioid analgesic consumption following traumatic injury. MethodsThis retrospective multi-institutional pilot study included admitted patients to four level 1 trauma centers with vehicular trauma over four months (n = 176). We examined the effect of positive urine drug screen (UDS; 7-drug panel, examined individually and combined, yes/no) and positive blood alcohol content (BAC, ≥80 mg/dL) on pain management with opioid analgesics over the hospital stay. Average daily opioid consumption was examined using a repeated measures mixed model, by positive UDS and BAC findings, adjusting for age, injury severity score, and non-opioid analgesia. Opioid analgesics were converted to milligram morphine equivalents (MME) and analyzed with a square-root transformation due to non-normality. ResultsA positive drug or alcohol test was reported in 33.5% (59/176), including 12.5% (n = 22) with positive UDS and 26% (n = 45) with a positive BAC. There were no differences in gender, injury severity scores, Glasgow coma scores, or cause of vehicular trauma between substance users and non-users; only age was significantly different. Patients with a positive UDS consumed significantly more opioids compared to those with a negative UDS (34.7 MME vs. 24.7 MME, p = 0.04), after adjustment. Individually, detection of opiates, THC, cocaine, and amphetamines were associated with increased opioid consumption compared to their UDS negative counterparts; on the other hand, benzodiazepines and alcohol intoxication were associated with reduced opioid consumption during the course of hospitalization. However, none of the individual UDS results reached statistical significance. The largest effect of all the individual drugs was with opiates, which was associated with a borderline significant increase in opioid analgesic consumption (p = 0.06). ConclusionsOur preliminary data suggest drug use may significantly alter acute pain management following traumatic injury, corresponding to 40% increase in opioid analgesia for substance users than non-users. These results may have broad reaching implications because of the high prevalence of substance use in the trauma population.

Evaluation of endogenous urinary biomarkers for indirect detection of urine adulteration attempts by five different chemical adulterants in mass spectrometry methods.

Reliable detection of urine adulteration attempts to circumvent positive drug testing represents a critical step for laboratories in abstinence control settings. An ideal workflow for high-throughput testing would involve simultaneous detection of adulteration attempts in the same run with drug detection. Monitoring of degraded or oxidized endogenous urinary compounds as indirect markers has been previously evaluated for that purpose exemplified for the adulterant potassium nitrite (KNO2 ). Fifteen, previously identified endogenous markers should now be evaluated for their general applicability to detect adulteration attempts for the adulterants hypochlorite-based bleach (NaOCl), peroxidase and peroxide (H2 O2 ), pyridinium chlorochromate (PCC), and iodine (I2 ). Initial experiments revealed similar results for the tested adulterants regarding degradation of indolylacryloylglycine (IAG), uric acid (UA), or UA derivatives. 5-Hydroxyisourate (HIU), the oxidation product of UA, was however only formed by KNO2 , PCC, and H2 O2 . Amino acids showed larger adulterant-dependent differences. All reactions were shown to be influenced by the adulterant concentration and the urinary pH with large variances depending on compound and adulterant. Except for HIU/PCC, all markers were stable within +/- 30% variation for all adulterants at -20°C. Receiver operating characteristics indicated best sensitivity and specificity over all adulterants for IAG (specificity 0.9, sensitivity 1.0) and UA (specificity 1.0, sensitivity 0.9). HIU gave best results for KNO2 , PCC, and H2 O2 and N-acetylneuraminic acid for PCC and H2 O2 , respectively. When integrating a limited number of targets into existing screening methods, monitoring of UA, IAG, N-acetylneuraminic acid, and HIU is recommended.

Can synthetic urine replace authentic urine to "beat" workplace drug testing?

Synthetic urine (SU), which was primarily utilized by drug testing laboratories as a matrix for quality control preparations, is now commercially sold and can be used to "fool" a positive drug test. To determine if SU can pass as authentic urine, we challenged Army urine drug testing specimen accessioning and testing procedures using eight different commercial SU products. Adulteration (Sciteck AdultaCheck® 6) and Onsite SU (Synthetic UrineCheck™) test strips were also evaluated. Five of the eight SU were identified by physical observation. All SU products screened negative in the drug immunoassay and additionally passed the specimen validity testing (SVT) as authentic urine. Furthermore, SU was not detected as adulterated with the adulteration test strips (Sciteck AdultaCheck® 6) but was successfully detected as SU with the On-site synthetic urine (Synthetic UrineCheck™). To deter SU use, direct observation, as utilized by the military, may be recommended during the collection process.

Suitability evaluation of new endogenous biomarkers for the identification of nitrite-based urine adulteration in mass spectrometry methods.

Urine adulteration to circumvent positive drug testing is a fundamental challenge for toxicological laboratories all over the world. Untargeted mass spectrometry (MS) methods used in metabolomics had previously revealed uric acid (UA), histidine, methylhistidine, and their oxidation products, for example 5-hydroxyisourate (HIU) as potential biomarkers for urine adulteration using potassium nitrite (KNO2 ). These markers should be further evaluated for their reliability, stability, and routine applicability. Influence of KNO2 concentration, urinary pH, reaction time, and stability at room temperature, 4°C, and-20°C was determined in urine under varying conditions. Analysis was performed after protein precipitation with acetonitrile by liquid chromatography-high resolution mass spectrometry (LC-HRMS). Receiver operating characteristics (ROC) analysis was applied for cut-off evaluation after biomarker quantification (n=100 per group). Blinded measurements (n=50) were performed to check the general applicability to identify adulterated samples under routine conditions. The higher the adulterant concentration, the lower the concentrations of histidine, methylhistidine, and UA. In return, amounts of their oxidation products increased. Highest changes were observed under weak acid conditions (pH4-5). Storage at -20°C ensured sufficient stability for all oxidative markers over onemonth. ROC evaluated biomarker performance and application to unknown samples revealed satisfying results, with HIU as the most suitable biomarker (positive predictive value (PPV) 100%), followed by UA (PPV 93%). HIU and UA proved suitable markers to identify urine adulteration using KNO2 and are ready for implementation into routine MS procedures.

Racial disparities in discontinuation of long-term opioid therapy following illicit drug use among black and white patients

BackgroundAmong patients prescribed long-term opioid therapy (LTOT) for chronic pain, no study has yet examined how clinicians respond to evidence of illicit drug use and whether the decision to discontinue opioids is influenced by a patient’s race. MethodsAmong outpatients of black and white race initiating LTOT through the VA between 2000 and 2010, we reviewed electronic medical records to determine whether opioids were discontinued within 60 days of a positive urine drug test. Logistic regression was used to examine differences by race. ResultsAmong 15,366 patients of black (48.1%) or white (51.9%) race initiating LTOT from 2000 to 2010, 20.5% (25.5% of blacks vs. 15.8% of whites, P <. 001) received a urine drug test within the first 6 months of treatment; 13.8% tested positive for cannabis and 17.4% for cocaine. LTOT was discontinued in 11.4% of patients who tested positive for cannabis and in 13.1% of those who tested positive for cocaine. Among patients testing positive for cannabis, blacks were 2.1 times more likely than whites to have LTOT discontinued (adjusted odds ratio [AOR] 2.06, 95% confidence interval [CI] 1.04–4.08). Among patients testing positive for cocaine, blacks were 3.3 times more likely than whites to have LTOT discontinued (AOR 3.30, CI 1.28–8.53). ConclusionsAmong patients testing positive for illicit drug use while receiving LTOT, clinicians are substantially more likely to discontinue opioids when the patient is black. A more universal approach to administering and responding to urine drug testing is urgently needed.

An Initial Assessment of Leon County Florida's Pre-Arrest Adult Civil Citation Program.

Momentum is building behind law enforcement-assisted diversion programs. Some of these programs have been designed specifically for drug-involved offenders, while others focus on adults who have no prior involvement in the criminal justice system. The Leon County Pre-Arrest Diversion program, which has been operating since March 2013, offers first-time arrestees the opportunity to participate in an alternative to arrest-as-usual. Successful completion of the program results in avoidance of a formal criminal arrest record. This paper provides an initial assessment of participants involved in the program during the first 3years of operation. Results indicate male participants, those who submitted a positive drug test at program initiation, and those who presented significantly greater behavioral health needs were more likely to fail to complete the program and become rearrested. These findings are discussed with regard to practices among pre-arrest diversion programs.

Examining Individual Characteristics and Program Performance to Understand Two-Year Recidivism Rates Among Drug Court Participants: Comparing Graduates and Terminators.

Drug courts strive to break the cycle of substance use and crime by providing community-based treatment and rehabilitation. The purpose of the present study was to (a) identify significantly different factors between program participants (i.e., graduates/terminators) that may affect recidivism and (b) examine these significant individual and program performance factors associated with two-year recidivism. Secondary data were examined for a stratified random sample of drug court participants ( N = 534). Examining any two-year post-program recidivism (defined as an arrest, conviction, or incarceration), over one third (37.6%) of graduates and almost all program terminators (95.3%) had two-year post-program recidivism ( p < .001). For the overall sample, age, outpatient treatment, marital status, number of times treated for a psychiatric problem in a hospital, substance use (i.e., past-30-day cocaine use and intravenous opiate use), number of positive drug tests, and receiving any sanction/therapeutic response were associated with two-year post-program recidivism. Further analyses suggested age and outpatient treatment were particularly important for program graduates. Findings provide information for early targeting of resources to drug court participants most at risk of poorer post-program outcomes by identifying factors known at program entry and indicators during program participation.