Des Plaines, IL, United States
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Haller D.L.,St Lukes Roosevelt Hospital Center | Haller D.L.,Columbia University | Acosta M.C.,Columbia University | Acosta M.C.,National Development and Research Institutes Inc. | And 8 more authors.
American Journal of Transplantation | Year: 2010

As substance abusers need to demonstrate abstinence prior to transplant, valid/reliable drug tests are needed. Patients may deny use, fearing surgery will be delayed. Breath, blood and urine tests have brief detection windows that allow patients to evade detection. Routine laboratory tests do not include all substances of abuse. Hair analysis overcomes these barriers, increasing the likelihood that active users will be identified. This study compared results for alcohol, opioids and cocaine based on 445 self-report, breath, urine and hair samples from 42 patients who had been denied a transplant due to recent substance abuse. Compared to hair toxicology, sensitivity for conventional drug tests was moderate for cocaine and opioids, but poor for alcohol. Of positive hair tests, only half were corroborated through other tests. In contrast, specificity was high across tests and substances, with positive findings from conventional tests confirmed through hair toxicology. Based on a 90-day detection window for hair analysis, two negative tests suggest 6 months of continuous abstinence. Hair testing should be considered as an alternative approach for monitoring substance use in the transplant population, either as a routine procedure or when the veracity of findings from conventional tests is in doubt. © 2010 The American Society of Transplantation and the American Society of Transplant Surgeons.

Reisfield G.M.,Florida College | Jones J.T.,United States Drug Testing Laboratories
Journal of Analytical Toxicology | Year: 2015

The disposition of oxycodone (OC) and metabolites in hair remains poorly characterized. We present a case involving a pharmacist in an impaired professionals' monitoring program in whom hair testing yielded OC on two occasions. On both occasions, his hair was negative for the oxymorphone (OM) metabolite at the cutoff concentration of 100 pg/mg. He claimed that, absent the detection of metabolite, the OC necessarily represented external contamination. This prompted a review of the laboratory's OC-positive hair results for the quarter April-June 2014. Overall, 466 specimens contained OC, with a mean (median) concentration of 2,375 (1,060) pg/mg. Of these OC-positive specimens, only 47 (10%) contained detectable OM. When OC was present at or below the mean (median) concentration, only 2.2% (1.3%) of specimens were OM-positive. In the setting of OC administration, the detection of OM in hair is unlikely at a cutoff concentration of 100 pg/mg. More consistent demonstration of OC metabolite(s) in hair will require the validation of methods to detect OM at lower concentrations and/or methods to detect noroxycodone. © The Author 2015. Published by Oxford University Press. All rights reserved.

Marques P.,Pacific Institute for Research and Evaluation | Hansson T.,Lund University | Isaksson A.,Lund University | Walther L.,Lund University | And 3 more authors.
Traffic Injury Prevention | Year: 2011

Objective: The rate of failed interlock blood alcohol content (BAC) tests is a strong predictor of recidivism post-interlock and a partial proxy for alcohol use. Alcohol biomarkers measured at the start of an interlock program are known to correlate well with rates of failed BAC tests over months of interlock use. This study evaluates 2 methods of measuring low blood levels of the biomarker phosphatidylethanol (PEth). PEth is a 100 percent alcohol-specific biomarker and strongly intercorrelated with several independent indicators of drinking driving risk, including 8 other biomarkers, 3 psychometric assessments, and the rate of failed interlock BAC tests during many months of interlock use. Does a more sensitive method of measuring PEth at program entry detect drinking even among those who subsequently log no failed interlock tests? Methods: In a sample of 281 driver blood samples, PEth was measured by both high-performance liquid chromatography (HPLC) and liquid chromatography tandem mass spectrometry (LCMSMS) in order to compare sensitivity and accuracy. The average rate of failed interlock BAC tests was the criterion measure for marker sensitivity. LCMSMS, calibrated to detect low levels of drinking as a possible measure of abstinence violation, was judged relative to the standard HPLC assay for PEth measured up to 4 μmol/L. Results: The 2 methods showed a good quantitative relationship (r2 >.86). LCMSMS detected positive PEth levels in samples that were below the limit of detection of the HPLC method. PEth measured by LCMSMS was positive for a higher proportion of driving under the influence (DUI) offenders who logged zero failed interlock BAC tests than were detected by HPLC. Conclusion: Although HPLC is the widely used standard for measuring PEth in clinical alcoholism samples, the LCMSMS method, when calibrated to detect trace amounts of the major component of PEth, can detect abstinence levels of alcohol near zero intake and still correlate strongly with other indicators related to alcohol use and road safety. © 2011 Taylor & Francis Group, LLC.

Jones J.,United States Drug Testing Laboratories | Jones M.,United States Drug Testing Laboratories | Plate C.,United States Drug Testing Laboratories | Lewis D.,United States Drug Testing Laboratories
Analytical Methods | Year: 2011

Phosphatidylethanol, a series of abnormal phospholipids formed in the presence of ethanol and phospholipase D, has gained popularity as a long-term biomarker of ethanol ingestion. A liquid chromatography tandem mass spectrometric method for a specific, prevalent isomer, 1-palmitoyl-2-oleoyl-sn- glycero-3-phosphoethanol, was developed and validated using dried blood spots. Dried blood spots offer numerous advantages over venipuncture including reduced costs, invasiveness and discomfort. Dried blood spots were prepared from authentic whole blood specimens that had been tested using a previously published procedure. Comparison of the results from the two assays demonstrated excellent correlation. The data suggest that dried blood spots may be a useful tool for the detection of alcohol abuse and abstinence monitoring. © 2011 The Royal Society of Chemistry.

Jones J.,United States Drug Testing Laboratories | Magri R.,Colegio Iberoamericano Of Adicciones At Hospital Pereira Rossell | Rios R.,United States Drug Testing Laboratories | Jones M.,United States Drug Testing Laboratories | And 2 more authors.
Analytical Methods | Year: 2011

A liquid chromatography-tandem mass spectrometry method for the simultaneous detection of cotinine and caffeine in umbilical cord was fully validated. The analytes were quantified using multiple reaction monitoring and corresponding stable isotope internal standards (cotinine-d3 and caffeine-13C3). The method demonstrated acceptable imprecision (<12%) and bias (<13%). The limit of detection was 4 ng g -1 and 40 ng g-1 for cotinine and caffeine, respectively. The determined relative matrix effects for cotinine and caffeine were 3.0% and 3.2%, respectively. The method was used to successfully analyze two authentic umbilical cords that were matched with corresponding meconium specimens that had been analyzed for cotinine and caffeine using a previously published method. A simple, one-step collection procedure and the availability of specimen for every donor make umbilical cord a simple alternative for newborn toxicology. © 2011 The Royal Society of Chemistry.

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