Transcript Dr Charles Appleton

Common Drug-Testing Methodologies
Dr Charles Appleton
Queensland Medical Laboratory
Substance Abuse in the Workplace
Toxicology
Common Drug-Testing Methodologies
Scope
• Which methodologies – strengths & limitations
• Screening
• Confirmation
• The Standards & Accreditation
• Includes compliance & accreditation, quality control
• Quality practice
• Testing outside of Standards
Toxicology
Common Drug-Testing Methodologies
Approach
• The Standards
• The methodologies
• Where does synthetic cannabinoid testing sit?
Toxicology
Common Drug-Testing Methodologies
AS/NZS 4308:2008 for urine
AS 4760-2006 for oral fluid
define procedures for
– Collection
– Transportation
– Analysis
– Reporting
(cover a relatively small number of substances but the principles are
applicable outside of the standard)
Toxicology
Common Drug-Testing Methodologies
Methods of analysis:
• Screening – predominantly immunoassay workplace/laboratory
• Confirmation – exclusively mass spectrography generally gas or liquid chromatography
MS is the detection and characterisation stage
Toxicology
Common Drug-Testing Methodologies
Immunoassay:
• Generally a “class” method
– Cannabinoids**
– Opiates**
– Sympathomimetic Amines**
– Cocaine**
– Benzodiazepines*
– Barbiturates
– Phencyclidine
– Methadone
– and others
Toxicology
Common Drug-Testing Methodologies
Immunoassay:
Thresholds (mg/L) differ from Country to Country
Recommended by:
Cannabinoids
Cocaine metabolites
Sympathomimetic Amines
Opiates
Benzodiazepines
Phencyclidine
Standards Australia
(AS/NZS 4038)
50
300
300
300
200
SAMHSA
50
300
1000
2000
25
Toxicology
Toxicology
8
Courtesy of Bio-Rad Laboratories Ltd
Toxicology
9
Toxicology
10
Common Drug-Testing Methodologies
Confirmation procedures
• Sample cleanup/extraction
• Chromatographic separation of different drugs and
metabolites of those drugs
– gas, high performance liquid chromatography
• Identification and quantitation of the individual
parent and metabolite peaks
– mass spectrography
Toxicology
11
Toxicology
12
Common Drug-Testing Methodologies
Urine testing - Important considerations:
• Sensitivity and specificity
• Adulteration/creatinine
• Other considerations:
– Historical positives
– Legitimate “innocent” positives
– False positives
– Passive positives
Toxicology
Common Drug-Testing Methodologies
Adulteration • Process of compromising or attempting to
compromise the integrity of the sample after
passage but prior to testing
Toxicology
Common Drug-Testing Methodologies
Adulteration (urine) • water – dilute substances in the sample to a
level below the threshold for detection
• oxidising agents – chemically “burn” the drug
• nitrites, acid, etc – chemically alter the drug or
the drug-antibody interaction
• Note – adulterant checks do not detect
sample substitution
Toxicology
Common Drug-Testing Methodologies
Creatinine • normal product of muscle metabolism
• concentration in urine is determined by the amount
of muscle in the subject’s body and the amount of
water that his kidneys are excreting at the time of
sample collection
• there is a (usually) minor contribution from diet
• an indicator of the overall concentration of the
sample
Toxicology
Common Drug-Testing Methodologies
Urine Creatinine • average concentration
• 10-12 mmol/L in males
• 8-10 mmol/L in females
• “usual range”- 5-15 mmol/L
• creatinine less than 0.5 mmol/L (50 mg/L)
• “not consistent with human urine”
• creatinine 0.5 – 1.7 mmol/L (50 – 200 mg/L)
• “may indicate dilution in some individuals”
Toxicology
Cases – Cannabinoids
Non-negative initial urine screen
GCMS ASSAY - URINE THC CONFIRMATION
Date
Lab No
d9-THCA
U.Creat
ug/L
mmol/L
Ratio
14/12/09
8.6
12
1.4
The urine was very dilute. This suggests a large water intake
prior to passage of the urine, or perhaps adulteration of
the sample with water after collection. This may be used
to dilute out any drug metabolites to concentrations below
detection limits.
Toxicology
18
Common Drug-Testing Methodologies
Urine testing - Important considerations:
• Sensitivity and specificity
• Adulteration/creatinine
• Other considerations:
– Historical positives
– Legitimate “innocent” positives
– False positives
– Passive positives
Toxicology
Common Drug-Testing Methodologies
Urine testing - Historical positives
– Characteristic of lipid-soluble (dissolve in body fat)
substances
– Seen predominantly after prolonged high dose
use
– Within the Standard, consideration applies to
cannabis and benzodiazepine users only
– Less well-defined with respect to other drugs such
as synthetic cannabinoids
Toxicology
Cases – Cannabinoids
Non-negative initial urine screen
GCMS ASSAY - URINE THC CONFIRMATION
Date
Lab No
d9-THCA
U.Creat
ug/L
mmol/L
06/11/09
13/11/09
20/11/09
596
screen neg
18
37.6
8.2
45.1
Ratio
16
0.4
Large fluctuations in the urinary creatinine will complicate interpretation of absolute
values.
Toxicology
21
Common Drug-Testing Methodologies
Urine testing - Legitimate “innocent” positives
– Over-the-counter medications
– Prescribed medications
– Food constituents
– Products of metabolism of other drugs
Toxicology
Cases – Opiates
Non-negative initial urine screen
MS ASSAY - URINE OPIATE CONFIRMATION
Date
Codeine
Morphine
U.Creat
(ug/L)
(ug/L) (mmol/L)
18/12/09
265
556
18.7
Cod/Crea
Ratio
14
Mor/Crea
Ratio
30
Assayed to AS/NZS 4308:2008 requirements.
The cutoff level for both Codeine and Morphine is 300ug/L.
MS confirms the initial opiate screen and reveals a pattern
indicative of recent use of codeine.
There is no suggestion of use of illicit opiates.
Toxicology
23
The metabolic pathway of the opiates.
XII-Biotech-C-Opiate Chemistry-3
Toxicology
24
Cases – Opiates
Non-negative initial urine screen
MS ASSAY - URINE OPIATE CONFIRMATION
Date
Codeine
Morphine
U.Creat
Cod/Crea
Mor/Crea
(ug/L)
(ug/L) (mmol/L)
Ratio
Ratio
13/01/10
<50
413
19.6
<3
21
(27)
MS confirms the initial opiate screen and reveals the presence
of a small amount of morphine as well as a trace of
codeine.
Although it is not possible to exclude the possibility that
this may reflect use of morphine or of heroin recently with
use of codeine some days prior to that, this is the pattern
typically seen after ingestion of foodstuffs containing
poppy seed.
There is no absolute indication of use of illicit opiates.
Toxicology
25
Cases – Sympathomimetic Amines
Non-negative initial urine screen
MS ASSAY - URINE SYMPATHOMIMETIC AMINE CONFIRMATION
Cut-off
Amphetamine
>1500 ug/L
150 ug/L
Methamphetamine
>1500 ug/L
150 ug/L
MDMA
Not detected
150 ug/L
MDA
Not detected
150 ug/L
Phentermine
Not detected
500 ug/L
Ephedrine
Not detected
500 ug/L
Pseudoephedrine
Not detected
500 ug/L
Creatinine
14.8 mmol/L
Amphetamine
Methamphetamine
1580 ug/L
6100 ug/L
Toxicology
26
Sympathomimetic Amines – the faces
Toxicology
27
Cases – Sympathomimetic Amines
Non-negative initial urine screen
MS ASSAY - URINE SYMPATHOMIMETIC AMINE CONFIRMATION
Cut-off
Amphetamine
>1500 ug/L
150 ug/L
Methamphetamine
Not detected
150 ug/L
MDMA
Not detected
150 ug/L
MDA
Not detected
150 ug/L
Phentermine
Not detected
500 ug/L
Ephedrine
Not detected
500 ug/L
Pseudoephedrine
Not detected
500 ug/L
Creatinine
15.9 mmol/L
Assayed to AS/NZS 4308:2008.
Subject prescribed Dexamphetamine
Toxicology
28
Cases – Sympathomimetic Amines
Non-negative initial urine screen
MS ASSAY - URINE SYMPATHOMIMETIC AMINE CONFIRMATION
Cut-off
Amphetamine
Not detected
150 ug/L
Methamphetamine
Not detected
150 ug/L
MDMA
Not detected
150 ug/L
MDA
Not detected
150 ug/L
Phentermine
>1500 ug/L
500 ug/L
Ephedrine
Not detected
500 ug/L
Pseudoephedrine
Not detected
500 ug/L
Creatinine
17.9 mmol/L
Phentermine
31300 ug/L
Toxicology
29
Cases – Sympathomimetic Amines
Non-negative initial urine screen
MS ASSAY - URINE SYMPATHOMIMETIC AMINE CONFIRMATION
Cut-off
Amphetamine
917 ug/L
150 ug/L
Methamphetamine
3040 ug/L
150 ug/L
MDMA
Not detected
150 ug/L
MDA
Not detected
150 ug/L
Phentermine
Not detected
500 ug/L
Ephedrine
Not detected
500 ug/L
Pseudoephedrine
Not detected
500 ug/L
Creatinine
12.6 mmol/L
Subject has Parkinson disease.
Toxicology
30
Cases – Benzodiazepines
Non-negative initial urine screen
MS ASSAY - URINE BENZODIAZEPINE CONFIRMATION
Cut-off
Oxazepam
151 ug/L
200 ug/L
Temazepam
215 ug/L
200 ug/L
Diazepam
Not detected
200 ug/L
Nordiazepam
<50 ug/L
200 ug/L
7-Aminoclonazepam
Not detected
100 ug/L
7-Aminoflunitrazepam Not detected
100 ug/L
7-Aminonitrazepam
Not detected
100 ug/L
Alpha OH-alprazolam Not Detected
100 ug/L
Creatinine
11.0 mmol/L
Assayed to AS/NZS 4308:2008.
Subject reports prescribed Valium.
Toxicology
31
Metabolite patterns of benzodiazepines
(Source – taken & amended from www.nature.com/clpt/jpurnal/v76/n6/fig_tab/clpt2005539ft.html)
Most simply inactivated by demethylation/hydroxylation/amination/conjugation but:
Toxicology
32
Common Drug-Testing Methodologies
Urine testing - False positives
– Initial screen yields a non-negative finding but
subsequent confirmation fails to reveal the
presence of any recognised substance
– May be due to antibody cross-reactivity, presence
of a related substance which is not included in the
confirmation testing, analytical interference, etc
Toxicology
Cases – Opiates
Non-negative initial urine screen
MS ASSAY - URINE OPIATE CONFIRMATION
Date
Codeine
Morphine
U.Creat
(ug/L)
(ug/L) (mmol/L)
13/01/10
<50
61
11.9
Cod/Crea
Ratio
<4
Mor/Crea
Ratio
5
No trace of codeine is detected.
Subject reports taking Duro-Tuss.
Toxicology
34
Sympathomimetic Amines – the faces
Toxicology
35
Sympathetic Amines – the family
Toxicology
36
Sympathetic Amines – the family
Toxicology
37
Cases – Benzodiazepines
Non-negative initial urine screen
MS ASSAY - URINE BENZODIAZEPINE CONFIRMATION
Cut-off
Oxazepam
Not detected
200 ug/L
Temazepam
Not detected
200 ug/L
Diazepam
Not detected
200 ug/L
Nordiazepam
Not detected
200 ug/L
7-Aminoclonazepam
Not detected
100 ug/L
7-Aminoflunitrazepam Not detected
100 ug/L
7-Aminonitrazepam
Not detected
100 ug/L
Alpha OH-alprazolam Not Detected
100 ug/L
Creatinine
3.7 mmol/L
Assayed to AS/NZS 4308:2008.
Subject reports prescribed Zoloft.
Toxicology
38
Cases – Benzodiazepines
Non-negative initial urine screen
Toxicology
39
Common Drug-Testing Methodologies
Urine testing - Passive positives
– This consideration applies to smoked substances
– Essentially only cannabis at presence although
synthetic cannabinoids may become a concern
– Opium and cocaine smoking is no longer a
common practice
Toxicology
Cases – Cannabinoids
Non-negative initial urine screen
GCMS ASSAY - URINE THC CONFIRMATION
Date
Lab No
d9-THCA
U.Creat
ug/L
mmol/L
Ratio
10/12/09
30
375
12.2
The subject is a flight attendant who claims that she attended a party in which cannabis
may have been used 2 days prior to sample collection.
Toxicology
41
Common Drug-Testing Methodologies
Urine Conclusions
• Ensure that reports are adequate for the
purpose
• Interpretation is often not intuitive –
potentially demand additional laboratory
resources
Toxicology
Common Drug-Testing Methodologies
Oral fluid testing
(AS 4760:2005)
Important considerations:
• History of the Standard
• Pros & Cons
AS 4760-2006
Procedures for specimen collection and the
detection and quantitation of drugs in oral fluid
• John Henry, Standards Australia, 2003:
– “Delegates agreed that a standard on saliva-based drug
testing would be required eventually. We are not
currently in possession of the information necessary for a
standard to be commenced.”
•
Forum On Saliva-based Drug Testing (Held at Standards Australia’s Head Office in
Sydney on Wednesday 23rd May, 2003)
AS 4760-2006
Procedures for specimen collection and the
detection and quantitation of drugs in oral fluid
• 2005 – Draft Standard DR 05590 released for public
comment
• 2005 – Victorian police commence trial of random
roadside testing of oral fluid for 4 classes
• 2006 – 1st November, AS 4760-2006 published
• 2006 – random road-side testing of oral fluid for
drugs became widespread – 2 classes only
AS 4760-2006
Procedures for specimen collection and the
detection and quantitation of drugs in oral fluid
• Prior to 2005 – oral fluid drug testing performed in few
Australian industries
• Increasing pressure from unions to change from urine testing
to oral fluid testing
• 25th Aug, 2008 – Saliva testing OK: AIRC
• “In an important decision for employers across Aust, AIRC SDP
Jonathan Hamberger has given the tick to saliva testing for
workplace drug tests” (OHN 753).
AS 4760-2006
Shell Refining (Australia) Pty Ltd, Clyde Refinery
v
Construction, Forestry, Mining and Energy Union
(DR2008/1238)
[125] Once these two issues* are satisfactorily resolved, any
random drug testing should be conducted using oral fluids.
Until then it would not be unreasonable for the company to
implement a urine based testing regime on an interim basis.
*existence of accredited laboratories
*wish to test for drugs other than those in the Standard
AS 4760-2006
Procedures for specimen collection and the
detection and quantitation of drugs in oral fluid
• Monday, 05 December 2011 2:13pm
• FWA backs "role" for urine testing, finds saliva tests flawed
AS 4760-2006
HWE Mining Pty Ltd
v
Construction, Forestry, Mining and Energy Union
(FWA 8288 (30 November 2011))
Oral screening linked to false negatives
Vice President Lawler accepted expert evidence indicating oral screening was flawed:
• saliva testing devices were linked to a "significant incidence" of false negative
results for some drugs, including cannabis;
• a large number of Victorian motorists who tested positive to cannabis in laboratory
tests after accidents had returned a negative result in the roadside saliva test;
• on-site saliva testing devices had a low sensitivity for cannabis and their
effectiveness could be reduced by the use of particular substances; and
• there was no Australian Standard to test saliva for the prescription sedative
benzodiazepine. On-site saliva tests could only detect high concentrations and
could not detect levels where users would be impaired.
In the light of these matters, HWE was "eminently reasonable" in its bid to retain
urine testing, Vice President Lawler said.
AS 4760-2006
Procedures for specimen collection and the
detection and quantitation of drugs in oral fluid
• Wednesday, 28 March 2012 12:34pm
• Saliva swabs better indicator of "likely impairment" from
cannabis
• FWA Senior Deputy President Jonathan Hamberger sided with
the union on a number of issues, most notably the drug-test
method.
• His decision in favour of oral testing appeared in conflict with
another recent ruling by FWA on a similar issue.
AS 4760-2006
Endeavour Energy
v
Communications, Electrical and Plumbing Union
(FWA s739 (28 March 2012))
Saliva swabs better indicator of "likely impairment" from cannabis
Senior Deputy President Hamberger expressed concern about the fairness of urine
testing, given it could identify the presence of cannabis consumed days or even
weeks prior to the test.
"This means a person may be found to have breached the policy even though their
actions were taken in their own time and in no way affect their capacity to do their
job safely," he said.
"The employer has a legitimate right (and indeed obligation) to try and eliminate the
risk that employees might come to work impaired by drugs or alcohol such that
they could pose a risk to health or safety. Beyond that the employer has no right to
dictate what drugs or alcohol its employees take in their own time.
"It is precisely because it only detects for recent use that oral fluid testing is a better
indicator of the likely impairment as a result of smoking cannabis."
FWA found that oral fluid testing was the appropriate method for determining
whether employees were under the influence of drugs at work.
AS 4760-2006
Common Drug-Testing Methodologies
Oral fluid testing
(AS 4760:2005)
Important considerations:
• History of the Standard
• Pros & Cons
AS 4760-2006
Advantages with oral fluid testing
• Privacy less of a consideration
•
• Recency of use
•
– no problem with “historical positives”
• Interpretation of reports
– generally straightforward
AS 4760-2006
Problems with oral fluid testing
• Workplace health and safety risk.
•
• Only detects drug users who may potentially present affected
if they have used prior to testing on the day of the test.
• Contrary to common claim, test result does not directly relate
to performance/impairment
• On-site testing devices yet to meet Standard
• More work needed on interferences, adulterants, etc
• Laboratory confirmation includes ALL drugs listed in the
Standard.
AS 4760-2006
Review of findings
FALSE NEGATIVES
•
•
•
•
•
Look at 24 months 2010 & 2011 only
4 codeine in 83 controls
1 codeine in a false positive cocaine
1 amphetamine in 83 controls
(1) cocaine in 83 controls
6 THC in samples positive for ATS only
AS 4760-2006
Onsite test performance
• •THC – looking at 2010 & 2011 only
– 13.9% of all referred non-negative samples
– 1.1% insufficient to confirm
– 78.7% false positive
– 20.2% true positive
AS 4760-2006
Onsite test performance
• •Opiates – looking at 2010 & 2011 only
– 42.5% of all referred non-negative samples
•
– 1.4% insufficient to confirm
– 31.4% false positive
– 67.2% true positive
•
•
•
•
all (3) codeine
0 codeine with morphine
0 codeine with heroin
0 morphine
AS 4760-2006
Onsite test performance
• Amphetamine Type Stimulants – looking at 2010 &
2011 only
– 19.0% of all referred non-negative samples
– 2.3% insufficient to confirm
– 63.3% false positive
– 34.4% true positive
• 31.2% methamphetamine
• 2.3% amphetamine
• (1%) MDMA
AS 4760-2006
Onsite test performance
• Cocaine
– <1.0% of all referred non-negative samples
– 1 insufficient to confirm
– 4 false positive
– but (one) false negative
AS 4760-2006
Common Drug-Testing Methodologies
Oral Fluid Conclusions
• A relatively new Standard – not “mature” yet
• The on-site testing devices have some way to go
before becoming “reliable”
• False and innocent positives are costly
• False negatives are worrying
• Need better “feel” for what the levels actually mean
• Need more experience re interferences
• Basically, this is a young field
AS 4760-2006
Common Drug-Testing Methodologies
Synthetic Cannabinoids
Definition: Substances which
• Are at least partially man-made
• Bind to CNS CB1 receptor with a medium to high
affinity
• When binding to CB1, act as agonist
• Are commonly marketed so as to avoid detection
of unlawful drug use
Toxicology
Synthetic Cannabinoids
Scope:
•
•
•
•
•
•
History
Chemical nature
Manufacture considerations
Legality
What does the Standard bring to bear?
Analytical aspects
Toxicology
Synthetic Cannabinoids
History:
• 1965 THC synthesised
• 1980 Cannabinoid receptors recognised
• 1984 John W Huffman’s group commenced
synthesising substances for medical use
• 2004 “Spice” herbal mixtures sold in Germany
• 2008 CP-47,497 & JWH-018 identified in
“Spice”
Toxicology
Synthetic Cannabinoids
History - Australia:
• 2010 use increasing in WA mining industry
• January 2011 my first Australian enquiry
• 7 Australian laboratories offering testing
• Antibody screening test available early 2012
Toxicology
Synthetic Cannabinoids
Scope:
•
•
•
•
•
•
History
Chemical nature
Manufacture considerations
Legality
What does the Standard bring to bear?
Analytical aspects
Toxicology
Synthetic Cannabinoids
Chemical nature – The Classes
•
•
•
•
•
•
Classical cannabinoids e.g. THC, HU-210
Nonclassical cannabinoids e.g. CP-47,497
Hybrid cannabinoids e.g. AM-4030
Aminoalkylindoles e.g. JWH-018, JWH-073
Eicosanoids e.g. methanandamide
Others
Toxicology
Synthetic Cannabinoids
Chemical nature – The Classes
Toxicology
Synthetic Cannabinoids
Scope:
•
•
•
•
•
•
History
Chemical nature
Manufacture considerations
Legality
What does the Standard bring to bear?
Analytical aspects
Toxicology
Synthetic Cannabinoids
Manufacture and supply:
•
•
•
•
•
Impure substances imported
Solution sprayed onto herbs
Dried down, packaged and sold
No quality control of dosage or distribution
No continuity of composition – manufacturer
attempts to “keep ahead” of detection
• Concerns with manufacturing modifications
Toxicology
Synthetic Cannabinoids
Scope:
•
•
•
•
•
•
History
Chemical nature
Manufacture considerations
Legal considerations
What does the Standard bring to bear?
Analytical aspects
Toxicology
Synthetic Cannabinoids
Legal considerations:
• Worldwide variation in banning these
• In Australia:
Toxicology
Synthetic Cannabinoids
Synthetic 'cannabis' gets nationwide ban - Aja Styles – The Australian July 7, 2011
Banned - Kronic and other synthetic cannabis-like substances moved to the prohibited
substances list.
Eight synthetic cannabis-like substances will be classified as prohibited substances
throughout Australia from July 8, with plans to rule out any attempts to circumvent
state bans on substances like Kronic.
Parliamentary Secretary for Health and Ageing, Catherine King said the changes to
classification of specific chemical compounds would enable a nationwide, uniform
prohibition on these drugs.
The chemicals to be prohibited ( using the common name) are: AM-694, JWH – 250, JWH –
200, JWH – 073, JWH – 122, JWH- 018, Cannabicyclohexanol, CP 47,497 – most of
these can be found in retail products known as Kronic, Spice, Karma, Voodoo, Kaos and
K2.
"In response to calls for uniform restrictions on these types of substances, the
Commonwealth has considered the matter and made a decision to prohibit eight of the
most widely-used and abused synthetic cannabinoids."
Yet broader restrictions are still being considered with advice on such restrictions being
sought from Advisory Committee on Medicines Scheduling's meeting in October.
Toxicology
Synthetic Cannabinoids
New synthetic cannabis dodges Aussie ban
Fiona Willan, ninemsn- 12:30 AEDT Wed Oct 12 2011
Synthetic cannabis is still being sold in Australian stores,
three months after a nationwide-ban was introduced.
Authorities are now scrambling to outlaw a new strain of
Kronic herbal smoking mixture, which a New Zealand
company has released specifically for the Australian
market.
The company, Lightyears Ahead, has managed to dodge
Australian laws by releasing a mixture that buyers claim is
as potent as marijuana but does not contain any banned
chemicals.
Toxicology
Synthetic Cannabinoids
Scope:
•
•
•
•
•
•
History
Chemical nature
Manufacture considerations
Legal considerations
What does the Standard bring to bear?
Analytical aspects
Toxicology
Synthetic Cannabinoids
The Standard – urine or saliva
•
•
•
•
Collection and handling
On site screening
Within laboratory screening
MS confirmation/characterisation/quantitation
Toxicology
Synthetic Cannabinoids
Analytical considerations – On site screening
– Now at least 3 on site tests available or
becoming available but
– No consistency with the metabolites
sought
– No consistency with detection thresholds
– No certainty that confirmation
laboratories are testing for the same
substances
Toxicology
Synthetic Cannabinoids
Analytical considerations – on site screening
• All test for JWH-018 & JWH-073 metabolites if no
others
• The least sensitive detects 50 ug/L
• At this stage, none detect cannabis metabolites
Toxicology
Synthetic Cannabinoids
Analytical considerations – laboratory
screening
• Now available
Toxicology
Synthetic Cannabinoids
Analytical considerations – MS confirmation
• At least 7 Australian laboratories offering MS
detection and quantitation
• Apply considerations from AS/NZS 4308
• Standards expensive
• Standards were difficult to obtain
• Deuterated standards remain difficult to obtain
• Commercial controls not available yet
Toxicology
Synthetic Cannabinoids
Analytical considerations – MS confirmation (cont)
• Laboratories test for a limited number of
substances – range differs from lab to lab
• Sensitivities not defined in Standard - determined
by individual laboratory decision which is based at
least in part on analytical considerations
• “Menu” continually expanding
Toxicology
Synthetic Cannabinoids
Analytical considerations – what are we
finding?
WA lab - July 2011
• Testing for metabolites of JWH-018, JWH073 and JWH-122 only at that time
• Initially average of 10% positive, up to 50%
from some sites
Toxicology
Synthetic Cannabinoids
Analytical considerations – what is QML finding?
• Testing for JWH-018, JWH-073, JWH-122, JWH200 & JWH-250 parent and metabolites
• Detection threshold 10 ug/L
• Positive finding in approx. 2% of samples
• JWH-018 metabolite and JWH-073 metabolite are
the prevalent findings but a single JWH-122 and
d9-THCA finding
Toxicology
Synthetic Cannabinoids
Analytical considerations – what are other
labs doing?
• Testing for JWH-018 & JWH-073 at least
• Up to 8 others but menu continuously
expanding
• Detection thresholds vary from 50 ug/L to
0.1 ug/L
• Positive rates vary from 1% to 10%
Toxicology
Common Drug-Testing Methodologies
Synthetic Cannabinoid Conclusions
Future considerations – where are we
heading?
• No sign of diminishing requirement for
testing
• No sign of falling use
• No court challenge to findings yet
• No challenge to action taken on positive
finding yet
Toxicology
Common Drug-Testing Methodologies
Synthetic Cannabinoids
Future considerations – what’s missing?
• Detailed pharmacokinetics and detection
characteristics
• Clinical toxicology
Short term clinical effects
Long term clinical effects
Acute toxicity
Toxicology
There are
traps for the
unwary
Toxicology
Errors have
consequences
Toxicology