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Toxicology > Lecture 12, 13, 14 - Drug Testing in the Workplace > Flashcards

Lecture 12, 13, 14 - Drug Testing in the Workplace Flashcards

1
Q

What is regulated drug testing

A

mandatory for certain workers, strict rules, list of drugs, accredited labs

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2
Q

What is non-regulated drug testing

A

not mandatory, no rules, any drugs, not accredited

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3
Q

What are the arguments for drug screening

A
  • job safety
  • absenteeism
  • quality/quantity of production
  • increased health costs
  • increased liability costs
  • unlawful activity
  • government regulations
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4
Q

What are arguments against drug screening

A
  • opposition to US enforcement and US rules
  • union opposition
  • legal concerns and complications
  • does not measure performance
  • opponents question extent of problem
  • opponents prefer education
  • opponents question accuracy
  • what employees do off the worksite is not the employers concern
  • marijuana and cocaine are safe drugs
  • marijuana is a legal drug in many countries
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5
Q

What industries are using screening

A
  • transportation
  • petroleum
  • mining
  • pulp and paper
  • sports
  • security
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6
Q

What types of testing are done

A
  • pre employment
  • random
  • reasonable suspicion
  • post accident
  • return to duty
  • follow up
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7
Q

What are pharmacokinetic considerations

A
  • absorption, distribution, metabolism, elimination
  • urine variables
  • limitations: dose, time, effect
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8
Q

What are DOT mandatory tests

A
  • amphetamines
  • cannabinoids
  • cocaine metabolite
  • opioids
  • phencyclidine
  • ethanol
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9
Q

What drugs are included in non-regulated testing

A
  • benzodiazepines
  • barbiturates
  • methadone
  • methaqualone
  • propoxyphene
  • LSD
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10
Q

What is the elimination time for amphetamines

A

1-2 days

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11
Q

What is the elimination time for cannabinoids

A

1-30 days

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12
Q

What is the elimination time for cocaine metabolites

A

12-48 hours

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13
Q

What is the elimination time for opioids

A

1-3 days

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14
Q

What is the elimination times for phencyclidine

A

1-30 days

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15
Q

What is the elimination time for ethanol

A

up to 14 hours

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16
Q

What is the elimination time for barbiturates

A

1 day - 3 weeks

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17
Q

What is the elimination time for benzodiazepines

A

1 day - 6 weeks

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18
Q

What is the elimination time for methadone

A

1-3 days

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19
Q

What is the elimination time for methaqualone

A

1-7 days

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20
Q

What is the elimination time for propoxyphene

A

1-3 days

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21
Q

What is PCP (phencyclidine)

A

AKA: Angel dust, peace pills, hogs, elephant
tranquilizer, super joint, rocket fuel

Appearance: Crystal, powder, liquid or tablet

Class: Hallucinogen

Dose: Injested, smoked, injected, snorted

Effect: Unpredictable and variable. Rapid thought
and action. Euphoria to depression.
Hallucinations, irrational and violent
behavior.
Increased sensory perception.

22
Q

What is amphetamine

A

AKA: Speed, Bennies, Black Beauties, CoPilots,
Dexies, Meth Crystal, Uppers, ICE

Appearance: Varied pills, powders or solutions

Class: CNS stimulant

Dose: Ingested, injected, snorted or smoked

Effects: Euphoria, mood elevation, increased alertness
and energy. Increased heart rate and blood
pressure, tremor anxiety and sweating. “Rush”
and “Crash”
Hyperirritability, restlessness, bizarre behavior,
weight loss, paranoia
Chest pain, dizziness, tremors, convulsions,
hallucinations, psycosis, brain damage and
cardiac arrest

23
Q

What is opioid

A

AKA: Codeine, Morphine, Oxycodone, Oxymorphone,
Hydrocodone, Hydromorphone, Heroin, Dust, Horse, Junk, H,
Smack

Appearance: White/Brown Powder, Tablets, Tonics

Class: Narcotic Analgesic, CNS depressants

Dose: Injected, sniffed, smoked, ingested

Effects: Skin flushing “rush”, euphoria “nod”, diminished sensory
perception, lethergy and confusion.
Respiratory depression can lead to death.
Physical dependence can develop quickly. Withdrawl includes
nausea, diarrhea, insomnia, sweating, muscle spasms, chills,
tremors, vomiting and weakness.
IV users risk AIDS and hepatitis

24
Q

What is cannabinoid

A

AKA: Dope, Grass, Weed, Smoke, Pot, Hash, Reefer, Joint,
Mary Jane, etc.
Appearance Green/brown dried leaf, light to dark colored,
resin/past or oil.

Class: Psychoactive substance (possible use as appetite
stimulant, anti-nausea, epilepsy, neuromuscular).

Dose: Smoked or ingested

Effects: Euphoria, passivity, relaxation, drowsiness, increased
auditory and visual perceptions, disinhibition and
sensory distortion.
Impaired short-term memory, diminished learning
ability, attention lapses, disorientation,
depersonalization, paranoia, delirium, hyperemesis
syndrome, and hallucinations.
Blood shot eyes and increased heart rate are
common. Alcohol amplifies effects

25
Q

What is cocaine

A

AKA: Coke, Nose Candy, Snow, Toot, Blow, Crack

Appearance: White crystalline powder or transparent crystals

Class: CNS Stimulant, Local Anaesthetic, Vasoconstrictor

Dose: Injected, smoked, absorbed via mucus membranes

Effects: Sweating, rapid shallow breathing, increased heart rate
and blood pressure, elevated temperature, and euphoria.
May induce tremors, twitching, chest pain, nausea,
seizures, respiratory depression, cardiac arrhythmias
and death.
Other effects include weight loss, constipation,
impotence, difficulty urinating, nasal septal necrosis and
lung damage

26
Q

What is alcohol

A

AKA: Ethanol, ethyl alcohol

Class: CNS depressant

Effect: Drowsiness, dizziness, flushing, slurred speech,
staggering, double vision, stupor and loss of
consciousness. Overdose may lead to respiratory
failure.
Withdrawal symptoms include headache, stiff
muscles, nausea, weakness, tremors and vomiting,
convulsions, hallucinations and rarely death

27
Q

What are legal considerations of drug testing

A
  • Drug testing is not illegal in Canada
  • Testing safety-sensitive workers is
    accepted
  • Random testing not accepted
  • Accident/Incident testing is accepted
  • Pre-employment testing allowed
  • Pre-access testing more accepted term
  • Sanctions should be case specific
  • Alcohol testing is a measure of impairment
  • Drug testing not a measure of impairment
  • Focus of Canadian court appears to be on ability
    to perform job and individual rights
  • Focus is on alcohol/drug impairment vs.
    presence
  • Focus is not on risk of impairment
  • Focus is not on company liability due to major
    accident
  • Policy and legal prudence are paramount
  • Court testimony in support of the testing
    and interpretation of drug testing results is
    an important part of a toxicologist’s job for
    this type of testing (forensic testing).
  • Training/preparation for being an expert
    witness is strongly recommended
28
Q

What are analytical considerations of drug testing

A
  • Sample collection
  • Drug testing procedure
  • Non-laboratory based testing
29
Q

What are sample collection considerations

A
  • Collection supplies
  • Chain of custody
  • Collection protocol
  • Donor drug history
  • Specimen adulteration
30
Q

What are collection supplies for drug testing

A
  • Specimen containers
  • Temperature strip
  • Evidence tape
  • Chain of custody form
  • Tamper evident bag
  • Instructions
31
Q

What is the collection protocol for drug testing

A
  • Identification of donor
  • Explanation of procedure
  • Identification of specimen
  • Split sample specimen collection
  • Completion of chain of custody form
  • Sealing of specimen
  • Transportation to laboratory
32
Q

What are the elements of the chain of custody

A
  • Identification of specimen
  • Acknowledgment of testing
  • Identification of collector
  • Security of specimen
  • Individual(s) performing testing
    The result for that specimen is from that
    individual and has not been tampered with
33
Q

What is the drug testing procedure

A
  • Specimen log-in
  • Chain of custody verification
  • pH and creatinine (or s.g.) check
  • Preliminary testing by immunoassay (IITF)
  • Verify ALL positives by GC/MS, LC/MS, or
    GC (ethanol) (Alternate confirmation
    methods)
34
Q

What is an immunoassay drug test

A
  • Preliminary test only
  • Antigen - Antibody test
  • Rapid test results
  • Easily automated for high volume
  • Tests for drug family
  • Possible cross reaction
35
Q

What is GC/MS drug testing

A
  • Confirmation test
  • Extraction of drug
  • Clean up / Concentration / Derivatization
  • Chromatography
  • Detection
36
Q

What are alternative confirmation methods

A
  • LC/MS
  • LC/MS/MS
  • LC/TOF
  • GC/MS/MS
  • GC/TOF
  • Other
37
Q

What are methods of specimen adulteration

A
  • Internal dilution
  • External dilution
  • Substitution
  • Contamination
  • Tampering
38
Q

How to detect specimen adulteration

A
  • Collection site protocol
  • Sample Temperature
  • Creatinine/SG
  • pH
  • Oxidizing adulterants
    *Odor/Color/Particulates
  • Screening or Confirmation interference
39
Q

What are common myths for adulterating specimens without being caught

A
  • WD40
  • Varnish on glass
  • Oral bleach
  • Oral bleach / vinegar
  • Mega-vitamins
  • Face north and close left eye
40
Q

Blood as a specimen

A

Low concentration - related to effect – short
retention
Invasive to collect – requires expertise
Ample experience with blood

41
Q

Urine as a specimen

A

High concentration - not easily related to effect
Large amount of sample - Relatively easy to obtain
Sample adulteration is a problem
Extensive experience with urine
Acceptable SAMHSA sample type

42
Q

Hair as a specimen

A

Low concentration - not related to effect
Long retention time for drug
Somewhat invasive to collect
Limited opportunity for adulteration
Reasonable experience with hair

43
Q

Oral fluid as a specimen

A

Low concentration
Small amount of sample – easy to obtain
Limited opportunity for adulteration
Reasonable experience and history with oral fluid
Acceptable SAMHSA sample type (but not used)

44
Q

Sweat as a sample type

A

Low concentration - not related to effect
Longer window of detection
Limited opportunity for adulteration
Limited experience with sweat

45
Q

Breath as a sample type

A

Used only for ethanol testing
Comparable to blood ethanol
Extensive experience with breath
Acceptable SAMHSA sample type

46
Q

What are the pros of POCT

A

– Cost
– Rapid and on-site testing
– Internal control of testing

47
Q

What are the cons of POCT

A

– False positives and negatives
– No confirmation
– Real cost
– Unqualified, untrained, unmotivated,
distracted operators
– Little or no QA/QC
– No documentation
– Biased testing
– Not SAMHSA accepted methods
– Difficult to standardize
– Legal defensibility is more difficult
– No professional review
– Success very user dependent
– Not “fool proof”

48
Q

What is the medical review officer

A
  • Licensed doctor of medicine/osteopathy
  • Knowledge of drug abuse disorders
  • Certified training program (with retraining)
  • Receives all results
  • Contacts all positive donors
  • Determines “reportable” positives
  • Reports results to company
49
Q

What is the interpretation of a negative result

A

– Drug not present at all
– Drug present but less than cut-off
– Drug present but masked
– Error

50
Q

What is the interpretation of a positive result

A

– Drug present, above cut-off and confirmed
– False positive is not a reasonable possibility
– Indicates drug use in past hours to days
– Not a measure of impairment
– Cannot differentiate use from abuse

Toxicology (20 decks)

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