Detection of Drugs in Nails (fingernails and toenails): Three Year Experience

Nails (fingernails and toenails) are made of keratin. As the nail grows, substances incorporate into the keratin fibers where they can be detected 3-6 months after use. Samples are collected by clipping of 2-3 mm of nail from all fingers (100 mg). We present drug testing results from 10,349 nail samples collected from high-risk cases during a 3-year period of time. Samples were analyzed by validated analytical methods. The initial testing was performed mostly using enzyme-linked immunosorbent assay, but by liquid chromatography-tandem mass spectrometry (LC-MS-MS) as well. Presumptive positive samples were subjected to confirmatory testing with sample preparation procedures including washing, pulverizing, digestion and extraction optimized for each drug class. 

The total of 7,799 samples was analyzed for amphetamines. The concentrations ranged from 40 to 572,865 pg/mg (median, 100-3,687) for all amphetamine analytes. 

• Amphetamine and methamphetamine were present in 14% of the samples, 
• 22 samples were positive for 3,4-methylenedioxymethamphetamine (0.3%), 
• 7 for methylenedioxyamphetamine (0.09%) 
• and 4 for 3,4-methylenedioxy-N-ethylamphetamine (0.05%). 
• Cocaine and related analytes were found in 5% samples (7,787 total), and the concentration range was 20-265,063 pg/mg (median 84-1,768). 
• Opioids overall ranged from 40 to 118,229 pg/mg (median 123-830). 
• The most prevalent opioid was oxycodone (15.1%) and hydrocodone (11.4%) 
• compared with 1.0-3.6% for the others, including morphine, codeine, hydromorphone, methadone, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine and oxymorphone. 
• Carboxy-Δ-9-tetrahydrocannabinol positivity rate was 18.1% (0.04-262 pg/mg, median 6.41). 
• Out of 3,039 samples, 756 were positive (24.9%) for ethyl glucuronide (20-3,754 pg/mg, median 88). 
• Other drugs found in nails included barbiturates, benzodiazepines, ketamine, meperidine, tramadol, zolpidem, propoxyphene, naltrexone and buprenorphine. 

Nail analyses have become a reliable way of determining the long-term use and abuse of drugs. Extraction techniques are simple and produce accurate and precise results. Sensitive analytical instrumentation, mainly LC-MS-MS, allows for detection of femtogram (10(-15) g) quantities of substances in nails. Samples were from a high-risk population, therefore the extraordinary positivity rate was observed.

Via:  http://ht.ly/SsNUz 

By: Shu I1, Jones J1, Jones M1, Lewis D1, Negrusz A2.

• 1United States Drug Testing Laboratories, Inc., 1700 South Mount Prospect Road, Des Plaines, IL 60017, USA.
• 2United States Drug Testing Laboratories, Inc., 1700 South Mount Prospect Road, Des Plaines, IL 60017, USA

Symptomatic Exposures among California Inmates 2011-2013

Prisoners have a high prevalence of substance misuse and abuse, but few studies have examined symptomatic exposures among incarcerated populations. We sought to further characterize the nature of these exposures among this population using the California Poison Control System data. Keyword searches identified inmate cases in 2011-2013 for patients 20+ years old exposed to a single substance and taken to hospital from jail, prison, or police custody. 

Comparisons were made with non-inmate cases during the same period, using similar limitations. Body stuffers and body packers were analyzed as a subgroup. Seven hundred four inmate cases were compared to 106,260 non-inmate cases. Inmates were more likely to be younger, male, and to have engaged in drug misuse or abuse. They most commonly ingested methamphetamine, heroin, acetaminophen, and anticonvulsants. Inmates were more likely to receive activated charcoal, whole bowel irrigation, undergo endotracheal intubation, and to experience a major clinical outcome or death. 

When body stuffers and packers were removed, clinical findings were similar, though the odds of a major outcome or death became statistically non-significant. Body stuffers and body packers primarily used methamphetamine and heroin, and compared with other inmates had significantly higher odds of both adverse clinical effects and poor outcome. 

This large series provides a profile of symptomatic exposures among inmates, a little-studied population. The potential for high morbidity among body stuffers and packers suggests that a high index of suspicion of such ingestions be maintained when evaluating patients prior to incarceration.

Via:  http://ht.ly/S6INw

By: Butterfield M1, Al-Abri S, Huntington S, Carlson T, Geller RJ, Olson KR.
1Department of Internal Medicine, Tulane University Medical Center, New Orleans, LA, USA

Ethnic Hair Care Products May Increase False Positives in Hair Drug Testing

The question of why different races appear more susceptible to hair contamination by external drugs remains controversial. This research studied susceptibility of head hair to external cocaine and methamphetamine when hair products have been applied. Three different chemical classes of ethnic hair products were applied to Caucasian, Asian, and African hair. 

Some products increased the methamphetamine and cocaine concentrations in all hair types. A unique finding of this research is that certain ethnic hair products can replace moisture as a diffusion medium, thereby increasing the susceptibility to contamination over 100-fold compared to petroleum-based products.

Via: http://ht.ly/RU69p

By: Kidwell DA1, Smith FP2, Shepherd AR3.

• 1Chemistry Division, Naval Research Laboratory, Washington, DC 20375, United States.
• 2University of New Haven, West Haven, CT 06516, United States. Electronic address: NRLSummerResearchFaculty@gmail.com.
• 3American Society for Engineering Education Science and Engineering Apprenticeship Program, United States.

Crack Pipe Sharing among Street-Involved Youth in Vancouver

Over the study period, 567 youth reported smoking crack cocaine and contributed 1288 observations, among which 961 (75%) included a report of crack pipe sharing. In multivariate analysis, factors that were associated with crack pipe sharing included difficulty accessing crack pipes; homelessness; daily non-injection crystal methamphetamine use; daily crack smoking; encounters with the police; and reporting unprotected sex.

The prevalence of crack pipe sharing was high among our sample and independently associated with structural factors including difficulty accessing crack pipes and homelessness. Crack pipe sharing was also associated with high-intensity drug use and a number of other markers of risk and vulnerability. Collectively, these findings highlight opportunities for health services to better engage with this vulnerable group and reduce this risky behaviour.

Via:  http://ht.ly/QXBUx  HT @bccfe 

Mapping the Spread of Methamphetamine Abuse in California From 1995 to 2008

Below:  Methamphetamine abuse and dependence (MA) discharges in California by geographic distribution for selected years.

Methamphetamine abuse and dependence (MA) incidence increased exponentially in 3 phases interrupted by implementation of laws limiting access to methamphetamine precursors. MA growth from 1999 through 2008 was 17% per year. MA was greatest in areas with larger White or Hispanic low-income populations, small household sizes, and good connections to highway systems. Spatial misalignment was a source of bias in estimated effects. Spatial autocorrelation was substantial, accounting for approximately 80% of error variance in the model.

From 1995 through 2008, MA exhibited signs of growth and spatial spread characteristic of drug epidemics, spreading most rapidly through low-income White and Hispanic populations living outside dense urban areas.

Via:  ht.ly/PfNPo HT @EmoryRollins

How Should Network-Based Prevention for Homeless Youth Be Implemented?

Below:  Sociometric data on life-time methamphetamine use (in grey) among homeless youth, Holllywood, CA, 2008 (n = 136)

There is a great desire both among academics [2-11] and our community-based collaborators to utilize network-based prevention programs to reduce risk taking among homeless youth. This interest is driven by the relatively low cost of these programs, coupled with an understanding that such programs might engage homeless youth who are transient, hidden and distrustful of adults. This represents an exciting convergence around the desirability and probable acceptability of network based prevention. What remains unclear is how and with whom to implement these programs.

RAND present fascinating results indicating that opinion leaders and popular peers are among those with whom youth are most likely to drink and use drugs. RAND recognize the complexity of recruiting substance using opinion leaders for interventions to reduce substance use, but suggest that these peers may still be appropriate people to train as peer leaders. We respectfully question this interpretation. It is entirely possible that these popular and respected peers are popular and respected because of their participation in risky behaviors. Being popular and respected often requires adhering to the norms and values of a network—in this case a network for whom risk-taking is normative. Thus, it is possible that asking youth to curb or abandon risk behaviors could compromise the popularity and respect they hold. As an illustrative example, Fig. 1 shows that substance-using youth are not only popular within egocentric networks of youth (as RAND have shown), but also occupy central positions within sociometric networks of homeless youth, lending further evidence to the hypothesis that risky behavior might be an important component of popularity for homeless youth. Given the often tenuous nature of social standing among homeless youth, we are wary of the practical efficacy of attempting to change norms that may confer status among this population.

Read more at:  ht.ly/PpwYu HT @uscsocialwork