Workplace Drug Testing on Urine Samples: Evidence for Improving Efficacy of a First-Level Screening Program

Previous reports revealed poor performance in identifying drugs of abuse users through first-level workplace drug testing (WDT), based on urine samples. In a cross-sectional study, we evaluated: (i) the effect of creatinine normalization of drug values from diluted urine samples (creatinine levels ≤20 mg/dL) on the prevalence of drug users; (ii) the independent procedure-related predictors of positivity and dilution.

Workers' urine samples were collected at the workplace or at our certified laboratory between 2008 and 2012. All samples were analysed for drugs of abuse by immuno-enzymatic method in our laboratory, according to the Italian WDT law. Detectable drugs of abuse concentrations lower than the positive cutoff values were normalized based on mean levels of urinary creatinine. Detectable concentrations of drugs were confirmed by GC/MS. Multivariate logistic regression was used to detect independent procedure-related predictors of positive and diluted urine samples.

Of the 3080 urine samples screened, 51 (1.7%) were found positive for some drugs of abuse (26 cannabinoids and 16 cocaine) and 116 (3.8%) were diluted. Seventeen out of 23 diluted urine samples with detectable concentrations of cannabinoids or cocaine were found positive after urine creatinine normalization and GC/MS confirmed both negative and positive results. This increased the percentage of positivity for cannabinoids and cocaine from 1.35% to 2.09% (+55%, p=0.0005), which is closer to the expected prevalence of drug users based on Italian self-reported surveys. Collection of samples in the laboratory was an independent predictor of positivity (OR=2.33, 95%CI 1.27-4.28) and diluted urine sample (OR=1.65, 95%CI 1.04-2.61).

Efficacy of first-level  WDT could be improved by well-controlled pre-analytical procedures and urine creatinine normalization of detected concentrations of drugs of abuse.

Via:  http://ht.ly/Ss1yt 

By: Crespi V1, Maio RC, Veronesi G, Gianfagna F, Taborelli S, Ferrario MM.

1Toxicology Laboratory, Occupational and Preventive Medicine, Varese Hospital, Varese, Italy.

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 

The Interplay Between Drug-Use Behaviors, Settings & Access to Care: Exploring Attitudes & Experiences of Crack Cocaine Users in Rio De Janeiro & São Paulo, Brazil

Despite the growing attention surrounding crack cocaine use in Brazil, little is understood about crack users’ histories, use patterns and the interplay of drug-use behaviors, settings, and access/barriers to care. Qualitative studies seldom cross-compare findings regarding people who use crack from different settings. This study aims to explore the insights of regular crack users in two major Brazilian cities and to examine how social and contextual factors, including stigma and marginalization, influence initial use and a range of health and social issues.

For study participants from both cities, frequent crack cocaine use plays a central role in daily life and leads to a range of physical, psychological, and social consequences. Common concerns among users include excessive crack use, engagement in risky habits, infrequent health service utilization, marginalization, and difficulty reducing use.

Disadvantaged conditions in which many crack cocaine users grow up and live may perpetuate risk behaviors and stigma may further marginalize users from necessary health and recovery services. Reducing stigma and moralizing discourse related to drug use, especially among health professionals and law enforcement personnel, may help encourage users to seek necessary care. New harm-reduction-based care and treatment alternatives for marginalized drug users are being developed in parts of Brazil and elsewhere and should be adapted and expanded for other populations in need.

Read at:   http://ht.ly/QzkAM HT @reitoriaUFRJ

Prevalence of Hospitalized Live Births Affected by Alcohol and Drugs and Parturient Women Diagnosed with Substance Abuse at Liveborn Delivery: United States, 1999–2008

Below:  Prevalence (per 10,000) on a natural log scale and Loess trend curves with 95% confidence interval for (A) live births affected by alcohol and drugs and neonatal drug withdrawal syndrome, and (B) maternal substance abuse at liveborn delivery: United States, 1999–2008.

From 1999 to 2008, prevalence increased for narcotic- and hallucinogen-affected live births and neonatal drug withdrawal syndrome but decreased for alcohol- and cocaine-affected live births. Maternal substance abuse at delivery showed similar trends, but prevalence of alcohol abuse remained relatively stable. Substance-affected live births required longer hospital stays and higher medical expenses, mostly billable to Medicaid.

The findings highlight the urgent need for behavioral intervention and early treatment for substance-abusing pregnant women to reduce the number of substance-affected live births.

Read at:   http://ht.ly/Qz46f  HT @CSRIncorporated