DRUG TESTING: LATEST TRENDS
Drug testing has returned to the news recently – but how up to date are you? What drugs are most commonly found in the workplace? What are the three major technological developments in drug testing? What is the law about roadside drug testing? Dr Claire George shares answers to these and more.
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Drug and alcohol abuse can harm health outcomes, relationship and family stability, corporate reputation and even social cohesion. It is the range of these issues and associated risks which provide the contexts in which drug testing occurs. They include testing for drug and alcohol treatment, for family law courts over child-welfare cases, for custodial programmes and for routine workplace safety. These are not bounded contexts; they shift according to changes in perceptions of harm and of public morality as well as changes in legislation and standards of governance.
To illustrate: since 2000, there has been a strong overlap between criminal justice and drug treatment services after the Criminal Justice and Court Services Act 2000 gave police the power to drug test detainees in police custody, and the courts the power to order pre-sentence drug tests and drug testing of offenders under the supervision of the probation service1. The Drug Interventions Programme was borne out of this provision. DIP tests for specified Class A drugs in individuals aged 18 and over, charged or convicted of ‘trigger offences’ including property crime, robbery and specified Class A drug offences2.
WORKPLACE DRUG TESTING
In the workplace context, testing 10 years ago was almost exclusively used for safety-critical roles – such as piping engineers on oil rigs – in which the potential for physical harm requires that staff have no lapses in concentration. Testing now is increasingly used for non-safety critical roles as well, for example office based staff who manage colleagues in safety critical situations. In so doing, this extends the notion of harm to include the financial and reputational impact that drug misuse can bring to an organisation.
ROADSIDE DRUG TESTING
Concateno has been providing random roadside drug testing for the australian police since 2004. The State of Victoria, which is at the forefront of the country’s road-safety initiatives, was the first in the world to effect a change in legislation and allow random testing. Other australian states have followed. Since the introduction of testing in Victoria, incidences of drivers detected with illicit drugs halved over a five-year period, from one driver in 44 to one driver in 94 3.
In the UK, the Drugs (Roadside Testing) Act 2011 includes a new specific offence of driving or being in charge of a motor vehicle with a concentration of a controlled drug above a specified limit. The new offence will make it easier for the police to take action against drug drivers, by removing the need for the police to prove impairment4. It is expected that offence this will come into effect in 2014. The drugs to be covered by the offence and the specified limits for each will be determined following advice from an expert panel, formed recently by the Department for Transport (DfT).
NEW CONSUMPTION HABITS
Concomitant with changes to the contexts or environments in which testing occurs are changes in consumption habits. Historically, drugs commonly used in the UK included amphetamines, heroin, cocaine and cannabis. But the use of prescription drugs and ‘legal highs’ has become increasingly common.
Legal highs, drugs which are typically stimulant in nature and are not currently controlled under the Misuse of Drugs Act 1971, present an unprecedented challenge for UK drugs policy and for testing laboratories, due to the number of new compounds being introduced via internet sellers and head shops.
The increase in availability of these psychoactive substances was the basis in 2005 for setting up a european-wide mechanism for rapidly sharing information between European Union institutions and member states. 49 new psychoactive substances were identified in 2011, the highest number of substances ever reported in a single year since formal monitoring began5.
In 2010, the newly notified substances list was dominated by synthetic cannabinoids (23) and synthetic cathinones (8)5. Synthetic cannabinoids, marketed as a safe “legal alternative to cannabis”, are readily available and are sold under names including Spice, K2, K9, Cloud Nine, Annihilation and Black Mamba. Synthetic cathinones, also known as “bath salts”, include Mephedrone, MDPV, Cathinone and Methcathinone and are another recent phenomenon.
Many synthetic cannabinoid compounds have been controlled as class B drugs under the Misuse of Drugs Act 1971 including JWH-018, JWH-122, HU210, HU-243 and CP50-5561. But in recent years, newer synthetic cannabinoid compounds have been identified.
Data from the Home Office Forensic Early Warning System in July 2012 included results from a test purchasing exercise which showed the presence of uncontrolled synthetic cannabinoids such as AM2201, RCS-4 and UR-144 in substances on sale via the internet.
The Advisory Council on the Misuse of Drugs, an independent expert body set up to advise the government on drug-related issues, proposed in October 2012 that additional substances, including newer synthetic Cannabinoids6, should be classified as Class B under the Misuse of Drugs Act 1971. This has not yet come into force.
PRESCRIPTION DRUGS, TRAMADOL
The misuse of prescription drugs also appears to be increasing. A recent ACMD report on tramadol, an opioid drug used for pain relief, quoted the results of a 2011 street drug trends survey (Daley and Simonson 2011), which identified a rise in tramadol use in the last year in 16 out of the 20 areas studied in the UK7.
A study conducted by Concateno, analysing 17,500 UK samples, identified tramadol in about 5% of samples. Anecdotally, it appears as though in most cases the presence of tramadol was linked to misuse through drug diversion.
The ACMD report also highlighted figures from the Office of National Statistics which showed that the number of deaths where tramadol had been mentioned on the death certificate had risen sharply, from 83 deaths in 2008 to 154 deaths in 20117.
BACK TO THE WORKPLACE
Drug use in the workplace also appears to have increased in recent years. Concateno’s 2012 High Society report examined data from more than 1.6million drug tests conducted by Concateno’s laboratories on behalf of 856 UK employers over a five-year period, from 2007-2011, to measure the incidence of drug use among employees.
In 2011, the data from this report demonstrated a 3.23% positivity rate for drugs in the workplace. This indicates that about one in 30 people has drugs in their system at any point in time. The 2011 positivity rate represented a 43% increase on figures from 2007, rising from 2.26% to 3.23% over that period.
The graph in the linked pdf (above and below) illustrates drug prevalence in workplace samples tested by Concateno over this five-year period, with cocaine, opiates and cannabis being the most frequently detected drugs8. It is worth noting that the relatively high number of opiate positives observed in this study might be due to the use of undeclared over-the-counter medication rather than abuse. But it is also possible that the figures show a degree of opiate misuse among the working population.
Changes in both drug-consumption habits and the environments in which drug testing is needed have been the main drivers of innovation in testing technologies. Three categories of advancement stand out:
>> increased test sensitivity, allowing for lower drug levels to be detected
>> introduction of wider testing panels, expanding the range of drugs which can be identified
>> miniaturisation of testing technologies, bringing forward increasingly portable testing devices which enable rapid decision making.
A pioneering advance which illustrates these improvements has been the introduction of high-quality portable oral fluid testing analysers, like the Alere™ DDS®2 Mobile Test System for police roadside drug testing.
Drug testing continues to develop around the harms that drugs can cause and the contexts in which these harms are experienced. Once, national consumption habits centred round what could be considered established drugs of abuse such as heroin. But now the advent of online stores has both globalised the supply of drugs and accelerated the abuse of new drugs. Understanding their pharmacology, toxicity, potential for harm and the contexts in which their consumption is likely to provoke risks will form the basis of the next generation of drug-testing devices.
Research references are given on last page below:
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Dr CLAIRE GEORGE has over 14 years’ experience in drug testing, holds a visiting lectureship at King’s College London and lectures on the MSc Toxicology course run by The University of Birmingham. She was secretary to the LTG (formerly The London Toxicology Group) for 11 years, then elected vice chair. She was a board member of the European Workplace Drug testing Society for 6 years and is a past council member of the International Association of Therapeutic Drug Monitoring and Clinical Toxicology.