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W3: The French experience of establishing an oral fluid roadside drug test
S2
Tuesday 10 June 2014 / Toxicologie Analytique & Clinique (2014) 26, S1-S3
Results. – Sensitivity of OIT seem to increase. The DrugTest 5000 and Drugwipe demonstrated respectively a sensitivity of 93 % and 72 % for Δ9-tetrahydrocannabinol during roadside studies. The Drugwipe is very sensitive just after smoking, but it rapidly decreases within 1.5 hours. The type of OF collection has to be specified when using OF as confirmation matrix, as THC recovery ranged from 50 to 70 % and is dependent on the storage conditions. While matrix effects due to the collector buffers are observed, stability is often guaranteed via the stabilizing buffers. In a roadside study, we observed that after 5 minutes collection time, about 0.11-1.15 mL of OF was collected. Therefore, the final drug concentrations in neat OF have to be calculated via the following formula: C = [CUPLC/MS . (V1 + (W1-W2))] / [V2 x (W1-W2)] with C being the drug concentration in neat OF, CUPLC/MS the concentration obtained via the calibration curve, V1 the buffer volume, V2 the theoretical total collected volume and W1 and W2 respectively the weight of the collection device after and before OF collection. Neat OF THC concentrations in the placebo controlled study ranged from 12,361 ng/g 5 minutes after smoking down to 34 ng/g 80 minutes after 2 smoking sessions. Under placebo conditions, a median of 8 ng/g THC in OF was observed. The impact of all these observations on DUID legislations will be discussed. Conclusion. – OF has its limitations as a toxicological matrix. However, in situations where ‘recent’ drug use in combination with analytical cut-offs for interpretations are used, OF combines an easy collection of samples with a quick analysis of large batches. W3
The French experience of establishing an oral fluid roadside drug test O. Roussel (1), M. Perrin-Rosset (2), C. Fuché (3), M. Carlin (4) (1) Forensic toxicology unit, forensic sciences institute of the gendarmerie nationale, Rosny-sous-Bois, France; (2) French navy headquarters, bureau for risk management, Paris, France; (3) Centre of research and expertise on logistic, Le Chesnay, France; (4) Faculty of health & life sciences, northumbria university, Newcastle, UK. Introduction. – In 2005, following on from the findings of the ROSITA and DrUID projects, the French government made the decision to investigate possible alternative matrices to urine for drug screening at the roadside. A special committee, which included French ministerial representatives, was established in 2006 and they decided to use a special procurement contract in the form of a “competitive dialogue”: this allowed manufacturers of screening devices to improve their product in accordance with the committee’s recommendations. From initial investigations carried out, oral fluid (OF) was found to be the best alternative matrix (non invasive sample taking, difficult to adulterate, existing prototypes), and so this was chosen for this work. The devices included in the work were screening tests based on immunochromatographic methods. Method. – In France the four major categories of drugs tested for are cannabis, cocaine, opiates and amphetamines therefore the devices selected had to detect these compounds. The French gendarmerie and police played an important role in this previously unfamiliar testing and 3 OF devices remained for evaluation in the final step of the selection process. For this step, 2 field evaluation studies were carried out in 3 of the most active territorial road units by the Centre of Research and Expertise on Logistic (CREL). In the first study, approximately 500 individuals were involved. A urine sample was collected for screening, if positive a blood sample for confirmation and one of the OF devices was tested. In the second study, 100 participants were involved and standard urine and blood confirmation was carried out but also OF was tested against all three of the devices for a comparative study. The toxicology unit of our laboratory performed more than 400 of the confirmatory analyses by a validated GC-MS method. For both of the field studies, CREL processed the findings from the roadside units carrying out the screening and
determined sensitivity, specificity and efficacy of the 3 devices. As a result, the Rapid Stat® (Mavand) screening device was introduced for roadside drug testing. French law was subsequently modified in July 2008 to allow the use of an OF screening test operated by a police officer (as opposed to medical personnel). Results & discussion. – This change in legislation has resulted in a dramatic increase in the number of roadside drug tests performed and consequently the number of confirmatory analyses in blood (an increase from 15,000 in 2004 to 76,000 in 2010). Although OF has a number of factors requiring consideration when collecting, analysing and interpreting findings, it has become an accepted matrix for this type of testing and one which we are investigating. In March 2011, a new public contract was announced. A new device (Drugwipe5S®, Securetec) was appointed, for 2011 to 2015. Last year, the Directorate General of the French Gendarmerie tasked our laboratory to carry out a feasibility study on the use of OF in confirmatory analyses. This includes evaluating financial, organisational and philosophical implications and establishing risk assessment criteria. With help from laboratories in Belgium and Switzerland, the analytical component of this study is now underway and several steps are planned, including the selection of the OF collection device, the choice of biological markers and the validation of both field testing devices and analytical methods. At this time, the collection device has already been chosen, the biological markers are being established and analytical method development is in progress. Since the work is in the early stages, no conclusion can be drawn as yet however, OF analysis offers us an interesting alternative matrix for future screening and confirmation. W4
Hair as a toxicological matrix R. Kronstrand National board of forensic medicine, Linköping, Sweden. Hair is a unique matrix that provides a calendar of previous use of drugs and medications, and therefore it complements the use of blood and urine which both have a limited window of detection. Segmental analysis may also provide a close insight to the temporal pattern of use. The Society of Hair Testing recommends hair testing for several toxicological investigations including post mortem toxicology, drug facilitated assaults, child custody cases and driver’s license regranting. Besides the common testing for drugs of abuse and medications, testing for alcohol markers such as EtG and FAEE in hair are becoming more important as complements to the blood biomarkers CDT and PEth. This lecture will give an overview of how hair as a matrix can assist the toxicologist in the interpretation of casework from these different areas but also highlight some of the limitations. W5
Hair analysis in DFSA cases A. Knapp (1), J. Bois-Maublanc (2), C. Mayer-Duverneuil (1), I. Etting (1), S. Lefeuvre (2), J.-C. Alvarez (1) (1) Pharmacologie/Toxicologie, CHU R.-Poincaré, APHP, Garches et université Versailles St-Quentin en Yvelines, France ; (2) Laboratoire de biochimie, CHR Orléans, France. Objectives. – Drug Facilitated Sexual Assault (DFSA) is defined by the covert administration of psychotropic substances to a victim in order to sexually abuse her or him. Most frequently used molecules are benzodiazepines, antihistamines, some neuroleptics and GHB. When delay between facts and sampling is too important for blood and urine analysis, hair can be an interesting alternative matrix to establish the involvement of drugs in the crime. However, the analysis and the interpretation may be tricky. The aim of this study is to present specific DFSA challenges through some case reports.
Tuesday 10 June 2014 / Toxicologie Analytique & Clinique (2014) 26, S1-S3
Results. – Sensitivity of OIT seem to increase. The DrugTest 5000 and Drugwipe demonstrated respectively a sensitivity of 93 % and 72 % for Δ9-tetrahydrocannabinol during roadside studies. The Drugwipe is very sensitive just after smoking, but it rapidly decreases within 1.5 hours. The type of OF collection has to be specified when using OF as confirmation matrix, as THC recovery ranged from 50 to 70 % and is dependent on the storage conditions. While matrix effects due to the collector buffers are observed, stability is often guaranteed via the stabilizing buffers. In a roadside study, we observed that after 5 minutes collection time, about 0.11-1.15 mL of OF was collected. Therefore, the final drug concentrations in neat OF have to be calculated via the following formula: C = [CUPLC/MS . (V1 + (W1-W2))] / [V2 x (W1-W2)] with C being the drug concentration in neat OF, CUPLC/MS the concentration obtained via the calibration curve, V1 the buffer volume, V2 the theoretical total collected volume and W1 and W2 respectively the weight of the collection device after and before OF collection. Neat OF THC concentrations in the placebo controlled study ranged from 12,361 ng/g 5 minutes after smoking down to 34 ng/g 80 minutes after 2 smoking sessions. Under placebo conditions, a median of 8 ng/g THC in OF was observed. The impact of all these observations on DUID legislations will be discussed. Conclusion. – OF has its limitations as a toxicological matrix. However, in situations where ‘recent’ drug use in combination with analytical cut-offs for interpretations are used, OF combines an easy collection of samples with a quick analysis of large batches. W3
The French experience of establishing an oral fluid roadside drug test O. Roussel (1), M. Perrin-Rosset (2), C. Fuché (3), M. Carlin (4) (1) Forensic toxicology unit, forensic sciences institute of the gendarmerie nationale, Rosny-sous-Bois, France; (2) French navy headquarters, bureau for risk management, Paris, France; (3) Centre of research and expertise on logistic, Le Chesnay, France; (4) Faculty of health & life sciences, northumbria university, Newcastle, UK. Introduction. – In 2005, following on from the findings of the ROSITA and DrUID projects, the French government made the decision to investigate possible alternative matrices to urine for drug screening at the roadside. A special committee, which included French ministerial representatives, was established in 2006 and they decided to use a special procurement contract in the form of a “competitive dialogue”: this allowed manufacturers of screening devices to improve their product in accordance with the committee’s recommendations. From initial investigations carried out, oral fluid (OF) was found to be the best alternative matrix (non invasive sample taking, difficult to adulterate, existing prototypes), and so this was chosen for this work. The devices included in the work were screening tests based on immunochromatographic methods. Method. – In France the four major categories of drugs tested for are cannabis, cocaine, opiates and amphetamines therefore the devices selected had to detect these compounds. The French gendarmerie and police played an important role in this previously unfamiliar testing and 3 OF devices remained for evaluation in the final step of the selection process. For this step, 2 field evaluation studies were carried out in 3 of the most active territorial road units by the Centre of Research and Expertise on Logistic (CREL). In the first study, approximately 500 individuals were involved. A urine sample was collected for screening, if positive a blood sample for confirmation and one of the OF devices was tested. In the second study, 100 participants were involved and standard urine and blood confirmation was carried out but also OF was tested against all three of the devices for a comparative study. The toxicology unit of our laboratory performed more than 400 of the confirmatory analyses by a validated GC-MS method. For both of the field studies, CREL processed the findings from the roadside units carrying out the screening and
determined sensitivity, specificity and efficacy of the 3 devices. As a result, the Rapid Stat® (Mavand) screening device was introduced for roadside drug testing. French law was subsequently modified in July 2008 to allow the use of an OF screening test operated by a police officer (as opposed to medical personnel). Results & discussion. – This change in legislation has resulted in a dramatic increase in the number of roadside drug tests performed and consequently the number of confirmatory analyses in blood (an increase from 15,000 in 2004 to 76,000 in 2010). Although OF has a number of factors requiring consideration when collecting, analysing and interpreting findings, it has become an accepted matrix for this type of testing and one which we are investigating. In March 2011, a new public contract was announced. A new device (Drugwipe5S®, Securetec) was appointed, for 2011 to 2015. Last year, the Directorate General of the French Gendarmerie tasked our laboratory to carry out a feasibility study on the use of OF in confirmatory analyses. This includes evaluating financial, organisational and philosophical implications and establishing risk assessment criteria. With help from laboratories in Belgium and Switzerland, the analytical component of this study is now underway and several steps are planned, including the selection of the OF collection device, the choice of biological markers and the validation of both field testing devices and analytical methods. At this time, the collection device has already been chosen, the biological markers are being established and analytical method development is in progress. Since the work is in the early stages, no conclusion can be drawn as yet however, OF analysis offers us an interesting alternative matrix for future screening and confirmation. W4
Hair as a toxicological matrix R. Kronstrand National board of forensic medicine, Linköping, Sweden. Hair is a unique matrix that provides a calendar of previous use of drugs and medications, and therefore it complements the use of blood and urine which both have a limited window of detection. Segmental analysis may also provide a close insight to the temporal pattern of use. The Society of Hair Testing recommends hair testing for several toxicological investigations including post mortem toxicology, drug facilitated assaults, child custody cases and driver’s license regranting. Besides the common testing for drugs of abuse and medications, testing for alcohol markers such as EtG and FAEE in hair are becoming more important as complements to the blood biomarkers CDT and PEth. This lecture will give an overview of how hair as a matrix can assist the toxicologist in the interpretation of casework from these different areas but also highlight some of the limitations. W5
Hair analysis in DFSA cases A. Knapp (1), J. Bois-Maublanc (2), C. Mayer-Duverneuil (1), I. Etting (1), S. Lefeuvre (2), J.-C. Alvarez (1) (1) Pharmacologie/Toxicologie, CHU R.-Poincaré, APHP, Garches et université Versailles St-Quentin en Yvelines, France ; (2) Laboratoire de biochimie, CHR Orléans, France. Objectives. – Drug Facilitated Sexual Assault (DFSA) is defined by the covert administration of psychotropic substances to a victim in order to sexually abuse her or him. Most frequently used molecules are benzodiazepines, antihistamines, some neuroleptics and GHB. When delay between facts and sampling is too important for blood and urine analysis, hair can be an interesting alternative matrix to establish the involvement of drugs in the crime. However, the analysis and the interpretation may be tricky. The aim of this study is to present specific DFSA challenges through some case reports.