When we think of drug and alcohol testing, we tend to think of the adults that are affected with or without the testing, but often, an even more vulnerable life is combined in the mix - a child. This issue of Substance focuses on this topic by way of steps to consider when presenting a case on parental substance abuse, as well as new research that demonstrates the usefulness of hair toxicology for improving the outcomes of children affected by drug exposure in child abuse cases. We hope you find them, and the rest of the issue, as valuable as we do.
16
Substance 4 Expert advice on evidentiary steps in child abuse toxicology cases. 6 Efficacy of hair specimen toxicology vs. urine toxicology for identifying child drug exposure. 8 What ISO 17025 certification means for USDTL clients. 13 Nearly triple the number of buprenorphine police seizures in 2014 than for methadone. Clarity in Toxicology | v.6 i.3 In Defense of Children Finding clarity and focus in child abuse court cases and toxicology testing. Fall 2015
Transcript
Substance
4Expert advice on evidentiary steps in child abuse toxicology cases.
6Efficacy of hair specimen toxicology vs. urine toxicology for identifying child drug exposure.
8What ISO 17025 certification means for USDTL clients.
13Nearly triple the number of buprenorphine police seizures in 2014 than for methadone.
Clarit y in Toxicology | v.6 i.3
In Defense of Children
Finding clarity and focus in
child abuse court cases and
toxicology testing.
Fall
2015
2 Fall 2015 Substance
Letter from the editor
A SEASON OF THANKS
As 2015 comes to a close, we present some tools for the family law practitioner, to help create more promising futures for the children in greatest need.
I hope this issue finds you in great anticipation of the holiday season. We have been working hard to bring you this issue of Substance, and we are pretty excited about it.
When we think of drug and alcohol testing, we tend to think of the adults that are affected with or without the testing, but often, an even more vulnerable life is combined in the mix - a child. This issue of Substance focuses on this topic by way of steps to consider when presenting a case on parental substance abuse, as well as new research that demonstrates the usefulness of hair toxicology for improving the outcomes of children affected by drug exposure in child abuse cases. We hope you find them, and the rest of the issue, as valuable as we do.
In putting together our Fall issue, we looked back at how much our newsletters have progressed over the last year. We are thrilled they have become such a vital part of our communication with our community. The expansion into the magazine quality publication it is today has garnered wonderful reviews from you, our readers.
We want to thank you for your continued support and feedback; from client satisfaction surveys to emails of praise, we are grateful. We are constantly striving to bring you relevant information and be your resource for substance abuse toxicology. We would not be as effective at this without your feedback.
I and everyone here at USDTL wish you, your families, and your businesses the very best for the holiday season. We are really proud of how far we have come in 2015, and look forward to an even brighter 2016.
Happy Holidays!
Thanks for reading,Michelle Lach, Editor-in-Chief
3USDTL
SubstanceFall 2015volume 6
issue 3
Editor-in-Chief Michelle Lach, MSIMC
Managing & Design EditorJoseph Salerno, MS
Graphic DesignerDru Wagner, MA
Science Advisory BoardDouglas Lewis, D.Sc.
Joseph Jones, MS NRCC-TCAdam Negrusz, Ph.D. F-ABFT
Substance is a quarterly news magazine of toxicology science, data, and news. It is our mission to distill the technical world of toxicology, drug testing, and addiction science into plain words. If you have suggestions for topics you would like to know more about, let us know.
Parental substance abuse introduces daunting complications into Juvenile and Family Court cases. Properly applied investigation, substance abuse monitoring, and treatment are crucial to ensuring the safety of children impacted by these issues.
6
HIGH YIELD DETERMINATIONS |
Joseph Salerno, MS
New research demonstrates an increased usefulness of hair toxicology testing for improving outcomes of child abuse cases over traditional urine toxicology testing.
8
A HABIT OF EXCELLENCE |
Joseph Salerno, MS
Following on 25 years of industry leading innovation, experience, and professionalism, USDTL reaffirms the commitment to quality by achieving accreditation for the international ISO/IEC 17025 labratory standard.
13
DATA IN ACTION
CESAR FAX: 2014 NFLIS finds nearly three times more buprenorphine than methadone reports.
14
NATIONAL POSITIVITY RATES
Quarterly positivity results for drug and alcohol testing in fingernail and hair specimens.
Cover illustration by Joseph Salerno.
4 Fall 2015 Substance
THE SHELTER OF THE LAW
Parental substance abuse introduces daunting complications into Juvenile and Family Court cases. Properly applied investigation, substance abuse monitoring, and treatment are crucial to ensuring the safety of children impacted by these issues.
by Eric Frazer, Psy.D. and Linda Smith, Ph.D.
One of the most common issues that arises in Juvenile and Family Court is parental substance abuse. Once this allegation has been raised, there is immediate concern about the child’s safety and well-being. In particular, there is often concern about neglect and abuse. For example, will the parent prioritize drug seeking over caring for the child? Will the parent drive under the influence, with the child in the vehicle? Less commonly mentioned in the courtroom, especially in the family courtroom, is potential child exposure to drugs. Unfortunately, this is a significant risk to children, and should be considered and discussed in every case.
One of the challenges family lawyers and courts face is how to properly investigate the substance abuse allegation and determine if it is a valid concern. Gathering and organizing the most relevant information has historically been difficult to do because of a lack of awareness regarding what is most relevant and important. Fortunately, the drug testing lab can bridge that gap of uncertainty, especially when there is an allegation about child exposure.
The objective for any lawyer and the court is to have sufficient information available to rule in, or out, the substance abuse allegations. This information may be presented via admissible evidence, witness testimony, and/or expert testimony. The following pointers may be helpful to legal professionals so that they are able to most effectively present a case on this matter.
Step 1 - Inquiry & InvestigationOne of the first steps in evaluating a substance
abuse allegation is to ask research informed questions so that the most relevant data can be gathered. Questions should be focused on potential exposure of the children to parental drug possession or use. For example, relevant questions may include:
• Where does the defendant allegedly store the drugs?
• Does the child have easy access to these storage containers and locations?
• Is the child typically present when the drugs are used?
• In what ways may the child have been exposed?• What steps, if any, did the parent take to
protect the child from accidental exposure?
Step 2 - Drug & Alcohol MonitoringIf a parent tests positive on an alcohol or drug
test, this may result in a motion, agreement, or court order for ongoing monitoring. However, many questions then arise. For example, how long should the monitoring extend? Should it include both alcohol and drugs? What type of drug monitoring method should be used (urine/hair/SCRAM/Soberlink, etc.)?
In general, consulting with a drug testing specialist may be helpful to determine which
Continued on page 12, Family Law
USDTL 5
Where are drugs stored and can children access them?
Is the child exposed to drug use and by what method?
What steps did the parent take to prevent accidental drug exposure to the child?
What addiction treatment method will best address the parental drug abuse?
How severe is the drug addiction?
What support and treatment is necessary for the child?
Length of time of drug testing?
Method of monitoring to use?(hair/urine/SCRAM/Soberlink)
Monitoring/Testing frequency?
What will happen if a test is missed or failed?
Who are test results reported to?
The objective for any lawyer and the court is to have sufficient information available to rule in, or out, substance abuse allegations. These steps may be helpful for most effectively presenting a case on the matter.
I. Inquiry & Investigation
II. Drug & Alcohol Monitoring
III. Drug & Alcohol Treatment
6 Fall 2015 Substance
Literature Review
HIGH YIELD DETERMINATIONS
New research demonstrates an increased usefulness of hair toxicology testing for improving outcomes of child abuse cases over traditional urine toxicology testing.
by Joseph Salerno, MS
Stauffer, SL, Wood, SM, and Krasowski, MD. (2015). Diagnostic yield of hair and urine toxicology testing in potential child abuse cases. Journal of Forensic and Legal Medicine, 33: 61-67.
Recent research has demonstrated an increased efficacy of hair specimen toxicology testing over urine testing for improving outcomes for victims in child abuse cases. The retrospective chart review covering more than 10 years of data (January 2004 - April 2014) found that the clinical outcomes for children of abuse were improved in 86.5% of hair toxicology results that identified child drug exposure that could not be explained by legal medical administration of medications to the child. In contrast, clinical outcomes remained unchanged in all of the 457 urine screens conducted in the child abuse cases during this period. The study was published by researchers from the Department of Pathology at the University of Iowa Hospitals and Clinics, Iowa City, IA.
In 2012, 678,810 substantiated cases of child abuse were reported by the US Department of Health and Human Services. 1,593 of those cases were ultimately fatal for the child. The risk of harm to a child increases dramatically if the person in charge of the welfare of the child is intoxicated (alcohol or drugs), experiencing drug withdrawal, or pursuing the acquisition of drugs. In many cases of suspected child abuse, the detection of
drug biomarkers in child specimens such as hair or urine may be the first objective finding that can be reported in the case.
Stauffer et al’s research suggests that the choice of testing has a potentially high impact on the ultimate welfare of the child. Their study focused on 457 child abuse cases in which both hair and urine toxicology testing were simultaneously conducted.
Notably, the results of this study indicated that urine toxicology testing had little efficacy for identifying actionable drug results. Urine screening was able to identify actionable illegal drug exposure less than 5% of the time, with more than 95% of positive results explainable by documented legal administration of medications to the child, predominately opiate pain relievers and benzodiazepines.
Hair toxicology testing was able to identify illegal drug exposure in 77.4% of cases with positive drug testing results. Hair testing most often identified cocaine, cannabinoid, and amphetamine exposure, in that order of frequency.
Interestingly, in 64% of hair testing positives, the parent drug compound was identified in absence of the metaboloite of the native drug. This pattern of testing results is consistent with a scenario of significant environmental exposure of the child, where a child has been placed in a potentially harmful situation by their caregivers.
7USDTL
A Comparison of Hair and Urine Toxicology in Child Abuse Cases
Data are based on 457 child abuse cases involving simultaneous hair and urine drug testing.
Positive test results thatimproved outcomes for
child abuse victims:
Urine Testing0%
Hair Testing86.5%
Number of child abuse cases that identified the drug biomarker in a hair specimen:
Impact of drug detection in hair specimens on clinical outcomes:
Positive test results thatidentified illegal drug exposure of a child:
Hair Testing77.4%
Urine Testing>5%
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ISO / IEC17025
We are proud to announce that we are the first laboratory in the world to be ISO/IEC 17025 accredited for drug and alcohol testing in umbilical cord, fingernail, and toenail specimens.
ISO/IEC 17025 accreditation is the single most important competency standard applied to testing and calibration laboratories around the globe. Laboratories accredited to this standard have demonstrated significant technical ability to reliably generate and reproduce accurate, precise and consistent data.
On September 4, 2015, USDTL attained ISO/IEC 17025 accreditation showing full compliance with the competency standards of the International Organization for Standardization and the International Electrotechnical Commission in the field of Forensic Testing.
The scope of our accreditation encompasses all
aspects of our laboratory system, well beyond just our accredited general laboratory methodologies. Not one single function within the umbrella of our testing services is outside the scope of our accreditation. All specimen types analyzed by USDTL are accredited, including umbilical cord, meconium, breast milk, all keratinized specimens
(fingernails, toenails, hair), urine, oral fluid, and blood. USDTL is now the only lab in the United States to offer PEth (phosphatidylethanol) testing for alcohol use under the ISO/IEC 17025 standard.
As a global innovator in the science and technology of substance abuse toxicology, we have maximized the capabilities of our instruments to achieve the lowest positive result cutoffs in the industry for many toxicology tests. Our carboxy-THC cutoff level for a positive cannabinoid test result is the lowest achieved by any reference lab in the U.S. Exhaustive research and maximization of our technology led us to develop the lowest umbilical testing cutoffs in the industry. Our use of technology to improve our clients’ data has always been a premier aspect of our work.
Now, in addition to being at the forefront of toxicology expertise, our methodologies and instrumentation are fully accredited to the ISO/IEC 17025 standard. As a forensic testing laboratory this is of the highest importance to us, because every testing result has
the possibility of becoming evidence in a court of law.
Accreditation under this standard increases the evidential acceptance of our laboratory results in virtually all jurisdictions.
Continued on page 10, Accreditation.
A HABIT OF EXCELLENCE
Following on 25 years of industry leading innovation, experience, and professionalism, USDTL reaffirms the commitment to quality by achieving accreditation for the international ISO/IEC 17025 labratory standard.
by Joseph Salerno, MS
8 Fall 2015 Substance
ISO/IEC 17025 accreditation is the single most important competency standard applied to testing and calibration laboratories
around the globe. Laboratories accredited to this standard have demonstrated significant technical ability to reliably generate and
reproduce accurate, precise and consistent data.
ISO / IEC17025 9USDTL
Accreditation under this standard increases the evidential acceptance of our laboratory results in virtually all jurisdictions.
Accreditation, continued from page 8.
The 17025 standard was first codified by ISO and IEC in 1999, and was further amended and improved in 2005. Explicit requirements for continuing improvement of management systems, with an emphasis on the responsibilities of senior management, is central to the 2005 revisions. An efficient management system ensures fast resolution of laboratory issues regarding methods and equipment. Even before ISO/IEC 17025 accreditation, this was one of the cornerstones to USDTL’s results turn-around time - one of the fastest in the industry - and outstanding customer advocacy, and will remain so moving forward.
It is important to point out that this standard and level of expertise is nothing new to us. Since our beginnings in 1991, we have always maintained the highest level of quality and competency, providing our clients with the most responsive and personal service in the drug and alcohol testing industry. ISO/IEC 17025 accreditation reaffirms that commitment to our clients, and officially codifies it for all aspects of our testing and client advocacy. Now, as before, our clients can always have absolute confidence that the results of every specimen tested by our laboratory will meet the international standards.
Immediately after accepting his new leadership role in 2014, USDTL Laboratory Director, Dr. Adam Negrusz, began the endeavor to achieve ISO/IEC 17025 accreditation. Working closely with QC/QA Manager, Michelle Pilkington, Dr. Negrusz set out to successfully finish the process within two years. All their efforts, combined with a company-wide determination, allowed us to achieve accreditation within 14 months time - 10 months less than our original goal. That accomplishment is a testament to USDTL’s historical adherence to the highest possible laboratory and business standards.
To view our certificate of accreditation, visit us online at www.usdtl.com/media/certifications/USDTL-ISO17025.pdf. If you have questions about ISO/IEC 17025 accreditation, please contact us at [email protected] or 800.235.2367.
Page 9 illustration by Joseph Salerno.
10 Fall 2015 Substance
College of American PathologistsForensic Drug Testing Accreditation
Oklahoma State Department of Health Certified Laboratory
11USDTL
DID YOU KNOW?USDTL holds several international, state, and federal certifications and accreditations.
College of American PathologistsForensic Drug Testing Accreditation
Iowa Department of Health Approved Laboratory Lists
Illinois Department of Financial and Professional Regulation Controlled Substances Licensee
New York State Department of Health Clinical Laboratory Permit
Maryland Department of Health and Mental Hygiene Office of Health Care Quality Medical Laboratory Permit
Florida Agency for Health Care Administration Licensed Clinical Laboratory
Note: Most states do not require certification or licensure of drug testing laboratories. The licenses and certifications shown here are required by these specific states.
12 Fall 2015 Substance
Family Law, continued from page 4.
testing protocol should be used. At minimum, the testing protocol should specify:
• The length of time of the testing; • The type of testing that will be used;• The frequency of testing; • What will happen if there is a missed or failed
test;• Who the drug test reports will be sent to.
Furthermore, if there is concern around child exposure to drugs, hair follicle testing of the child may be the most accurate procedure to scientifically document the exposure. New research demonstrates that exposure to cocaine, marijuana, and methamphetamine can be better detected in hair samples of children than in urine samples. In many states, child exposure to drugs is considered child neglect/abuse, therefore the testing can be very informative and have legal relevance.
Step 3 - Drug & Alcohol TreatmentPositive alcohol/drug test results typically lead to
a request for treatment. There are multiple research-informed and evidenced-based treatment types for addiction. These include motivation enhancement therapy, cognitive behavioral therapy, mindfulness therapy, 12-step, and others.
The treatment selection should match the severity of the abuse issue. For example, milder forms of drug abuse generally respond well to harm reduction treatment, cognitive-behavioral therapy, motivation enhancement therapy and mindfulness therapy. Moderate to severe forms of abuse will generally benefit from 12-step attendance and more intensive interventions that will target personality vulnerabilities and impulsivity. If a litigant has repeatedly failed treatments, a long-term inpatient treatment may be needed.
For the child, s/he will also need treatment and support to help cope with the stressors of having a parent who abuses drugs. The treatment should incorporate developmentally appropriate education about drug abuse. In addition, when the parent
sustains abstinence, the parent should participate in parent-child therapy sessions to help rebuild trust and the parent-child relationship.
Substance abuse allegations can be overwhelming to the court. The frequency, severity, and risks of the allegations are often high. Historically, information and resources to address this issue have been limited, especially when child exposure allegations are raised. Fortunately, research has provided information on the optimal methods to gather information to rule in or out the veracity of the allegation. Through a combination of appropriate drug testing (parent and child) and thorough, research informed inquiry and investigation, these allegations can be more easily addressed.
References:Thomas K. Greenfield; Yu Ye; Jason Bond; William
C. Kerr; Madhabika B. Nayak; Lee Ann Kaskutas; Raymond F. Anton; Raye Z. Litten; Henry R. Kranzler. (2014) Risks Of Alcohol Use Disorders Related To Drinking Patterns In The U.S. General Population. Journal of Studies on Alcohol and Drugs. 75(2), 319–327.Witkiewitz K, Lustyk MK, & Bowen, S. (2013)
Retraining The Addicted Brain: A Review Of Hypothesized Neurobiological Mechanisms Of Mindfulness-Based Relapse Prevention. Psychology of Addictive Behaviors. 27(2):351-65. Witbrodt, Jane; Ye, Yu; Bond, Jason; Chi, Felicia;
Weisner, Constance; Mertens, Jennifer. (2014) Alcohol And Drug Treatment Involvement, 12-Step Attendance And Abstinence: 9-Year Cross-Lagged Analysis Of Adults In An Integrated Health Plan. Journal of Substance Abuse Treatment. 46 (4), 412–419.Barnett, Nancy P.; Meade, E. B.; Glynn, Tiffany R.
(2014) Predictors Of Detection Of Alcohol Use Episodes Using A Transdermal Alcohol Sensor. Experimental and
Clinical Psychopharmacology. 22 (1), 86-96.
Drs. Eric Frazer and Linda Smith are forensic psychologists with more than two decades of expertise in child custody matters. They are co-founders of Child Custody Analytics, LLC, which enables family lawyers to access psychological information simply and efficiently through their online platform. For more information visit: childcustodyanalytics.com
13USDTL
DATA IN ACTION
CESAR FAX: 2014 NFLIS Finds Nearly Three Times More Buprenorphine Than Methadone Reports
The National Forensic Laboratory Information System (NFLIS) collects drug test results from law enforcement-encountered drug items submitted to and analyzed by state and local forensic laboratories across the country. NFLIS data can provide valuable information about trends in the drugs seized by U.S. law enforcement. In 2014, the number of NFLIS reports for buprenorphine reached a high of 15,209, almost three times the number of methadone reports (5,559). Buprenorphine reports increased from 90 in 2003
(one year after buprenorphine was approved to treat opioid dependence) to 15,209 in 2014. In contrast, methadone reached a peak of 10,016 reports in 2009, and has since decreased each year. In 2014, the Northeast had the highest rate of buprenorphine reports (9.79 per 100,000 persons aged 15 or older), while the West had the lowest rate (2.09 per 100,000 persons). More information about buprenorphine can be found in the CESAR FAX Buprenorphine Series, available online at http://go.umd.edu/cesarfaxbuprenorphine.
NOTES: Estimates are calculated using the National Estimates Based on All Reports (NEAR) methodology, which has strong statistical advantages for producing national and regional estimates. Estimates are based on drug cases and items submitted to participating state and local laboratories during the calendar year and analyzed within three months of the end of the calendar year. Up to three drugs can be reported for each drug item (or exhibit) analyzed by a laboratory. State and local policies related to the enforcement and prosecution of specific drugs may affect drug item submissions to laboratories for analysis. Laboratory policies and procedures for handling drug evidence may also vary. For example, some analyze all items submitted, while others analyze only selected items. Many laboratories do not analyze drug evidence if the criminal case was dismissed from court or if no person could be linked to the item. Thus, NFLIS data might underestimate the availability of drugs in the illicit market that state or local labs do not systematically identify.
SOURCE: Adapted by CESAR from data provided by the U.S. Drug Enforcement Administration (DEA), Office of Diversion Control, Drug and Chemical Evaluation Section, Data Analysis Unit and from NFLIS Annual Reports (available online at https://www.nflis.deadiversion.usdoj.gov/Reports.aspx).
BuprenorphineMethadone
4,000
02002 2004 2006 2008 2010 2012 2014
2,409
36
8,000
12,00010,016
15,209
7,508
5,559
16,000
Estimated Number of Total NFLIS Reports for Methadone and Buprenorphine, 2001-2014
USDTL NATIONAL POSITIVITY RATES*
Fingernail Specimens
Amphetamines | 17.2%
Cocaine | 4.9%
Opiates | 9.3%
Cannabinoids | 19.1%
Benzodiazepines | 3.3%
Oxycodone | 5.4%
Tramadol | 4.4%
Fentanyl | 0.0%
Buprenorphine | 27.8%
Ketamine | 0.0%
Ethyl Glucuronide | 18.6%
Barbiturates | 0.5%
Methadone | 1.4%
10 02030
Not shown: Meperidine 0.0%, Phencyclidine 0.2%, Propoxyphene 0.0%
14 Fall 2015 Substance
Ketamine | 0.0%
Report date range: April 1, 2015 – September 30, 2015* These data report national positivity rates for forensic toxicology tests conducted by USDTL on behalf of external clients and are not reflective of systematic research results.
Hair Specimens
Amphetamines | 15.8%
Cocaine | 6.5%
Opiates | 14.7%
Cannabinoids | 10.6%
Oxycodone | 10.7%
Tramadol | 4.3%
Fentanyl | 0.7%
Buprenorphine | 48.2%
Ketamine | 2.6%
Barbiturates | 0.5%
Methadone | 2.3%
20 50100
Not shown: Meperidine 0.1%, Phencyclidine 0.1%, Propoxyphene 0.1%
Benzodiazepines | 2.6%
Ethyl Glucuronide | 13.7%
15USDTL
EVENTS & EXHIBITS
• February 3-5 – Louisiana Association of Drug Court Professionals 2016 Conference – New Orleans, LA
• February 3-9 – American Bar Association’s 2016 Midyear Meeting – San Diego, CA
• February 14-16 – National Association for Court Management 2016 Midyear Conference – Mobile, AL
• March 15-18 – National Organization of Alternative Programs 2016 Annual Education Conference – West Palm Beach, FL
• March 20-23 – National Conference on Juvenile Justice – Las Vegas, NV
1700 S. Mount Prospect Rd. | Des Plaines, IL 60018 | 800.235.2367 | www.USDTL.com
United States Drug Testing Laboratories, Inc.1700 S. Mount Prospect Road|Des Plaines, IL|60018Main: 847.375.0770|www.USDTL.com|Fax: 847.375.0775
