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Drug Testing in Biological Matrices: Hair and Urine


Medical Toxicologist, Medical Review Officer, and Emergency ... Via hair follicle during active growth phase. Drug in perspiration from sweat/sebaceous glands ... – PowerPoint PPT presentation

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Title: Drug Testing in Biological Matrices: Hair and Urine

Drug Testing in Biological Matrices Hair and
  • Medical Toxicologist, Medical Review Officer, and
    Emergency Physician
  • Division of Medical Toxicology, Department of
    Traumatology and Emergency Medicine
  • Hartford Hospital
  • Associate Medical Director, Connecticut Poison
    Control Center
  • Associate Professor of Emergency Medicine
  • University of Connecticut School of Medicine

  • Generally applied when presence of a compound or
    concentration has some meaning
  • Therapeutic drug monitoring
  • Quantitative
  • Detection of illicit drugs
  • Usually qualitative
  • End-of-shift workplace monitoring
  • Quantitative comparison to OSHA regulations

Validity of Biomonitoring
  • Compound has defined source of exposure
  • Compound is excreted in matrix of interest
  • There is a control or reference population (if
  • Testing is defined as
  • Screening prone to false positives or false
  • Confirmatory interpretation issues related to
    clinical relevance and limit of

Applications of Hair Testing
  • Almost any drug could be detected if commercial
    reason to develop test
  • For practical purposes, testing is done for
  • Usual drugs of abuse similar to workplace NIDA
  • Pharmaceutical agents as research tools
  • Variety of compounds in forensic or research
  • Heavy metals
  • Inappropriately for number of environmental

Identification of Compound in Hair
  • Incorporation
  • Via hair follicle during
    active growth phase
  • Drug in perspiration from
    sweat/sebaceous glands
  • External contamination
  • Specimen preparation and washing
  • Varies by laboratory
  • May be addressed by measurement of metabolites

Hair Growth Cycle
  • Generally gt90 of the scalp hair is in active
    growth phase
  • Average growth rate is 1 cm/month

From http//www.lahairmd.com/info/hairlossm.htm
Similar to diagram found in Habif TP. Clinical
Dermatology A Color Guide to Diagnosis and
Therapy, 2nd edition CV Mosby Co, 1990
Sampling For Drugs of Abuse
  • Hair sampling generally done with 50 or more
    hairs cut at scalp level
  • Sectioning the hair can be used to compare one
    period of time to another
  • Does not reflect previous few days of use
  • Urine tests generally identify use within last
    few hours to several days

Example Hair Testing For Cocaine/Metabolite
  • Hair Testing for Cocaine reported results
  • Sample 1 Positive for cocaine (measured on whole
    length of hair) at 454 ng/10 mg hair weight
  • Sample 2 (4 ½ months later) Positive for cocaine
    in 2nd (15.8 ng/10 mg hair) and 3rd segments
    (73.5 ng/10 mg hair) only
  • Sample 3 (5 ½ months after 1) Positive for
    cocaine (qualitative on whole length of hair)
  • Hair Testing Interpretation

Example Hair Cocaine And Time of Cocaine Use
  • Approximate Hair Growth Periods vs. Estimated
    Time of Cocaine Incorporation
  • I used to use, but havent used any cocaine in
    the last 3 months
  • Sequential hair samples show decreased
    concentration over time
  • April 2006 March 2006 February 2006
    January 2006
  • May 2006 April 2006 March 2006
    February 2006 January 2006

Example Use of Hair and Urine Testing For
Cocaine Metabolite
0 1 2 3 4 cm
Scalp End
Tip of Hair
Sample 2
Sample 3
  • Urine Testing for Cocaine Metabolite
  • 1/24/06 Positive
  • 1/26/06 through 6/26/06 Negative

Case Summary
  • Urine testing reliably identifies cocaine use
    within previous few days.
  • In conjunction with decreasing cocaine content in
    hair over time and no cocaine present in hair
    that grew over last couple months, there is no
    clinical laboratory evidence of cocaine use since
    the positive urine test.

CAVEATS But what about
  • variability in hair growth?
  • Largest variable is in the length of time in
    resting phase
  • May lead to appearance of prolonged clearance
    time for the fraction of hair that is no longer
    incorporating drug, but also not falling out
  • variability in hair color?
  • Higher melanin (eumelanin vs. pheomelanin)
    associated with more binding of some (basic)
  • variability in hair type/treatment?
  • Higher incorporation into damaged
    (chemically-treated) hair
  • Oval or flat hair shafts will curl, raising
    questions about true length (e.g. stretched?)
  • external contamination?
  • Usually indicates significant excretion from
    pores, so not really external contaminant
  • Low-level findings can be differentiated by
    proper laboratory steps

So, Is Hair Testing A Good Idea?
  • Definition of good?
  • Reliable technique to identify past substance use
  • Sequential testing may support abstinence and
    identify relapse
  • If adequate specimen handling and preparation
  • May not identify all uses and users at very low
  • resulting in unintended bias
  • In one study, 15 doses of codeine over 5 days
    would be detected months later (at recommended
    federal cutoffs) in
  • 100 of those with black hair
  • 50 of those with brown hair
  • 0 of those with blond or red hair
  • Not a practical concern for most cases where drug
    concentrations are much higher than reporting (or
    detection) cutoffs

Hair Testing
  • Collection
  • Processing
  • Analysis
  • Interpretation

And In Response To Tests
  • PassYourTest
  • UrineClear
  • PerfectUrine
  • ClearTest
  • 45 Minute Chewable Tablet
  • Take the chewable with 48 ounces of water.
  • Wait 45 minutes.
  • Urinate 2-3 times during the hour that you are
  • The tablet is effective for up to 6 hours.
  • Helpful Hints
  • Avoid toxins for 48 hours before using this
  • Drink water before and after using this product.

(No Transcript)
So If Your Client Looked Like This
Then Like This
Be very suspicious!
Take Home Messages
  • GC/MS or LC/MS techniques are reliable in the
    identification of chemical compounds
  • Hair analysis is a reasonable mechanism to
    evaluate long term (months) drug abstinence
  • There are issues near reporting cut-offs and
    limits of detection in the interpretation of
    positive tests that might be addressed by
  • Analysis of metabolites
  • Sequential sectioning
  • Sample washing techniques
  • The laboratory and toxicologists can provide
    assistance in interpretation

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