What Can Dead People Tell Us? Postmortem Toxicology for Attorneys
|
|
- Oliver May
- 5 years ago
- Views:
Transcription
1 What Can Dead People Tell Us? Postmortem Toxicology for Attorneys Dr. Allison A. Muller Diplomate, American Board of Applied Toxicology Principal/Owner: Acri Muller Consulting, LLC Learning objectives List 3 things that happen to the body after death that relate to drugs Define the terms pharmacokinetics and pharmacodynamics Explain one way that postmortem changes affect drug levels State one example of how a drug level cannot be tied to a cause of death State one example of how a drug level can be tied to a cause of death 2 1
2 First some definitions Pharmacokinetics 3 First some definitions Pharmacodynamics 4 2
3 First some definitions Volume of distribution 5 First some definitions Lipophilicity 6 3
4 Changes to the body after death 7 Postmortem redistribution (PMR) the basics 8 4
5 Sources of drug levels Vitreous humor Urine Bile Tissue Blood Femoral Heart May be ante mortem (hospital blood) 9 Example of test results Detailed Findings: Analysis and Comments Result Units Rpt. Limit Specimen Source Analysis By Caffeine Positive mcg/ml Hospital Blood LC/TOF MS Nicotine Positive ng/ml Hospital Blood LC/TOF MS Amphetamine 66 ng/ml Hospital Blood LC MS/MS Methamphetamine 180 ng/ml Hospital Blood LC MS/MS Other than the above findings, examination of the specimen(s) submitted did not reveal any positive findings of toxicological significance by procedures outlined in the accompanying Analysis Summary. 10 5
6 Units of measurement Weight Abbreviation Conversion Factor Gram G 1 g = 1000 mg Milligram mg 1 mg = 1000 mcg = g Microgram Mcg 1 mcg = mg = g Kilogram Kg 1 kg = 1000 g 11 Know the menu for toxicology testing 12 6
7 Example of test results Analysis Summary of Reporting Limits: All of the following tests were performed for this case. For each test, the compounds listed were included in the scope. The Reporting Limit listed for each compound represents the lowest concentration of the compound that will be reported as being positive. If the compound is listed as None Detected, it is not present above the Reporting Limit. Please refer to the Positive Findings section of the report for those compounds that were identified as being present Acode 52409B Amphetamines Confirmation, Blood (Forensic) Hospital Blood Analysis by High Performance Liquid Chromatography/TandemMass Spectrometry (LC MS/MS) for: Compound Amphetamine Ephedrine MDA MDEA Methamphetamine Norpseudoephedrine Rpt Limit 10 ng/ml Compound Phendimetrzine Phenmetrazine Phentermine Phenylpropanolamine Pseudoephedrine Rpt Limit 10 ng/ml 10 ng/ml Acode 8062B Postmortem Toxicology Expanded w/o Alcohol, Blood (Forensic) Hospital Blood Analysis by Enzyme Linked Immunosorbent Assay (ELISA) for: Compound Barbiturates Rpt Limit ng/ml Compound Cannabinoids Rpt Limit 10 ng/ml 13 Drug levels and cause of death: a link? Simple, right? Compare levels to a table and voila! Therapeutic vs. toxic vs. lethal levels 14 7
8 Interpreting toxicology lab reports Minimum threshold Therapeutic versus toxic ranges 15 Pitfalls when interpreting drug levels postmortem Site of sampling Time of sampling PMR Referring to lists of lethal concentrations Trauma 16 8
9 Details needed to assess postmortem case Medical/ drug history Autopsy Death scene evidence Tox/lab reports 17 Heroin postmortem 18 9
10 Fentanyl postmortem 19 Ethanol postmortem 20 10
11 Case example (1) Patient prescribed fentanyl patch for pain Opioid naïve patient No patches found on body at autopsy Levels of fentanyl postmortem deemed to be in lethal range Cause of death related to this prescription opioid pain patch? 21 Case example (2) Woman found dead following an auto accident Was in car underwater for several days before being found History of drug abuse. In addiction treatment Heroin metabolites found postmortem Syringes found in car Was she high at the time of the accident? 22 11
12 Case example (3) Man was sold heroin at 7 pm Found dead in his home at 12 midnight Toxicology findings: heroin metabolites, diazepam, methamphetamine Was the death due to the drug he was sold at 7 pm? 23 Case example(4) Man has a negative ( ) postmortem toxicology screen for opiates but has a history of oxycodone use for chronic pain 24 12
13 Allison A. Muller, PharmD, Diplomate American Board of Applied Toxicology (215)
An Introduction to Forensic Toxicology
An Introduction to Forensic Toxicology Jennifer Shea, PhD, FCACB Ken Obenson, MBBS MFFLM (UK) FRCPC (Anat) FRCPC (Forensic Path) Dip American Brd of Path (Anat & Clin/Cytopath/Forensic Path) April 11,
More informationAll substances are poisons: there is none which is not a poison. The right dose differentiates a poison and a remedy. (Paraclesus, )
All substances are poisons: there is none which is not a poison. The right dose differentiates a poison and a remedy (Paraclesus, 1493-1541) Discussion Questions About Paraclesus Quote 1. Do you agree
More informationSeptember HCMC Toxicology Transition: Additional information and Frequently Asked Questions
September 2016 HCMC Toxicology Transition: Additional information and Frequently Asked Questions Many clinicians have asked for more information about the Urine Drug Compliance Analysis (LAB8742) switch
More informationTests recently added to the NMS Labs test menu. New Tests are effective immediately.
Immediate Action In our continuing effort to provide you with the highest quality toxicology laboratory services available, we have compiled important changes regarding a number of tests we perform. Listed
More informationTests recently added to the NMS Labs test menu. New Tests are effective immediately.
Immediate Action In our continuing effort to provide you with the highest quality toxicology laboratory services available, we have compiled important changes regarding a number of tests we perform. Listed
More informationUrine Drug Testing to Monitor Opioid Use In Managing Chronic Pain
Faculty Disclosure Henry C. Nipper, PhD, DABCC Dr. Nipper has listed no financial interest/arrangement that would be considered a conflict of interest. Urine Drug Testing to Monitor Opioid Use In Managing
More informationConflict of Interest Disclosure
Patient Rx Drug Misuse and Abuse: Compliance Toxicology Monitoring in Clinical Practice Toxicology Staff Andrea Terrell, Ph.D., DABCC Chief Scientific Officer George Behonick, Ph.D., DABFT, Manager, FBU
More informationLearning Objectives. Drug Testing 10/17/2012. Utilization of the urine drug screen: The good, the bad, and the ugly
Utilization of the urine drug screen: The good, the bad, and the ugly Jennifer A. Lowry, MD Chief, Section of Medical Toxicology Children s Mercy Hospital Kansas City, MO Learning Objectives Describe the
More informationUsing Liquid Chromatography Tandem Mass Spectrometry Urine Drug Testing to Identify Licit and Illicit Drug-Use in a Community-based Patient Population
Using Liquid Chromatography Tandem Mass Spectrometry Urine Drug Testing to Identify Licit and Illicit Drug-Use in a Community-based Patient Population Adam S. Ptolemy 1, Colleen Murray 2, Edward Dunn 3,
More informationDRUG - RELATED DEATH
DRUG - RELATED DEATH Lithuania EVELINA PRIDOTKIENĖ D R U G, TA B A C C O A N D A L C O H O L C O N T R O L D E PA R T M E N T H E A D OF N AT I O N A L F O C A L P O I N T Background: Since 2010 data on
More informationTests that have had changes to the method/ CPT code, units of measurement, scope of analysis, reference comments, or specimen requirements.
In our continuing effort to provide you with the highest quality toxicology laboratory services available, we have compiled important changes regarding a number of tests we perform. Listed below are the
More informationUrine Drug Testing. Methadone/Buprenorphine 101 Workshop. Ron Joe, MD, DABAM December 10, 2016
Urine Drug Testing Methadone/Buprenorphine 101 Workshop Ron Joe, MD, DABAM December 10, 2016 Learning objectives Clarify the purpose of urine drug testing (UDT) Distinguish between UDT for detection of
More informationMEDICAL POLICY Drug Testing
POLICY: PG0069 ORIGINAL EFFECTIVE: 01/01/11 LAST REVIEW: 11/13/18 MEDICAL POLICY Drug Testing GUIDELINES This policy does not certify benefits or authorization of benefits, which is designated by each
More informationMEDICAL POLICY Drug Testing
POLICY: PG0069 ORIGINAL EFFECTIVE: 01/01/11 LAST REVIEW: 04/10/18 MEDICAL POLICY Drug Testing GUIDELINES This policy does not certify benefits or authorization of benefits, which is designated by each
More informationForensic Toxicology. William C. Bress, PhD State Toxicologist Adjunct Assistant Professor Department of Biology University of Vermont
Forensic Toxicology William C. Bress, PhD State Toxicologist Adjunct Assistant Professor Department of Biology University of Vermont History of Forensic Toxicology Paracelsus (1493-1541) 1541) Orfila (1787-1853)
More informationUrine Drug Testing Methods 3-5
Urine Drug Testing Methods 3-5 Type of Test Logistics Pearls Initial Screening Test: Immunoassay Confirmatory Test: Gas chromatography-mass spectrometry (GCMS) + or Liquid chromatography-mass spectrometry
More informationControlled Substance Monitoring in the Age of the Opioid Epidemic
Controlled Substance Monitoring in the Age of the Opioid Epidemic Paul E. Hilliard, MS, MD Hospital Pain Committee Chair Department of Anesthesiology CME housekeeping I have no financial disclosures AKA,
More informationCutoff levels for hydrocodone in a blood test
Cutoff levels for hydrocodone in a blood test The premier DNA and drug testing company in the North Texas area. Specializing in legal cases but also provide testing for employers and private individuals.
More informationThe Drug Testing Process. Employer or Practice
Disclosures Clinical Professor, Jefferson Medical College BOD MROCC [Medical Review Officer Certification Council] BOD National Sleep Foundation BOD POEMS [Pennsylvania Occupational & Environmental Medicine
More informationMEDICAL POLICY No R2 DRUG TESTING
Summary of Changes MEDICAL POLICY DRUG TESTING Effective Date: April 10, 2017 Review Dates: 5/15, 5/16, 11/16, 2/17 Date Of Origin: May 13, 2015 Status: Current Clarifications: Deletions: Additions: Pg.
More informationNational Drug Early Warning System (NDEWS) Sentinel Community Site (SCS) Drug Use Patterns and Trends: SCE Narrative
National Drug Early Warning System (NDEWS) Sentinel Community Site (SCS) Drug Use Patterns and Trends: SCE Narrative The SCE Narrative is written by the Sentinel Community Epidemiologist (SCE) and provides
More informationForensic Toxicology Scope of Testing and Detection Limits
Forensic Toxicology Scope of Testing and Detection Limits Table of Contents QUALITATIVE ANALYSES... 2 Volatile Screen by GC/FID... 2 Carbon Monoxide by Microdiffusion... 2 Ethylene Glycol by GC/MS... 2
More informationLaboratory Testing to Support Pain Management: Methods, Concepts and Case Studies
Laboratory Testing to Support Pain Management: Methods, Concepts and Case Studies Frederick G. Strathmann, PhD, DABCC, (CC,TC) Medical Director, Toxicology Associate Scientific Director of MS ARUP Laboratories
More informationClinical Policy: Outpatient Testing for Drugs of Abuse Reference Number: PA.CP.MP.50
Clinical Policy: Reference Number: PA.CP.MP.50 Effective Date: 01/18 Last Review Date: 09/17 Coding Implications Revision Log Description Urine drug testing is a key diagnostic and therapeutic tool that
More informationORAL FLUID AS A CHEMICAL TEST FOR THE DRE PROGRAM : HISTORY, THE FUTURE, AND PRACTICAL CONSIDERATIONS
ORAL FLUID AS A CHEMICAL TEST FOR THE DRE PROGRAM : HISTORY, THE FUTURE, AND PRACTICAL CONSIDERATIONS Barry K Logan PhD, DABFT National Director of Forensic Services, NMS Labs Willow Grove PA Disclaimer
More informationTesting for Controlled Substances
Testing for illicit drugs Testing for Controlled Substances 1 Purposes: Employment Sports Screening medical eval. Legal Monitoring Treatment Probation Prescribing controlled substances Forensics 2 Drug
More informationProcedure for Toxicology Analysis Version 7 Toxicology Unit Effective Date: 03/14/2014 Issued by Drug Chemistry Forensic Scientist Manager
Toxicology Analysis 1.0 Purpose - This procedure specifies the required elements for analyzing toxicology submissions and reporting drug testing results. 2.0 Scope This procedure applies to all submissions
More informationValidation Report for the Neogen Fentanyl Kit for ELISA Screening of Whole Blood and Urine Specimens
Validation Report for the Neogen Fentanyl Kit for ELISA Screening of Whole Blood and Urine Specimens This document describes the validation of a Neogen Fentanyl kit for the semi-quantitative analysis of
More informationFATAL POISONINGS BY MEDICINAL OPIOIDS IN FINLAND
FATAL POISONINGS BY MEDICINAL OPIOIDS IN FINLAND ERKKI VUORI 12.-13.11.2012 HJELT INSTITUUTTI OIKEUSLÄÄKETIETEEN OSASTO FINLAND IS AN IDEAL COUNTRY FOR POST- MORTEM TOXICOLOGICAL INVESTIGATIONS High autopsy
More informationApplications of High Resolution Mass Spectrometry in Forensic Toxicology. Patrick Kyle, PhD.
Applications of High Resolution Mass Spectrometry in Forensic Toxicology Patrick Kyle, PhD pkyle@umc.edu Financial Disclosures Grant/Research Support: None Salary/Consultant Fees: None Board/Committee/Advisory
More informationProcedure for Toxicology Analysis Version 4 Toxicology Unit Effective Date: 05/10/2013. Toxicology Analysis
Toxicology Analysis 1.0 Purpose - This procedure specifies the required elements for analyzing toxicology submissions and reporting the results of the analysis. 2.0 Scope This procedure applies to all
More informationWELCOME! 12/13/2018. Today s Topic: Urine Drug Screens in OUD Treatment UW PACC
Psychiatry and Addictions Case Conference UW Medicine Psychiatry and Behavioral Sciences 12/13/2018 WELCOME! Today s Topic: Urine Drug Screens in OUD Treatment Should I test and how should I do drug testing
More information2017 Drug Screen Tests
2017 Drug Screen Tests The ABCs of Applying the CMS 2017 HCPCS Codes Written by: Karen D. Chappell, EJD, MBA, CIRCC, CPMA, CPC-I, CHC Terminology Immunoassay Qualitative Therapeutic Quantitative GC/MS
More information3703 Camino del Rio South 100-A San Diego, CA, Phone Fax CLIA# 05D Director: David J.
Drug Adherence Assessment Report Prescribed Medications: NO MEDICATION LIST PROVIDED CONSISTENT RESULTS - REPORTED MEDICATION DETECTED (PARENT DRUG AND/OR METABOLITE) REPORTED PRESCRIPTION FLAG ANTICIPATED
More informationDrug Screening: Things You Need to Know
Drug Screening: Things You Need to Know (a view inside the clinical laboratory) Gary L. Horowitz, MD Director, Clinical Chemistry, Beth Israel Deaconess Medical Center Associate Professor of Pathology,
More informationFrequently Asked Questions: Opiate Dependency and Methadone Maintenance Treatment program follow-up
Frequently Asked Questions: Opiate Dependency and Methadone Maintenance Treatment program follow-up Dr. Bhushan M. Kapur Associate Professor Department of Laboratory Medicine and Pathobiology, Faculty
More informationTest Definition: PDSOX Pain Clinic Drug Screen, Chain of Custody, Urine
Reporting Title: Pain Clinic Drug Screen, CoC, U Performing Location: Rochester Specimen Requirements: Container/Tube: Chain-of-Custody Kit (Supply T282) containing the specimen containers, seals, and
More informationUrine Drug Screening: The Essentials of Interpretation
Urine Drug Screening: The Essentials of Interpretation Loralie J Langman, PhD DABCC (CC, MD, TC), F-ABFT Director Clinical and Forensic Toxicology Laboratory, Mayo Clinic Professor, Mayo Clinic College
More information1/27/ New Release, Quest Diagnostics Nichols Institute, Valencia
NEW TESTS Please Note: Not all test codes assigned to each assay are listed in the table of contents. Please refer to the complete listing on the page numbers indicated. Test Code Test Name Effective Date
More informationLinking Opioid Treatment in Primary Care. Roxanne Lewin M.D.
Roxanne Lewin M.D. The Facts Fewer than 10 percent of individuals with an alcohol use disorder and only about 20 percent of individuals with an opioid use disorder receive specialty treatment. Many individuals
More informationOxymorphone Distribution in Biological Matrices: A Collection of Case Studies
Oxymorphone Distribution in Biological Matrices: A Collection of Case Studies Brian Simons, Forensic Toxicologist Montgomery County Coroner s Office / Miami Valley Regional Crime Laboratory May 1, 2008
More informationPain Management Drug Testing: A Laboratory Perspective
Ernest Jimenez III, M.T.(ASCP) Nothing to declare. Laboratory manager at Pharos Diagnostics, LLC., located in Tucson, AZ. Pain Management Drug Testing: A Laboratory Perspective 1 2 Pain Management Drug
More informationFentanyl Postmortem Redistribution: Preliminary Findings Regarding the Relationship Among Femoral Blood and Liver and Heart Tissue Concentrations
Fentanyl Postmortem Redistribution: Preliminary Findings Regarding the Relationship Among Femoral Blood and Liver and Heart Tissue Concentrations Kristin Luckenbill 1,2, Jonathan Thompson 3, Owen Middleton
More informationINTOXICATION DEATHS ASSOCIATED WITH DRUGS OF ABUSE OR ALCOHOL BALTIMORE, MARYLAND QUARTERLY REPORT: SECOND QUARTER, 2008
INTOXICATION DEATHS ASSOCIATED WITH DRUGS OF ABUSE OR ALCOHOL BALTIMORE, MARYLAND QUARTERLY REPORT: SECOND QUARTER, 28 A report from the Office of Epidemiology and Planning Baltimore City Health Department
More informationMedical Affairs Policy
Medical Affairs Policy Service: Urine Drug/Alcohol Screening and Testing PUM 250-0013-1803 Medical Policy Committee Approval 03/06/18 Effective Date 07/01/18 Prior Authorization Needed No Disclaimer: This
More informationClinical Policy: Outpatient Testing for Drugs of Abuse Reference Number: PA.CP.MP.50
Clinical Policy: Reference Number: PA.CP.MP.50 Effective Date: 01/18 Last Review Date: 09/18 Coding Implications Revision Log Description Urine drug testing is a key diagnostic and therapeutic tool that
More informationDrug Profiles of Apprehended Drivers in Victoria
Drug Profiles of Apprehended Drivers in Victoria J Gerostamoulos, P McCaffrey, O H. Drummer and M Odell*. Victorian Institute of Forensic Medicine, Department of Forensic Medicine, Monash University, 57-83
More informationPROJECT ECHO OPIOID USE DISORDER IN PREGNANT WOMEN
PROJECT ECHO OPIOID USE DISORDER IN PREGNANT WOMEN 1 OPIOID USE DISORDER IN WOMEN Recognition & Prevention Date: August 14 th, Time: 8 am Presenters: Deepa Nagar MD, Andria Peterson PharmD Maternal Treatment
More informationTests recently added to the NMS Labs test menu. New Tests are effective immediately.
Immediate Action In our continuing effort to provide you with the highest quality toxicology laboratory services available, we have compiled important changes regarding a number of tests we perform. Listed
More informationAlcohol. Ethanol Highlands Parkway, Suite 100 Smyrna, GA 30082
Alcohol The alcohol of interest is ethanol. Ethanol has a sedative effect in the brain. Ethanol intoxication symptoms include blurred vision, slurred speech, poor coordination and difficulty thinking depending
More informationInvestigation of Propofol in Post- Mortem and Ante-Mortem Specimens by GC/MS
Investigation of Propofol in Post- Mortem and Ante-Mortem Specimens by GC/MS Mike Frontz, Robert Rodriguez, Gary Kunsman Bexar County Medical Examiner s Office, San Antonio, TX Brad Hall, Patricia Schroeder,
More informationEffective Date: Approved by: Laboratory Executive Director, Ed Hughes (electronic signature)
1 Policy #: 803 (PLH-803-02) Effective Date: NA Reviewed Date: 4/11/2008 Subject: URINE DRUG SCREENS Approved by: Laboratory Executive Director, Ed Hughes (electronic signature) Approved by: Laboratory
More informationPain Medication Management Program Supports Patient Outcomes and Adherence
PeaceHealth Laboratories UPDATE 2015 Revised Edition Pain Medication Management Program Supports Patient Outcomes and Adherence BENEFITS Monitors analgesic medication adherence to ensure patient safety
More informationDisclosures. You're in Control or Urine Control Clinical Pearls of Drug Testing Case Studies. 9/20/17
You're in Control or Urine Control Clinical Pearls of Drug Testing Case Studies Jeffrey Fudin, BS, PharmD, FCCP, FASHP www.paindr.com Disclosures Astra Zeneca (Speakers Bureau) Collegium (Consultant) Daiichi
More informationDiscuss the recent spread of opioid misuse. Discuss the rise of the current opioid crisis, a national addiction/overdose problem
Objectives Discuss the recent spread of opioid misuse Discuss the rise of the current opioid crisis, a national addiction/overdose problem Includes medical and illicit opioids Objectives Discuss the dangers
More informationLaboratory Service Report
4 05/25/19 Client C702884-DLP ROCHESTER Amphetamines, Confirmation Positive Confirmed POSITIVE by LC-S/S for the following: Amphetamine = 52 ethamphetamine = 124 ethamphetamine exists in the d- and l-isomeric
More informationTRIM reference DD17/ Endorsed by Publication date Review date
Participant procedure: drug Procedures provide practical step by step guidance to describe processes and actions required to enable the implementation of a policy or guideline. They can also be developed
More informationUrine drug testing it s not always crystal clear
Urine drug testing it s not always crystal clear Kirk Moberg, MD, PhD, FASAM Executive Medical Director, UnityPoint Health Illinois Institute for Addiction Recovery Clinical Professor of Internal Medicine
More informationPain Medication Management Program Monitors Patient Compliance
PeaceHealth Laboratories UPDATE 2014/15 Edition Pain Medication Management Program Monitors Patient Compliance BENEFITS Monitors analgesic medication adherence to ensure patient safety and protect your
More informationA substance that reduces pain and may or may not have psychoactive properties.
GLOSSARY OF TERMS AMPHETAMINE-TYPE STIMULANTS (ATS) A group of substances, mostly synthetic, with closely related chemical structure which have, to varying degrees, a stimulating effect on the central
More informationGold Standard for Urine Drug Testin Urine Drug Testing Why U rine? Urine?
Gold Standard for Urine Drug Testing Developed by TRMC Pain Management Center Jill Duffy, RN,BC Pam Kennell, RN, BC Heidi Beisch, RN Urine Drug Testing A DIAGNOSTIC tool For an OBJECTIVE test Based on
More informationPowering Efficient Behavioral Health Care Services
Powering Efficient Behavioral Health Care Services Streamlining behavioral health care decisions through comprehensive and efficient drug monitoring Quest Diagnostics has you and your patients covered
More informationPayment Policy: Urine Specimen Validity Testing Reference Number: CC.PP.056 Product Types: ALL Effective Date: 11/01/2017 Last Review Date:
Payment Policy: Reference Number: CC.PP.056 Product Types: ALL Effective Date: 11/01/2017 Last Review Date: Coding Implications Revision Log See Important Reminder at the end of this policy for important
More informationDrug Testing Index. A comprehensive analysis of workplace drug use trends
Drug Testing Index A comprehensive analysis of workplace drug use trends Employer Solutions Annual Report Fall 2016 Table of contents Analysis Drug Positivity in U.S. Workforce Rises to Highest Level in
More informationGuidelines on Autopsy Practice: Scenario 3: Suspected illicit drugs
Guidelines on Autopsy Practice: Scenario 3: Suspected illicit drugs Updates made August 2005 1. Pathology encountered: causes of death re-ordered, with addition of chronic alcohol ketoalcoholic syndrome
More informationClearing Up The Confusion About Substance Abuse Testing
Clearing Up The Confusion About Substance Abuse Testing 2018 Indiana Safety and Health Conference and Expo Presented by Tiffany Ellefson, DISA/Midwest Toxicology Services Items to cover Latest Trends in
More informationApril 28, RE: Immediate Action test change notification. Dear Valued Client:
April 28, 2010 RE: Immediate Action test change notification Dear Valued Client: The following pages detail important information regarding a test requiring database modifications. Please be advised that
More informationIllicit Opioid and Methamphetamine Trends in Maine
Illicit Opioid and Methamphetamine Trends in Maine Marcella H. Sorg, PhD Margaret Chase Smith Policy Center University of Maine Objectives Provide an overview of the illicit opioid crisis in Maine, focusing
More informationSubstance abuse is a significant problem in the United
Interpretation and Utility of Drug of Abuse Immunoassays Lessons From Laboratory Drug Testing Surveys Stacy E. F. Melanson, MD, PhD; Leland Baskin, MD; Barbarajean Magnani, PhD, MD; Tai C. Kwong, PhD;
More informationEDUCATIONAL COMMENTARY rd TEST EVENT Chemistry Urine Drug Testing
EDUCATIONAL COMMENTARY 2003 3 rd TEST EVENT Chemistry Urine Drug Testing Educational commentary is provided through our affiliation with the American Society for Clinical Pathology (ASCP). To obtain FREE
More informationEvaluation of the Impact of Expanding ELISA Screening in DUID Investigations. Aileen Lu*, Karen S. Scott, Aya Chan-Hosokawa, and Barry K.
Evaluation of the Impact of Expanding ELISA Screening in DUID Investigations Aileen Lu*, Karen S. Scott, Aya Chan-Hosokawa, and Barry K. Logan FSF Emerging Forensic Scientist Award Oral Presentation Disclosure
More informationFlakka : The Truth Behind the Latest Designer Drug Media Storm. Donna Papsun, MS, D-ABFT-FT Forensic Toxicologist, NMS Labs
Flakka : The Truth Behind the Latest Designer Drug Media Storm Donna Papsun, MS, D-ABFT-FT Forensic Toxicologist, NMS Labs Flakka Flakka Headlines What is Flakka? Flakka = Spanish slang for thin, pretty
More informationThe Latest Prescription Trends for Controlled Prescription Drugs
The Latest Prescription Trends for Controlled Prescription Drugs September 1, 2015 Christopher M. Jones PharmD, MPH Senior Advisor Office of Public Health Strategy and Analysis Office of the Commissioner
More information3703 Camino del Rio South 100-A San Diego, CA, Phone Fax CLIA# 05D years
Drug Adherence Assessment Report CleanAssure TM (DRIED BLOOD SPOT): Detection Range see NOTES. Prescribed Medications: NO MEDICATION LIST PROVIDED CONSISTENT RESULTS - MEDICATION DETECTED (PARENT DRUG
More informationGet Your Specimens in Order: The Importance of Individualized Test Orders and Timely Test Utilization
Get Your Specimens in Order: The Importance of Individualized Test Orders and Timely Test Utilization Prepared and presented by Jennifer Bolen, JD Disclosures for Jennifer Bolen, JD Consultant - Generation
More informationDetection of Drugs-of-Abuse by Tandem Mass Spectrometry.
Detection of Drugs-of-Abuse by Tandem Mass Spectrometry. Dr Tim Laurens MSc.Chem(Pretoria), Ph.D. Chem (Pretoria), MSc.Toxicology (Surrey,UK) FRSChem, MFSSoc Email: laurensj@lancet.co.za / tim.laurens@up.ac.za
More informationAnalysis and interpretation of drug testing results from patients on chronic pain therapy: a clinical laboratory perspective
Article in press - uncorrected proof Clin Chem Lab Med 2009;47(8):971 976 2009 by Walter de Gruyter Berlin New York. DOI 10.1515/CCLM.2009.220 2009/180 Analysis and interpretation of drug testing results
More informationQuest Diagnostics Drug Testing Index Full Year 2015 Tables
Quest Diagnostics Drug Testing Index Full Year 2015 Tables Table 1. Annual Positivity Rates Urine Drug Tests (For Combined U.S. Workforce) (More than 9.5 million tests from January to December 2015) Year
More information10/9/18. Learning Objectives. Get Your Specimens in Order: The Importance of Individualized Test Orders and Timely Test Utilization
Get Your Specimens in Order: The Importance of Individualized Test Orders and Timely Test Utilization Prepared and presented by Jennifer Bolen, JD Disclosures for Jennifer Bolen, JD Consultant - Generation
More informationImplementing the 2017 President s Challenge: Primary, Secondary & Tertiary Prevention of Addiction & Substance Misuse
Implementing the 2017 President s Challenge: Primary, Secondary & Tertiary Prevention of Addiction & Substance Misuse Jay Butler, MD, President of ASTHO, Chief Medical Officer, Alaska Department of Health
More informationFentanyl and Synthetic Opioids- Awareness and the Enforcement Pillar. July-16-18
Fentanyl and Synthetic Opioids- Awareness and the Enforcement Pillar Opioid Situation-How we got here 2012 Oxycontin moves to the tamper proof version OxyNeo (Purdue Pharma) 2012/2013 Patch diversion and
More informationNeoSal Oral Fluid Collection System Solutions for Forensic Drug Detection
PERFORMANCE OF THE NEOSAL ORAL FLUID COLLECTION SYSTEM Neogen develops and manufactures a comprehensive range of ELISA test kits and accessories for forensic drug detection. Neogen offers solutions to
More informationPharmacokinetics and Disposition of UDM Comparison of Various Sources for Drug Testing: Urine, Blood, Hair, Saliva. Edward J. Cone, Ph.D.
Pharmacokinetics and Disposition of UDM Comparison of Various Sources for Drug Testing: Urine, Blood, Hair, Saliva Edward J. Cone, Ph.D. Johns Hopkins School of Medicine, Baltimore, MD & ConeChem Research,
More informationDRUG AND ALCOHOL-FREE AUC PROPERTY POLICY
DRUG AND ALCOHOL-FREE AUC PROPERTY POLICY Policy Statement In accordance with Egyptian and US law, the University has adopted a drug and alcohol-free AUC property policy. All University students are required
More informationTest Definition: PCDSO Pain Clinic Drug Screen, Urine
Reporting Title: Pain Clinic Drug Screen, U Performing Location: Rochester Specimen Requirements: Collection Container/Tube: Plastic urine container Submission Container/Tube: Plastic, 60-mL urine bottle
More informationClaire Gilbert, Tony Margetts, Gilda Nunez, Bryony Sedgwick, Tim Allison. Thanks to Hull Public Health, Prof. Marks and Paul Smith
There is something in the heroin: responding to a rise in drug related deaths and the emergence of fentanyl and carfentanil in a local illicit drug market Claire Gilbert, Tony Margetts, Gilda Nunez, Bryony
More information10/16/2017. Objectives. Drug Testing Interpretation in Addiction Care. Background. Which is Nonadherent?
Objectives Drug Testing Interpretation in Addiction Care Brandi Puet, Pharm.D. Describe the difference between immunoassay and confirmatory testing. List explanations for unexpected negative or positive
More informationToxicology aspects of SUDI. Dr Stephen Morley STH
Toxicology aspects of SUDI Dr Stephen Morley STH Epidemiology of SUDI toxicology Neonatal-placental transfer Breast milk 3 rd person administration Association between illicit drug use in pregnancy and
More informationB. To assess an individual when clinical evaluation suggests use of non-prescribed medications or illegal substances; or
Integrated Reference #: MP/D010 Page: 1 of 7 PRODUCT APPLICATION: PreferredOne Community Health Plan (PCHP) PreferredOne Administrative Services, Inc. (PAS) ERISA PreferredOne Administrative Services,
More informationYou Can t Fool the Bladder Police. Effective Use of Urine Drug Screening
You Can t Fool the Bladder Police Effective Use of Urine Drug Screening Why Test? Accountability Create and maintain safe treatment environment Compliance with licensing or policy Collection Supervised
More informationTHE ROLE OF ALCOHOL, LICIT AND ILLICIT DRUGS IN TRAFFIC IN EASTERN EUROPE
THE ROLE OF ALCOHOL, LICIT AND ILLICIT DRUGS IN TRAFFIC IN EASTERN EUROPE T. Varga 1, M. Vali 2, R. Wachowiak 3, F. Longauer 4, M. Zorec-Karlovsek 5 1. Dept. of Forensic Medicine, University of Szeged,
More informationRapid Alcohol Screening Devices. p19
CLIA-WAIVED Product Catalog RAPID DRUG SCREENING DEVICES Rapid Urine Drug Screening Devices. p5 Rapid Alcohol Screening Devices. p19 Complementary Products. p23 HELPING YOU MAKE INFORMED DECISIONS ABOUT
More informationRising Threats in the Nation s Drug Epidemic
WiFi: CWAGNM No Password Rising Threats in the Nation s Drug Epidemic Michael E. Prevoznik Senior Vice President and General Counsel Conference of Western Attorneys General Annual Meeting July 2018 2 An
More informationA Review of the Methods, Interpretation, and Limitations of the Urine Drug Screen
Section Editor: Kelly M. Smith, PharmD, BCPS, FASHP, FCCP A Review of the Methods, Interpretation, and Limitations of the Urine Drug Screen E. Claire Markway, PharmD; Stephanie N. Baker, PharmD, BCPS Abstract:
More informationClinical Policy: Outpatient Testing for Drugs of Abuse
Clinical Policy: Reference Number: CP.MP.50 Last Review Date: 07/18 See Important Reminder at the end of this policy for important regulatory and legal information. Coding Implications Revision Log Description
More informationOverview of the AACC Academy s LMPG: Using clinical laboratory tests to monitor drug therapy in pain management patients
Overview of the AACC Academy s LMPG: Using clinical laboratory tests to monitor drug therapy in pain management patients Gwen McMillin, PhD, DABCC(CC,TC) Professor, University of Utah Medical Director,
More informationNURSING INTAKE. Provider Name: Provider Signature: Nursing Summary. Are you pregnant at this time?
NURSING INTAKE Provider Name: Provider Signature: Date: Nursing Summary Are you pregnant at this time? 3 = Don t know 4 = Tubal ligation 5 = Menopause 6 = History of hysterectomy 7 = Other: 8 = N/A patient
More informationThe Utility of Urine Drug Screening
The Utility of Urine Drug Screening Treating Addiction, Saving Lives Sea Cruises Bye Tazmania, still far from New Zealand February 8 th, 2018 Mandy Manak, MD FASAM, ISAM, CSAM, MRO Medical Director, ICDO
More informationCan adderall cause a false positive on a drug test
Can adderall cause a false positive on a drug test The Borg System is 100 % Can adderall cause a false positive on a drug test If you're about to take a drug test, watch out if you are taking one of these
More informationDRUG OVERDOSE DEATHS ANALYSIS
Overview CUYAHOGA COUNTY MEDICAL EXAMINER DRUG OVERDOSE DEATHS ANALYSIS Analysis of Fentanyl-Related Overdose Deaths in Cleveland/Cuyahoga County, Ohio in 2014 April 2015 The Cuyahoga County Medical Examiner
More information