SOFT 2004 Meeting Abstracts - Society of Forensic Toxicologists

F26
TESTING MEDICAL PROFESSIONALS FOR AN EXPANDED MENU OF DRUGS-
PRELIMINARY SUMMARY OF POSITIVE FINDINGS
Matthew McMullin* and Anthony Costantino. National Medical Services, Willow Grove, PA, USA.
A
Testing medical professional for drugs of abuse presents a challenge because of their access to drugs of
choice that are not included in the scope of most drug testing menus. To assist substance abuse recovery
programs, designed to allow medical professionals to continue to practice in their field of expertise, we
developed an expanded menu of analytes that includes many of the known abuse drugs encountered in the
medical professional population. The positive results data was summarized in three drug groups: Group I
includes those analytes contained in a SAMHSA regulated test menu; Group 2 includes additional opiates
and amphetamine like compounds not covered in the SAMHSA scope, benzodiazepines, propoxyphene,
barbiturates, and methadone; Group 3 includes (cut-off concentration in nglmL) nor-alfentanil (0.5),
butorphanol (20), nor-fentanyl (0.5), ketamine (100), MDMA (200), nor-meperidine (200), nalbuphine (8),
nor-sufentanil (0.5) and tramadol (500). Group 1 and 2 analytes were screened by EMIT while group 3
analytes are screened by LCIMSIMS. All screens were confirmed by either GCIMS or an alternate
LCIMSIMS procedure. The confirmation menus were extensive with low concentration cut-offs. Ethanol
and ethyl glucuronide were not included in this study.
A total of 5,817 samples from medical professionals were tested for group I and 2 drugs. The number of
positive drugs findings for the SAMHSA drugs include in group I was 100, with amphetamine at 56 and
opiates at 34 representing most of the positive findings. With the group 2 drugs there were an additional
386 positive drug findings with 193 benzodiazepines findings and the expanded opiates panel (excluding
morphine and codeine) accounting for 134 of the positive findings. A total of 4,043 samples were tested
for group 3 analytes, and there were 186 positive drug findings. Tramadol, meperidine, and nalbuphine
were the most frequently reported positive findings in the group 3 drugs, accounted for 120, 30 and 14,
respectively.
Drug Groupings
Positive Drug Findings!
Drug Group
Cumulative Positive
Drug Findings
(Group 1) SAMHSA Drugs 100 of 5817 samples 100
(Group 2) expanded EMIT panels 386 of 5817 samples 486
i
. (Group 3) LCMSMS panel
i
207 of4043 samples 693
These preliminary finding support the use of expanded testing menus when testing medical professionals
who are in drug recovery programs. Caution must be used when interpreting these findings since some
positive findings were listed as prescribed medications.
Keywords: medical professional, positive-rate, LCIMSIMS.
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