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Medical Review Officer• Licensed physician•“Expert in drug and alcohol testing and theapplication of federal regulations to the process.”• Consultant• Business, industry, labor, government oracademia• Relating to prevention, detection and controlof drug abuse in the workplace
Drug Abuse Testing• Strict, invariable procedures, federally mandated (DOT)• Certified lab, separate from all other testing• MRO interpretation required• COAT-PE• ‘SAMHSA 5’ - cocaine, opioids, amphetamine, THC,PCP• ETOH breath testing• Screening, then confirmatory if + by cutoffs
Page 2 and 3:
Special Thanks!• Howard Greller
Page 4 and 5:
Laboratories• Clinical Laboratory
Page 7 and 8:
Magic Answer Box?• Low volume, of
Page 9 and 10:
Assay Methods• Spot & spectrochem
Page 11:
Testing“You’re fired, Jack. The
Page 14 and 15:
Spectrochemical• Sophisticated sp
Page 16 and 17:
Spectrochemical• Older tests wait
Page 18 and 19:
Spectrochemical• Improve Selectiv
Page 20 and 21:
Immunoassays• Non-competitive•
Page 26:
Competitive“Inverse” assay
Page 30 and 31:
Immunoassays• Nonisotopic immunoa
Page 32 and 33:
EMITGoldfranks 9th edition
Page 34 and 35: ChromatographySeparation and Detect
Page 36 and 37: Thin LayerChromatography• Extract
Page 38 and 39: Thin LayerChromatography• Fast, e
Page 40 and 41: High-PerformanceLiquid Chromatograp
Page 42 and 43: High-PerformanceLiquid Chromatograp
Page 44 and 45: Gas Chromatography• Similar to HP
Page 46 and 47: Gas Chromatography• Substances ha
Page 48 and 49: Mass Spectrometry
Page 50 and 51: LC/MS/MS• High sensitivity and sp
Page 52 and 53: Relative ComparisonMethod Speed Cos
Page 54 and 55: Drug Screens
Page 56 and 57: Cocaine• Highly specific• Benzo
Page 58 and 59: The “second handsmoking” defens
Page 60 and 61: Opioids• Morphine, codeine,heroin
Page 62 and 63: ChallengesDextromethorphan• Dextr
Page 64 and 65: PCP• Phencyclidine• False Posit
Page 66 and 67: Amphetamines• Amphetamine assay p
Page 68 and 69: TCA Challenges• Cross react with
Page 70 and 71: Adulteration• 2004: First mandato
Page 72 and 73: In Vivo Adulteration“Ingest prior
Page 74 and 75: In Vitro Adulteration“Add after u
Page 76 and 77: Urine SubstitutionOntario Smith
Page 78 and 79: CholinesterasesButrylcholinesterase
Page 80 and 81: Anion Gap ReliabilityLow Anion Gap
Page 82 and 83: Forensics• Aid medical / legal in
Page 86 and 87: Post MortemToxicology
Page 88 and 89: Specimens• Blood• Reported as
Page 90 and 91: Other sources
Page 92 and 93: Legal Ethanol
Page 94 and 95: The Barman’s Paradox• Legally d
Page 96 and 97: The Clues1. Wide turns2. Straddling
Page 98 and 99: What’s in a Drink?• 10 oz beer
Page 100 and 101: • Specific gravity 0.8 g/ml• Vd
Page 102 and 103: “Breathanol”• [expired air] s
Page 104: Photo References1. http://www.offth
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