Last year, for the first time, drug overdose deaths in the US exceeded the number of motor vehicle fatalities.
and certain consequences for positive test results in treatment, prevention, highway safety, the workplace, health care, and in many other setings. Drug tests are a vital component to the America’s and the world’s future drug policy. Today, most drug tests identify a small
used all illegal drugs combined compared to 51.8% who used alcohol and 27.4% who used tobacco. Can our country’s drug policy be
improved? Yes, it can. We need to work together to ensure our drug policy keeps ahead of the rapidly evolving drug epi- demic. However, it cannot be improved by legalizing the currently illegal drugs. With legalization the root biological cause of drug abuse would be unrestrained and result in increases in addiction, violence, death and in the destruction of families and communities. If we care about our public health and our public safety, drugs of abuse must remain illegal. Effective education, testing, and treatment pro- grams are essential. Te goal of an improved drug policy
must be to reduce nonmedical drug use, what is broadly defined as “demand reduc- tion”. Drug tests are crucial to any effective effort to reduce nonmedical drug use. Demand reduction can be enhanced by far wider use of drug tests linked to swiſt
30 datia focus
number of individual drugs. For example only cocaine, PCP, marijuana, amphet- amines, MDMA, and non-synthetic opiates (morphine and codeine) are tested in the panels for the US Department of Health and Human Services (DHHS). Tere are now thousands of addicting designer and syn- thetic drugs with a virtually infinite number of new compounds waiting in the wings. Tis problem is mitigated to some extent because most people who use the newer drugs of abuse simultaneously use the most common drugs of abuse. For this reason, testing for a relatively small number of the most common drugs identifies many people who are using those rarer drugs that are not identified by routine drug panels. Tis drug use patern is changing as the nonmedical use of prescription drugs and new designer drugs increasingly replace familiar street drugs. Tis migration from older drugs to newer drugs is due to their lower cost, to the ease of obtaining them confidentially by the Internet, and to the fact that current standard drug tests fail to detect them. Te US has led the way in provid-
ing technically sophisticated and legally defensible drug testing programs for the workplace. A thoughtful process has protected the rights of medical privacy of the individuals tested by the creation of chain-of-custody procedures, high labora- tory standards, and a confidential medical review of positive laboratory test results. Tat is the foundation upon which the drug testing industry is building to meet the threat of the thousands of new drugs that will dominate the market in the future. Over the past decade drug testing has
escaped the confines of the urine cup to include testing of hair, oral fluids and sweat.
Drug testing has also escaped from the labo- ratory to include onsite rapid-result testing first in urine and more recently in oral fluids. Tese changes are just the beginning of a series of new technologies that will promote public health and safety as the epidemic of prescription and designer drugs spreads. In the future, high-risk individuals and
even ordinary citizens will not be able to start a car without triggering a sensor for the recent use of drugs and alcohol by the driver. Te future of drug tests can be seen today in the continuous monitoring of high-risk individuals with bracelets to identify and immediately report any use alcohol. One-day breath tests for drugs of abuse will be as cheap and as sensi- tive as are the breath tests now used for alcohol. Future drug tests will have the ability to distinguish between medical and nonmedical drug use because of their distinctly different paterns of drug use. Medical drug use requires relatively low and stable blood levels while nonmedical abuse of these same drugs demonstrates rapidly peaking high blood levels fol- lowed by rapid falls. Te drug tests of the future will identify when the last drug use occurred, whether that use was acute or chronic, and what the approximate blood levels were at various times in the recent past. For example, with marijuana the changing blood levels and ratios of parent THC and metabolites produce a signature of when the marijuana use occurred and what the peak blood levels were. It will be possible to select among drug
tests with varying detection windows for different applications. For example, short drug detection windows will be useful for highway or safety sensitive testing while drug tests with long detection windows will reach back for weeks or even months to identify alcohol and other drug use in zero tolerance programs. We can see that long detection window now with new emerging technologies for the detection of alcohol metabolites in hair and even fingernails.
spring 2012
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