Workplace drug testing in Italy: Findings about second‐stage testing

Workplace Drug Testing (WDT) in Italy includes two levels of monitoring: a first stage concerning drug testing on urine samples and a second involving both urine and hair analysis. The second stage is performed only on workers who tested positive at the first level. We analyzed urine and hair specimens from 120 workers undergoing second‐level testing between 2009 and 2012. Eighty percent of them had tested positive for cannabinoids during the first level analysis, and 15.8% for cocaine. Both urine and hair samples were analyzed in order to find the following drugs of abuse: amphetamines, buprenorphine, cannabinoids, cocaine, ecstasy, methadone, and opiates. Urine analyses were performed by immunological screening (EMIT); urine confirmatory tests and hair analyses were performed by gas chromatography‐mass spectrometry (GC‐MS). As regards second‐stage testing on urine samples, 71.2% of workers were always negative, whereas 23.9% tested positive at least once for cannabinoids and 2.5% for cocaine. Hair analyses produced surprising results: 61.9% of hair samples tested negative, only 6.2% tested positive for cannabinoids, whereas 28.8% tested positive for cocaine. These findings confirm that second‐level surveillance of WDT, which includes hair analysis, is very effective because it highlights drug intake – sometimes heavy – that cannot be revealed only through urine analyses. The employees for whom drug addiction is proved can begin rehabilitation, while keeping their job. Eventually, our results confirmed the widespread and undeclared use of cocaine in Italy. Copyright © 2014 John Wiley & Sons, Ltd.     

A systematic investigation of forensic hair decontamination procedures and their limitations

The effectiveness of decontamination procedures used for the removal of external drug contamination in forensic hair analysis is an ongoing debate. This investigation evaluated wash methods complying with Society of Hair Testing (SoHT) guidelines and their capacity to remove cocaine (COC) and methamphetamine (MA) from artificially contaminated hair. The most effective decontamination method was determined using a systematic approach, involving (1) an initial washing solvent screen, (2) optimization of wash duration, (3) comparison of sequential wash methods, and (4) reanalysis of clinical hair samples. For analysis, hair was subjected to micro‐pulverized methanolic extraction prior to quantitation by ultra‐high performance liquid chromatography?tandem mass spectrometry (UHPLC?MS/MS). Methanol (MeOH) and 0.1 M phosphate buffer (pH 6) were the most effective organic and aqueous solvents, respectively, removing 28%–38% of COC and 16%–31% of MA. Wash durations longer than 30–60 minutes did not remove additional amounts, and a more efficient sequential wash method was subsequently developed. Despite this, the interpretation of reportable results relative to the SoHT cut‐off levels was unchanged for most clinical hair samples reanalyzed after washing by agitation for 30 minutes with MeOH. These findings highlight the inability of decontamination solvents to completely remove external COC and MA contamination from hair, including wash methods adhering to SoHT guidelines.     

External contamination of hair with cocaine: evaluation of external cocaine contamination and development of performance-testing materials

The National Laboratory Certification Program undertook an evaluation of the dynamics of external contamination of hair with cocaine (COC) while developing performance testing materials for Federal Drug-Free Workplace Programs. This characterization was necessary to develop performance materials that could evaluate the efficacy of hair testing industry's decontamination procedures. Hair locks (blonde to dark brown/black) from five different individuals were contaminated with cocaine HCl. Hair locks were then treated with a synthetic sweat solution and hygienic treatments to model real-life conditions. Hair locks were shampooed daily (Monday through Friday) for 10 weeks, and samples of the hair locks were analyzed for COC, benzoylecgonine (BE), cocaethylene (CE), and norcocaine (NCOC). Three commercial analytical laboratories analyzed samples under three protocols: no decontamination procedure, individual laboratory decontamination, or decontamination by an extended buffer procedure at RTI International. Results indicated substantial and persistent association of all four compounds with all hair types. Hair that was not decontaminated had significantly greater quantities of COC and BE than did hair that was decontaminated. The only hair samples below detection limits for all four compounds were those decontaminated 1 h after contamination. Additionally, BE/COC ratios increased significantly over the 10-week study (regardless of decontamination treatment). From 21 days postcontamination until the end of the study, the mean BE/COC ratio for all hair types exceeded 0.05, the proposed Federal Mandatory Guidelines requirement. The largest variability in results was observed for samples decontaminated by participant laboratories. This suggests that current laboratory decontamination strategies will increase variability of performance testing sample results. None of the decontamination strategies used in the study were effective at removing all contamination, and some of the contaminated hair in this study would have been reported as positive for cocaine use based on the proposed Federal Mandatory Guidelines.     

药品中核磁共振检测定性能力验证样品制备与评价结果分析

目的：评价参与药品中核磁共振检测定性能力验证实验室的检测能力。方法：制备高纯阿魏酸纯度标准物质;参照国家标准物质研制技术规范采用单因素方差分析考察样品均匀性;采用t检验考察样品分别在高温和光照下储藏7天、14天的运输稳定性,采用标准曲线法考察样品在常温放置12个月的长期稳定性;按照CNAS规定的程序实施本次能力验证。结果：阿魏酸纯度标准物质在均匀性、稳定性方面均能满足药品中核磁共振检测定性能力验证使用的要求。在13家实验室16台仪器的反馈结果中,12家15台仪器的测定结果评定为合格,1家实验室的1台仪器结果为不合格,合格率为93.75%。结论：本次能力验证可以真实地反映参试单位的检测水平,绝大多数参加能力验证的实验室具备了药品中核磁共振检测定性能力。     

药物中有效成分含量测定能力验证项目研究

为评价全球各主要国家或经济体推荐的药品检测实验室的检测能力,经亚太实验室认可组织(APLAC)的授权,上海市食品药品检验所(SIFDC)和中国合格评定国家认可委员会(CNAS)共同组织实施了该能力验证计划(APLAC T080)。参加实验室采用高效液相色谱法测定复方卡托普利中氢氯噻嗪和卡托普利的含量。实施方采用了0.3σ法对能力验证样品进行了均匀性和稳定性实验,采用Z比分数法评定了各实验室的结果。以参加实验室测定结果的稳健均值作为氢氯噻嗪和卡托普利含量的指定值,以稳健标准差作为能力验证评估标准差。在18个国家或经济体推荐的38个实验室中33个实验室按时反馈了结果,其中24个实验室结果满意;5个实验室结果可疑;4个实验室结果不满意。     

The International Interlaboratory Quality Control Program for Measurement of Antiretroviral Drugs in Plasma: a global proficiency testing program

The International Interlaboratory Quality Control Program for Measurement of Antiretroviral Drugs in Plasma was initiated in 1999 by Radboud University Nijmegen Medical Center, The Netherlands, and continued later on in collaboration with the Dutch Association for Quality Assessment in Therapeutic Drug Monitoring and Clinical Toxicology (www.kkgt.nl). The aim of this analysis was to evaluate the first 10 years of the Program and to determine variables associated with reporting of less accurate results. Two rounds are organized annually in which blind samples are shipped to participants containing a low, medium, or high concentration of each antiretroviral drug. Any reported result that deviates more than 20% from the spiked concentration is defined as inaccurate. By the end of 2009, the number of laboratories participating in the Program had increased to 56; 44 (79%) are located in Europe. A total of 12,798 test results was available for analysis, of which 2104 (16.4%) were reported as inaccurate. Performance was best for samples containing nevirapine (mean of inadequate scores per round: 11.1%) and lopinavir (11.9%) and worst for indinavir (18.7%), atazanavir (18.9%), saquinavir (19.6%), and nelfinavir (21.3%). High and medium concentrations were less frequently reported as inaccurate than low concentrations: 13.5%, 13.0%, and 22.4%, respectively. Although the overall performance of the laboratories varied per year, a trend was visible for improvement over time with 19.9% of the results being inaccurate in 2002 (n = 20 laboratories) to 15.7% in 2009 (n = 56 laboratories). The Program provides a proficiency testing program in which laboratories are alerted to potential analytical errors while performing therapeutic drug monitoring in HIV-infected patients. Laboratories should put more effort in adequately analyzing concentrations of antiretroviral drugs with low minimum effective concentrations.     

California Association of Toxicologists proficiency testing program.

A proficiency testing program that has been conducted by the California Association of Toxicologists for 10 years is described. The purpose of the program is to allow each participant the opportunity to evaluate their methodology and efficiency on a qualitative as well as quantitative basis with other laboratories in the organization. The program is conducted entirely on a volunteer basis with the sample prepared by a different member each time. The selection of drugs for inclusion in the sample, the preparation and distribution, and the collation and dissemination of the results are discussed. An evaluation of all aspects of the program is presented.     

Workplace drug testing in Italy – critical considerations

Workplace drug testing (WDT) was established in Italy on 30 October 2007. Two tiers of survey are required: the first tier concerns drug testing on urine samples, the second involves both urine and hair analysis. Between July 2008 and December 2011, 10 598 workers’ urine samples and 72 hair samples for opiates, cocaine, cannabinoids, amphetamines, methylenedioxyamphetamines, methadone, and buprenorphine were tested in our laboratory. Urine analyses were performed by immunological screening (EMIT); hair analysis and confirmation tests in urine were performed by gas chromatography–mass spectrometry (GC‐MS). Employees tested positive in urine for drugs of abuse numbered 2.8% in 2008, 2.03% in 2009, 1.62% in 2010, and 1.43% in 2011. As regards the second level of analysis, we observed that only one‐third of the workers who had been tested positive for drugs of abuse were referred to an Addiction Treatment Unit in order to verify drug addiction. Our experience shows that, four years after approval of the law on WDT, the percentage of workers positive for drugs of abuse in urine has reduced in comparison to the first year. Moreover, our data show that most of the times employees who tested positive are tardily referred or not referred at all to a Public Addiction Treatment Unit to verify drug addiction. This makes us believe that the legal provisions are widely disregarded not paying the right tribute to the fact that Italy is one of few European countries with legislation on WDT. Copyright © 2013 John Wiley & Sons, Ltd.     

Comparison of patterns of drug levels in head and body hair for medico-legal and workplace testing

This paper presents concentration ranges and positivity rates for the common drugs, alcohol markers, new psychoactive substances (NPS) and anabolic steroids tested in head hair (n = 138,352) and body hair (n = 9532) on samples of hair from medico-legal (n = 112,033) and workplace (n = 35,851) sectors tested in our laboratory. Statistically significant higher levels were found more often in the various types of body hair when compared with head hair, but fewer cases exhibited lower levels. For example, statistically significant higher levels were detected in leg hair for cannabinol, THC, methadone and EtG and in beard hair for THC, THC-COOH and 6-acetylmorphine. In contrast, significantly lower levels were detected in axilla hair for cannabinol, THC and for EDDP, but median levels of mephedrone and DHEA were higher. Overall, higher medium levels were detected in head hair samples tested in the UK when compared with those previously published for samples tested in Germany, indicating geographical differences in drug consumption. Recommendations are, firstly, that hair testing laboratories use the results of their own compiled previous positive results for guidance when interpreting hair testing results and, secondly, that laboratories periodically share and combine their accumulated data with other testing laboratories. The latter could be used to establish reference ranges associated with specific technical procedures which would improve interlaboratory comparability and improve laboratory testing services when interpreting hair testing results.     

Quantitative analysis of cocaine in human hair by HPLC with fluorescence detection

Cocaine is currently one of the most widespread abuse drugs in the world. Since hair cocaine concentrations are a reliable marker of exposition to the drug, an original liquid chromatographic method has been developed for the determination of cocaine in human hair. The chromatographic analysis was carried out on a Hydro-RP C18 column, using a mobile phase containing a phosphate buffer (pH 3.0)-acetonitrile-methanol (75:15:10, v/v/v). Native cocaine fluorescence was monitored at 315nm while exciting at 230nm. Mirtazapine was used as the internal standard. Sample pre-treatment was carried out by incubative extraction with 0.1M HCl followed by solid-phase extraction with C2 cartridges. Good linearity was obtained over a working range of 0.3-100.0ng/mg. Both extraction yield (>89%) and precision values (R.S.D.<6.2%) were highly satisfactory. The method was successfully applied to hair samples collected from cocaine users. Thus, the method is suitable for the long-term monitoring of cocaine use by means of hair testing.     

抗生素HPLC含量测定能力验证研究

目的 了解和评价参加实验室采用HPLC法进行抗生素含量测定的能力。方法 按照CNAS-GL03:2018《能力验证样品均匀性和稳定性评价指南》规定的方法进行均匀性检验和稳定性检验。以z比分数作为统计量对参加实验室的检测结果进行评价,算法为稳健统计方法,选择全部参加实验室上报结果的中位值作为指定值、标准化四分位距作为能力评定标准差。结果及结论 能力验证样品的均匀性和稳定性均符合要求。在142家参加实验室中,123家实验室的检测结果评定为“满意”,满意率为86.6%;14家实验室的检测结果评定为“可疑”,可疑率为9.9%;5家实验室的检测结果评定为“不满意”,不满意率为3.5%。     

抗生素HPLC含量测定能力验证研究

目的 了解和评价参加实验室采用HPLC法进行抗生素含量测定的能力。方法 按照CNAS-GL03:2018《能力验证样品均匀性和稳定性评价指南》规定的方法进行均匀性检验和稳定性检验。以z比分数作为统计量对参加实验室的检测结果进行评价,算法为稳健统计方法,选择全部参加实验室上报结果的中位值作为指定值、标准化四分位距作为能力评定标准差。结果及结论 能力验证样品的均匀性和稳定性均符合要求。在142家参加实验室中,123家实验室的检测结果评定为“满意”,满意率为86.6%;14家实验室的检测结果评定为“可疑”,可疑率为9.9%;5家实验室的检测结果评定为“不满意”,不满意率为3.5%。     

Hair testing for cocaine and metabolites by GC/MS: criteria to quantitatively assess cocaine use

A simple, rapid and sensitive method has been developed and validated for the determination of cocaine and its main metabolites (benzoylecgonine and cocaethylene) in human hair. The method involved solid‐phase extraction with an Oasis HLB extraction cartridge and subsequent analysis by GC/MS. The limit of detection was 0.01 ng mg^?1 for cocaine, 0.04 for benzoylecgonine and 0.03 for cocaethylene. The method validation included linearity (with a correlation coefficient >0.99 over the range 0.2–50 ng mg^?1), intra‐ and inter‐day precision (always lower than 12%) and accuracy (mean relative error always below 17%) to meet the bioanalytical acceptance criteria. The procedure was further applied to 40 hair samples from self‐reported cocaine users arrested by the police who provided a positive urine‐analysis for cocaine, and was demonstrated to be suitable for its application in forensic toxicology. New approaches were raised to detect false‐negative results that allow a better interpretation of hair testing results. Copyright © 2012 John Wiley & Sons, Ltd.     

Workplace drug testing (WDT) likely to increase in Europe

Will it take a series of drug-related accidents that have already occurred in the USA before workplace drug testing (WDT) becomes accepted in Europe as a preventive measure? Currently, the development of WDT in most European countries lags some 10–15?years behind that in the USA. – Labour authorities in Europe now ought to take initiatives to demand a mandatory programme for accrediting drug analytical laboratories for WDT. – Companies should realise that illicit drug use is no longer only a problem at street corners, and that having a testing system in place is important, not just for public health, but also for their reputations as responsible societal actors. – Improved networking among police and regulatory authorities is required to keep pace with the rapid appearance and dissemination of new substances of abuse. – European research collaboration, including the newly formed European Workplace Drug Testing Group, is needed to assess the impact of drug-testing policies on accidents and other outcome variables, and thereby to convince the general public and politicians that drug testing is beneficial and necessary. – A 1993–1994 survey of quality analysis in some 200 European laboratories reported from Institut Municipal d'Investigació Mèdica (IMIM), Spain, showed good agreement between nominal and found concentrations but that only 10% of the laboratories could both screen, identify and quantify samples. – Experiences from Italy show that proficiency testing schemes lead to improved accuracy of results. These were some major conclusions of the First European Symposium on Drug Testing held at Huddinge University Hospital in Stockholm, Sweden, 30 March to 1 April 1998, organised by Karolinska Institute, with participants from 22 countries.     

化妆品中地塞米松检测能力验证研究

目的：设计组织化妆品中地塞米松测定能力验证项目,评价实验室检测化妆品中地塞米松的技术能力和水平,促进各参加实验室对该类测试项目检测能力的提高。方法：通过实施能力验证计划,获得各参加实验室化妆品中地塞米松含量的测定结果,对结果进行稳健统计分析,通过Z比分数评价实验室检测能力。结果：样品通过分析,在P<0.05显著水平,制备的300瓶样品均匀性符合要求且在整个计划周期内保持稳定,满足能力验证计划要求。40家参加能力验证的实验室中39家结果为满意结果,满意率为97.5%。结论：多数参加实验室检测能力评价为满意,表明化妆品中地塞米松检测水平总体良好。实验操作误差是造成个别实验室结果离群的主要原因。     

Qualitative and Quantitative Detection of Botulinum Neurotoxins from Complex Matrices: Results of the First International Proficiency Test

In the framework of the EU project EQuATox, a first international proficiency test (PT) on the detection and quantification of botulinum neurotoxins (BoNT) was conducted. Sample materials included BoNT serotypes A, B and E spiked into buffer, milk, meat extract and serum. Different methods were applied by the participants combining different principles of detection, identification and quantification. Based on qualitative assays, 95% of all results reported were correct. Successful strategies for BoNT detection were based on a combination of complementary immunological, MS-based and functional methods or on suitable functional in vivo/in vitro approaches (mouse bioassay, hemidiaphragm assay and Endopep-MS assay). Quantification of BoNT/A, BoNT/B and BoNT/E was performed by 48% of participating laboratories. It turned out that precise quantification of BoNT was difficult, resulting in a substantial scatter of quantitative data. This was especially true for results obtained by the mouse bioassay which is currently considered as “gold standard” for BoNT detection. The results clearly demonstrate the urgent need for certified BoNT reference materials and the development of methods replacing animal testing. In this context, the BoNT PT provided the valuable information that both the Endopep-MS assay and the hemidiaphragm assay delivered quantitative results superior to the mouse bioassay.     

Hair as a biological indicator of drug use, drug abuse or chronic exposure to environmental toxicants

In recent years hair has become a fundamental biological specimen, alternative to the usual samples blood and urine, for drug testing in the fields of forensic toxicology, clinical toxicology and clinical chemistry. Moreover, hair-testing is now extensively used in workplace testing, as well as, on legal cases, historical research etc. This article reviews methodological and practical issues related to the application of hair as a biological indicator of drug use/abuse or of chronic exposure to environmental toxicants. Hair structure and the mechanisms of drug incorporation into it are commented. The usual preparation and extraction methods as well as the analytical techniques of hair samples are presented and commented on. The outcomes of hair analysis have been reviewed for the following categories: drugs of abuse (opiates, cocaine and related, amphetamines, cannabinoids), benzodiazepines, prescribed drugs, pesticides and organic pollutants, doping agents and other drugs or substances. Finally, the specific purpose of the hair testing is discussed along with the interpretation of hair analysis results regarding the limitations of the applied procedures.     

Comparison of urine and hair testing for drugs of abuse in the control of abstinence in driver's license re-granting

The purpose of the study was to compare the detection rate of illicit drugs in urine and hair specimens. The samples were taken from subjects trying to regain their revoked driver's license after a drug- or alcohol-related traffic offence. In 2010, we screened 14 000 urine and 3900 hair samples for amphetamines, methamphetamines, cannabinoids, cocaine, opiates, methadone, and benzodiazepines as well as for ethylglucuronide. We used the low threshold values of the new German guidelines for Medical Psychological Assessment (MPA). Positive screening tests were confirmed with gas chromatography-mass spectrometry (GC-MS), gas chromatography-tandem mass spectrometry (GC-MS/MS) or liquid chromatography-tandem mass spectrometry (LC-MS/MS). The results show that positivity rates for methamphetamines, MDMA, cocaine, and monoacetylmorphine were 1.7-, 5.7-, 3.8- and 9.3-fold higher in hair than in urine. In contrast, the detection rate for benzodiazepines was higher in urine than in hair (oxazepam, 0.21% versus 0%, nordiazepam 0.10% versus 0.03%). The positivity rate in hair for ethylglucuronide was 6-fold (12.7%) that for urine testing (2.1%). The study reveals that in the control of abstinence in the context of driving license re-granting there are in part large differences of positivity rates for some drugs or metabolites between hair and urine samples. These differences should be kept in mind by physicians and psychologists in traffic medicine who are ordering the drug testing.     

Drugs of abuse in maternal hair and paired neonatal meconium: an objective assessment of foetal exposure to gestational consumption

In a prospective sample of 80 mother‐infant dyads, we investigated whether drugs of abuse in maternal hair measured during the pregnancy trimesters were also present in neonatal meconium. Principal drugs of abuse were analyzed in the three consecutive maternal hair segments and meconium samples by ultra‐performance liquid chromatography tandem mass spectrometry assay. Of the 80 mothers, 32 (40%) presented one or more hair shafts with at least one of the analyzed drugs of abuse and/or its metabolites. The drug of abuse with a higher prevalence in our study population was methamphetamine: 19 mothers had methamphetamine in one or more hair segments (59.4%). The second most detected drug of abuse was cocaine; nine mothers presented cocaine in one or more hair segments (28.1%). Nineteen pregnant women consumed at least one drug of abuse during the first trimester, ten continued consuming drugs of abuse during the second trimester; and nine consumed until the end of pregnancy. Five of the nine newborns from mothers who consumed drugs during the whole pregnancy showed drugs of abuse in meconium samples. Newborns from the 23 remaining mothers with one or two hair shafts positive to drugs of abuse did not present drugs in their meconium. Indeed from these results, it seems that discontinuous and/or sporadic consumption during pregnancy could produce a negligible transplacental passage and hence negative results in meconium. Furthermore, the role of placenta in the metabolism and excretion of drugs of abuse is still to be precisely investigated. Copyright © 2015 John Wiley & Sons, Ltd.     

Simultaneous quantification of THC‐COOH,OH‐THC,and further cannabinoids in human hair by gas chromatography–tandem mass spectrometry with electron ionization applying automated sample preparation

The detection of Δ⁹‐tetrahydrocannabinol (THC), cannabidiol (CBD) and cannabinol (CBN) in hair, for the purpose of identifying cannabis consumption, is conducted in many forensic laboratories. Since external contamination of hair with these cannabis components cannot be excluded, even after hair decontamination, only the detection of THC metabolites such as 11‐nor‐9‐carboxy‐Δ⁹‐tetrahydrocannabinol (THC‐COOH) or 11‐hydroxy‐Δ⁹‐tetrahydrocannabinol (OH‐THC), is considered to prove cannabis consumption. At present, testing for THC metabolites is not standard practice due to its analytical complexity. For these reasons, we developed a novel method for the detection of THC‐COOH and OH‐THC as well as THC, CBD, and CBN in one single analytical run using gas chromatography–tandem mass spectrometry (GC–MS/MS) with electron ionization. After manual hair washing and grinding, sample preparation was fully automated, by means of a robotic autosampler. The hair extraction took place by digestion with sodium hydroxide. A solid‐phase extraction (SPE) was chosen for sample clean‐up, using a mixed‐mode anion exchange sorbent. Derivatization of all analytes was by silylation. The method has been fully validated according to guidelines of the Society of Toxicological and Forensic Chemistry (GTFCh), with a limit of detection (LOD) of 0.2 pg/mg for THC‐COOH and OH‐THC and 2 pg/mg for THC, CBD and CBN, respectively, thus fulfilling the Society of Hair Testing (SoHT) recommendations. The validated method has been successfully applied to our routine forensic case work and a summary of data from authentic hair samples is given, as well as data from proficiency tests.