• Alcohol and Drugs? • 5-Drugs of Abuse Tests

Douglas E. Lewis1, Guida Brown2, Irene Shu1, and Joseph Jones1 1United States Drug Testing Laboratories, Des Plaines, IL, United States 2Hope Council, Kenosha, WI, United States

The Use of Fingernail Drug Screening in Multiple Convicted OWI Offenders in Kenosha County, WI

ABSTRACT Aim: Kenosha County has been piloting the use of direct alcohol biomarkers, dried blood spot phosphatidylethanol (PEth) and fingernail ethyl glucuronide (EtG), as part of its evaluation process for multiple convicted operating while intoxicated (OWI) offenders. In addition to the alcohol biomarkers, selected subject on initial evaluation also had a five drug panel fingernail drug analysis performed to identify those individuals that had a history of binge use of one or more of these common classes of drugs of abuse.

Methods: Beginning in 2011 as part of a Kenosha Country pilot program, all three or more conviction offenders received as part of their initial evaluation a DBS PEth and a fingernail EtG. Depending on the initial evaluation, selected subjects were also tested for a five-drug panel in fingernail. Specimens were collected by the subjects themselves under the direct observation of the evaluator. Laboratory testing utilized the proposed SAMSHA hair and nails screening and confirmation cut-offs as proposed in the Federal Register Vol. 69, No. 71 (Tuesday, April 13, 2014/ Notices.)

Results: 255 subjects met the criteria of three or more OWI convictions, and all were required to undergo PEth and/or EtG testing. 235 of the subjects submitted DBS PEth tests, and 206 submitted fingernail EtG tests. Only 114 of the subjects were required to submit a 5-drug panel on fingernails upon assessment. Number of drug-positive samples was 2, 14, 16, 15, and 0 for amphetamines, opiates, cocaine, cannabinoid, and phencyclidine, respectively.

Conclusions: This survey gave us an insight into the potential drugs that this particular population uses. We had no empirical evidence to hypothesize as to the extent of the illicit and prescription drug that this population might be using at the time of their arrival at evaluation. Solely relying on self-report of drug use history may be inaccurate. On the other hand, we believe that this study also under-reports the actual drug use since it was limited to only a 5-drug panel. A more extended drug-testing panel including prescription opioids may have unmasked more use and would be advised for future studies.

INTRODUCTION METHODS

• WI state DOT1: o Highest rate of drunken driving in the nation o As of 12/31/2012, 79,272 had three or more OWI

convictions in WI state

• Multiple convicted offenders may have a history of binge use of alcohol or drugs-of-abuse

• Long-term alcohol biomarkers and drugs present in fingernail are indicative of substance binges.

• DBS PEth

o Detection window: ~28 Days o Efficient for detecting binge alcohol drinking2

• Fingernail EtG and drugs

o Detection window in nail: 3-6 months o Detectable in one week after alcohol or drug use o Nail results are less variable than hair results3

RESULTS

Phospholipids Phospholipase D Phosphatidylethanol

(PEth) Ethanol

Dried Blood Spot (DBS)

Ethanol Glucuronidation Ethyl Glucuronide (EtG)

DISCUSSIONS and CONCLUSION • Long-term alcohol biomarkers may imply the multiple convicted OWI offenders’ history of

alcohol-binging behavior.

• 59.1% of the tested subjects were positive for alcohol biomarker(s), suggesting that they continued to binge after their last OWI arrest by the time of DSP evaluation.

• Only 35.1% of subjects tested for 5-drugs-of-abuse in fingernail were positive; cocaine, THC, and opiates were the most prominent drug classes.

• Prevalence of illicit-drug use was higher in the binge-drinker population.

• More extensive drug test panel including prescription opioids is warranted in the pilot program.

• Alcohol Biomarker Tests

800.235.2367 • www.USDTL.com 1700 S. Mt. Prospect Road • Des Plaines, IL • 60018

• Alcohol Biomarkers: • Nail 5-Drug (SAMSHA cutoff): DBS PEth (≥20ng/mL) Nail EtG (≥20pg/mg)

Amphetamines Opiates Cocaine Cannabinoid (THC) Phencyclidine (PCP)

235 DBS PEth 206

Nail EtG

114 Nail

5-DOA

• Kenosha County, WI (Hope Council) enrolled multiple OWI conviction offenders (≥3 times) in Drivers Safety Plan (DSP), which includes biomarker testing of substance uses.

• Total of 255 subjects were included in the pilot program since 2011.

• Subjects collected the specimens themselves under direct observation for the following testing (see right for the number of tests submitted):

DBS PEth Only

Nail EtG Only

PEth/EtG Combined

*Filled: positive *Empty: negative

115 (48.9%)

120 (51.1%) 110

(53.4%) 96 (46.6%)

149 (59.1%)

103 (40.9%)

*40 (35.1%) tested positive for one or more drug classes

AMP OPI COC THC PCP

2

12

16 15

0

Drug(s) + Drugs –

Positive PEth and/or EtG

Negative PEth and EtG

REFERENCES 1. Wisconsin Department of Transportation Safety &

Consumer Protection website (last modified April 29th, 2014)

2. G. Viel, et al., Int. J. Mol. Sci., 2012, 13, 14788. 3. J. Jones, et al., Am. J. Anal. Chem., 2012, 3, 83.

GRANT SUPPORT Part of the testing was funded through NIAAA 1R43AA016463-02.

CONFLICT OF INTEREST The authors have no financial relationships that related to the topic of this presentation.

CONTACT US: 262.658.8166 • www.HopeCouncil.org 5942 6th Avenue • Kenosha, WI • 53140