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More War-on-Drugs Voodoo: Saliva Screening

Dr. Barry K. Logan of NM$ is working with the government pushing for random, no-reasonable suspicion traffic stops and mandatory random screening.

Although touted as a useful tool to combat drunk and drugged driving, on-the-spot saliva drug screening is a war-on-drugs development that aims to target everyone, even the innocent. While the goal is to expand the saliva test to the workplace, the schools, and the family courts and programs, the rollout will target random drivers. Rather than contribute to the decrease in impaired driving incidents, however, the practice will likely criminalize legitimate medication therapies by identifying minuscule and sub-therapeutic levels of some drugs.

This technology is being sprung onto the public ahead of any validation studies that connect a positive screening test in the field to actual impairment, but that has not stopped its premature use. House Bill 5385 in Michigan, for example, was set to force people to have this test, and this test exclusively, on demand. On Thursday, granting Michigan a temporary reprieve from this chicanery, state Rep. Mike Callton (R.MI) announced that the saliva test amendment would be dropped from the legislation based on the inaccuracy of the test. But it isn’t just about accuracy. It’s about targeting drivers randomly for non-impairment.

Drug testing ordinarily follows a two-pronged approach: a screen, and then a confirmation. Drug screening of body fluids is achieved by Enzyme Immunoassay (EIA)/Enzyme-Linked Immunosorbent Assay (ELISA), followed by confirmation, if the initial screen is positive. Confirmation takes longer and utilizes gas or liquid chromatography (typically), ie: GC/MS or LC/MS/MS, but it is more accurate and can serve to rule out false positive screens. There are limits of detection for each specified substance, and these are listed in each manufacturer’s FDA-regulated package insert; values below the detectable limits for commonly prescribed drugs are not of toxicological (or therapeutic) interest.

As the drug testing industry expands and takes on a life of its own that has little to do reality, the limits of detection are an issue. The saliva tests are not FDA approved, nor are there any clear methods or limits of detection anywhere, not to mention any connection to actual driving impairment or even any clear description of targeted parent drugs versus metabolites. There are no uniform guidelines for calibration, or specimen handling, and no algorithms exist to ensure chain of custody. The gaps between oral fluid drug detection and blood level confirmation with actual impairment are neatly filled in with “predictive toxicology.”

Furthermore, on Point of Care Testing (POC), even the Department of Transportation (NHTSA) explains that saliva tests are inaccurate:

THE FUTURE IN DETECTING DRUGS IN DRIVERS

Having an immediate drug test result obtained from a POCT-type test would permit the officer to confront the driver with the drug test result and make the DUID charge. At this time, however, only the urine based POCT technology appears to provide the accuracy and reliability required, and use of this technology is not yet widespread. With the advent of more “zero tolerance” laws, we may see the use of this technology grow. The development of sweat and oral fluid technology holds great promise for the field, but the most recent evaluations indicate that it may be a few more years before the desired sensitivity, specificity, accuracy, and reliability are attained.

That a drug test isn’t exactly proven, however, hasn’t stopped the forensics/police/prosecutor community in the past. Just a few years ago, a urine test (EtG test) to determine alcohol use was pimped as the gold standard. Many doctors, nurses and other professionals in supervised treatment programs, as well as others who were on probation or parole supervision, had to submit to this test, to determine their compliance in the supervised programs. Professional licences were revoked or people went to jail, for ‘non-compliance,’ based on the ‘gold standard’ urine alcohol test. The courts were sold.

But then, the test was deemed to be bogus:

CommunityMy FDL

More War-on-Drugs Voodoo: Saliva Screening

Dr. Barry K. Logan of NM$ is working with the government pushing for random, no-reasonable suspicion traffic stops and mandatory random screening.

Although touted as a useful tool to combat drunk and drugged driving, on-the-spot saliva drug screening is a war-on-drugs development that aims to target everyone, even the innocent. While the goal is to expand the saliva test to the workplace, the schools, and the family courts and programs, the roll-out will target random drivers. Rather than contribute to the decrease in impaired driving incidents, however, the practice will likely criminalize legitimate medication therapies by identifying minuscule and sub-therapeutic levels of some drugs.

This technology is being sprung onto the public ahead of any validation studies that connect a positive screening test in the field to actual impairment, but that has not stopped its premature use. House Bill 5385 in Michigan, for example, was set to force people to have this test, and this test exclusively, on demand. On Thursday, granting Michigan a temporary reprieve from this chicanery, state Rep. Mike Callton (R.MI) announced that the saliva test amendment would be dropped from the legislation based on the inaccuracy of the test. But it isn’t just about accuracy. It’s about targeting drivers randomly for non-impairment.

Drug testing ordinarily follows a two-pronged approach: a screen, and then a confirmation. Drug screening of body fluids is achieved by Enzyme Immunoassay (EIA)/Enzyme-Linked Immunosorbent Assay (ELISA), followed by confirmation, if the initial screen is positive. Confirmation takes longer and utilizes gas or liquid chromatography (typically), ie: GC/MS or LC/MS/MS, but it is more accurate and can serve to rule out false positive screens. There are limits of detection for each specified substance, and these are listed in each manufacturer’s FDA-regulated package insert; values below the detectable limits for commonly prescribed drugs are not of toxicological (or therapeutic) interest.

As the drug testing industry expands and takes on a life of its own that has little to do reality, the limits of detection are an issue. The saliva tests are not FDA approved, nor are there any clear methods or limits of detection anywhere, not to mention any connection to actual driving impairment or even any clear description of targeted parent drugs versus metabolites. There are no uniform guidelines for calibration, or specimen handling, and no algorithms exist to ensure chain of custody. The gaps between oral fluid drug detection and blood level confirmation with actual impairment are neatly filled in with “predictive toxicology.”

Furthermore, on Point of Care Testing (POC), even the Department of Transportation (NHTSA) explains that saliva tests are inaccurate:

THE FUTURE IN DETECTING DRUGS IN DRIVERS

Having an immediate drug test result obtained from a POCT-type test would permit the officer to confront the driver with the drug test result and make the DUID charge. At this time, however, only the urine based POCT technology appears to provide the accuracy and reliability required, and use of this technology is not yet widespread. With the advent of more “zero tolerance” laws, we may see the use of this technology grow. The development of sweat and oral fluid technology holds great promise for the field, but the most recent evaluations indicate that it may be a few more years before the desired sensitivity, specificity, accuracy, and reliability are attained.

That a drug test isn’t exactly proven, however, hasn’t stopped the forensics/police/prosecutor community in the past. Just a few years ago, a urine test (EtG test) to determine alcohol use was pimped as the gold standard. Many doctors, nurses and other professionals in supervised treatment programs, as well as others who were on probation or parole supervision, had to submit to this test, to determine their compliance in the supervised programs. Professional licences were revoked or people went to jail, for ‘non-compliance,’ based on the ‘gold standard’ urine alcohol test. The courts were sold.

But then, the test was deemed to be bogus. (more…)

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