Main description:

It is at least a decade since scientists turned their imaginations to creating new compact, portable test instruments and self-contained test kits that could be used to analyze urine and saliva for alcohol, drugs, and their metabolites. Although the potential applications for such tests at the site of specimen collection, now called "on-site" or "point-of-care" testing, range far beyond hospital emergency rooms and law enforcement needs, it was catalyzed by the requirements of workplace drug testing and other drugs-of-abuse testing programs. These programs are now a minor national industry in the United States and in some western European countries, and cover populations as diverse as the military, incarcerated criminals, people suspected of driving under the influence of alcohol and other drugs, all athletes from college to professional ranks, and of course the general employed population, which is monitored for illegal drug use and numbers in the millions. It is not surprising, then, that the need for rapid and precise tests, conducted economically by trained professionals, has become a major goal. Current government approved and peer reviewed laboratory methods for urine analysis serve present needs very well and have become remarkably robust over the past twenty years, but the logistics of testing some moving populations, such as the military, the Coast Guard, workers on off-shore oil platforms, and athletes-perhaps the most mobile of these groups-are unacceptably cumbersome.

Contents:

Chapter 1
Clinical Point-of-Care Testing for Drugs of Abuse
Jimmie L. Valentine
1 General Considerations
2 Pediatric Clinical Considerations
3 Adolescent Clinical Considerations
4 Adult Clinical Considerations
5 Physiological Considerations for Clinical Testing
6 Conclusions
References

Chapter 2:
On-Site Tests for Therapeutic Drugs
Alan H. B. Wu
1 Rationale for Therapeutic Monitoring and Need for On-Site Drug Testing
2 On-Site and Point-of-Care (POC) Drug Testing
3 Direct On-Site Testing Instruments and Devices for Therapeutic Drugs
4 Indirect On-Site Testing for Therapeutic Drugs
4.1 Monitoring of Lipid Lowering Medications
4.2 Monitoring of Antithrombotic Medications
4.2.1 Heparin
4.2.2 Oral Antithrombotic Therapy
4.2.3 On-Site Testing for Anticoagulant Drugs
5 Conclusion
References

Chapter 3:
On-Site Workplace Drug Testing
David Armbruster
1 Background
2 Conducting On-Site Workplace Drug Testing
3 The Future of On-Site Workplace Drug Testing
References

Chapter 4:
Program Requirements, Standards, and Legal Considerations for On-Site Drug Testing Devices in Workplace Testing Programs
Theodore F. Shults and Yale H. Caplan
1 Introduction
2 What Is 'On-Site' Testing from a Standards Perspective?
3 Establishing Federal Standards for On-Site Drug Testing
3.1 Drug Testing Advisory Board (DTAB)
3.1.1 Collection Site
3.1.2 Collector/Tester
3.1.3 Collection Device/Test Device
3.1.4 Specimen
3.1.5 Collection Procedure
3.1.6 On-Site Testing
3.1.7 Laboratory Testing
3.1.8 Quality Control/Quality Assurance (QC/QA)
3.1.9 Reporting
3.1.10 Medical Review Officer
3.2 The DTAB End Game
4 The Legal Requirements for Confirmatory Testing in Private Sector On-Site Testing
5 The Legal Requirements for a Medical Review Officer in Private Sector On-Site Testing
6 New Liability Risks of Drug Testing Providers and On-Site Drug Testing-Another Factor in Establishing Standards
7 Conclusion
Notes

Chapter 5:
On-Site Testing Devices in the Criminal Justice System
Leo J. Kadehjian and James Baer
1 Drug Testing in the Criminal Justice Arena
1.1 Introduction
1.2 On-Site Testing
1.3 Use of Noninstrument Drug Testing Devices
2 Legal Admissibility, Evidentiary Weight, and Due Process
2.1 Standards for Admissibility of Scientific Evidence
2.2 Cases Addressing the Use of Noninstument Drug Testing Devices
2.3 Requirements for Repeat and/or Confirmation Testing
3 Conclusions
References

Chapter 6:
On-Site Testing Devices and Driving-Under-the-Influence Cases
J. Michael Walsh
1 Introduction
2 On-Site Testing in DUI Cases
3 Summary
References

Chapter 7
Analysis of Ethanol in Saliva
Kurt M. Dubowski
1 Introduction
2 Saliva as a Specimen; Saliva Collection; Relationship of Saliva and Blood-Alchohol
2.1 Saliva Collection
2.2 Relation of Saliva-Alcohol to Alcohol in Other Body Fluids
3 Saliva-Alcohol Testing Principles and Procedures
4 Commercial Saliva-Alcohol Screening Test Devices
5 Quality Assurance
5.1Testing Personnel
6 Interpretation and Use of Results
References

Chapter 8: Analysis of Drugs in Saliva
Vina Spiehler, Dene Baldwin, and Christopher Hand
1 Roadside or On-Site Saliva Drug Testing
1.1 Introduction
1.2 Saliva Collection
1.3 Cutoff Concentrations in Saliva
1.4 Amphetamines
1.5 Benzodiazepines
1.6 Cannabinoids
1.7 Cocaine
1.8 Opiates
1.9 Conclusion
2 Cozart RapiScan Saliva Drug Test System
2.1 Introduction
2.2 Testing Principle
2.3 Quality Control
2.4 Interpretation
2.5 Performance
2.6 Adulteration