It used to be that drug testing was a no-brainer. Just use the cup, test it and you're through. But today, substance abuse detection has taken on a whole new level of analysis and technology. That means agencies can receive more accurate results by using a variety of methods, but they also need to pay close attention to detail in order to choose the right testing device.

Corrections agencies should carefully consider which drugs they test for most often, research the methods work best for detecting those drugs and understand the usage windows that each device reads.

"Each specimen provides a different set of information," said J. Michael Walsh to attendees at the Innovative Technologies for Community Corrections conference in Boston last week.

The conference, which was hosted by the National Law Enforcement and Corrections Technology Center, provided workshops on a variety of community corrections-related technologies from drug testing devices to electronic monitoring programs.

Walsh, whose firm The Walsh Group conducted an evaluation of oral fluid testing devices for the federal government, said it is important for users of these devices to keep abreast of the changes in technology to be able to get what they need.

"The technology is evolving rapidly. We have seen significant improvements [in performance of these devices]. There's every reason to be optimistic," he said.

The testing devices on the market today measure traces of drugs in blood, saliva, urine, hair and sweat. Blood and saliva or oral fluid testing measure the presence of drugs only after they enter the blood stream; urine detection also requires a drug to enter the system; detection by sweat is more delayed as the substance must be absorbed by the system and then exit through perspiration; and hair testing measure deposits of substances from the system and, to some extent, by the environment.

All these variables, combined with differing time periods for maximum detection, require agencies need to also consider why they are testing, how often they need to test, what windows of detection they need and where they are testing.

"If you are seeing offenders quarterly, monthly or weekly, it may shift your choice," said Walsh.

Understanding Testing Technologies' Capabilities

The characteristics of drug testing devices are important to grasp as agencies evaluate the right product for their use.

Hair

Hair testing, which is typically done by a laboratory, has the capability of revealing drug use from weeks to months in the past. It provides a longer window for detection and can pinpoint usage to certain weeks, possibly even days, depending on hair length and analysis.

The downsides to hair testing are that it cannot detect very recent use as the substance takes about a week to grow into the hair shaft from the scalp.  In addition, some research has shown that drugs can be detected on a hair shaft from contact with an environment, such as smoke from marijuana. However, analysis of the hair shows these drug substances differently. Drugs from the environment would be located on the outer shaft and hair from within a person's system would be shown on the inner hair shaft. In addition, some studies have shown a hair color bias with detection of certain drugs. For example, black hair tends to bind certain drugs more easily than blond hair. Bleaching of the hair can also alter drug detection.

Oral Fluid

Oral fluid testing detects drug use through the saliva typically from a device with a pad that is swiped inside the mouth.  These tests can be done both in a laboratory and onsite, such as at a roadside stop.

The benefits to this type of testing are that it is quick and less invasive. It also detects drug usage from only a few hours before the test is administered. Concerns about these tests include that it is difficult to get a good specimen, as the oral swab has to obtain a certain amount of fluid from the mouth. This means that a confirmation test is recommended, such as with a urine test.  Also, some drugs, such as marijuana, are not detected as readily by this means.

Sweat

Sweat patch tests detect drug levels emitted from the sweat glands and the patches are typically left on a person's skin for a period of time.

This type of test is non-invasive and tampering with a sweat patch is identifiable. Concerns are that skin contamination can show up in the sweat patch if the skin is not cleaned properly before application. In addition, some drugs such as cocaine have been detected at higher levels in a sweat patch than in urine testing for the same individual. Other substances, such as marijuana, do not have a high detection rate.

Pupillometry

Eye monitors can be used to detect drug use by comparing a person's pupil to a recorded baseline reading.

When using these devices, tests record the starting or resting pupil, pupil size, response to flashlight, and saccadic velocity, which measures how fast a pupil tracks from one position to another. Changes in these parameters can indicate drug use, which can be confirmed by another type of drug test.

In addition to understanding the capabilities of these testing devices, practitioners also should consider performance of the different devices in comparison to each other. The Walsh Group has conducted a study comparing detection rates for different substances among a group of oral fluid testing technologies.

Oral Fluid Technology Comparison

As part of a grant from the federal Office of Drug Control Policy, The Walsh Group conducted a study looking closely at oral fluid testing devices and how well they work. The advantages to using them, according to Walsh, include the correlation between drug concentration in oral fluid and use as well as detection of very recent usage. Disadvantages include the possibility of contamination of oral fluid by the inhalation of certain drugs.

The study considered the performance of several devices that are on the market: Branan Medical's Oratect, Varian's (formerly Ansys) OraLab, Securetec's Drugwipe, Ultimed's SalivaScreen, Orasure's Uplink and Cozart's RapiScan.

The devices detect up to five or six drugs or more. Several of the devices use a pad detector while others use a pipette and test tube.

In the performance measurement, The Walsh Group considered detection cutoffs claimed by the manufacturers as well as recent recommended cutoff levels by the Substance Abuse and Mental Health Services Administration (SAMSHA). These cutoffs are indicative of the amount of drug required in a sample for each device to provide a reading.

The devices were tested 10 times at each cutoff level, which ranges from low to medium to high and the SAMSHA levels.

According to Walsh, who presented the study's findings at the Innovative Technologies in Community Corrections conference, with methamphetamines, most of the devices performed well at the cutoff levels that each manufacturer required for positive readings. The same was true for opiates. The test of cocaine, however, was a different story.

According to Walsh, the Ansys device was the most sensitive in detecting presence of the drug. The Branan device detected above recommended cutoffs, as did Securetec's device. Ultimed's product performed respectably. Two instrument devices did not fare as well, however, when cocaine was distilled to its metabolite form, benzoylecgonine, the devices performed very well.

Amphetamine tests showed that most devices detected well. But, in tests for marijuana the technologies did not perform as expected.

At the standard 50 nanograms, only three devices detected the drug. Others required larger amounts of the drug to show a reading, which would mean that a user would need to use the drug within the previous 45 minutes to be detected. This, Walsh said, is not very helpful to community corrections or law enforcement, as they usually want to detect drug use in a larger time frame. The metabolite form of marijuana was detected well by all devices.

Only one of the devices, Cozart's RapiScan, claimed to detect benzodiazepine and did well.
 
When comparing performance according to the SAMSHA cutoff guidelines, Walsh said that the devices had mixed results and many were not able to detect drug usage at those levels.

According to Walsh, since the tests were done and the results published last year, several of the manufacturers have come out with more advanced designs that are even more sensitive to the presence of these drugs.

(For more information about the study, click here:
http://www.ingenta.com/isis/searching/ExpandTOC/ingenta?issue=pubinfobike://pres/jat/2003/00000027/00000007&index=5)

Beyond side-by-side scientific comparisons, several corrections agencies have done some hands-on testing of their own with drug detection devices. One agency, the Lycoming County, Pa., Probation Office, has tested Securetec's Drugwipe product in a drug court setting.

Counties Test for Drugs with New Devices

The drug court in Lycoming County has been in operation since 1998 with one judge assigned to drug court cases involving Level Three or Level Four offenders. Robert McCullough, Chief Probation Officer with the Lycoming County Probation Office, described these offenders as participating in a "last ditch diversion effort" when they come to the drug court. If they were not to receive drug court programming, McCullough said, they would likely spend two to five years at a state correctional institution.

It is in this setting that probation officials decided to try two Drugwipe products.

For the drug court, officials use the Drugwipe product to test oral fluid to detect within recent drug use windows and use the Drugwipe patch to determine longer windows of drug usage. In addition, the agency uses urinalysis and a portable Breathalyzer.

According to McCullough, a probation officer needs several characteristics from both short and long term testing methods: accuracy, immediate results, ease of use in the field, legally defensible, non-gender specific, sanitary and non-invasive.

With these requirements in mind, McCullough suggests that no one device can do it all. "I know of no single testing method that will give you everything. There are problems with all of them," he said.

But Drugwipe has helped the agency detect usage by its drug court participants.

The product, which can be used on surfaces and on the body to detect traces of drugs, has helped the agency pinpoint users in 342 cases out of 7,624 tests. All of those whose Drugwipe tests have indicated drug usage have admitted to doing so, which meant that no confirmation lab test was required.

McCullough, who praised the device, also described instances where Drugwipe has been able to detect drug traces when none of the agency's other available testing methods could. In one case a female offender was suspected of dealing drugs while on probation, but she tested negative for drug use. Then, officers decided to take a surface sample from the inside of her vehicle. That came back positive for cocaine and she then admitted to her activities.

There are other instances where the device has been helpful, too.

"How many times have you sent agents into the field and the offender says he can't go to the bathroom? Or, you have two male agents and a female offender and you need a urine sample?" McCullough said.

While some drug testing devices help community corrections officers pinpoint the facts about drug use, there are others that can be useful as screening tools to target offenders for further testing.

The Essex County, N.J., Probation Division has found that the PassPoint Substance Abuse Screener, which measures an offender's pupil when the offender looks inside the pupillometry device, is extremely useful. The measurements taken by this device are compared to a recorded baseline that is taken when no drug use was suspected. All subsequent readings are compared to this baseline.

Although the device cannot detect with certainty that an offender has used drugs, it does pick up on abnormalities that indicate the offender might need to be drug tested with another method. It is this screening that Essex County Chief Probation Officer Peter Conerly has said is a benefit.

"I recognized that we needed to do more testing. I look at this as increasing our ability to test," he said in a presentation at the Innovative Technologies in Community Corrections Conference.

Conerly also was pleased with other benefits of using pupillometry: it is quick and easy to use, only taking 30 seconds once a baseline has been established, it is gender non-specific and it is low cost, depending on the number of tests conducted. On the other hand, the device can only detect a narrow window of usage - within 48 hours - and needs to be used in conjunction with other testing devices to confirm drug use.

One of the main draws for the probation office to the technology was cost. Because Conerly's office conducts about 2,000 drug tests per month that are sent to the lab - at $5 a piece - the pupillometry option became viable.

He said that to break even in comparison to the laboratory costs, the probation division needed to reach 700 testing events monthly. By doing better than that, the cost of using the device was about $2.59 per event, Conerly said.

Conerly said the screening device also helps to prevent against drug "over testing" by narrowing down those offenders whose readings are abnormal. While the device cannot differentiate between an offender on cold medicine, for example, versus one using drugs, it is still helpful, he said.

"To some extent it doesn't matter because it is a screening," Conerly added.

Future Development

While agencies look to conduct pilots of the new drug testing technologies that are available, they will have to wait about a year to get their hands on a new rapid on-site hair analysis test.

Drug Risk Solutions, which is developing the test, spoke to attendees of the Innovative Technologies in Community Corrections conference about the qualities of hair testing and how it can play a role in community corrections.

Hair testing provides information about chronic drug use history, distinguishes specific time periods and is a difficult test for offenders to evade since each test is an observed one. But the downside is that these samples need to be sent to a lab and can take time to ship to a lab for testing.

Drug Risk Solutions hopes to help with that.

"We want a method with an answer in less than an hour at a cost [of] taking it to a laboratory," said Carl Selavka of Drug Risk Solutions.

The technology being developed will open the center of the hair in minutes and extract up to eight samples within one hour, said company president David Brill.

Since the test is not ready for market, the company is seeking corrections and law enforcement sites to pilot the product for accuracy and use. Once the product comes to market, Brill suggests that agencies think carefully about incorporating on-site hair analysis into their drug testing programs and adopt certain policies to ensure that they are obtaining the maximum benefit from the technology:

*require availability of lab confirmation testing for all on-site screening tests (The hair analysis tests indicate negative results.)
*provide a medical review officer to oversee the process
*use a baseline test and then conduct quarterly re-tests to ensure drug-free compliance
*do not use hair analysis to cover a previous period
*don't let offenders know which drug test they will be receiving at any given time
*communicate to offenders that over-the-counter medications can show up in the test
*communicate that a drug-contaminated environment can have an effect on test results.

A thorough understanding of these new technologies, combined with solid policies for their use alone and in combination, gives community corrections agencies a whole new set of tools to use as they supervise offenders in the community. And, with the advance of these technologies, the ultimate goal of rehabilitation may be realized even sooner.

Resources:

To reach The Walsh Group, visit http://www.walshgroup.org

To reach Peter Conerly of Essex County, N.J. Probation Division, call 973-395-3025.

For information about PassPoint, visit http://www.passpoint.org/

To reach Robert McCullough of Lycoming County, Pa., Probation Department, call 570-327-2391

For information about Drugwipe, call 570-327-6112.

For information about Drug Risk Solutions visit the website at http://www.drugrisk.com