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Publication: Behavioral Healthcare
Date published:
Language: English
PMID: 71998
ISSN: 19317093
Journal code: BHHC

Those struggling with substance abuse can be remarkably creative when it comes to cheating on a drug test. They attempt the unthinkable - ingesting dangerous substances to mask the presence of drugs, or even using prosthetics filled with clean or synthetic urine to mimic the process of voiding a sample.

As a result, the field has had to adapt. Now, two out of the three methods of manipulation can be fairly easily detected. Chemical adulteration can be detected with "sample check" wet chemistry, whilediluted samples are identified by creatinine levels and specific gravity measurements.

However, substitution still can only be detected through "diligent, gender-specific, full-frontal supervision," accordingto Chris Scanneil, president and CEO of Marker Test, Inc. "It's still subject to human error, which can range up to 15 or 20 percent," notes Scanneil. "[Agencies] might deny it, but the data is there."

To target the third method, Marker Test has developed a way to identify samples that don't belong to the individuals who submitted them. Clients ingest a liquid "marker" that can be seen when the sample is sent to the lab for analysis. If the marker isn't there, it's proof that the sample was substituted.

"Of course, that doesn't necessarily mean that the subject is using drugs," Scanneil points out. "But it does indicate an attempt to manipulate the sample. And if a client is trying to trick the test, in many cases that's just as good as a positive result."

Verified results

The method was first developed at the Cologne prison in Germany by Prof. Ruprecht Keller, MD, PhD, to curb drug-related violence. To date, the Matker Test has been used in over 400,000 drug tests in Europe and the Middle East, and will soon be available in the United States.

"The biggest part of any drug test is the integrity of the sample," notes Scanneil. "That's the whole premise behind the marker approach. It's about security, the chain of custody, and the ability to verify the tests with a traceable marker."

Marker Test is administered by having subjects orally ingest a small amount (less than one milliliter) of liquid, which contains a highly purified polyethylene glycol. Within 30 minutes, a detectable amount of the marker can be identified through liquid choromatography-mass spectrometry (LC-MS) analysis.

"When the marker appears, it is very distinct and very easy to interpret," Scannen1 explains. "Once you ingest the liquid, the glycol is filtered by the kidney. It's not metabolized and cannot be stored anywhere in the body. It can be thought of as a realtime inert chemical barcode that marks urine individually."

Over 1,000 distinct markers are possible, so it's statistically improbable to predict which marker an individual will receive. A barcode is included that allows laboratory technicians to identify which marker a sample should contain, but that information is only accessible by authorized personnel.

"The marker is double-blind so neither the administrator, nor the subject knows which one is being used," Scannell explains. "There is no way to bias the test on either side. There are no disputed positive results and no questions about chain of custody."

A non-disruptive enhancement

To integrate the new process into an agency's existing workflow, Marker Test transfers the LC-MS method to a trusted laboratory, which does not require any additional equipment. In fact, the results appear in the same retention window as a normal drug profile, according to Scannell.

"That part is critical for logistics and workflow," he says. "It's a non-disruptive enhancement of the process for both the agency and the lab with whom they are partnered."

Once collection professionals are trained, workflow can be improved simply by removing the need for supervision. Staff is no longer required to waste their time policing the bathrooms when subjects are providing a sample. As a result, resources can be better utilized.

"That staff is now freed to attend to more meaningful and productive tasks," Scannell says. "Counselors can start evaluations right away and begin discussing treatment options. Plus, more samples can be processed in the same amount of time."

In addition to freeing up staff, having more accurate information about a client's state of mind can help improve how treatment is approached. According to Scannell, 10% to 20% of clients lie and cheat their way through drug tests, so counselors often end up evaluating them based on faulty assumptions.

"A counselor may believe they are treating a person in recovery, but in reality they are still treating an addict," he says. "Those people are still engaged in deceptive behavior, so they are not actually in recovery. Consequently, precious time and resources are being wasted."

In Europe, a number of methadone clinics have adopted the Marker Test and report a 20% improvement in recovery rates. According to Scannell, the credit is due to the ability to identify those clients who go through elaborate means to cheat a drug test, which enables more appropriate treatment decisions to be made.

"Either the client isn't ready for treatment, or they can admit their behaviors and go into a recovery program," he explains. "If an addict doesn't have a safety net like methadone, they start to figure things out. They finally realize that they're an addict and that they need treatment."

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