Driving under the influence of marijuana is a serious traffic safety concern in the United States. Delta 9-tetrahydrocannabinol THC is the main active compound in marijuana. We examined whether the oral fluid THC test can be used as a valid alternative to the blood THC test using a sensitivity and specificity analysis and a logistic regression, and estimate the quantitative relationship between oral fluid THC concentration and blood THC concentration using a correlation analysis and a linear regression on the log-transformed THC concentrations. Overall, 8. Using blood test as the reference criterion, oral fluid test for THC positivity showed a sensitivity of
Competing Interests The authors declare that there are no competing interests. Eighty-three club goers underwent the on-site drug screening test with one device. Specifically, the devices can be used for rapid on-site testing as a first screening [ Oral fluid drug testing validity ]. Note that the proposed guideline would not allow employers to collect both urine and oral fluid during the same collection event. The prevalence of cannabis-involved driving in California. Foren Sci Int. Specimen validity testing is performed on every Oral-Eze specimen received in our laboratory to verify that the Leather rubber is human saliva.
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While some instant oral fluid collection devices may be available, note that they are often not properly cleared and are not sensitive enough to detect usage of certain drug classes. Clin Chem Lab Med. Kinetic interaction of microparticles KIMS. Marquet P. You can select testing based upon the unique needs of your drug testing program. Requests to do so should be addressed to the Editor. Specific gravity is a measure of the density of a substance compared to the density of water. A similar depot effect occurs with nicotine. Sweat patches usually are used as an adjunct to other forms of testing. Predominantly, the preferred technique is MS due dgug its high Porn pics of krystal jordan and specificity. Guidelines for testing drugs under international control in Oral fluid drug testing validity, sweat and saliva. Increasing emphasis on treatment outcomes as evidence of program effectiveness has added significance to drug tests in OTPs. Oral-fluid drug testing is an alternative to urine drug validtiy in OTPs that is approved by SAMHSA Clark ; for a recent review of oral-fluid drug testing, see Kintz and SamynOral fluid drug testing validity only when a qualified offsite laboratory performs the specimen analysis. Exhibit describes several widely available immunoassays.
Oral fluid samples were collected at recreational settings e.
- What is Oral Fluid Drug Testing?
- Drug screening is usually performed on urine or oral fluid samples.
Brian F. This volume features various aspects of oral fluid drug testing from specimen collection to screening and confirmatory analyses as well as pharmacokinetics of drugs in oral fluid ethanol, cannabinoids, cocaine, amphetamines, opiates, benzodiazepines, and others including new psychoactive substances. The authors present strengths and limitations of oral fluid as a test matrix, analytical methods for the detection and quantification of commonly abused drugs and their metabolites in oral fluid, and different factors to consider before implementing oral fluid testing such as collection devices, specimen validity testing, If you originally registered with a username please use that to sign in.
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Adapted from Cone What collection device does Omega Laboratories use? Review: The physiology of saliva and transfer of drugs into saliva. Note: You clicked on an external link, which has been disabled in order to keep your shopping session open. These generally work satisfactorily for amphetamines, 68 , 69 buprenorphine, 70 cocaine, 65 , 71 — 73 methadone, 74 and other opioids, 72 , 75 , 76 and provide a reliable means to screen oral fluid. To date its main application has been to provide a non-invasive specimen for testing of possible drug-affected drivers.
Oral fluid drug testing validity. Frequently Asked Questions: Oral Fluid Testing
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Driving under the influence of marijuana is a serious traffic safety concern in the United States. Delta 9-tetrahydrocannabinol THC is the main active compound in marijuana. We examined whether the oral fluid THC test can be used as a valid alternative to the blood THC test using a sensitivity and specificity analysis and a logistic regression, and estimate the quantitative relationship between oral fluid THC concentration and blood THC concentration using a correlation analysis and a linear regression on the log-transformed THC concentrations.
Overall, 8. Using blood test as the reference criterion, oral fluid test for THC positivity showed a sensitivity of The oral fluid test is a highly valid method for detecting the presence of THC in the blood but cannot be used to accurately measure the blood THC concentration.
Marijuana is a commonly used drug in the United States. In , there were an estimated Experimental and epidemiological studies showed that recent marijuana use is associated with decreased driving performance—e. From to , the prevalence of marijuana detected among drivers involved in fatal car crashes tripled from 4. Different cut-off points of blood THC concentrations have been proposed for establishing per se laws, which make operating a motor vehicle a criminal offense for an individual if he or she has a specific amount of drug or metabolite in his or her body.
This threshold concentration is a legal limit, and exceeding this threshold serves as proof of legal impairment Grotenhermen et al. Compared to collecting whole blood samples, measuring THC in oral fluid is a less intrusive and less costly method of testing Grotenhermen et al. In this study, we assess the validity of oral fluid THC test versus blood THC test using sensitivity and specificity analysis and a logistic regression, and estimate the quantitative relationship between the oral fluid THC concentration and the blood THC concentration using a correlation analysis and a linear regression on the log-transformed THC concentrations.
The first NRS was conducted in ; since then, it has been conducted in , , and The NRS was a national field survey based on voluntary and anonymous random stops of non-commercial drivers at locations across the 48 contiguous states Kelley-Baker et al.
The survey included questions on driver demographic characteristics such as age and race, drinking and drug use habits such as time of last marijuana use, trip information including trip origin and destination, seatbelt usage, and vehicle information such as number of passengers and vehicle type. All information was collected from the drivers via electronic tablet except for gender, which was recorded via officer observation.
In addition, breath alcohol, oral fluid alcohol, and oral fluid drug concentration tests were administered and whole blood specimens were collected during the survey process Kelley-Baker et al. Among 11, eligible drivers, Compared to all the drivers who participated in the NRS, these drivers had a similar age distribution and proportion of females, but included fewer whites A similar screening and confirmation process was carried out for measuring THC concentrations in whole blood samples.
First, it is the minimum detectable concentration of THC in the whole blood. Second, it is the cutoff point for establishing per se laws by many states National Conference of State Legislatures We conducted a series of logistic regression of the binary blood THC test positive vs. Higher values of accuracy and AUC indicate better predictive ability of the dichotomized oral fluid THC concentrations at the selected cut-off in distinguishing between positive and negative blood THC tests.
The highest accuracy 0. We first calculated positive rates of THC in both blood and oral fluid samples and computed sensitivity and specificity of the oral fluid THC test in predicting the positivity of blood THC.
The analysis was conducted using the whole sample and then stratified by driver characteristics. The first model assessed the crude association. The second model adjusted for BAC and time of last marijuana use. The third model further controlled for demographic characteristics of driver age, gender, and race. We tested the interaction terms between BAC and oral fluid THC test, but the interaction terms were excluded from the final models because they were not statistically significant.
We also examined the association between the continuous blood THC concentration and the continuous oral fluid THC concentration among drivers with positive THC in either blood or oral fluid. We calculated Pearson correlation coefficient between these two concentrations in both the original and natural-log transformed scales. We then built linear regression models of the natural-log transformed blood THC concentration on the natural-log transformed oral fluid THC concentration.
Similar to the logistic regression, we used a value of 0. Finally, we conducted two sensitivity analyses. In the first sensitivity analysis, we multiply imputed the missing data on gender and time of last use of marijuana using the multiple imputation by chained equations algorithm to create complete data for the covariates in the adjusted models Van Buuren and Groothuis-Oudshoorn The second sensitivity analysis accounted for complex survey design in the NRS survey.
Analyses were conducted using R version 3. Overall, 9. Both the unadjusted and adjusted regression models showed that positivity in oral fluid THC was significantly associated with positivity in blood THC. After adjusting for driver BAC, last time use of marijuana and demographic characteristics, having a positive oral fluid THC test was associated with an fold increase in the odds of having a positive blood THC test.
Other covariates significantly associated with positivity in blood THC included BAC, race, and last time use of marijuana. By including BAC and last time use of marijuana, the predictive ability of the logistic regression improved with AUC increased from 0.
Log-transformed values were associated with a higher Pearson correlation coefficient 0. This study showed that oral fluid tests are reasonably accurate in detecting blood THC positivity with a Information on BAC and last time use of marijuana may be used to enhance our ability in predicting the positivity in blood THC.
Our study reaffirms the findings reported by Kelley-Baker et al. We improved the prediction models by including covariates and using the log-transformation to yield a better linear correlation.
This sensitivity analysis supports our conclusion that the oral fluid test is a valid alternative to detect the positivity of THC in the blood.
We then identified optimal cut-off concentration in oral fluid that provided the highest possible diagnostic accuracy for predicting positivity of THC in blood using accuracy and AUC. It is worth noting that less than half of the eligible drivers Driver age, race and last time use of marijuana were reported by the drivers via electronic tablet and thus can also be subject to bias. With the improvement of the detection limits in both oral fluid and whole blood samples in the future, we expect to observe a higher degree of agreement in the positivity of THC tests between the oral fluid and blood samples.
Currently, marijuana test based on oral fluids is limited primarily to detecting THC only. Notwithstanding, the NRS provided valuable data in assessing the validity of the oral fluid test as a less invasive and less costly alternative to blood test in detecting the presence of THC in the blood. Oral fluid test is a highly valid method for detecting the presence of THC in the blood and thus could be used as a screening tool for detecting marijuana-related DUI.
Therefore, the oral fluid test is not an accurate method for estimating THC concentrations in the blood. HJ conducted the statistical analysis and wrote the paper; SZW assisted in the statistical analysis and reviewed and revised the paper; STC participated in the acquisition of data and reviewed and revised the paper; GL participated in the conception and design and reviewed and revised the paper; and QC participated in the design of the study, supervised the statistical analysis and wrote the paper.
All co-authors approved the final version of the paper. Guohua Li serves as editor-in-chief of the journal Injury Epidemiology. He was not involved in the review or handling of this manuscript. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Huiyan Jin, Email: moc. Sharifa Z. Williams, Email: ude. Stanford T. Chihuri, Email: ude. Guohua Li, Email: ude. Qixuan Chen, Email: ude.
National Center for Biotechnology Information , U. Journal List Inj Epidemiol v. Inj Epidemiol. Published online Feb Huiyan Jin , 1 Sharifa Z. Williams , 1 Stanford T. Chihuri , 2 Guohua Li , 2, 3 and Qixuan Chen 1. Author information Article notes Copyright and License information Disclaimer. Corresponding author. Received Oct 16; Accepted Feb 6. This article has been cited by other articles in PMC.
Abstract Background Driving under the influence of marijuana is a serious traffic safety concern in the United States. Methods We examined whether the oral fluid THC test can be used as a valid alternative to the blood THC test using a sensitivity and specificity analysis and a logistic regression, and estimate the quantitative relationship between oral fluid THC concentration and blood THC concentration using a correlation analysis and a linear regression on the log-transformed THC concentrations.
Conclusions The oral fluid test is a highly valid method for detecting the presence of THC in the blood but cannot be used to accurately measure the blood THC concentration. Keywords: Blood samples, Cannabis, Delta 9-tetrahydrocannabinol, Driving under the influence, Marijuana, Oral fluid samples. Background Marijuana is a commonly used drug in the United States. Statistical analysis We first calculated positive rates of THC in both blood and oral fluid samples and computed sensitivity and specificity of the oral fluid THC test in predicting the positivity of blood THC.
Open in a separate window. Female 0. Discussion This study showed that oral fluid tests are reasonably accurate in detecting blood THC positivity with a Conclusions Oral fluid test is a highly valid method for detecting the presence of THC in the blood and thus could be used as a screening tool for detecting marijuana-related DUI. Acknowledgements Not applicable. Notes Ethics approval and consent to participate Not applicable. Consent for publication Not applicable.
Competing interests Dr. Contributor Information Huiyan Jin, Email: moc. Traffic Safety Facts Research Note.