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Antibiotics Cause False Positives on Heroin Tests

NEW YORK (Reuters Health) – Athletes and hopeful job applicants often hinge their careers on a clean drug test, but the use of certain antibiotics may cause an unsuspecting person to test positive for heroin even though they’ve never touched the drug, according to study findings released Tuesday.

Researchers led by Dr. Lindsey R. Baden of Harvard Medical School in Boston, Massachusetts, investigated this problem after they came across a patient in their practice who tested positive for opiates, and who was also taking an antibiotic called levofloxacin. The patient was nearly kicked out from a drug treatment center because of the result, which later proved to be false.

Opiates are a class of drugs that include the illegal drug heroin, and several other controlled drugs such as methadone, morphine, Demerol and codeine.
In their study, Baden and colleagues tested 13 different types of antibiotics, including levofloxacin and Cipro, all belonging to a class of chemicals called quinolones, to see what effect they would have on commercial opiate tests.

The researchers diluted the antibiotics to concentrations that would be expected to occur in urine and then tested the antibiotic samples using five different commercial tests to see if they would cause a positive result for opiates.
Two antibiotics, levofloxacin and ofloxacin, caused a strong positive result on four of the five tests.

Most of the other antibiotics also caused a positive result on at least two or three of the five tests. For example, Cipro, the drug given to thousands of people to fight possible anthrax exposure, resulted in a positive test in one out of the five tests.
To confirm these results in people, they had six people take a standard dose of one of the two antibiotics and collected their urine samples every 6 hours for the next 48 hours.
On one of the five tests, all three patients taking levofloxacin tested falsely positive within 2 hours and up to 22 hours after taking the drug. The results were similar in patients taking ofloxacin, the investigators report in the December 26th issue of The Journal of the American Medical Association.

Baden told Reuters Health that he suspects that the false positives result from the similar three-dimensional structures of opiates and the antibiotics. He also pointed out that other types of chemicals could cause a similar reaction.

According to Baden, it is possible that people have suffered consequences of a false positive test, because “a positive drug test is often assumed true, while the protestations of the person being tested are looked at as self-serving.”
Baden recommends that anyone who tests falsely positive for opiates ask to have drug testing performed to confirm the result.

SOURCE: The Journal of the American Medical Association 2001;286:3115-

ACLU complaints more than splitting hairs

For the American Civil Liberties Union of Illinois to be working on behalf of Chicago police officers is not unusual.

Over the years the ACLU has represented an extremely broad range of clients with civil-rights claims, so it should not surprise Mayor Richard Daley, Chicago aldermen and city police officials to find on their desks Monday a two-page broadside mailed Friday by the organization supporting rank-and-file officers and attacking a controversial random drug-testing procedure that the department plans to begin using on them.

The procedure—an analysis of hair clippings—can detect illegal drug use from about 7 to about 90 days prior to the taking of the test. Hair analysis, pioneered in the late 1970s, has almost no overlap with urinalysis, now used on all officers, which detects only recent drug ingestion.

And it has already resulted in a threefold increase in the number of drug-related dismissals of police recruits, upon whom it has been performed since last fall.

What is unusual is that the ACLU is agitating unilaterally, having not received any requests for help from officers. Indeed, the leadership of the Fraternal Order of Police has already OKd the city’s idea to make all officers subject to hair testing under the terms of next year’s new union contract.

But both national and local ACLU leaders say the FOP should reconsider, that the police union and the city are putting too much faith in technology that the ACLU charges is unregulated and prone to giving false positive results and results that discriminate against minorities.

The National Institute on Drug Abuse, one of the National Institutes of Health, shares some of these doubts. NIDA’s leading researcher on hair analysis, chemist Edward Cone, said Friday “the consensus of scientific opinion is that there are still too many unanswered questions for (hair analysis) to be used in employment-testing situations.”
A Food and Drug Administration spokeswoman said the agency stands by a 1990 policy statement calling hair analysis an “unproven . . . unreliable” procedure. A 1992 consensus opinion of the Arizona-based Society of Forensic Toxicologists concludes that “results of hair analysis alone do not constitute sufficient evidence of drug use for application in the workplace,” and the hair analysis expert at the U.S. naval labs reiterated Friday he has “significant worries” about the process.

Yet at the same time, a leading analytical chemist at the National Institute of Standards and Technology, also a government agency, said hair analysis labs “did a very good, very consistent job” detecting drugs in recent blind checks when they were sent identical sets of contaminated and uncontaminated samples.

One concern of skeptics is that drug residue in the air or on certain surfaces may misleadingly show up in a non-user’s hair sample. Another is that, per the naval lab research, darker, coarser hair is more susceptible to yielding both actual and false positive results than light, fine or bleached hair.

And since ethnic and racial minorities in the U.S. tend to have dark hair, the argument goes, the test will yield discriminatory results.

But another widely published expert on hair testing, criminologist Tom Mieczkowski of the University of South Florida at St. Petersburg, said such concerns are wildly exaggerated. Mieczkowski said current research shows that the hair preparation and analysis techniques now used by the most experienced labs—including industry leader Psychmedics Corp. of Cambridge, Mass., the lab Chicago uses—have nullified concerns about environmental contaminants and pigment bias, and have demonstrated hair analysis is even more reliable than urinalysis.

Psychmedics vice president Bill Thistle added that the 1990 FDA statement does not apply to contemporary methods and that courts now routinely accept hair analysis into evidence. He charged that naysayers and contrarians are motivated by a dislike of workplace drug testing.
In the case of the ACLU, Thistle is not off the mark.

The organization’s volunteer lobbying on behalf of Chicago cops is rooted in its position that to perform random drug tests on employees who have shown no signs of using drugs is an invasion of privacy. The ACLU prefers specialized skill-performance testing when there is evidence of on-the-job impairment.

But even ostensibly neutral, apolitical scientists seem to have sincere disagreements about hair analysis. This, too, is not unusual, particularly in an emerging technical field. These disagreements deserve a full hearing before the city decides to make locks the key to the future of our police officers.

Drug Tests Bring Worries Of Accuracy

“I go to extraordinary lengths before I call a positive.”�Dr. David
Berg, Medical review officer said.
The water-cooler talk is true: Poppy seeds can produce a positive test for heroin, and cold medicine can suggest methamphetamine.
But medical experts say workers have little to worry about as changes in Iowa�s drug-testing law go into effect today.

That�s because the new law requires medical review officers to evaluate drug tests. They act as judges, determining whether the positive test is a result of illegal drug use or a legitimate medical cause.

“I�m there to protect people from false positives as much as I�m there to find drug (evidence) for their employers,” said Dr. David Berg, an MRO and director of occupational medicine for the Des Moines office of HealthSouth. “I go to extraordinary lengths before I call a positive.”

Accuracy is a concern as private-sector employers gain more power to test employees for drugs and alcohol. Occupational health clinics and laboratories say the law could lead to more business, but they don�t expect a rush starting today.

Business groups have been pushing for a change for years, and some construction companies and other safety-sensitive employers are moving quickly to start testing, said James Aipperspach, president of the Iowa Association of Business and Industry. But most are still learning about the changes and deciding what options to take.
Employers are not required to test. They could randomly test workers for alcohol and other drugs. They could test if they have reasonable suspicion that a worker is under the influence. They could require workers to get treatment after a confirmed positive drug test, or they could fire them. Critics say the law gives employers more power than police. They also question the reliability of testing, and say the workers would have little recourse if they falsely test positive.

The new law protects employers from liability unless they clearly should have known a false positive test result was in error and ignored the correct test result.
The Iowa Civil Liberties Union isn�t saying whether it will fight the law. But lawyers and legislators have talked to the group about a challenge, said executive director Ben Stone.
Random testing could result in more false positives, said Craig Zwerling, a University of Iowa professor and expert on drug-testing.

Statistics vary widely on the likelihood of false positives, depending on the test and the lab. Civil libertarians say 5 percent is a conservative estimate.
Medical experts acknowledge that false positives aren�t impossible. But they say urinalysis, the most common means of drug testing, has improved.
The Iowa Methodist Medical Center laboratory�s testing is more than 99 percent reliable, said Rich Snyder, who supervises drug testing.

The lab uses a combination of gas chromatography and mass spectrometry, which is considered by most experts to be the most precise procedure for the detection of banned substances. The new Iowa law requires such a technique to be used to confirm positive tests.

Employees can request a second confirmatory test at another lab, at their expense. If that test comes back negative, the employer must reimburse the employee.
But tests still read some innocuous substances as illegal drugs. Because of the poppy seed problem, the federal government is raising the threshold for the detection of opiates in urine. Additional tests can be done to determine whether a Vicks inhaler is causing a methamphetamine positive, experts say.

Medical review officers also look at more than the test, searching for evidence of needle tracks or asking whether the person is on a prescription drug.
Testers also watch for adulterated samples. An industry is booming on the Internet, providing drug users with tips and products to taint their tests. Snyder said most of the methods, such as mixing the urine with bleach or soap, are easy to catch.
Medical review officers also are on guard for every excuse imaginable. They�ve heard them all, including the one gold-medal snowboarder Ross Rebagliati gave when he tested positive during the Olympics. Second-hand marijuana smoke will produce a positive test only in extreme cases, research has shown.
“There�s no way,” Berg scoffed.

Reporter Lynn Hicks can be reached at hicksl@news.dmreg.com or (515) 284-8211.

Hair Tests catch more blacks than whites

Hair tests for “drugs” have become more popular because they are supposedly harder to beat than urine tests and can determine use months prior to the test and are thus even less relevant to on the job performance. In addition, coarse black hair holds “drug” residues longer than thin blond hair. This has the added advantage of increasing the power of the state over minorities.

” It’s a major problem” warned J. Michael Walsh, executive director of the President’s Drug Advisory Council under Presidents Reagan and Bush and now a consultant to the urinalysis industry.” From the perspective of those like Walsh, whose focus is on middle class marijuana use this indeed can be a problem. Also they show hard drug use that would be missed by urine tests. However, they do not detect any use in the last week.

About 20 million Americans undergo drug tests each year, according to the Institute for a Drug-Free Workplace, a Washington-based prohibitionist lobby. The majority are job applicants without rights of appeal.

About 80 percent of companies that test for drugs rely solely on urine, and only 2 percent use hair. One reason is legality. Urine tests have universal acceptance in courts, while skepticism about the science behind hair tests persists. The other reason is politics. Employers, state regulators and courts want approval from federal public-health experts before they go ahead with hair testing. And the regulators remain skeptical. To date, “hair analysis for the presence of drugs is unproven, unsupported by scientific literature or controlled trials,” Food and Drug Administration spokes-woman Sharon Snider said.
Hair tests are becoming more popular. That’s partly because the tests turn up more drug users than urinalysis and counter some of urine testing’s shortcomings. Also important are sustained lobbying and marketing efforts by Psychemedics Corp. of Cambridge, Mass, which dominates the hair-testing market.

A decade ago, Psychemedics’ biggest customers were Nevada casinos. Today, they include Anheuser-Busch, the Federal Reserve System and General Motors. Florida entrepreneur H. Wayne Huizenga, founder of Blockbuster Entertainment, gets much of the credit. He led a group of investors that bought Psychemedics out of debt in 1989. With Blockbuster as a mainstay customer, the firm grew to more than 750 clients, according to its 1996 Securities and Exchange Commission filings. (Huizenga sold Blockbuster, he is now the nation’s largest used car salesman.)

In that year, Florida legislators, pushed by Huizenga’s lobbyists, (He owns the Dolphins.) approved hair testing in the state. The law grandfathered Psychemedics’ patented hair-testing process and set high hurdles for future competitors. By the end of 1997, according to company general counsel William Thistle, Psychemedics had 1,000 clients. Thistle and other Psychemedics executives insist patented methods are unbiased and produce no “false positives” from innocent drug exposure. If hair testing were to supplant urine testing for drugs, Thistle ventured in an interview, from three to 10 times more illicit drug users would be caught. The result could be a new epoch in the nation’s drug-war history: “Drug users wouldn’t be employed,” Thistle said flatly, “or they’d be in rehabilitation programs.”
“Hair testing may turn out to have a complementary role in workplace testing,” said Robert Stevenson, deputy director of the Workplace Programs Division of the federal Center for Substance Abuse Prevention. “But we have yet to resolve remaining questions about its fairness and the ability to interpret results consistently.”

Using scheduled urine tests, the New York City Police Department caught one drug abuser in seven year, according to a published report. In the first 18 months of random hair test by Psychemedics, more than 30 NYPD employees tested positive. In another comparison, involving 774 job applicants to Steelcase Corp., a Michigan furniture maker, urinalysis tests were 2.7 percent positive. Psychemedics hair tests on the same applicants were 18 percent positive. But hair testing also has its flaws. It can’t catch recent drug use the way urine tests can, because traces of ingested drugs take about five to seven days to show up in hair. On the other hand, hair tests can detect drug use within 90-day period.

In the real world, one would hope that African American leaders would object to these tests on obvious grounds, but on the other hand, they would take some of the focus off of marijuana. (There is one “easy” way to beat these tests, but it may itch a little and be a little drafty in the winter.)

(Not If You Use Our Shampoos Though!!)