There are many variables regarding the analyses of substance abuse testing. Clients will often ask about specifics pertaining to the determination of time, dose and frequency when detecting substance(s) of abuse.

When testing a reservoir matrix- a material or substance which can accumulate and retain drug and alcohol biomarkers (eg., urine, blood, hair, nail, umbilical cord, or meconium, etc.), the reported quantitation of a drug or its metabolite cannot be used to determine when/if a specific substance was used, how much of a substance was used or how often a substance was used. Test results show only if a substance was detected or not detected.

A specimen’s window of detection provides an estimated timeframe for detecting substance(s) of abuse. Based on extensive research studies, the generally accepted windows of detection for specimens used in our testing are as follows:

• Scalp Hair- Up to approximately 3 months prior to collection.
• Fingernail- Up to approximately 3-6 months prior to collection.
• Umbilical Cord- Up to approximately 20 weeks prior to birth.
• Meconium- Up to approximately 20 weeks prior to birth.
• Urine- Up to approximately 2-3 days prior to collection.
• Blood (PEth)-May be up to approximately 2-4 weeks prior to collection.

It is important to know that the interpretation of drug testing results may be determined by a Medical Review Officer (MRO). A Medical Review Officer is a licensed physician (MD or DO) who has knowledge of substance abuse disorders and has the appropriate medical training to interpret and evaluate an individual’s positive test result together with his or her medical history and any other relevant biomedical information.¹This is an incredibly important aspect of drug testing. A laboratory can detect substances, but an MRO may be used to interpret what that detection means.

1. Journal of Occupational and Environmental Medicine: (January 2003-Volume 45-Issue 1-p 102-103) Qualifications of Medical Review Officers (MRO’s) in Regulated and Nonregulated Drug Testing. Departments: ACOEM Consensus Opinion Statement

On August 18, 2014, the pain reliever tramadol (Ultram®) will be scheduled as a Class IV controlled substance by the U.S. Drug Enforcement Administration.1 Tramadol is a synthetic, opioid pain reliever similar in strength to codeine. In 2012, more than 40 million tramadol prescriptions were written in the United States, more than any other opioid medications except for hydrocodone and oxycodone.2

In 1994, clinical data suggested tramadol had a very low abuse potential.3 Research has since shown that tramadol can produce a euphoric high similar to oxycodone. At doses greater than prescription levels, tramadol has addiction reinforcing effects similar to morphine and oxycodone.

Between 2004-2012, emergency department visits related to illicit tramadol use increased from 4,800 incidents to more than 16,000.1 Adverse effects of tramadol include sedation, dizziness, respiratory depression, seizures, apnea, and death.4

Withdrawal symptoms often occur following both abrupt and tapered discontinuation of tramadol use, suggesting an issue of drug dependence for tramadol users.

In the year 2000, tramadol was present in only 82 law enforcement drug seizures. This number increased to 1806 by 2012.1 A 2002 study found that 87 out of 140 healthcare professionals testing positive for tramadol use obtained the drug with illegal prescriptions.

Tramadol is available in both single dose (25-100 mg) and extended release (100-300 mg) forms. Tramadol abusers can crush extended release tablets and ingest them for an instant, high-dose euphoria similar to OxyContin but without the cognitive impairment.2

Fingernail testing detects tramadol use for up to six months, while hair provides a three month look-back. Tramadol testing is available in USDTL’s extended drug panels. If you have questions or need more information about tramadol testing, contact our Client Services group at 800•235•2367 or at clientservices@usdtl.com.

References
1. Office of Diversion Control, Drug and Chemical Evaluation Section. (May 2013). Schedules of Controlled Substances: Placement of Tramadol into Schedule IV. Retrieved from https://www.dea.gov/drug-information/drug-scheduling
2. Nadia Awad. (2014). Now What? DEA Tosses Tramadol in Schedule IV. Retrieved from http://www.medpagetoday.com
3. John Fauber. (2013). Killing Pain: Tramadol the “Safe” Drug of Abuse. Retrieved from http://www.medpagetoday.com
4. Senay, E.C., Adams, E.H., et al. (2003). Physical Dependence on Ultram (tramadol hydrochloride): Both opioid-like and atypical withdrawal symptoms occur. Drug and Alcohol Dependence, 69:233-241.  DOI: 10.1016/s0376-8716(02)00321-6