A Testimony from the field: Use The Right Test to find the Best Answer

Originally published in Substance, Summer 2016.
Choosing the right test for your client can make all the difference.

by Gary Patrone

There are a variety of tests available, and choosing the right test can make the difference between answering questions and creating more of them for your client. One client, Sara (not her real name) contacted our office and explained how she was in the middle of a divorce and planned to curtail child visitation rights to her estranged husband in an upcoming court appearance. She knows that he uses methamphetamine and does not want her 12-year-old son exposed to drugs. She wanted to know which tests would be best suited for her to have included in the court order for her ex-husband.

The window of detection for methamphetamine in urine and saliva is approximately four days. After which, we may not find it. Sara’s ex-husband has a history of meth use but may abstain from using during the current legal discussions. Since a urine or saliva test would likely result in a negative result, we recommended a head hair test which has a ~90 day window of detection.

We also advised Sara that once she asks the court to test her ex-husband, opposing counsel will likely ask the court for reciprocity and ask to have her tested as well. We also suggested she cast a wide net and ask for a 10-panel hair test with head hair preferred, and body hair or fingernails as an alternate.

Sara agreed to the test, and we used USDTL for a quick turnaround time of three days from the collection date in order to meet her court appearance. We reviewed the results with her when they arrived, and she was shocked to learn that she showed positive for methamphetamine.

She was driving at the time and had to pull over and stop the car as she was nearing a panic attack. She had never used meth and insisted a mistake had to have happened either at my lab or the testing facility, USDTL. I assured her that the chain of custody had been maintained throughout the collection and testing process and, considering it was allergy season, asked her if she was using any cold medications. She could not remember using anything and avoids cold and flu medications as best she can.

Methamphetamine is a stereoisomer drug and is available in two forms: d- and l-. The d- form can be a pharmaceutical grade methamphetamine (Desoxyn) used to treat ADHD, severe obesity, and narcolepsy, but usually indicates the street drug crystal meth. The l- form is available over-the-counter as the active ingredient of the Vicks inhaler and is a metabolite of certain prescription medications. Illegally produced methamphetamine may contain mixtures of both isomers, with a substantially higher amount of d-methamphetamine present than most commercial products. Both d- and l- forms can register a positive methamphetamine result by immunoassay, and the d- form is 20 times more sensitive at producing a positive. The antibodies used in the ELISA only react at 4% for the l-form. Standard LC/MS/MS confirmation techniques do not distinguish between the d- and l- forms. If, however, the special isomer report reveals more than 20% d-methamphetamine present, the result usually indicates illicit methamphetamine use.1

I explained the difference between d- and l-meth and advised her that I would check with the lab to see if enough hair sample remained to run an isomer separation test to determine if the positive test results were due to the d- or l-isomer. She understood and agreed to call me the following day.

Sara indeed called me the next day and made a game-changing comment. She was perplexed by a statement her ex-husband made the day he left the house. There was a heated argument where Sara threatened to have him tested for drugs before granting joint custody and/or visitation rights to her 12 year old son. Her husband seemed unfazed and informed her that meth was in her system as well. She thought it was a preposterous statement since she would most certainly know if she smoked any illegal drugs and dismissed his comment as spiteful retaliation. She thought about that seemingly odd comment overnight and remembered the last thing he did before leaving the house for the last time was to change the water filter feeding the refrigerator. She asked me if it was possible for him to add crystal meth to the water filter providing contaminated water to the ice and water dispenser in the refrigerator door. Although I could barely wrap my mind around someone doing something so atrocious, even to his own son, I confessed it was indeed possible.

Smoking or injecting methamphetamine puts the drug very quickly into the bloodstream and brain, causing an immediate, intense “rush” and amplifying the drug’s addiction potential and adverse health consequences. The rush, or “flash,” lasts only a few minutes and is described as extremely pleasurable. Snorting or oral ingestion produces euphoria—a high, but not an intense rush. Snorting produces effects within three to five minutes, and oral ingestion produces effects within 15 to 20 minutes.2 So introducing methamphetamine to the water supply to the refrigerator may produce only subtle effects barely noticeable to anyone consuming the water or ice sourced from the refrigerator.

With this new information, I changed our strategy of running a test to separate the d- and l- isomers in the remaining hair sample from Sara. Instead I asked her to come in for another hair sample for a 5-panel hair test using a second lab. This would eliminate any possible notion that chain of custody was breached or samples mixed and serve to corroborate the findings of the first lab. I also asked her to bring in her 12-year-old son for the same hair test as a simple (not conclusive) check regarding the d- vs l-isomer issue and possibly linking the source of the drug to the refrigerator water dispenser.

She agreed with the strategy and both Sara and son came into the lab for hair testing. I made it exceedingly clear as I cleaned the utensils used in the collection process of her hair sample that I was eliminating any possibility of cross contamination and used a second set of utensils to collect the hair sample from her son. The samples were sent the same day and the answers would arrive in about a week.

The results arrived a week later shocking my staff and leaving me with an uneasiness that’s difficult to describe. Both Sara and her son tested positive for methamphetamine in their hair samples. Are the results conclusive that d-meth was found in both hair samples? No. Is it conclusive that meth was introduced into the water source for the refrigerator water and ice dispensers? No. Does it suggest that Sara’s husband, or anyone else, may have added meth to the water filter feeding the water supply to the refrigerator? No. These events are fresh, however, and may be just the beginning of larger events to come.

Questions still remain, and this event may likely find its way into a courtroom. Although the tests performed are not conclusive in several areas, it is a good start and provides a solid foundation in any likely dispute moving forward. Should additional confirmations be required, we have hair and nail samples available to us to test, and the d- and l- isomer separation test is still a viable option on new test samples.

Such potentially devious and malicious cases are not the norm, however we do see many complex cases that require a measure of judgment in which tests are chosen to best fit a particular set of circumstances. Our clients depend on our ability to get it right, and we do our level best to not disappoint them.

References:

1. How is methamphetamine abused? (2013, September). Retrieved from https://www.drugabuse.gov/publications/research-reports/methamphetamine/how-methamphetamine-abused
2. Stockard, F. (2014, July 25). Meth Addiction Facts: What’s True and What’s False? Retrieved from http://lighthouserecoveryinstitute.com/meth-addiction-facts/

Gary F. Patrone is CEO of ARCpoint Labs of Tempe and owns three labs operating within the Phoenix Valley. Gary serves both corporate and private clients in drug, alcohol, DNA, wellness and on-site testing services, creates workplace policies for both DOT and non-mandated companies and manages consortiums and random programs for corporate and private clients. Gary is an active member of the Tempe-South Rotary Club, an Ambassador of the Tempe Chamber of Commerce, member of the Business Development Committee, member of the Advisory Council for Brookline College and PIMA Medical Institute. Gary has authored articles for DATIA, the Arizona Small Business Association and writes a monthly column for the Arizona Republic.