by: Nachman Brautbar
"Intoxication, Drugs of Abuse Testing
& Forensics Application
By Nachman Brautbar, M.D.
Drug of Abuse and Hair Testing
Hair testing for drug of abuse testing has become extremely popular among employers. There have been several scientific forensic doubts about the use of this methodology for proof of abuse. For example, the Society of Forensic Toxicologists in 1990 stated: ""The use of hair analysis for employees in pre-employment drug testing is premature, and cannot be supported by the current information on hair analysis for drugs of abuse."" A 1997 study by the National Institute of Drug abuse reached a conclusion and indicated that significant ethnic bias may be the result of test for cocaine positivity. Analytical Toxicology in its issue in March/April 1998 indicated that removal of melanin from hair (a methodology used to remove the ethnic bias) ""does not eliminate the hair color bias when interpreting cocaine concentrations"" Public information available (Congressional records from May 14, 1999), indicated that the Department of the Army secretary raised questions about the Army's use of hair testing in a specific case, and members of Congress were expressing their discomfort with the procedure's reliability. Indeed, Representative, Cynthia McKinney, a Democrat of Georgia, and from Defense Secretary, William Cohen, that she is exploring possible Legislative remedy to prohibit human hair testing for drugs in the military, given that the hair testing has been proven by forensic toxicologists to be racially biased. Indeed, the paper by Kintz, et. al. published in the Journal of Forensic Scientific International, January 1997, Volume 17, pages 84 to 123 and 151 to 156, indicated that false positives are found even at low concentrations. Tissue hair analysis in good hands with good laboratory technology may give an idea about habitual use of some of the drugs; however, it is preferable that these should be combined with urinalysis utilizing either screening, or better confirmation methodology.
Practical Application to a Case Analysis
In order to summarize and make the above data applicable, I will describe two case scenarios.
Case #1:
A 28-year-old worker fell off the roof, 2nd floor, while on the job. He suffered several bone fractures, head contusion and was taken to the emergency room. At the emergency room urine was sent to the lab for drug screening. Upon recovery from the injury the patient requested Workers Compensation benefits, and was denied since the urine drug screening utilizing EMIT methodology (immunological) detected opiates. In his deposition the patient testified that he has never used drugs, did not use drugs on the date of injury either. On careful review of the medical records, it turned out that the physician on behalf of the employer had recommended denial of the Workers Compensation benefits, failed to review the paramedic ambulance notes which was called to the scene of the injury and had transferred the patient to the hospital. The emergency room notes sheet indicated that the patient had received IV morphine from the medic driver to sedate him from his severe pain of bone fractures and skull concussion. The evaluating physician further failed to note that the urine sample was obtained 4 hours after the patient's stay in the emergency room, and did not specify whether that was a fresh urine sample, catheterized urine, and did not specify the volume of the urine. The patient's physician provided a report documenting that there is no history of drug abuse, there was no evidence that the patient was impaired from testimonies from his supervisors and coworkers on the date that the injury occurred, and has further provided evidence that the urinalysis was taken several hours after the patient was administered IV morphine by paramedics at the emergency room, and therefore, the results were essentially erroneous and irrelevant to the patient's cause of injury. This is an example of how drug urine testing can be applied wrongfully, and cause unnecessary pain, anxiety, delay of benefits and major expenses to the insurance carrier and the citizens who end up paying these expenses out of their pocket.
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"Intoxication, Drugs of Abuse Testing
& Forensics Application
By Nachman Brautbar, M.D.
Drug of Abuse and Hair Testing
Hair testing for drug of abuse testing has become extremely popular among employers. There have been several scientific forensic doubts about the use of this methodology for proof of abuse. For example, the Society of Forensic Toxicologists in 1990 stated: ""The use of hair analysis for employees in pre-employment drug testing is premature, and cannot be supported by the current information on hair analysis for drugs of abuse."" A 1997 study by the National Institute of Drug abuse reached a conclusion and indicated that significant ethnic bias may be the result of test for cocaine positivity. Analytical Toxicology in its issue in March/April 1998 indicated that removal of melanin from hair (a methodology used to remove the ethnic bias) ""does not eliminate the hair color bias when interpreting cocaine concentrations"" Public information available (Congressional records from May 14, 1999), indicated that the Department of the Army secretary raised questions about the Army's use of hair testing in a specific case, and members of Congress were expressing their discomfort with the procedure's reliability. Indeed, Representative, Cynthia McKinney, a Democrat of Georgia, and from Defense Secretary, William Cohen, that she is exploring possible Legislative remedy to prohibit human hair testing for drugs in the military, given that the hair testing has been proven by forensic toxicologists to be racially biased. Indeed, the paper by Kintz, et. al. published in the Journal of Forensic Scientific International, January 1997, Volume 17, pages 84 to 123 and 151 to 156, indicated that false positives are found even at low concentrations. Tissue hair analysis in good hands with good laboratory technology may give an idea about habitual use of some of the drugs; however, it is preferable that these should be combined with urinalysis utilizing either screening, or better confirmation methodology.
Practical Application to a Case Analysis
In order to summarize and make the above data applicable, I will describe two case scenarios.
Case #1:
A 28-year-old worker fell off the roof, 2nd floor, while on the job. He suffered several bone fractures, head contusion and was taken to the emergency room. At the emergency room urine was sent to the lab for drug screening. Upon recovery from the injury the patient requested Workers Compensation benefits, and was denied since the urine drug screening utilizing EMIT methodology (immunological) detected opiates. In his deposition the patient testified that he has never used drugs, did not use drugs on the date of injury either. On careful review of the medical records, it turned out that the physician on behalf of the employer had recommended denial of the Workers Compensation benefits, failed to review the paramedic ambulance notes which was called to the scene of the injury and had transferred the patient to the hospital. The emergency room notes sheet indicated that the patient had received IV morphine from the medic driver to sedate him from his severe pain of bone fractures and skull concussion. The evaluating physician further failed to note that the urine sample was obtained 4 hours after the patient's stay in the emergency room, and did not specify whether that was a fresh urine sample, catheterized urine, and did not specify the volume of the urine. The patient's physician provided a report documenting that there is no history of drug abuse, there was no evidence that the patient was impaired from testimonies from his supervisors and coworkers on the date that the injury occurred, and has further provided evidence that the urinalysis was taken several hours after the patient was administered IV morphine by paramedics at the emergency room, and therefore, the results were essentially erroneous and irrelevant to the patient's cause of injury. This is an example of how drug urine testing can be applied wrongfully, and cause unnecessary pain, anxiety, delay of benefits and major expenses to the insurance carrier and the citizens who end up paying these expenses out of their pocket.
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