There are a variety of tests available for drug testing and choosing the right test can make all the difference in getting results that are meaningful and reliable. 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 of her ex-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 test would be best suited to have included in the court order to test 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 methamphetamine use and may abstain from using drugs during the current legal discussions to avoid having a positive drug test result in the event a urine test is ordered. In that scenario, a urine or saliva test would likely result in a negative result, so a head hair test, which has a ~90-day window of detection, is the best course of action. Methamphetamine is included in the 5-panel hair test, but there is always the chance of cross-addiction, so the 10-panel head hair test is the right test in this case.
It is reasonable to assume that once Sara requests the court to test her ex-spouse, opposing counsel will ask the court for reciprocity and order her to test as well. The best course of action is for Sara to test prior to asking the court to have her ex-spouse tested to avoid any embarrassing test results. In addition to casting a wide net with the a 10-panel hair test with head hair preferred, the court order should include alternate samples such as body hair or fingernails which have windows of detection of approximately six months, in the event the ex-spouse decides to get a buzz-cut.
Sara agreed to the hair test and we had the results back in a just few days. 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 methamphetamine and insisted a mistake had to have occurred at one of the testing facilities. A quick check showed the chain of custody had been maintained throughout the collection and testing process. Considering it was allergy season, we asked Sara if she was using any cold medications, specifically Vicks nasal inhaler. She could not remember taking anything for colds and actively avoids cold and flu medications as best she can.
Methamphetamine is a stereoisomer drug and is available in two forms: D-meth and L-meth. 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 methamphetamine. Other ADHD treatments will not affect these tests. The L-form is available over-the-counter as the active ingredient in 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 testing, and the D-form is 20 times more sensitive at producing a positive. The antibodies used in the ELISA test equipment only react at 4% for the L-form. Standard LC/MS/MS confirmation techniques do not distinguish between the D- and L-forms of methamphetamine. If, however, the special isomer report reveals more than 20% D-methamphetamine present, the result usually indicates illicit methamphetamine use.1
A D- and L-isomer separation test can be performed to determine if the methamphetamine found in Sara’s hair is a result of cold medication or the street drug crystal methamphetamine. We advised her that we would check with the lab to see if enough hair sample remained, after the first test, to run the additional isomer separation test. She understood and agreed to call us the following day.
Sara indeed called 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 if she did order a test, she would be required to test as well and that she would also test positive for methamphetamine. 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 if it was possible for him to add crystal methamphetamine to the water filter so the water supply to the ice and water dispenser in the refrigerator door would contain methamphetamine. Although l 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 quickly puts the drug into the bloodstream and brain, causing an intense and immediate “rush,” amplifying the drug’s addiction potential and adverse health consequences.
Snorting or oral ingestion produces a euphoric high, but not an intense “rush.” Snorting produces effects within three to five minutes while oral ingestion produces effects within 15 to 20 minutes.2 So introducing methamphetamine in the water supply to the refrigerator may produce only subtle effects that may be barely noticeable to anyone consuming the water or ice sourced from the refrigerator.
This new information changed our strategy of running a test to separate the D- and L- isomers in the remaining hair sample from Sara. Instead we asked her to come in for another hair sample for a less expensive 5-panel hair test, as it includes methamphetamine which was the only positive result from the previous 10-panel hair test. We also decided to use a second lab to eliminate any possible notion that chain of custody was breached or samples mixed and would also serve to corroborate the findings of the first lab. We also asked to have her 12-year-old son come in for the same 5-panel hair test as a simple check regarding the D- vs L- isomer issue (Vick’s inhaler use) and possible link to a common source of the drug, such as the refrigerator water dispenser.
She agreed with the strategy and both Sara and son came into the lab for hair testing. We made it exceedingly clear that the collection utensils used in the collection process of her hair sample were being cleaned just prior to the hair collection and that a second set of utensils were being used to collect the hair sample from her son to eliminate any possibility of cross contamination.
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. ls it conclusive that methamphetamine was introduced into the water supply to the refrigerator water and ice dispensers? Does it prove Sara’s ex-husband, or anyone else, added methamphetamine to the water filter feeding the water supply to the refrigerator? No, but the police were called to investigate the matter and what they found was incriminating. Two of four specialty boutique beer bottles, with a resealable rubber stopper, found in the recycle bin tested positive for methamphetamine and was the source of methamphetamine found in both Sara and her sons’ hair.
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. When it is critical to find the right answers, work with an expert who knows which tests to perform in drug testing.
1. How is methamphetamine abused? (2013, September). Retrieved from https://www.drugabuse.gov/pub!ications/research/reports/methamphetamine/howmethamphetamine-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 SonicTest LabsTM and owns three labs (Tempe, Phoenix, Mesa) operating within the Phoenix Valley. Gary serves both corporate and private clients in drug, alcohol, DNA, occupational health and wellness and on-site testing services, creates workplace policies for both D.O.T. and non-mandated companies and manages consortiums and random testing programs for corporate and private clients. He can test powders, pills, capsules, liquids, food items, syringes and a variety of other items for drugs, heavy metals, unknown chemicals & toxins. Gary is a 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 the Drug and Alcohol Testing Industry Association (DATIA), the Arizona Small Business Association, the United States Drug Testing Laboratories (USDTL) and writes a monthly column for the Arizona Republic.