umbilical cord testing: a discussion of prevalent issues
TRANSCRIPT
Umbilical Cord Drug Testing: A Discussion of Prevalent Issues
Why umbilical cord?Advantages of umbilical cord?Common concernsConclusionsQuestions
OBJECTIVES
Why Umbilical Cord?
Client inputQNS – frustration with meconium
Insufficient specimen for testing6.1% meconium specimens received
This is only part of the story!
Why Umbilical Cord?Non-Compliant Meconium
Year Study Enrolled Unavailable %1999 Arendt 218 61 27.92001 Lester 8527 3284 27.82003 Derauf 546 110 20.12005 Eylera 51 5 9.82010 Gray 102 14 13.7
Why Umbilical Cord?Total Non-Compliant Meconium
Year Study Enrolled Unavailable %1999-2010
9Studies 13951 3750 26.9
Ucord Advantages?
o Universal sample
o Turn around Time
o Integrity of chain of custody
o Improved costs
UCord Advantages?
o Universal sample• Plenty of sample • 6” segment• 2 QNS over 7 years• Ideal for surveys
UCord Advantages?
o Turn Around Time• Collected at birth• 2-5 day head start• Lab time same as Mec
UCord Advantages?o Turn Around Time
Receipt Screen ReportNegatives Confirm Report
Positives
9am-11am
11am-3pm
3pm-5pm
5pm-11am
11am-5pm
UCord Advantages?o Turn Around Time
Receipt Screen ReportNegatives Confirm Report
Positives
9am-11am
11am-3pm
3pm-5pm
5pm-11am
11am-5pm
UCord Advantages?o Turn Around Time
Receipt Screen ReportNegatives Confirm Report
Positives
9am-11am
11am-3pm
3pm-5pm
5pm-11am
11am-5pm
UCord Advantages?o Integrity of ID
1 mom
1 baby
1 collection
UCord Advantages?
o Lower costs
$150 savings
Whose cord is it?
o Belongs to baby• Stalk from the embryo
• Forms during first 5 weeks
Detection Window?o Experience vs Experiment*
o Matched with meconium
o Similar to meconium
o Approximately mid-term* J. Gareri (2013) Society of Hair Testing Annual Conference, Toronto, Canada
What do the values mean?
o Is she taking it as prescribed?
o Is she abusing?
o When did she take it?
What do the values mean?
o Testing a reservoir matrix
Cannot determineoTimeoDose oFrequency
What do the values mean?
o Appropriate Detection
Time Window
o Yes or NO
Drug given during L&D?
o Yes – we may see them
•Morphine
•Dilaudid (hydromorphone)
•Versed (midazolam)
Mom has a script for X?
o Is it in the profile
o Did she take enough
o Was she compliant
o Genetics
Mom has a script for X?
She says that she took X
so WHY is she negative?
Mom has a script for X?
She says that she took X
so WHY is she negative
Wrong question!
Mom has a script for X?
The cord is positive for X
Is there a reasonable explanation
The Right Question!
Discrepant Results?o Urine
o Hair
o Meconium
o Umbilical cord
o Self Report
Discrepant Results?o Different threshold to positivity
o Different detection window
o Different time to appear
o Recall bias / misclassification
Discrepant Results?
o Results to not refute each other
o Results are cumulative
Opiates
• Codeine
• Hydrocodone
• Oxycodone
• Morphine
• Hydromorphone
• Oxymorphone
Le, N. L., Reiter, A., Tomlinson, K., Jones, J., & Moore, C. (2005). The detection of oxycodone in meconium specimens. Journal of analytical toxicology, 29(1), 54-57.
Opiates
Heroin(Diacetylmorphine)
Morphine
6MAM(Monoacetylmorphine)
Opiates
Noscapine Meconin
A Heroin Contaminant
Jones, J., Jones, M., Jones, B., Sulaiman, K., Plate, C., & Lewis, D. (2014). The detection of codeine, morphine, 6-monoacetylmorphine, and meconin in human umbilical cord tissue: method validation and evidence of in utero heroin exposure. Therapeutic Drug Monitoring, 37(1), 45-52.
CONCLUSION
• Umbilical Cord Testing
o Gaining Popularity
o Number of Advantages
o Results similar to meconium
All Rights Reserved. Copyright © 2015 United States Drug Testing Laboratories, Inc.
Thank You
Questions?
[email protected] me on LinkedIn, too!
Additional Contact Info: [email protected]