New Forensic Toxicology Equipment Sets the Army up For More Precise and Specific Drug Testing

Photo By Stephanie Abdullah | The Hamilton instrument along with the Rapid Fire is revolutionizing how the Army is able to respond to emerging drug threats such as LSD. Tripler Army Medical Center (in the background) was the first to adapt to fully benefit from the new technology.  

FALLS CHURCH, VIRGINIA, UNITED STATES

04.09.2021

Story by Stephanie Abdullah 

U.S. Army Medical Command

According to the Army’s forensic program, drug abuse by service members is both a safety and a readiness issue for the Nation’s military. Therefore, the Department of Defense (DOD) must rely on its long-standing urinalysis drug testing program to detect and deter drug abuse in service members. The program is also tasked with identifying the danger posed by drug substances that are emerging threats. The need to rapidly adapt to changes observed in the drug testing population is frequently aided by adopting new technology. Recently, the DOD reinstated the testing of Lysergic Acid Dethylamide (LSD) to its testing panel and adopted new technology to accomplish this mission.

In December last year, the U.S. Army Forensic Toxicology Drug Testing Lab (FTDL) at Tripler Army Medical Center (TAMC) became the first of the five DOD drug testing labs (DTL) to fully adopt testing for LSD using the Hamilton and Rapid Fire Mass Spectrometry (RF/MS/MS) instrumentation. This combination technique allows for the Army to detect LSD in urine specimens quickly, and with precision. This technique is flexible and enables the DOD drug testing program to more efficiently add new substances to its testing menu when emerging threats are identified.

The Army requires that one hundred percent of personnel be tested for drug use annually. This includes testing for both illicit drugs as well as certain prescription drugs for which a person does not have a valid prescription. The requirement is achieved by random collections but commanders also conduct command directed testing, and probable cause testing. Random urinalysis accounts for the bulk of the work load.

According to the Army’s forensic program, there are five drug testing labs in the DOD and the Army has two of them. The Navy has two and the Air Force has one. All five of the DTLs process anywhere from 2600-5200 urine specimens each day. DOD instructions dictate what substances are on the drug testing panel. Every day, each lab is able to test each specimen for the possible presence of any of the 28 drug substances on the current drug testing panel.

Lt. Col. Tiffany Heady, the U.S. Army’s Forensic Toxicology Program Manager, explained how this mission is met. “The way we do this and the way most commercial labs do this is through immunoassay testing kits (IA) because they are generally reliable and can be put on automated chemical analysis instrument, she said. Technicians can place tubes on the testing instrument and push a few buttons and test racks and racks of urine specimens at one time.”

Heady said that IA is extremely important because it can screen a large number of specimens simultaneously for all of the substances on the panel and is used to quickly identify negative specimens which will be reported as negative and discarded. The IA technique is not only utilized in forensic drug testing labs, but it is also a primary urine drug screen by larger hospitals. IA is widely used as a screening technique. If the IA screen indicates that a urine specimen possibly contains a drug substance of interest, the specimen is required to undergo analysis by a second and different technique that enables the lab to determine the exact identity of the drug substance in the urine, as well as its amount. To determine the exact identity and an accurate amount of the drug substance in the urine, the lab performs a confirmation test on the urine specimen, using chromatography-mass spectroscopy (C/MS). This combination technique is considered highly reliable and is widely utilized across a wide variety of industries to include: pharmaceutical chemistry, environmental chemistry and seized drug analysis, just to name a few.

Heady said that this C/MS confirmation step is considered the “gold standard” in forensic drug testing. Since 98% of all specimens tested are negative in the IA initial screen only about two percent of the urine samples received at a lab are required to go through C/MS. If a specimen is determined to be negative for all the drug substances after the IA analysis, the specimen can be reported out as negative by the lab and testing on that specimen is considered complete. If, however, a sample is indicated as possibly positive after the IA step, it must undergo confirmation testing and also be positive in the C/MS step in order to be reported as a positive.

“Because of the punitive aspects of the program for Soldiers we have to be absolutely certain that a specimen is positive when we report it as such. Additionally, the chain of custody is proof of control of the specimen. If the chain of custody is questionable, a specimen cannot be reported as positive. Specimens must pass all three steps—IA, CS/MS and an intact chain of custody in order to be reported as a positive,” said Heady.

LSD was removed from the DOD menu in 2006 because the instance of LSD positive specimens was so low. However, recently LSD was added back to the menu because it has shown significance as a current drug threat. Unfortunately, the current system couldn’t efficiently meet the demand for testing for LSD.

“In forensic toxicology testing, we talk about specificity and sensitivity, said Heady. If my test is specific and it says it will pick up say--COVID for example, it will pick up COVID. It won’t pick up the flu or some other similar substance. When we’re speaking sensitivity and I say my test is sensitive for COVID for example, it will pick up COVID even if there are only a few virus particles floating around in your body somewhere.” Heady stated.

IA may be sensitive or specific for a drug class without being sensitive or specific for a specific drug within the drug class. While the IA is widely recognized as a screening technique in forensic drug testing due to its high throughput, it is often limited by its inability to identify the exact drug substance and cannot always accurately determine the amount of the drug substance in the urine specimen. For some drug classes, significant numbers of the presumptive positive results in the follow-on confirmation testing.

While the C/MS is the gold standard, it is a labor intensive and expensive technique, which is less suitable for efficiently analyzing the high volume which the DOD labs test on a daily basis.

“This is the case with LSD, said Heady. The IA kit that is commercially available for LSD is just ‘okay’ for forensic testing. The lack of sensitivity and specificity of the LSD IA kits meant the DOD forensic labs were getting swamped in the conformational step—in the C/MS. We could not keep up with the volume of the work. The new technology--the Hamilton automated liquid handler and the Rapid Fire-Mass Spectrometry (RF/MS), provides speed and the specificity we need in order to not get swamped in the C/MS step,” she said.

With the Hamilton and the Rapid Fire Mass Spectrometry, if the IA indicates 50 positives for LSD for example, those 50 positives can quickly be analyzed using the RF/MS/MS test, which is more sensitive and specific. When the RF/MS/MS reports out positives, technicians can have greater confidence in the accuracy of the results. The improved specificity of this new technology typically results in a smaller number of specimens requiring the additional confirmation testing. This leads to reduced workload on a lab’s confirmation testing staff and improved efficiency in the lab’s overall testing process.

“This is huge for us, said Heady. Because without these new instruments, the program really would not have a way to quickly get after emerging use of LSD. Readiness is our mission and it is very important that we are able to quickly adjust for emerging drug threats. Nationally there is not a lot of demand for clinical or forensic testing for LSD and that’s why the current commercially available LSD IA testing kits aren’t better. However, LSD may be an issue for us and so we needed a fast, reliable way to test for it; so we developed one,” said Heady.

The Rapid Fire testing instrument streamlines the testing process and can take days or weeks off of the timeline for testing results.

Planning for this new instrumentation has been seven years in the making, with the Navy providing critical procurement capability for all of the DOD testing labs. The equipment was installed and ready for use not long after the DOD added LSD back to the testing menu. While the Army’s lab at TAMC was the first to fully adapt this newly acquired technology, all five of the DOD testing labs are fully equipped to now use this instrumentation for analysis of LSD as well as additional drug substances in the future.

“These machines allow us to target and attack drug threats as they emerge,” said Heady.

“It is important for commanders to know if their Soldiers are taking illegal drugs or abusing prescription medications. Forensic drug testing is an assessment of force readiness. Our goal is to be so good at what we do that Soldiers will be deterred from using drugs,” Heady said.
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• Date Taken: 04.09.2021
• Date Posted: 04.13.2021 16:10
• Story ID: 393472
• Location: FALLS CHURCH, VIRGINIA, US