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Post-publication Peer Reviews to:

ARTICLES:
Sharon Levy, Lon Sherritt, Brigid L. Vaughan, Matthew Germak, and John R. Knight
Results of Random Drug Testing in an Adolescent Substance Abuse Program
Pediatrics 2007; 119: e843-e848 [Abstract] [Full text] [PDF]
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[Read P3R] Random Drug Testing Can Be Effective
Richard E. Struempler   (12 April 2007)

Random Drug Testing Can Be Effective 12 April 2007
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Richard E. Struempler,
Director of Toxicology
Doctors Laboratory, Inc.

Send letter to journal:
Re: Random Drug Testing Can Be Effective

rstruempler{at}doctorslabinc.com Richard E. Struempler

Your abstract conclusion "Unless proper procedures are used in collecting, analyzing, and interpreting laboratory testing for drugs, there is substantial risk for error" could apply to any laboratory test being performed for any reason.

Your article does a good job in describing your protocol and demonstrating how not to set up an effective drug- screening program, especially one that looks for something other than the standard "DOT" required drugs.

It is a well published fact that standard opiate assays will not detect oxycodone, and that most employment-related GC/MS confirmation procedures are not designed to look for anything other than codeine and morphine. That is equivalent to being critical for not detecting abormal electrolyte levels, when you are testing for only glucose and BUN. If you don't look for it, you're not going to see it. The issue is not lacking the ability to detect opioids, but rather establishing a proper protocol if your need warrants looing for oxycodone or other "non-standard" drugs.

We offer opioid testing as part of one of our routine panels and counsel our clients on this matter. We are able to confirm the opioids at the same time as codeine and morphine with minimal additional analytical expense. MDMA is routinely detected in our screening method along with amphetamine and methamphetamine and again is confirmed at the same time.

Any program that does not include at least basic specimen validity testing is signficantly flawed from the beginning, regardless of the application of your drug-screening process.

You indicated that some over-the-counter medications could result in false-positive results, but I saw no data indicating what those products were. I believe that this statement is in error. Properly performed GC/MS confirmation analysis eliminates this issue. Positive results from prescriptions medications (Adderal for amphetamine, Marinol for THC, Tylenol#3 for codeine and morphine, etc.) are not false-positive results, but rather positive results with a medical explanation. There is a huge difference in the two and one that must always be investigated with a positive result.

To suggest that because a drug-screening program is not perfect, that it is not effective is an unfortunate implication, because history has already demonstrated that at least within specific populations (DoD and DoT) that it has been amazingly effective. The key is to do it correctly and to continue to look for ways to do it better. Again, this concept applies to all laboratory testing not just testing for drugs of abuse.

While the body of the paper goes into some detail outlining weaknesses in "basic" programs, the abstract and its conclusion paints a very negative picture with a very broad brush, and one that effective programs do not deserve. Please do not fault the tool, when it is placed in the hands of the unskilled.

Conflict of Interest:

Director of Toxicology, HHS Responsible Person, Doctors Laboratory, Inc. Valdosta, GA