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Concateno Newsletter - August 2011

Concateno Newsletter - August 2011

Articles in this month's Concateno Newsletter:

Feature Drug: ketamine

Find out about this party drug and its effects on the bladder.

Hepatitis – where do we go from here?

Following on from World Hepatitis Day we look at the latest efforts to increase awareness and testing.

From safety critical to business critical:
the changing use of drug and alcohol testing in the workplace

Discussing the advent of drug and alcohol testing in all kinds of workplaces, not just safety critical industries.

‘Mephedrone as popular as cocaine’ – but do the facts match the headlines?

We investigate the worrying statistics surrounding this formerly legal high.

Adulteration – cheaters beware!

Concateno’s technicians carry out tests on all urine samples received at our London laboratory to check whether they have been adulterated. Although adulteration rates are less than 0.1%, this is still an important issue for our customers. Rates are much higher in samples which are collected by third parties or by customers themselves, as opposed to those collected by Concateno’s trained Collection Officers.

Our adulteration tests include creatinine, which indicates dilution, and a pH test to check for the addition of acids or bases. Samples are also checked visually for any obvious adulteration with soap or detergents. Most adulterated samples are categorised as either abnormal human urine (i.e. not containing the components of normal human urine) or substituted urine. The samples are cancelled as unfit for testing and a report is generated detailing the problem.

Adulterants that are added to urine include vinegar, bleach, oxidants such as sodium perborate, Steradent and other denture cleaning products and more recently, water purification tablets. Concateno now routinely tests all samples for the presence of oxidants using a screening method developed in house. This test improves upon the standard check which will not detect oxidants in samples that are more than a day old.

Abnormal samples

Creatinine is formed in the body from the natural metabolism of muscle tissue. Intake of moderate amounts of water (around 1-2 litres) can reduce the creatinine levels in urine significantly. Many samples are found to be in the dilute range but this is not considered to be adulteration and the affect on drug detection rates is minimal. All dilute samples are also given a Specific Gravity (SG) check which measures dissolved electrolytes and proteins in the urine. If a sample has an SG of less than 1.0001 it is considered abnormal urine.

Substitution

At a glance, many adulterated samples look like normal urine samples. But we’ve receive samples which are just cold tea or coffee, fruit juice or other soft drinks, or occasionally alcoholic drinks (one sample included cherry brandy). People have also supplied samples which appear to be tobacco soaked in water. Although these samples look 'normal' they do not contain creatinine and are usually also SG 1.0001 or less. Concateno’s technicians identify these ingredients using a range of techniques from smelling the sample to using GC/MS or LC/MS to test for caffeine, nicotine or their metabolites in the sample.

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Russia's deadliest new designer drug causes the user’s skin to turn green and scaly, hence its name:  krokodil, or crocodile.

Krokodil has a similar effect to heroin but it’s much cheaper to make yourself, which is why it has spread fastest in the poorest parts of the country. The active component is the over-the-counter painkiller codeine. Addicts mix the codeine with ingredients including gasoline, paint thinner, hydrochloric acid, iodine and red phosphorous, which they scrape from the striking pads on matchboxes.

The average user of krokodil does not live longer than two or three years and the few who manage to quit usually come away disfigured. At the injection site the addict's skin becomes greenish and scaly, like a crocodile's, as blood vessels burst and the surrounding tissue dies. Gangrene and amputations are a common result, while porous bone tissue, especially in the lower jaw, often starts to dissipate, eaten up by the drug's acidity.

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Transport Security Expo

13-14th September 2011, Olympia, London

Transport Security Expo features an extensive conference and knowledge centre workshop programme, supported by one of the largest dedicated technology exhibitions to be held in the European region each year.

Visit Concateno at stand A15

This is a highly specialised and unique event which gathers the world's leading experts to deliberate on the challenges faced and to drive the adoption of operational countermeasures.

Transport Security Expo's extensive conference programme has the objective of bringing the most critical and pressing issues to the forefront of the debate. It is held over two very full days and brings the world’s leading thinkers from the aviation, maritime, public transport and supply chain sectors together, and aims to inform, deliberate, and resolve many of the seemingly most intractable issues the collective faces.

The 2011 conference programme will include the following:

Two Day: Aviation Security Conference – 13-14th September
One Day: Maritime Security and Counter Piracy Conference – 13th September
One Day: Securing and Protecting Public Transport Systems – 14th September

Visit Concateno at stand A15


Whole Family Support for Drug and Alcohol Misusing Parents, Community Care

15th September 2011, Holiday Inn London

The event will focus on how multiagency working can help bring together adult care services, drug treatment providers and all those working in children’s services to safeguard children of substance misusing parents.

Concateno TrichoTech are the principal sponsors of the event and will be speaking alongside some key people in the child protection and substance misuse arena, including District Judge Nicholas Crichton and Professor Judith Harwin who have both been involved in the FDAC scheme.


Family Law Conference and Breakfast Briefing, Solicitors Group

15th September 2011, Holiday Inn Cardiff

We are running a breakfast briefing before the family law conference about drug and alcohol testing and the current scientific consensus. The conference, hosted by the Solicitors Group, provides an update on the new family procedures as well as a selection of talks on other family law issues.

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Name:

Ketamine – street names include Green, K, special K and super K.1

Properties:

Ketamine is a synthetic drug the recreational use of which was reported soon after its release to the medical market in 1965.2 Its intended medical use is as a short acting but powerful general anaesthetic used while operating on both humans and animals. That’s why it’s referred to as a horse tranquilizer.3,4

It is taken orally in tablet form, intra-nasally as a powder or intravenously as a liquid.5 In the UK, ketamine is currently classified as a Class C drug, making it illegal to possess and supply, although recent research on the harms of the drugs have led to some commentators calling for it to be upgraded.6

Effects:

Ketamine has powerful hallucinogenic effects, similar to LSD, which can distort reality.7 Low doses of ketamine can make users feel euphoric and energetic however in higher doses ‘out of body experiences’ have been reported.8 The effects usually last up to an hour.9

Risks:

Recent scientific studies have linked chronic ketamine use with severe bladder problems.10,11,12,13 Side effects such as incontinence and bladder shrinkage, as well as damage to the kidneys and ureter, have been found in people using ketamine frequently.14 Another study suggests that 20% of people who have taken high doses of ketamine several times a week over months to years have experienced urinary tract problems.15

High doses of ketamine can result in unconsciousness and potential respiratory collapse or heart failure.16 Repeated use has also been linked to memory impairment.17 Ketamine can be particularly dangerous when used alongside depressant drugs, including alcohol.18 An independent Lancet study ranked ketamine as more harmful than both cannabis and ecstasy.19

Usage:

Despite the health risks ketamine use has grown dramatically in the last 10 years.20 Recent research by the Independent Scientific Committee cited a 2009 study which found 68% of UK clubbers surveyed had taken the drug, compared with 25% in 2001.21 In addition, the 2010/11 British Crime Survey estimates that 2.1% of adults aged 16 to 24 had used ketamine in the last year, more than double the estimate in the 2006/07 survey (0.8%).22

If injected the average dose is between 50-100mg and when taken orally it can be between 200-300mg.23

Availability:

Due to the complicated synthesis and the difficulty of purchasing the necessary solvents and reagents, ketamine sold illicitly for recreational use appears to be obtained mainly by diversion of legitimate medical supplies.24 The average price of a gram of ketamine had fallen from £30 to £20 between 2005 and 2008, thought in part to be due to the increase in popularity.25

Concateno can provide testing for ketamine in urine, oral fluid and hair. Contact us to find out more.

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Last month, groups across the world were campaigning and testing to raise awareness of the global health threat posed by hepatitis. World Hepatitis Day which happened on the 28th July, forced us all to recognise that 1 in 12 people around the world are living with chronic hepatitis B or hepatitis C.

So what are the facts?

• 50% of injecting drug users are thought to have Hepatitis C.  UNDOC World Drug Report 20111
• Five out of every six people with chronic hepatitis C are unaware of their infection. Hepatitis C Action Plan for England2

Concateno works with hundreds of drug treatment providers whose clients are at a very high risk of contracting blood borne viruses like hepatitis. This is because they often share drug taking paraphernalia, not just needles but  such as cocaine straws or tourniquets, all of which could transfer blood. Injecting practices have improved significantly over the last 10 years due to increased awareness and the roll out of needle exchange projects throughout the UK. But despite the amazing work done by the World Hepatitis Alliance and other organizations such as the Hepatitis C Trust and the British Liver Trust, work still needs to be done to increase awareness of safe injecting practices, as the Health Protection Agency (HPA) data below demonstrates.

Risky injecting practices: England, Wales and Northern Ireland3

Risk

2007

2008

2009

Passing on or receiving used needles or syringes
in the last month: self-reported
Current injectors 23% 19% 19%
Current injectors 24 years or under 26% 22% 27%
Sharing of any injecting equipment in the past month Current injectors 47% 41% 37%

Testing times

Regular, easily available blood borne virus testing is a key method for measuring the effectiveness of awareness campaigns and initiating the discussion about the health implications of risky injecting practices, as well as getting people into treatment. The HPA’s ‘Hepatitis in the UK’ report highlighted a number of successful projects, including the Department of Health funded community pharmacy testing scheme and mobile testing awareness vans operated by the Hepatitis C Trust. These vehicles offer testing to hard-to-reach communities including homeless people, current drug users, and the South Asian community.4

Dried blood spot testing has been shown to increase uptake in groups where whole blood samples are less popular.5 Injecting drug users often have inaccessible veins and many substance misuse services can’t afford to have a qualified phlebotomist on their staff. The HPA wrote in their 2011 report 'In England, Scotland and Wales, the roll out of dried blood spot (DBS) testing, has contributed to the increased levels of testing in IDUs (injecting drug users).'6

There are still many barriers to testing, from tight service budgets to the reluctance of clients to get tested in the first place due to the stigma associated with this disease. Some services are trying innovative ways to increase uptake, including Turning Point’s Hertsreach Substance Misuse Service, whose needle exchange sharps bins now bear the message ‘Get tested… Get Vaccinated’. Glenda Lee, Service Manager for Hertsreach, comments: "We have seen a definite increase in clients contacting us for testing and information. It’s early days but it’s working!"

Click here to find out about Concateno’s new improved Blood Sample Collection kit for dried blood spot testing.

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The changing use of drug and alcohol testing in the workplace

Drug and alcohol testing in the workplace was once limited to monitoring safety critical activities. These activities require a level of performance which, if compromised by impairment of any sort – including the debilitating effects of drugs and alcohol – can be physically dangerous to the individuals affected and to their colleagues. In some cases, they can have additional harmful consequences both to the general public and to the environment.  Oil rig workers, train drivers and pilots all work in safety critical environments which require high levels of performance and therefore high levels of risk if standards of work are not met.

Workplace drug and alcohol testing has progressed and is now used for business critical as well as safety critical work. Testing here is still concerned with risk reduction. Not so much physical risk as the possible economic and social risks from compromised productivity, corporate reputation and staff cohesion. This reflects the many consequences that drug abuse can have over and above the immediate physical danger that impairment can bring. A truck driver whose drug abuse contributes to a road accident will put lives at risk as well as risking the reputation of the company he or she works for. A financial trader employed by a bank who completes a series of misjudged transactions whist under the influence of alcohol or drugs could cause immediate financial losses for investors and shareholders and longer term losses to the bank’s reputation.

For companies considering introducing drug and alcohol testing in non safety critical environments there is still the concern that it could be perceived as invasive and a way for organisations to interfere with their staff’s private lives. But perceptions of testing have changed and it is no longer a simple case of whether staff should be allowed to ‘bring the weekend into the workplace.’ Company drug and alcohol testing is a mechanism for supporting a company’s ethos both in regulated and unregulated environments and one of a number of measures which encourage staff responsibility at all levels as well as a means to help drive up standards of behaviour.

How testing is introduced in business critical environments is therefore crucial to how it is received by staff.  Testing can help reduce accidents, increase productivity and staff commitment, but it won’t happen by simply bolting a testing clause onto an existing drug and alcohol policy. It is only though negotiation and discussion that drug and alcohol testing can provide a means of monitoring drug use which also helps staff feel better about the company they work for. 

In the next edition of the Newsletter we’ll discuss issues which managers should think about before introducing drug and alcohol testing as well as a checklist of items to include in the company’s policy.  If you have questions you’d like answered about this, please email newsletter@concateno.com and we’ll do our best to answer them in the article.

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But do the facts match the headlines?

In July the Home Office published its latest survey of drug misuse in England and Wales and in the summary findings it stated that “For those aged 16 to 24, mephedrone use (4.4%) was at a similar level of use as powder cocaine (4.4%; the second most used drug amongst young people).”1

From this a number of newspapers spread the message in bold headlines such as the title above.2

Does this mean that workplaces with an active drug testing programme should ensure they include mephedrone tests? Should the Home Office’s Drug Intervention Programme (DIP), currently testing for heroin and cocaine use in people arrested for burglary, be extended too?

To gain a perspective on this statistic, the data needs to be put in context. The British Crime Survey (BCS) is conducted by the Home Office annually to find out how many people have been the victims of crime and what sort of crime. They interviewed over 46,000 people of all ages and from a wide range of economic and social backgrounds to build up a picture of crime trends in England and Wales. This presents a useful opportunity to find out about drug use trends as well, so the ‘Drug Misuse declared’ questionnaire is tacked on to the end of the BCS.

However, to achieve honest answers about potentially illegal activity, the drug use questionnaire takes place after the face to face interviews, with the respondents using the interviewers’ laptops to complete the questions themselves. The data is then encrypted at the same time so the interviewers do not know what the answers were.

Does the mephedrone statistic of ‘4.4% of 16-24 years old users’ stack up?

Firstly, this data refers to responses to the question “which drugs have you taken over the past 12 months?”. It is the yardstick the Home Office prefers to use when assessing drug trends. They also ask “which drugs have you taken in the last month”, which is often regarded as the measurement for regular use. However, mephedrone was not added to this section, only to ‘other drugs recently classified’, so an estimate for regular mephedrone use is not available.

Secondly, the survey began in April 2010 and ran until March 2011, so earlier respondents could have been answering the question based on their experience from before April 2010, a period when mephedrone was a available to buy legally: this could bias the data as it was not classified an illegal Class B drug until April 16th 2010.

Finally, it is worth noting that the survey also asked users what other drugs they took and found that 91% of mephedrone users had also taken cannabis, (72%) Cocaine (55%) and ecstasy (48%), indicating that few new drug users were drawn to mephedrone on its own.3

In addition to the survey’s findings, Concateno has tested hundreds of samples for mephedrone in the last year and detected only a very small number of positives.4

So should you test for it?

Concateno would only recommend including mephedrone testing if there is suspicion that it might be being used by the group in question, rather than automatically including it in a drug panel. However, trends in drug misuse can change fast and can be regional – it only takes an entrepreneurial dealer to move into an area for a sudden sharp spike in one particular drug group to occur in that region (or organisation). So we advise that you should review your drug and alcohol policy regularly, at least every two years, if not annually, to make sure it reflects recent trends that may have altered the drug misuse affecting your organisation.

Contact Concateno for more information.

Click here to read our Feature Drug article on mephedrone.

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Did you know..? - References:

Source: Shuster, S., ‘The Curse of the Crocodile: Russia's Deadly Designer Drug’, Time World, June 20, 2011 [accessed 15th August 2011]

Feature Drug: Ketamine - References:

1. Ketamine. Talk to Frank. [online] [accessed August 15th]
2. Report on Ketamine. ACMD Technical committee. [online] [accessed 15th August]
3. Ketamine. Talk to Frank.
4. Drugscope highlights concerns over trends in ketamine use. Drugscope. [online] [accessed 15th August]
5. Report on Ketamine. ACMD Technical committee
6. Ketamine use 'rises over decade'. BBC news. [online] [accessed 15th August]
7. Ketamine. Talk to Frank.
8. Report on the risk assessment of ketamine in the framework of the joint action on new synthetic drugs. EMCDDA. [online] [accessed 15th August]
9. Ketamine. Talk to Frank.
10. Chronic ketamine use kills bladder cells. New Scientist. [online] [accessed 15th August]
11. Recreational Ketamine: from pleasure to pain. BJU International. [online] [accessed 15th August]
12. Urinary tract disease associated with chronic ketamine use. BMJ Volume 336. [online] [accessed 15th August]
13. Journey through the K-hole: phenomenological aspects of ketamine use. NCBI [online] [accessed 15th August]
14. Recreational Ketamine: from pleasure to pain. BJU International.
15. Journey through the K-hole: phenomenological aspects of ketamine use. NCBI.
16. Drugscope highlights concerns over trends in ketamine use. Drugscope.
17. First ever large-scale study of ketamine users published. Addiction Journal. [online] [15th August]
18. DrugScope highlights concerns over trends in ketamine use. Drugscope
19. Development of a rational scale to assess the harm of drugs of potential misuse. Lancet. [online] [accessed 15th August]
20. Ketamine use 'rises over decade'. BBC news
21. Ketamine: New report highlights the harms of ketamine as well as the harms of classification. Independent Scientific Committee. [online] [accessed 15th August]
22. Drug Misuse Declared: Findings from the 2010/11 British Crime Survey. Home office. [online] [accessed 15th August]
23. Report on the risk assessment of ketamine in the framework of the joint action on new synthetic drugs. EMCDDA.
24. Report on the risk assessment of ketamine in the framework of the joint action on new synthetic drugs. EMCDDA.
25. Ketamine: New report highlights the harms of ketamine as well as the harms of classification. Independent Scientific Committee.

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Hepatitis - where do we go from here? - References:

1. UNODC, World Drug Report 2011 (United Nations Publication, Sales No. E.11.XI.10), p.30
2. Department of Health/General Health Protection, Hepatitis C Action Plan for England, (Department of Health Publications; 2004), p.12
3. Health Protection Agency, Health Protection Scotland, Public Health Wales, CDSC Northern Ireland, and the CRDHB. Shooting Up: Infections among injecting drug users in the United Kingdom 2009. London: Health Protection Agency, November 2010. p.9
4. HPA, Hepatitis C in the UK 2011. London: Health Protection Agency, Colindale July 2011.pp.21-23
5. Hickman, M., McDonald, T., Judd, A., Nicholes, T., Hope, V. et al., ‘Increasing the uptake of hepatitis C virus testing among injecting drug user in specialist drug treatment and prison setting by using dried blood spots for diagnostic testing: a cluster randomized controlled trial’ – Journal of Viral Hepatitis (2008) 15; 250-598
6. HPA, 2011, p.9

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Mephedrone as popular as cocaine - References:

1 Home Office Statistical Bulletin, Drug Misuse Declared: Drug Misuse Declared: Findings from the 2010/11 British Crime Survey England and Wales, [accessed 16th August 2011], p.11
2 Travis, A,. ‘Mephedrone, or 'meow meow', as popular as cocaine, drugs survey says’  Guardian.co.uk, [accessed 16th August 2011]
3 Home Office, 2011, p.22
4 In house unpublished data available on request

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