We are a Public Health lab running urine screening on abused children ("Alaska Cares") by LC/MS-MS, primarily screening for cocaine & metabolites. Depending on our findings, children may be removed from their parents. Our question is what (if any) threshold limits we should use in reporting these results. The SOFT limits for Drug-Facilitated Sexual Assault are 50 ng/mL for cocaine and benzoylecgonine, but should we use this or report to LOD? There are no Alaska state guidelines. Many thanks for your input.
Eileen Nickoloff Anchorage, AK
Larry Broussard, PhD
Thank you for the question Eileen. First of all, this question is slightly out of the realm of my expertise in that I have not had any personal experience with drug testing for this purpose. But I did perform a couple of literature searches and did find journal articles in which the 50 ng/mL cutoff was used so there is ample precedent for its use. I would be cautious of using the LOD and would prefer the LOQ if you choose to go below 50 ng/mL. A compromise cutoff between 50 and the LOQ would be 40% of the cutoff or 20 ng/mL (assuming your LOQ is lower than 20). SAMHSA requires laboratories to be able to detect at 40% of the cutoff which is where I got that suggestion (i.e. legally and scientifically defensible). My final comment would be that you should consult legal or legislative interpretative opinions because of the obvious potential ramifications. I know this was a long rambling answer but the bottom line is that I was unable to find a recommended cutoff so would caution that you choose a level that you can scientifically defend in terms of being able to identify and quantitate (i.e. LOQ or higher such as 40% of cutoff). Larry Broussard
Dr. Broussard, I am eager to learn of some of your initiatives and goals as AACC President. Thank you!
Larry Broussard, PhD
Thanks for the question and the opportunity to share some of my initiatives and goals for this year. First of all, the professional staff at AACC in conjunction with volunteer leaders in the past have built AACC into the premier organization that it is today. The Board of Directors functions as a team and I'm lucky enough to be the designated captain of the team this year. So I don't plan to start grand initiatives that could jeopardize the future of AACC either financially or as a leader within the professional medical community. I plan to continue to support recent past initiatives for increased interaction with clinical societies and government agencies. My primary initiative is to try to tackle the fundamental question of how to promote the value of laboratory testing and laboratory personnel as healthcare professionals. Dan Farkas has agreed to chair an advisory group that is tasked with better defining the problem of economic (under) evaluation of clinical laboratory services and providing recommendations on future actions. In addressing these issues, the group will also consider the "invisibility" of the laboratory professional and recommend action to promote visibility of and respect for laboratory medicine. This is obviously a very daunting task and if successful would only be the first steps toward eventual AACC programs of the future. In summary my plans are to keep AACC on track with its current successful activities while looking ahead to the future but not jumping headfirst into a recognition program that has the potential of being a financial drain without achieving any measure of success. As a former Treasurer, I am acutely aware of the financial state of AACC which is currently very stable but I am also aware that this could change quickly without rational and prudent policy decisions. Larry Broussard