Toxicology testing-related issues have taken on greater significance with the ever-rising tide of opioid and illicit drug use currently hitting the United States. Labs are on the frontlines, supporting physicians in identifying patients’ drug usage, managing patients taking opioids for pain, and educating physicians about the benefits and limitations of different types of testing methods.

A wide range of sessions at this year’s 69th AACC Annual Scientific Meeting & Clinical Lab Expo, including the sought-after small group Brown Bags, address this important issue. Attendees will learn about case studies in clinical toxicology, marijuana metabolites and pharmacokinetics, how people try to beat drug testing and defend positive results, and precision medicine guided pharmacotherapy in cancer.

Laboratorians concerned about staying on top of the latest designer drug trends and testing issues should attend Novel Psychoactive Substances in Emergency Toxicology (32105), a morning symposium that takes place on July 31 from 10:30 a.m. to noon.

“There has been so much interest in, and talk about, novel psychoactive substances (NPS) in our field, but I think a lot of laboratories are unsure of how to test for them,” session moderator Jennifer Colby, PhD, DABCC, FACB, medical director of toxicology at Vanderbilt University Medical Center in Nashville, Tennessee, told CLN Stat. Colby is co-presenting the session with Kai Li, MD, a toxicology fellow at the University of California, San Francisco’s Department of Emergency Medicine.

Because the landscape of NPS is changing constantly, these drugs are very difficult to test for, Colby explained. “As a drug becomes popular and is associated with toxicity, it is often banned. In response to the ban, a new drug will take its place. This is one of the major driving forces for the continual evolution of NPS,” she said. About 50 new NPSes are reported each year, but there’s wide geographic variability as far as which particular drugs are being abused.

“Even if it was possible to screen for every possible NPS, that would not be cost-effective for most labs. We use lots of freely available information to keep on top of the local drugs trends. Sometimes we get lucky and are able to identify the drug a patient took, but often we don’t. We always say that a negative doesn’t mean no drugs are in the sample, it just means we didn’t detect whatever is there,” Colby said. 

She and Li have been working to address these issues with the poison control center in San Francisco and the laboratory at Zuckerberg San Francisco General Hospital and Trauma Center. “This collaboration dates back almost 10 years, and I think it has been very successful. Kai and I are excited to share how we work together to decide what cases need testing, how we actually perform the testing, and how results are integrated into patient management,” Colby said.

During the session, Colby plans to provide some background information on NPS and a short lecture on the analytical tools that her laboratory uses to test for these drugs. Li will cover some of the toxidromes that they expect to see in patients exposed to NPS.

The session will use FXP touch, a mobile device-based audience response and engagement system that AACC is offering for the first time. “Together, Kai and I will walk though some cases, which will be interactive. We’re really hoping that our audience will participate in the case discussions,” Colby said.

Cannabis Impaired Driving: Biological Markers and Behavioral Indicators of Recent Cannabis Intake (33215), an afternoon symposium taking place Aug. 1 from 2:30 to 5 p.m.,  is another can’t miss session on toxicology at the conference. Cannabis’ approval for medical use in 29 states and legal use in 8 states and the District Columbia has created a serious safety issue with respect to driving, session moderator Marilyn Huestis, PhD, senior scientific advisor at NMS Labs in Willow Grove, Pennsylvania, and an adjunct professor of Epidemiology and Preventive Medicine at the University of Maryland School of Medicine, told CLN Stat.

The session will cover the latest research on the disposition of cannabinoids in blood and oral fluid in occasional and chronic frequent cannabis users after controlled cannabis administration, said Huestis, who was a plenary speaker on this topic at the AACC 68th Annual Scientific Meeting.

Presenters will discuss standardized field sobriety tests used to identify impairment and why oral fluid is an excellent roadside on-site screen for determining recent cannabis use. They’ll also talk about why it isn’t possible to select a single blood Δ-9-tetrahydrocannabinol (THC) concentration to detect impairment in all individuals. THC is the primary psychoactive compound in cannabis.

“Our latest cannabis-controlled drug administrative study identified markers of recent cannabis use in both occasional and chronic frequent cannabis users. These new markers will help to identify recent use despite the individual’s cannabis use history,” Huestis said.

Joining Huestis at the dais for this session will be Madeleine Swortwood, PhD, BA, assistant professor at Sam Houston State University in Huntsville, Texas; Rebecca Hartman, PhD, chief toxicologist at Monroe County Office of the Medical Examiner in Rochester, New York; and Barry Logan, PhD, executive director of Fredric Rieders Family Renaissance Foundation in Willow Grove, Pennsylvania.

Register now for the for the 69th AACC Annual Scientific Meeting & Clinical Lab Expo in San Diego July 30–Aug. 3 to catch the latest drug testing science and practice advice.