09/26/2024 | Press release | Distributed by Public on 09/26/2024 06:46
Public health officials rely on drug prevalence data to understand and address drug-related harms in communities. Tracking patterns in substance use can help identify new trends, offer early indications of emerging drugs, and enable effective intervention and treatment strategies. Helpfully, since 2013 both law enforcement drug seizures[1] and court-ordered mandatory drug testing have steadily increased, resulting in a sizeable database from which to study drug use patterns. Given the intersection of public health and criminal justice systems in the context of unlawful drug use, it is essential that drug prevalence data are accurate. This is particularly crucial given the soaring rates of opioid-related overdoses, fueled in large part by the introduction of highly potent fentanyl and related analogs.
Forensic toxicologists usually analyze urine or oral fluid for court-ordered mandatory drug testing. However, these tests only detect use during a short window of time (usually less than a week). Drug testing hair offers a longer window to detect use (generally up to a few months), but these tests do not typically search for fentanyl or fentanyl-related compounds. Law enforcement and policymakers need timely, evidence-based intelligence of drug prevalence in criminal justice populations, including patterns of fentanyl and fentanyl-related compounds. This will help inform prevention and enforcement strategies, improve public health measures, and help increase compliance with probation and parole conditions.
Researchers Megan Grabenauer and Nichole Bynum aimed to develop a better understanding of fentanyl prevalence in populations under court-ordered mandatory drug testing using a three-step approach. First, they determined the pervasiveness of fentanyl and a selection of fentanyl-related compounds in hair specimens submitted for such testing. They then compared results from court-ordered mandatory drug testing to results from the general workforce who were also tested for drug use. Finally, they conducted a six-year retrospective analysis comparing results for oral fluids and hair samples.
To discern the prevalence of fentanyl and related compounds in hair samples, the researchers used mass spectrometry[2] on 520 hair samples collected under court-ordered mandatory drug tests over a six-month period (late 2020 through early 2021) (Figure 1). They noted hair length, color, and curl type.[3] Samples positive for fentanyl were further examined for additional compounds.
Figure 1. Fentanyl-related compounds and other compounds included in the researchers' mass spectrometry detection method. The internal standards are listed in parentheses.
Fentanyl and Fentanyl-Related Compounds and Internal Standards | Opioids and Other Compounds and Internal Standards |
4-ANPP (4-ANPP-d5) para-Fluoro 4-ANPP Fentanyl (Fentanyl-d5) Acetyl fentanyl (Acetyl fentanyl-d5) Acetyl norfentanyl (Acetyl norfentanyl-d5) Benzylfentanyl Carfentanil (Carfentanil-d5) Chlorofentanyl para-Fluorobutyryl fentanyl 4-Fluoroisobutyryl fentanyl Fluorofentanyl Norfentanyl (Norfentanyl-d5) Phenyl fentanyl (Phenyl fentanyl-d5) Phenethyl 4-ANPP Valeryl fentanyl (Valeryl fentanyl-d5) |
6-Acetylmorphine (6-Acetylmorphine-d6) Benzoylecgonine (Benzoylecgonine-d3) Buprenorphine Cocaine (Cocaine-d3) Codeine (Codeine-d3) Hydrocodone (Hydrocodone-d6) Methamphetamine (Methamphetamine-d9) Methadone (Methadone-d9) Morphine (Morphine-d6) Oxycodone (Oxycodone-d6) Oxymorphone (Oxymorphone-d3) Tramadol Xylazine |
Key findings:
To further characterize drug use patterns and compare results from court-ordered mandatory drug tests to workforce test results, the researchers also conducted a retrospective analysis of court-ordered mandatory drug test results from a commercial toxicology laboratory.[6] The data from a six-year period (February 1, 2016 to February 28, 2022) screened oral fluid samples (n= 959,237)[7] and hair samples (n= 62,258).
How do drug test results among the population under court-ordered mandatory drug testing compare to those of the general workforce?
How does drug detection in the population under court-ordered drug testing change when the screening includes fentanyl and fentanyl-related compounds?
Researchers compared oral fluid and hair test results and found that different drugs were detected by each.[10]
Researchers also examined these results by court type and community supervision status. Tests of oral fluid and tests of hair samples both indicated that family court produced the largest proportion of positive results (Figure 3). The proportion of positive tests results was greater based on oral fluid than hair (Figure 4) for family court and problem-solving courts.
Figure 2. The most common drugs detected in court-ordered mandatory drug testing oral fluid and hair testing.
Figure 3. Positivity rates of oral fluid and hair tests, by court type.
Figure 4. Positivity rates for problem-solving courts, family courts, and probation/parole/pretrial, based on oral fluid and hair.
According to Grabenauer, "This project provides actionable information from numerous, geographically diverse U.S. jurisdictions. To the best of our knowledge, it is the first large-scale drug prevalence study in a [court-ordered mandatory drug testing] population and provides a view of drug combinations in this population, specifically fentanyl and fentanyl-related compounds in combination with other substances."
Prevalence data shapes drug policy at the federal, state, and local levels and informs drug reduction strategies. The data provided by this NIJ-funded research could be used in several different ways:
The work described in this article was supported by NIJ award number 2019-R2-CX-0017, awarded to RTI International. This article is based on the grantee report "Prevalence of Fentanyl and Its Analogues in a Court-Ordered Mandatory Drug Testing Population" (pdf, 23 pages), by Megan Grabenauer, Ph.D. and Nichole Bynum.