Legal Review for Testing of Drugs in Hair.

The legal issues associated with hair drug testing in general have significant differences from issues associated with urine drug testing. Discussed are cases that illuminate these differences. The issues in hair testing are not yet settled and legal precedent has not been forthcoming. Among the issues discussed is the admissibility of hair testing results based on its acceptance as scientific evidence. Some state jurisdictions still require that scientific evidence must be generally accepted in the scientific discipline where it belongs. The federal courts and an increasing number of state courts are using a less stringent standard and do not require majority acceptance by the scientific community. In some cases hair testing has been shown to be less intrusive than the use of other body samples, thus avoiding Fourth Amendment issues. However, a racial bias issue still exists based on the higher melanin content in the hair of African-Americans. A substantial issue is also whether environmental contamination of hair can be differentiated from the internal administration of a drug. The courts are also increasingly utilizing the differences between the time required for a drug or its metabolite to appear in a hair sample or urine sample in adjudicating cases.

Role of the clinical toxicologist in court.

The clinical toxicologist may play a role in court when issues arise concerning therapeutic drug monitoring, drug abuse, environmental chemicals, or toxic torts, where the traditional forensic toxicologist may not have expertise. Beyond being credible in court, the toxicologist's testimony must be based on good scientific evidence. The ruler for measuring good scientific evidence had previously been the Frye Test, or the general acceptance test. In 1993, however, the US Supreme Court established four balancing tests that should be used for the admissibility of scientific evidence. Although the ruling is binding only in federal courts, state courts are expected to follow. When testifying, the clinical toxicologist should be aware of other court rules and expectations. As with all testimony, objections from opposing counsel can be raised to disallow the presentation of evidence by a toxicologist. The toxicologist is usually used to establish causation of injury, whether from negligence, prenatal injury, or environmental chemicals. Several examples are presented.

Legal issues related to drug testing in the clinical laboratory.

As has been reported many times by the lay press, urine drug testing may pose some unique challenges. The clinical laboratory interested in industrial drug testing (typically known as employee drug testing) should be aware of the many challenges that may be brought on by the fact that the result may be contested in an adversarial proceeding. This is what makes the urine drug test a forensic test. It may be one piece of evidence or the only piece of evidence used in an adversarial proceeding that may decide on punitive or rehabilitative action against an employee. As a result, unique standards for governmental contract laboratories have been proposed from the National Institute on Drug Abuse, and special proficiency testing and accreditation procedures have been promoted by professional societies. These standards illustrate the sensitive nature of the results. Because the results are subject to adversarial proceedings, all parties concerned in the testing process should be aware of the legal issues surrounding urine drug testing. There are constitutional and statutory issues as well as tort issues such as negligence, defamation, invasion of privacy, battery, infliction of emotional distress, and others. Laboratories should be especially aware of these issues, since they may be brought in as a third-party defendant to a suit or brought in as a participant in gathering the evidence. The laboratory should also be aware of other legal ramifications such as chain of custody, expert testimony, and the acceptability of scientific evidence.

Optimization of a toxicology program.

This presentation covers a multiphasic approach to toxicological service. The service is to the hospital and the community as a whole. The optimization includes the analytical aspects of clinical, forensic, and industrial toxicology along with service associated with interpretations, chemical disasters and employee monitoring.

High-pressure liquid chromatography and enzyme immunoassay compared with gas chromatography for determing phenytoin.

We compared a gas-chromatographic method for determination of phenytoin with a high-pressure liquid chromatographic technique and with enzyme immunoassay by three instrumental procedures. More than 100 sera from patients being treated with this drug were assayed by all these techniques. The coefficient of variation was the lowest (4.0%) with liquid chromatography, but all methods gave a CV of less than 10%. The correlation coefficients for all methods exceeded 0.97 when compared to gas chromatography. Operation costs varied with the number of tests per batch, reagent costs, and operator labor costs. All assays gave comparable values for the therapeutic range, so it would be plausible to use more than one method in a situation where (e.g.) satellite laboratories handle different quantities of assays. In any of these techniques, interferences from carbamazepine, mephenytoin, phenobarbital, and primidone were negligible.