Understanding Drug Tests Georgia Youth Law Conference

Report
Drug Testing in Child Welfare Cases:
Understanding the Chemistry,
Methodology, and Legal Implications
NACC 2012 - Chicago, IL
LaMia Saxby, JD, CWLS
Diana Rugh Johnson, JD, CWLS
Information is only useful
when it can be understood.
Commonly Abused Drugs Classified as
Controlled Substances
CONTROLLED SUBSTANCE CATEGORY
DRUG
Schedule I
Heroin
Marijuana
LSD
Peyote
Schedule II
Cocaine
Methadone
Oxycodone
Codeine
Amphetamine
Methamphetamine
Schedule III
Testosterone
Other anabolic steroids
Schedule IV
Benzodiazepines
DRUGS AND THEIR METABOLITES
• Most drugs are metabolized in the liver
• Drug molecule is broken down and/or
transformed into smaller molecules called
metabolites
HEROIN
COCAINE
OXYCODONE
MARIJUANA
URINE DRUG SCREENS
POINT OF CARE TESTS
• Lateral flow immunochromatographic assays
• Drug metabolites are recognized and bound
by specific antibodies
• Chemical reaction  color change
SCHEMATIC OF THE POINT OF CARE
URINE TEST
·The conjugate pad is coated with colored,
colloidal gold nanoparticles conjugated
with antibodies
Structure of Antibodies
·The test line is affixed with drug
conjugates, which are structurally similar
to the portions of the drug metabolites
that the antibodies will recognize.
·Urine sample tested contains no drug
metabolites.
·The antibodies from the conjugate pad are
carried along the test strip. The antibodies
recognize and bind the drug conjugates on the
test line. The line changes color. The control
line changes color when the sample reaches it.
·Urine sample tested contains drug
metabolites
·The antibodies on the conjugate pad
recognize and bind the drug metabolites in
the sample. There are no antibodies free
to bind the drug conjugates on the test
line. No color change at test line.
LIMITATIONS OF
IMMUNOCHROMATOGRAPHIC ASSAYS
•
•
•
•
Concentration cutoffs
Relatively short detection window
Qualitative, not quantitative
Antibody cross-reactivity with over-thecounter medications
Typical Windows of Detection
DRUG
DETECTION WINDOW IN URINE
Amphetamine
2 days
Methamphetamine
2 days
Cocaine
2 days after single use
4 days after repeated use
Morphine
2-3 days
Methadone
3 days
Oxycodone
2-4 days
Codeine
2 days
Heroin
2 days
Phencyclidine
14 days
Marijuana
2-3 days after single use
30 days in chronic abuser
Typical Cutoff Concentrations
• Nanograms of metabolite per milliliter of urine
DRUG
CUTOFF CONCENTRATION
Amphetamine
1000 ng/mL
Benzodiazepines
200 or 300 ng/mL
Barbiturates
200 or 300 ng/mL
Cocaine
300 ng/mL
Opiates
300 ng/mL
Oxycodone
100 or 300 ng/mL
Methadone
300 ng/mL
Marijuana
50 ng/mL
Phencyclidine
25 ng/mL
Cutoff Concentrations
350
300
250
200
Positive test
150
Negative test
100
50
0
Benzodiazepines
Cocaine
Marijuana
Multiple positive drug tests
from a single use
Concentration ng/mL
120
Concentration cutoff for point of care test
100
Point of Care test
80
60
GC/MS test
40
Drug/EtOH evaluation
20
0
1
2
3
4
5
6
7
Day
8
9
10
11
12
Products that Interfere with
Amphetamine/Methamphetamine
Screening Immunoassays
CLASS OF DRUG
INTERFERING COMPOUND
SOME PRODUCT NAME(S)
Antihistamine
Brompheniramine
Allent, Andehist syrup,
Bromadrine PD, BromofedDMDallergy, Demetapp
Diet Pill
Ephedra (ephedrine)
Phentermine
Tyramine
Decongestant
Phenylpropanolamine
Pseudoephedrine
Phenylephrine
Acid reducer
Ranitidine
Actifed, Alka-Seltzer Plus,
Allegra-D, Clartin D,
Comtrex Daytime, Tylenol,
Tylenol Sinus, Vicks 44
Zantac
URINE DRUG SCREENS
GC/MS TESTS
• Gas chromatography/mass spectrometry
• Molecules (including drug metabolites) in purified
sample are separated from each other in the GC
column
• As each molecule leaves the GC column, it is
bombarded with electrons, which break the
molecule into fragments
• The fragments are detected and analyzed by the
mass spectrometer
• A drug metabolite’s fragmentation pattern is like
a fingerprint for that drug
GC/MS instrument
Inner workings of the GC/MS
Mass spectrometry distinguishes
between similar compounds
HAIR FOLLICLE TESTING
• Hair is composed of
mostly protein
• Principle protein =
keratin
• Drug metabolites in
bloodstream are
deposited in hair
follicle
• Metabolites get
trapped in keratin
matrix of hair as it
grows
Effect of Growth Rate
• Growth rate = 0.7 – 1.5cm/month
• Average growth rate = 1cm/month
• 3cm hair specimen represents ~3 month
period
• Standard sample collection = 3.75cm
• Lag times: abuse  incorporation of
metabolites into follicle  incorporation into
keratin matrix  growth of hair above surface
of skin
Test Results vs. Actual Use
T
P
R
?
Incarceration
U
90 days
90 days
July 30, 2010
July 20, 2010
July 10, 2010
June 30, 2010
June 20, 2010
June 10, 2010
May 31, 2010
May 21, 2010
May 11, 2010
May 1, 2010
April 21, 2010
April 11, 2010
April 1, 2010
March 22, 2010
March 12, 2010
March 2, 2010
February 20, 2010
February 10, 2010
January 31, 2010
January 21, 2010
January 11, 2010
January 1, 2010
December 22, 2009
Effect of
Hair Color
• Melanin is responsible for hair color
• Melanin is a polymer consisting of eumelanin
(black/brown) and phemelanin (red)
• Drug metabolites bind more to eumelanin than to
pheomelanin
• Racial difference: after the same dosage pattern
of codeine, Asians with black hair tested 56%
higher than Caucasians with black hair. Asians
have a higher percentage of melanin in their hair.
LEGAL EFFECTS OF SUBSTANCE ABUSE ON
REUNIFICATION
LAMIA N. SAXBY, Esq., CWLS
Special Assistant Attorney General
Fulton County, Atlanta, Georgia
Findings in deprivation proceedings.
(a) Findings. After hearing the evidence on any petition alleging deprivation,
the court shall make and file its findings as to whether the child is a deprived
child. If the court finds that the child is not a deprived child, it shall dismiss
the petition and order the child discharged from any detention or other
restriction theretofore ordered in the proceeding.
(b) Findings with regard to result of alcohol abuse or drug abuse. If the court
finds that a child is deprived, the court shall also make and file a finding as to
whether such deprivation is the result of alcohol abuse or drug abuse by a
parent or guardian.
(c) Disposition. The court shall proceed immediately or at a postponed
hearing to make a proper disposition of the case in accordance with Code
Section 15-11-55 if the court finds from clear and convincing evidence that
the child is deprived.
Assessment in Cases with Substance
Abuse Allegations
• Safety/Risk Assessment
– Is child deprived?
• If No, are there services needed that will assist the
mother/father/guardian with better meeting the needs
of the child.
–
–
–
–
Parenting classes
Parent aid
Family counseling
Individual counseling
» For parent
» For child
Basis for deprivation
CAUSES:
• Inadequate supervision
• Inadequate parental care
– Neglect of child
» physical, mental, emotional health
– Abandonment
– Abuse
» Physical (visible marks/outcry/mandated reporter)
» Emotional (verbal abuse, targeting 1 child)
» Sexual (medical neglect, failure to protect)
• Inadequate housing
– Not poverty concerns but housing conditions
» Deplorable conditions
» Latent safety risks (rodents, health code violations)
Does Parental Substance Abuse Affect the
Child?
• Do not focus on Parental Fault
• Focus Assessment on needs of child
– Is the child clearly at risk of harm if she is allowed
to remain in the caregiver’s custody
• Does mom feed her baby inappropriate food even after
being advised by the parenting specialist about risks of
inappropriate food choices
– Choking hazards, digestion issues, failure to thrive
What is Parent’s Drug of Choice?
• Marijuana
– Must show adverse effects on child
• Cocaine (Crack)
– Extensive history used to establish
that conditions of deprivation are likely to continue
• Methamphetamines
– COA took judicial notice of the children exposed to
methamphetamines are at an increased risk of victimization
because the drug increases paranoia and rage
Affects of parental substance abuse on
Children
• An extensive history of substance abuse
problems and/or a current extended period of
unrehabilitated substance abuse show an
unresolved pattern of behaviors that increase
the likelihood that the conditions of
deprivation that brought the child into care
are likely to continue.
Substance abusing parent
CAN maintain custody
Where no evidence was presented that the
mother's drug use had an adverse effect on the
children, and there is no evidence to show the
mother was such a chronic abuser of alcohol or
drugs that such an effect can be inferred here,
the child is
Usually allowed to remain in
the custody of the parent.
MARIJUANA, ALCOHOL,
PRESCRIPTION DRUGS
Although we do not condone the mother's abuse of
prescription drugs or the father's use of marijuana, the
evidence does not clearly and convincingly establish
that M. L. C. is deprived. Rather, it is uncontroverted
that the parents, despite their problems, have taken
care of M. L. C.
Evidence showing that M. L. C. is a good student and a
well-adjusted child who recognizes the pitfalls of drug
use attests to the fact that her basic physical, mental,
and emotional needs have been met. IN RE MLC 249
Ga. App. 435 (2001)
METHAMPHETAMINE ABUSE
The juvenile court was entitled to infer from the
mother's continued use of methamphetamine that the
mother was suffering from a chronic substance abuse
problem that she could not easily control or overcome
&deprivation likely to continue.
RECENT COURT CASES
Substance Abuse
and
the Effects on Reunification
Court Can Require Parent
To Remain Drug Free
• If deprivation is found to have been the result of alcohol or other
drug abuse by a parent or guardian, . . . the court is authorized to
further order that legal custody of the child may not be
transferred back to the child's custodian or guardian whose
abuse of alcohol or another drug resulted in the child's
deprivation unless such person undergoes substance abuse
treatment and random substance abuse screenings and those
screenings remain negative for a period of no less than six
consecutive months.
• Therefore, it was within the juvenile court's discretion to require
that the mother successfully complete all components of her
substance abuse treatment, including the aftercare rehabilitation
program, while remaining drug free, before reconsidering its
deprivation order awarding temporary custody of the child to the
maternal grandmother
TERMINATION OF PARENTAL RIGHTS AFTER
COMPLETION OF TREATMENT
• The child was placed in the Department’s custody
after the mother failed to test negative for illegal drugs
for six months, failed to provide adequate housing and
employment and neglected the child’s medical and
dental needs.
• The mother successfully completed the residential
portion of her drug treatment program BUT refused to
complete the aftercare portion, a requirement of her
reunification case plan.
TERMINATION AFTER FAILURE TO REMAIN SOBER AND
TO COMPLETE CASE PLAN
• The father did not fulfill the goals of his
reunification case plan when he continued to
abuse alcohol, failed to pay support, and was
repeatedly incarcerated.
• Here, the Court properly determined that the
termination of parental rights was supported
by clear and convincing evidence.
RECENT IMPROVEMENTS
• The Court of Appeals held that although the
mother had made some efforts to improve,
the COA held that recent improvements do
not establish that the parent is capable of
maintaining the progress.”
Excessive History of Drug Abuse
• Mother gave birth to child 6 wks premature. Child was
diagnosed with “cocaine addiction affecting the
fetus/newborn via the placenta and breast milk.”
• In addition to the mother testing positive for drugs at
the birth of NH, the mother tested positive for cocaine
and marijuana 18 days after birth of child. Mom
admitted to being addicted to crack cocaine for 5 years
and to smoking crack & marijuana during her pregnancy
INFERENCE OF DEPRIVATION
In determining whether a child is without proper
parental care or control, a juvenile court can
consider the parent’s excessive use of or a
history of chronic, unrehabilitated abuse of
controlled substances. From the chronic drug
use, a court can also infer an adverse impact on
the child and find the child deprived.
INFERENCE OF DEPRIVATION
• Despite the mother’s claim at the hearing
that she had stopped using drugs because of
her baby, the court is entitled to, reject her
testimony when compared to the other
evidence in the case, and find the child
deprived based upon the mother’s chronic
use of illegal drugs.
In the interest of N.H., 297 Ga App 344 (2009)
Deprivation Likely to Continue
• Mother and newborn test positive for cocaine at
delivery. Ch was found deprived because of
mom’s substance abuse & Dept history
• For 2 yrs mom failed to comply with reunification
goals to complete drug treatment, maintain
housing& employment & complete parenting
classes.
• COA: court did not err in finding
cause of deprivation likely to cont.
– In the Interest of S.H., 296 Ga App 768 (2009)
LACK OF FINANCIAL SUPPORT
• The COA emphasized the fact that the parents’
status as substance abusers rendered them
unable to provide for the child financially, rather
than the mere fact that both of the child’s
parents were substance abusers.
• Focus is on needs of the child rather than on
parental fault.
– In re C.N.G. 204 GA App 239 (1992)
REVIEW OF LEGAL CONSIDERATIONS
1. Courts MUST make specific findings as to
alcohol/drug abuse in deprivation orders
2. Safety/Risk assessment made in cases with
substance abuse allegations
3. Basis for deprivation:
1. Inadequate housing, supervision
2. Abuse, Neglect
4. Inference of Deprivation?
5. Deprivation likely to continue?
REMEMBER,
FOCUS ON NEEDS OF CHILDREN
&
NOT ON PARENTAL FAULT!
Thank You & Good Day!
LAMIA N. SAXBY, Esq., CWLS
Special Assistant Attorney General
Fulton County, Atlanta, Georgia

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