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The aegis bouncer is young, maybe mid-twenties, alpine and agile and armed. He’s friendly. He asks, “Good morning, sir. Recreational? Can I see your ID?” and directs me to the left, into a zig-zag of retractable belt barriers absolute at a long, ablaze counter.
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Along the bank abaft the adverse is a filigree of peg hooks not clashing those suspending Combos and blah basics in roadside accessibility stores. The accoutrements actuality are transparent, their capacity green, white-labelled with names like Dejected Dream, Ghost Train Haze, Kool-Aid Kush and Industrial Paint. There are orange and red liquids in bright bottles; there are aliment with names like Fantastic Brownie and Cheeba Chews; there are t-shirts, hoodies and beanies monogrammed with the Anesthetic Man logo.
When it’s my turn, Armando Rios greets me. He has abbreviate hair, a checkerboard accustomed and a close-cropped goatee. Until afresh he was a trimmer, he tells me, but is now a budtender. I butt this slowly, abandoned afterwards mentally switching out the chat “bud” for “bar.”
I acquaint him I’d like buy maybe a sixteenth of article with a crazy name, for a adventure I’m writing. He asks what it’s about. I acquaint him it’s about a biologic appraisal developed by CU Toxicology, a University of Colorado non-profit aftereffect aloof bottomward the road. I acquaint him that, in a distinct nine-minute run, it can appraisal for 112 compounds in 500 drugs with antic accuracy, and that it’s cheap. I acquaint him that the appraisal can ascertain metabolites of THC, the alive additive in all these accoutrements of dope, with 20 times the acuteness of the archetypal pee cup, axis negatives into positives for canicule post-toke.
I don’t acquaint him the appraisal could acknowledge to your employer abundant added than a smoke sesh, that it produces an itemized grocery account of every actinic that entered your body, or that it could change the doctor-patient accord for good.
Ogre Indica, 1g, bought at Anesthetic Man, Denver, Colo.
Rios nods. “How about ‘Ogre’? A few of the budtenders abominable acclaim it. It’s added of a anatomy high.”
Ogre. Perfect.
It’s $16 for the gram, $21.79 with tax. I pay in cash, and Rios seals the marijuana into a white, artificial commitment envelope, in a capped alembic that adeptness contrarily authority takeout bloom dressing. Abaft me, a band of eight bodies has formed. It’s 11 a.m. on a Wednesday.
America is a nation of druggies. Comprising about 5% of the planet’s population, Americans smoke, pop, shoot and contrarily blot 80% of the all-around opioid supply, 99% of the world’s hydrocodone (think Vicodin, Percocet, Percodan and Oxycontin) and two-thirds of the world’s actionable drugs. The claimed costs can be immeasurable (see Hoffman, Seymour Philip); the bread-and-butter ones ambiguous unfathomable, abutting $200 billion a year, according to a 2011 U.S. Justice Department report. That’s about the Czech Republic’s GDP, up in smoke, bottomward the hatch.
Among the aloft types of biologic testing, the aboriginal and best accustomed relates to pre-employment and employment-related testing. The added has to do with addiction and recovery, and the third with allowance patients administer abiding pain. The fourth category, whose contour awfully exceeds its prevalence, has to do with sports-related biologic testing of the array accident before, during and afterwards the 2014 Winter Olympics in Sochi, Russia.
Precisely 4,906 biologic tests were projected for the Sochi games, according to organizers. Compare that to the estimated 486 actor tests in the added three categories done in the United States abandoned in 2011, according to the Adventure Planning Group – a cardinal the close expects to ascend to 592 actor by 2016.
And depending on a biologic test's invasiveness and the actuality or aggregation requesting it, medical aloofness hangs in the balance.
Generalized apprehension periods for drugs in assorted actual specimens. Adapted from NHTSA graph, based on NIDA research.
Image: Mashable illustration
Drug use can be activated in a few ways, best anon via the blood. But besides the affair of accepting to ache accession with a needle, drugs tend to leave the claret bound – aural a few hours. Beard testing is the opposite: A 1.5-inch-long abbreviate of about 100 hairs can atom drugs taken in the aftermost 90 days, but it doesn’t abduction annihilation from the accomplished anniversary to 10 days. Spit testing is accepting traction, but like hair, articulate fluids abduction a bound cardinal of compounds at apparent levels, and they move out of the aperture in 24 to 48 hours.
That leaves urine, the industry accustomed now and for the accountable future.
Most urine tests absorb the pee cup or, added technically, a urine immunoassay application thin-layer chromatography, a technology that dates from the 1970s — the aforementioned acclimated in abundance tests. They’re bargain — $5 ample and $20-$40 at retail drugstores (look for names like “TeenSaver”). They’re additionally about non-invasive, with no hair-snipping or blood-tapping needed, and they accommodate actual feedback. They about appraisal for amid 3 and 14 drugs, in added words, for smoker pot or alarming curve of cocaine.
But pee cups accept their limits. Biologic apprehension depends on the antibodies actuality the appropriate appearance to lock in a attenuated set of antigens – in this case, drugs. Often, they ambit up a added array of molecules than intended, consistent in apocryphal positives and cross-reactions. The antidepressant trazodone or alike breath sprays like Vick’s can activate a absolute for amphetamines; naproxen, ibuprofen and riboflavin can masquerade as marijuana’s cannabinoids.
The abstruse appellation actuality is “specificity,” which refers to the adeptness of a biologic appraisal to anticipate what’s what in a sample. For pee cups, specificity isn’t great: a 14-panel cup has aloof one band for opiates, but there are dozens of actual altered opiates, from heroin to oxycodone. The band catches some and misses others.
Another pee cup weakness has to do with its sensitivity, or adeptness to ascertain tiny amounts of drug. Often, the cutoffs are aerial abundant that biologic users can booty a brace of canicule off and canyon a pee cup test.
On top of the all-a-quiver science, pee cup biologic tests abridgement acknowledged punch. If the little band apparent “BZO” (for benzodiazepines) disappears, it’s alone a presumptive positive. In adjustment to blaze you, apprehension you or bandy you out of a affliction administration program, testers will accelerate your pee to a laboratory, area it’s run through a apparatus costing several hundred thousand dollars. The apparatus puts the urine through two gauntlets. The aboriginal uses either aqueous or gas chromatography to abstracted compounds based on the biologic molecules’ appearance and reactivity. Afresh the compounds are ushered into a accumulation spectrometer, which assault them afar with ions and samples the colors of ablaze arising from their afterlife throes. The colors admit their absolute attributes – and with far added acuteness than that of the antecedent pee cup.
On the added hand, pee cups won’t acquaint your employer about the decree medications in your anesthetic cabinet.
Blair Whitaker (R) and lab administrator Kim Plath, at CU Toxicology in Aurora, Colo., on Feb. 3, 2014.
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Image: Mashable, Chloe Coleman
CU Toxicology is technically a one-person operation, “a basal company,” as Blair Whitaker describes it. But Whitaker, 52, operates as added than one person. He talks absurdly and grasps the aspect of questions afore I'm absolutely bright on them myself. He has been a computer engineer, software architect and adventure capitalist. Whitaker has assorted titles alike now: administrator of business operations for the non-profit CU Toxicology and CEO of the for-profit Claro Scientific Laboratories.
His successes bought a big abode abreast the Denver Country Club, area he and his wife confused from California a decade ago to accession the three kids. In 2009, he started attractive for his abutting thing. He met people, went to conferences, advised pitches and projects: How about an ultrasound adjustment advised to attending at glycogen levels in athletes? Presurgical comestible supplements? Cat aliment alloyed with abrasion pheromones? And so on.
Whitaker, a cyclist, had been cerebration about developing a way to appraisal comestible supplements for a ample cardinal of abeyant adulterants – hidden steroids, say, or hormones or narcotics – that could get an aristocratic amateur aback busted.
Then he came beyond Uwe Christians.
Uwe Christians in his appointment at CU Toxicology in Aurora, Colo., on Feb. 3, 2014.
Image: Mashable, Chloe Coleman
Christians, 51, an M.D. as able-bodied as a Ph.D. pharmacologist/toxicologist, has been accomplishing accumulation spectrometry aback the mid-1980s, aback in his built-in Germany he acclimated a adaptation of the address for his M.D. apriorism on the metabolism of cyclosporine in alarmist displace patients. He runs a lab alleged iC42 in a architecture alleged Biosciences East, a aloft Air Force eyes factory.
The lab bottomward the anteroom from his appointment hosts 14 high-end mass-spec machines and a aggregation abundant on best Germans.
Christians had the ability and accessories to advance Whitaker’s sports supplement test. Application the mass-spec machines they created a distinct appraisal spanning 150 compounds in a distinct run. It worked.
But the sports bazaar didn’t pan out. Whitaker began to apprehend that World Anti-Doping Agency-type testing is a baby niche. Instead, he afflicted advance and focused on toxicology screening (drug testing), a abundant beyond market, which happens in every pediatric and developed affliction clinic, methadone berth and addiction center. Not to acknowledgment at bags of employment-related biologic testing locations beyond the country.
Whitaker and Christians removed steroids and added compounds from the account and, afterwards consulting with addiction accretion and affliction administration experts, added added drugs. They accustomed at 112 compounds in 16 classes spanning 500 prescription, adulterous and over-the-counter drugs. It was as acute as archetypal acknowledging tests but as advanced as the sea. For example, if a pee cup’s marijuana band triggered a presumptive absolute at 50 nanograms per milliliter of THC metabolite, this appraisal would ascertain bottomward to 2.5 ng/ml.
It amounted to what looked like an angry biologic screen. But it didn’t absolutely work.
The sample alertness lab at CU Toxicology in Aurora, Colo., on Feb. 3, 2014.
Image: Mashable, Chloe Coleman
The botheration wasn’t with the chemistry; Christians had nailed that. It was the software. In aboriginal 2011, Whitaker active up a aboriginal chump who beatific in 89 urine samples, but the abundance of abstracts that came out of the mass-spec aggregation bound afflicted his lab team.
Whitaker, who has a amount in electrical engineering, saw the abundance of abstracts as a algebraic problem. He spent six months aggravating to untangle the abstracts application Excel spreadsheets and Visual Basal code. The aftereffect was ugly, but it worked. As a bonus, this odd alliance of analytic allure and arresting processing additionally automatic abundant of the testing effort, authoritative the accomplished affair bargain and scalable.
He assertive the University of Colorado School of Anesthetic to barrage CU Toxicology as a non-profit to host the assignment and accommodate accessible face for the accomplishment – that way his for-profit Claro Labs could break in the background, demography a ability for every appraisal performed and owning the software Whitaker created. By January 2014, he was active hundreds of samples a week.
Seven of them were mine.
Since recreational marijuana became acknowledged in Colorado Jan. 1, 2014, accepting a bit of edger accessible for appropriate occasions has been like accepting a appropriate pilsner or single-malt scotch on hand. Guests don’t usually accompany it up, but are best agog aback you do. On Friday, Jan. 24 at about 10 p.m., I lit up with a friend.
I hadn’t absolutely accustomed what Rios the budtender had meant by Ogre actuality a “body high.” A acquaintance of abundance who runs a medical marijuana berth in Boulder, though, alleged Ogre “a abundant indica” and declared its after-effects as “more of a couch-lock, added a blurred array of high.”
I smoke rarely, but abundant to accept abstruse to stop at about six compact hits from the bottle pipe. The anatomy did tingle, but the arch seemed aloft it all – trains of anticipation alone batty as against to dematerialization into aphotic tunnels, as if they had never existed in the aboriginal place.
At about 3:30 p.m. the abutting day, I abounding two of several cups Whitaker had supplied. One was an Insta-Screen 14-panel pee cup immunoassay; the added was destined for a AB Sciex 5500 bike accumulation spectrometer at Whitaker and Christians' CU Toxicology lab. I put that one in the barn freezer, advising my wife to abstain application it to arctic her sparkling water.
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The Insta-Screen’s lower THC band achromatic in a brace of minutes. Positive, as expected. Until I ran out of CU Toxicology cups, which would appear on Wednesday, I would accurately ample those already a day, allowance their orange lids tight, and accumulation them on top of a bag of Ling Ling Mini Spring Rolls until demography them to CU Toxicology in bulk.
The afterward Monday, 2.5 canicule post-Ogre, I collection a brace of afar in ablaze snow to a band capital on Chambers Alley in Aurora to a abode alleged Wiz-Quiz, a adjustment employment-related sample beneficiary for testing giants such as Quest Diagnostics and LabCorp. The franchisee proprietor, Ben Duka, was unlocking afresh afterwards avaricious takeout for lunch. He had a dispersed beard and thin, gray-speckled hair. He wore a red Jeff Gordon NASCAR anorak and, on the boilerplate feel of his appropriate hand, a ample arena with a BMW logo. He told me business is up and bottomward depending on hiring about town.
On Duka’s walls afraid 13 diplomas with citations such as “DOT Urine Biologic Testing Course.”
I would do a five-panel cup – amphetamine, methamphetamine, cocaine, marijuana, opiates – for $25. In baby allowance with a toilet, a sink, a abbreviate adverse and no accessible agency of dehydration one’s hands, I broiled the cup. Duka came in, pulled on acrylic gloves, arrested the affection ring-like temperature readings, tore accessible a brownish adhesive to aftermath a array of immunoassay dipstick, and biconcave it in my piss. All negative. Aback in his office, he swiped my acclaim agenda through an iPhone adapter and printed me a affidavit adage as much.
Three canicule later, on Thursday, I delivered the arctic blocks urine for testing at iC42. I’d anon see how abundant marijuana metabolite was absolutely in my system. I had little doubt.
The sample alertness lab at CU Toxicology in Aurora, Colo., on Feb. 3, 2014.
Image: Mashable, Chloe Coleman
The development of technology like mass-spec biologic tests has bodies both aflame about its abeyant for accession accretion and chief care, for example, but at the aforementioned time afraid about the ethical dilemmas that absorb this all-inclusive accession of claimed data.
One of the primary hurdles is cost. CU Toxicology about accuse amid $100 and $200 per test, depending on the adjustment and volume. Alike costs associated with basal pee cup tests can add up. For example, doctors generally outsource mass-spec appraisal for urine samples, cutting up added costs of $50 to $250 per drug, says Tony Smith, advance lab artisan for Children’s Hospital Colorado.
“So that $50 biologic awning became a $700 appraisal by the time it’s complete,” Smith says.
At Northstar Transitions, an addiction accretion affairs in Boulder, they run CU Toxicology’s appraisal with anniversary new accession and afresh already anniversary anniversary they’re in the program, says Mike Ferrell, the organization’s controlling director. The appraisal has spotted cocaine in clients’ bloodstreams two weeks out, abundant best than the archetypal three to four canicule the pee cup detects. The test’s beyond agency Ferrell and colleagues apperceive if someone’s been drinking, demography Xanax, aroma (synthetic marijuana) and so on, afterwards acclimation cher abstracted tests for confirmation. It alike spots nicotine.
“It takes the assumption out,” Ferrell says. “We adeptness see buprenorphine in a heroin aficionado aggravating to self-medicate off the street, or cocaine if they’ve been application speedballs. And that sets the bounce for how we’re action to advance in treatment. It’s been actual informative.”
University of Colorado Hospital’s Centermost for Addiction Accretion and Rehabilitation (CeDAR) does the appraisal on every new accommodating and afresh afresh aback they leave. It can accomplish all the difference, says Michael Dinneen, who leads CeDAR’s extended-care treatment. One client, a assistant by profession, accumulated Benadryl and several added drugs to aftermath a accurate high. The appraisal spotted them. “It would accept gone beneath the alarm of all of the added tests that we do,” Dinneen says.
Lab administrator Kim Plath prepares the ascendancy samples at CU Toxicology.
Image: Mashable Chloe Coleman
In accession to addiction and recovery, the appraisal has begin adherents in UCH’s affliction administration and abiding affliction ranks. Jason Krutsch, M.D., a CU School of Anesthetic anesthesiologist who directs the university hospital’s interventional affliction clinic, says the appraisal helps “confirm and quantify not abandoned metabolites of drugs of abuse, but additionally those assigned in affliction management. It’s advantageous to us to see if patients are demography the meds we appoint for them.”
Consider additionally that the aforementioned capabilities enabling multiplexing biologic assays can – and are – acclimated to appraise the actinic markers of all array of action in the animal body. Christians has a 50-compound console that tests for the all-embracing bloom of the kidneys and claret barge linings. It includes amino acerbic profiles, oxidative accent markers, lipids, claret sugars and more.
The CU Toxicology appraisal is ultimately a new array of medical tool, and so its appulse could ability into realms as assorted as primary affliction to obstetrics. A broad-spectrum appraisal could authorize what medications a accustomed aged accommodating is absolutely demography – as against to what they say they’re taking, says Kennon Heard, M.D., a CU School of Anesthetic toxicology specialist and emergency physician.
“My ambition in 10 years is that we’re not action to bother allurement what they’re taking,” he says. “We’re action to booty a urine sample.”
Those acclimation urine tests can now affordably attempt into the clandestine habits and close actual apparatus of their targets like never before. It's affiliated to NSA spying, but for borer into bloodstreams rather than abstracts centermost lines.
Within the HIPAA-protected physician-patient relationship, that could able-bodied be a acceptable thing, accouterment a snapshot of actual action and pharmacological influence, bitter adverse biologic interactions in the bud.
But alike so, the technology raises ethical and acknowledged questions, says Ben Rich, administrator of the Department of Bioethics at the University of California Davis. Will physicians face corruption apparel for missing some borderline award of a ample multiplexing assay? Will the payer (an allowance company, say) assert on admission to the results, too? Will there be complete acknowledgment to the accommodating of the abounding ambit of these tests and abreast accord by the accommodating afore the biologic appraisal is given? Will patients on abiding analgesic assay absolutely accept an advantage to abatement the test?
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“What are the implications for me, vis-à-vis our relationship, if I say no?” Rich asks.
The questions become alike added agitating – and extensive – with account to employment-related biologic testing. Should administration apperceive if you’re demography claret burden or anti-seizure meds? If you’re on antidepressants? If you’re demography low doses of assigned painkillers because you pulled a beef in your back? If you accept prediabetes? Should they apperceive if you charge a little dejected bolus to get it up? The technology is there now, and the hundred or so bucks is a bead in the brazier compared to the $4,000 it costs, on average, to alter a U.S. worker.
Fortunately, some safeguards are in place. The Division of Workplace Programs for the federal Substance Corruption and Mental Bloom Services Administration (SAMHSA) clearly sets the standards for employment-related biologic testing beyond controlling annex entities. Unofficially, it sets the accent for ample swath of federal, accompaniment and clandestine area biologic testing.
Ron Flegel, the division’s director, says the bounden guidelines are actual bright both on how one can appraisal (the accustomed pee cup is still the appropriate aboriginal step, with mass-spec confirmation) and what one can appraisal for. Admitting clandestine area administration are not appropriate by law to chase the SAMHSA guidelines, they may acquisition themselves on all-a-quiver acknowledged arena if they don’t.
“It’s actual austere in the faculty that it’s abandoned activated for the drugs of corruption we accept in the guidelines,” Flegel says. “You can’t do DNA testing, abundance testing, analytic testing, genome testing – that sample is accurately accustomed abandoned for the drugs of corruption testing aural our program.”
An agent trims added leaves from pot plants at Anesthetic Man marijuana dispensary, in Denver, Colo., on Dec. 27, 2013
Things do change, though. Designer drugs like aroma accept been added to the U.S. Biologic Enforcement Administration account of controlled substances, he says, and an advising lath has appropriate abacus constructed opiates (oxymorphone, oxycodone, hydrocodone, hydromorphone) to SAMHSA’s bounden guidelines list. They’re because abacus articulate aqueous testing and, conceivably ancient later, beard testing to the menu. Would they accede auctioning the immunoassay and action beeline to a broad-based accumulation spectrometry test?
“You accept to acquiesce technology to move you forward,” Flegel says. “You could, possibly, accept a screening apparatus that could do it all-in-one.”
Existing employment-related law could accommodate a firmer backstop, says Matt Elliott, a activity law specialist and accomplice with Beckman Lawson in Fort Wayne, Ind. The Abiogenetic Advice and Nondiscrimination Act (GINA) of 2008 prohibits bigotry based on someone’s genes or abiogenetic history, “so administration are not accustomed to alike access that advice except beneath bound circumstances, and if they do access it, they’re not accustomed to use it to hire, blaze or actuate benefits,” Elliott says.
Also, the Americans with Disabilities Act (ADA) is ample abundant that aberrant corpuscle advance or alike accomplished biologic addiction are covered beneath the act, and administration can be accountable if they discriminate on such bases, he says. The aforementioned goes for decree drugs.
“How do you acquaint if it’s illicit?” Elliott asks. “It’s apparently one of those things that you as an employer don’t appetite to know, because you’re aperture your doors to accountability if you do appraisal for it.”
For his part, Whitaker is accommodating to let giants like LabCorp and Quest Diagnostics action for the application market.
“We can do application stuff, but you know, philosophically, I’d abundant rather be in aggravating to advice bodies than apprehension ‘em,” he says.
But it’s aboveboard to accept that multiplexing drug-screening assays won’t anon be in the testing giants’ – and their abounding clients’ – hands. CU Toxicology may be advanced of the pack, but its scientists aren’t the abandoned ones able of authoritative this ambition a reality. ARUP Laboratories already has a mass-spec claret appraisal accoutrement 67 compounds, and a urine appraisal accoutrement 37.
The columnist Todd Neff (left) with acquaintance Louie one day afterwards smoker Ogre, in Aurora, Colo.
Nearly a anniversary afterwards carrying my samples to CU Toxicology, Blair Whitaker called.
“You’re not action to accept this,” he said. “You were negative.”
He emailed me the .pdf of my biologic appraisal after-effects – my pre- and post-smoking tests on Friday, Jan. 24 and circadian follow-ups through the afterward Wednesday, seven in all. The Friday afternoon pre-test best up the debris of the 100 mg naproxen bolus I had popped that morning and the distinct beer I had sipped afterwards my Thursday night calm soccer game. But there was no adumbration of THC in my system, admitting the average pee cup positive.
Whitaker, acutely abundant added absorbed and aflame than worried, came by to aces up a bud of Ogre for actinic appraisal over at CannLabs. He wondered if the Ogre was all non-psychoactive CBD, a.k.a. cannabidiol, a hardly altered chemical. The mass-spec, acquainted for THC, would accept been dark to it. The less-choosy pee cup immunoassay could accept aloof accumulated CBD in with added cannabinoids of its accustomed appearance and appear out positive.
But CannLabs begin about no CBD in the bud. There was adored little THC, either – about 5%, as compared to the 15-20% in best strains they test. Heather Despres, who directs the lab, said the Ogre sample was a somewhat abate than the 180 mgs they usually set as a minimum for analysis, but that the after-effects were apparently solid.
Whitaker says 9% of CU Toxicology’s best contempo 3,058 tests came aback absolute for THC carboxy, one of two metabolites (the added actuality a hydroxy) that his and added marijuana mass-spec tests attending for. His appraisal has anesthetized every annual federal accomplishment awning (the admiral accelerate urine) for the drug. The association could be that accidental users everywhere abort their pee cup immunoassays but afresh canyon the accurately bounden mass-spec tests, he said.
“Are we missing them? I do apperceive we accept the best acute appraisal for THC carboxy,” Whitaker says. “The catechism for us is, if we get this abounding and we don’t get them all, what are we missing?”
It’s action to be boxy to acquisition out. Efforts to map out the metabolic pathways of meandering cannabinoids are bedridden by their adjournment to the DEA’s agenda I list, with rogues like LSD and heroin. Winning federal allotment – the aspect of basal medical appraisal – to abstraction agenda I drugs the DEA describes as accepting “no currently accustomed medical use” is awfully difficult, Whitaker says. The irony that medical marijuana is acknowledged in 20 states and the District of Columbia is adamantine to miss. Crystal meth and cocaine, agenda II drugs, are easier to study.
No agnosticism an accessible adaptation of the CU Toxicology awning will accommodate CBD metabolites, prednisone and added drugs. Probably, added companies will follow. How far will this new urine-scouring technology booty us? How far will we let it booty us?
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Regardless, the bodies who adjustment these tests are action to apperceive an abominable lot about us.
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The aegis bouncer is young, maybe mid-twenties, alpine and agile and armed. He’s friendly. He asks, “Good morning, sir. Recreational? Can I see your ID?” and directs me to the left, into a zig-zag of retractable belt barriers absolute at a long, ablaze counter.
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Along the bank abaft the adverse is a filigree of peg hooks not clashing those suspending Combos and blah basics in roadside accessibility stores. The accoutrements actuality are transparent, their capacity green, white-labelled with names like Dejected Dream, Ghost Train Haze, Kool-Aid Kush and Industrial Paint. There are orange and red liquids in bright bottles; there are aliment with names like Fantastic Brownie and Cheeba Chews; there are t-shirts, hoodies and beanies monogrammed with the Anesthetic Man logo.
When it’s my turn, Armando Rios greets me. He has abbreviate hair, a checkerboard accustomed and a close-cropped goatee. Until afresh he was a trimmer, he tells me, but is now a budtender. I butt this slowly, abandoned afterwards mentally switching out the chat “bud” for “bar.”
I acquaint him I’d like buy maybe a sixteenth of article with a crazy name, for a adventure I’m writing. He asks what it’s about. I acquaint him it’s about a biologic appraisal developed by CU Toxicology, a University of Colorado non-profit aftereffect aloof bottomward the road. I acquaint him that, in a distinct nine-minute run, it can appraisal for 112 compounds in 500 drugs with antic accuracy, and that it’s cheap. I acquaint him that the appraisal can ascertain metabolites of THC, the alive additive in all these accoutrements of dope, with 20 times the acuteness of the archetypal pee cup, axis negatives into positives for canicule post-toke.
I don’t acquaint him the appraisal could acknowledge to your employer abundant added than a smoke sesh, that it produces an itemized grocery account of every actinic that entered your body, or that it could change the doctor-patient accord for good.
Ogre Indica, 1g, bought at Anesthetic Man, Denver, Colo.
Rios nods. “How about ‘Ogre’? A few of the budtenders abominable acclaim it. It’s added of a anatomy high.”
Ogre. Perfect.
It’s $16 for the gram, $21.79 with tax. I pay in cash, and Rios seals the marijuana into a white, artificial commitment envelope, in a capped alembic that adeptness contrarily authority takeout bloom dressing. Abaft me, a band of eight bodies has formed. It’s 11 a.m. on a Wednesday.
America is a nation of druggies. Comprising about 5% of the planet’s population, Americans smoke, pop, shoot and contrarily blot 80% of the all-around opioid supply, 99% of the world’s hydrocodone (think Vicodin, Percocet, Percodan and Oxycontin) and two-thirds of the world’s actionable drugs. The claimed costs can be immeasurable (see Hoffman, Seymour Philip); the bread-and-butter ones ambiguous unfathomable, abutting $200 billion a year, according to a 2011 U.S. Justice Department report. That’s about the Czech Republic’s GDP, up in smoke, bottomward the hatch.
Among the aloft types of biologic testing, the aboriginal and best accustomed relates to pre-employment and employment-related testing. The added has to do with addiction and recovery, and the third with allowance patients administer abiding pain. The fourth category, whose contour awfully exceeds its prevalence, has to do with sports-related biologic testing of the array accident before, during and afterwards the 2014 Winter Olympics in Sochi, Russia.
Precisely 4,906 biologic tests were projected for the Sochi games, according to organizers. Compare that to the estimated 486 actor tests in the added three categories done in the United States abandoned in 2011, according to the Adventure Planning Group – a cardinal the close expects to ascend to 592 actor by 2016.
And depending on a biologic test's invasiveness and the actuality or aggregation requesting it, medical aloofness hangs in the balance.
Generalized apprehension periods for drugs in assorted actual specimens. Adapted from NHTSA graph, based on NIDA research.
Image: Mashable illustration
Drug use can be activated in a few ways, best anon via the blood. But besides the affair of accepting to ache accession with a needle, drugs tend to leave the claret bound – aural a few hours. Beard testing is the opposite: A 1.5-inch-long abbreviate of about 100 hairs can atom drugs taken in the aftermost 90 days, but it doesn’t abduction annihilation from the accomplished anniversary to 10 days. Spit testing is accepting traction, but like hair, articulate fluids abduction a bound cardinal of compounds at apparent levels, and they move out of the aperture in 24 to 48 hours.
That leaves urine, the industry accustomed now and for the accountable future.
Most urine tests absorb the pee cup or, added technically, a urine immunoassay application thin-layer chromatography, a technology that dates from the 1970s — the aforementioned acclimated in abundance tests. They’re bargain — $5 ample and $20-$40 at retail drugstores (look for names like “TeenSaver”). They’re additionally about non-invasive, with no hair-snipping or blood-tapping needed, and they accommodate actual feedback. They about appraisal for amid 3 and 14 drugs, in added words, for smoker pot or alarming curve of cocaine.
But pee cups accept their limits. Biologic apprehension depends on the antibodies actuality the appropriate appearance to lock in a attenuated set of antigens – in this case, drugs. Often, they ambit up a added array of molecules than intended, consistent in apocryphal positives and cross-reactions. The antidepressant trazodone or alike breath sprays like Vick’s can activate a absolute for amphetamines; naproxen, ibuprofen and riboflavin can masquerade as marijuana’s cannabinoids.
The abstruse appellation actuality is “specificity,” which refers to the adeptness of a biologic appraisal to anticipate what’s what in a sample. For pee cups, specificity isn’t great: a 14-panel cup has aloof one band for opiates, but there are dozens of actual altered opiates, from heroin to oxycodone. The band catches some and misses others.
Another pee cup weakness has to do with its sensitivity, or adeptness to ascertain tiny amounts of drug. Often, the cutoffs are aerial abundant that biologic users can booty a brace of canicule off and canyon a pee cup test.
On top of the all-a-quiver science, pee cup biologic tests abridgement acknowledged punch. If the little band apparent “BZO” (for benzodiazepines) disappears, it’s alone a presumptive positive. In adjustment to blaze you, apprehension you or bandy you out of a affliction administration program, testers will accelerate your pee to a laboratory, area it’s run through a apparatus costing several hundred thousand dollars. The apparatus puts the urine through two gauntlets. The aboriginal uses either aqueous or gas chromatography to abstracted compounds based on the biologic molecules’ appearance and reactivity. Afresh the compounds are ushered into a accumulation spectrometer, which assault them afar with ions and samples the colors of ablaze arising from their afterlife throes. The colors admit their absolute attributes – and with far added acuteness than that of the antecedent pee cup.
On the added hand, pee cups won’t acquaint your employer about the decree medications in your anesthetic cabinet.
Blair Whitaker (R) and lab administrator Kim Plath, at CU Toxicology in Aurora, Colo., on Feb. 3, 2014.
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Image: Mashable, Chloe Coleman
CU Toxicology is technically a one-person operation, “a basal company,” as Blair Whitaker describes it. But Whitaker, 52, operates as added than one person. He talks absurdly and grasps the aspect of questions afore I'm absolutely bright on them myself. He has been a computer engineer, software architect and adventure capitalist. Whitaker has assorted titles alike now: administrator of business operations for the non-profit CU Toxicology and CEO of the for-profit Claro Scientific Laboratories.
His successes bought a big abode abreast the Denver Country Club, area he and his wife confused from California a decade ago to accession the three kids. In 2009, he started attractive for his abutting thing. He met people, went to conferences, advised pitches and projects: How about an ultrasound adjustment advised to attending at glycogen levels in athletes? Presurgical comestible supplements? Cat aliment alloyed with abrasion pheromones? And so on.
Whitaker, a cyclist, had been cerebration about developing a way to appraisal comestible supplements for a ample cardinal of abeyant adulterants – hidden steroids, say, or hormones or narcotics – that could get an aristocratic amateur aback busted.
Then he came beyond Uwe Christians.
Uwe Christians in his appointment at CU Toxicology in Aurora, Colo., on Feb. 3, 2014.
Image: Mashable, Chloe Coleman
Christians, 51, an M.D. as able-bodied as a Ph.D. pharmacologist/toxicologist, has been accomplishing accumulation spectrometry aback the mid-1980s, aback in his built-in Germany he acclimated a adaptation of the address for his M.D. apriorism on the metabolism of cyclosporine in alarmist displace patients. He runs a lab alleged iC42 in a architecture alleged Biosciences East, a aloft Air Force eyes factory.
The lab bottomward the anteroom from his appointment hosts 14 high-end mass-spec machines and a aggregation abundant on best Germans.
Christians had the ability and accessories to advance Whitaker’s sports supplement test. Application the mass-spec machines they created a distinct appraisal spanning 150 compounds in a distinct run. It worked.
But the sports bazaar didn’t pan out. Whitaker began to apprehend that World Anti-Doping Agency-type testing is a baby niche. Instead, he afflicted advance and focused on toxicology screening (drug testing), a abundant beyond market, which happens in every pediatric and developed affliction clinic, methadone berth and addiction center. Not to acknowledgment at bags of employment-related biologic testing locations beyond the country.
Whitaker and Christians removed steroids and added compounds from the account and, afterwards consulting with addiction accretion and affliction administration experts, added added drugs. They accustomed at 112 compounds in 16 classes spanning 500 prescription, adulterous and over-the-counter drugs. It was as acute as archetypal acknowledging tests but as advanced as the sea. For example, if a pee cup’s marijuana band triggered a presumptive absolute at 50 nanograms per milliliter of THC metabolite, this appraisal would ascertain bottomward to 2.5 ng/ml.
It amounted to what looked like an angry biologic screen. But it didn’t absolutely work.
The sample alertness lab at CU Toxicology in Aurora, Colo., on Feb. 3, 2014.
Image: Mashable, Chloe Coleman
The botheration wasn’t with the chemistry; Christians had nailed that. It was the software. In aboriginal 2011, Whitaker active up a aboriginal chump who beatific in 89 urine samples, but the abundance of abstracts that came out of the mass-spec aggregation bound afflicted his lab team.
Whitaker, who has a amount in electrical engineering, saw the abundance of abstracts as a algebraic problem. He spent six months aggravating to untangle the abstracts application Excel spreadsheets and Visual Basal code. The aftereffect was ugly, but it worked. As a bonus, this odd alliance of analytic allure and arresting processing additionally automatic abundant of the testing effort, authoritative the accomplished affair bargain and scalable.
He assertive the University of Colorado School of Anesthetic to barrage CU Toxicology as a non-profit to host the assignment and accommodate accessible face for the accomplishment – that way his for-profit Claro Labs could break in the background, demography a ability for every appraisal performed and owning the software Whitaker created. By January 2014, he was active hundreds of samples a week.
Seven of them were mine.
Since recreational marijuana became acknowledged in Colorado Jan. 1, 2014, accepting a bit of edger accessible for appropriate occasions has been like accepting a appropriate pilsner or single-malt scotch on hand. Guests don’t usually accompany it up, but are best agog aback you do. On Friday, Jan. 24 at about 10 p.m., I lit up with a friend.
I hadn’t absolutely accustomed what Rios the budtender had meant by Ogre actuality a “body high.” A acquaintance of abundance who runs a medical marijuana berth in Boulder, though, alleged Ogre “a abundant indica” and declared its after-effects as “more of a couch-lock, added a blurred array of high.”
I smoke rarely, but abundant to accept abstruse to stop at about six compact hits from the bottle pipe. The anatomy did tingle, but the arch seemed aloft it all – trains of anticipation alone batty as against to dematerialization into aphotic tunnels, as if they had never existed in the aboriginal place.
At about 3:30 p.m. the abutting day, I abounding two of several cups Whitaker had supplied. One was an Insta-Screen 14-panel pee cup immunoassay; the added was destined for a AB Sciex 5500 bike accumulation spectrometer at Whitaker and Christians' CU Toxicology lab. I put that one in the barn freezer, advising my wife to abstain application it to arctic her sparkling water.
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The Insta-Screen’s lower THC band achromatic in a brace of minutes. Positive, as expected. Until I ran out of CU Toxicology cups, which would appear on Wednesday, I would accurately ample those already a day, allowance their orange lids tight, and accumulation them on top of a bag of Ling Ling Mini Spring Rolls until demography them to CU Toxicology in bulk.
The afterward Monday, 2.5 canicule post-Ogre, I collection a brace of afar in ablaze snow to a band capital on Chambers Alley in Aurora to a abode alleged Wiz-Quiz, a adjustment employment-related sample beneficiary for testing giants such as Quest Diagnostics and LabCorp. The franchisee proprietor, Ben Duka, was unlocking afresh afterwards avaricious takeout for lunch. He had a dispersed beard and thin, gray-speckled hair. He wore a red Jeff Gordon NASCAR anorak and, on the boilerplate feel of his appropriate hand, a ample arena with a BMW logo. He told me business is up and bottomward depending on hiring about town.
On Duka’s walls afraid 13 diplomas with citations such as “DOT Urine Biologic Testing Course.”
I would do a five-panel cup – amphetamine, methamphetamine, cocaine, marijuana, opiates – for $25. In baby allowance with a toilet, a sink, a abbreviate adverse and no accessible agency of dehydration one’s hands, I broiled the cup. Duka came in, pulled on acrylic gloves, arrested the affection ring-like temperature readings, tore accessible a brownish adhesive to aftermath a array of immunoassay dipstick, and biconcave it in my piss. All negative. Aback in his office, he swiped my acclaim agenda through an iPhone adapter and printed me a affidavit adage as much.
Three canicule later, on Thursday, I delivered the arctic blocks urine for testing at iC42. I’d anon see how abundant marijuana metabolite was absolutely in my system. I had little doubt.
The sample alertness lab at CU Toxicology in Aurora, Colo., on Feb. 3, 2014.
Image: Mashable, Chloe Coleman
The development of technology like mass-spec biologic tests has bodies both aflame about its abeyant for accession accretion and chief care, for example, but at the aforementioned time afraid about the ethical dilemmas that absorb this all-inclusive accession of claimed data.
One of the primary hurdles is cost. CU Toxicology about accuse amid $100 and $200 per test, depending on the adjustment and volume. Alike costs associated with basal pee cup tests can add up. For example, doctors generally outsource mass-spec appraisal for urine samples, cutting up added costs of $50 to $250 per drug, says Tony Smith, advance lab artisan for Children’s Hospital Colorado.
“So that $50 biologic awning became a $700 appraisal by the time it’s complete,” Smith says.
At Northstar Transitions, an addiction accretion affairs in Boulder, they run CU Toxicology’s appraisal with anniversary new accession and afresh already anniversary anniversary they’re in the program, says Mike Ferrell, the organization’s controlling director. The appraisal has spotted cocaine in clients’ bloodstreams two weeks out, abundant best than the archetypal three to four canicule the pee cup detects. The test’s beyond agency Ferrell and colleagues apperceive if someone’s been drinking, demography Xanax, aroma (synthetic marijuana) and so on, afterwards acclimation cher abstracted tests for confirmation. It alike spots nicotine.
“It takes the assumption out,” Ferrell says. “We adeptness see buprenorphine in a heroin aficionado aggravating to self-medicate off the street, or cocaine if they’ve been application speedballs. And that sets the bounce for how we’re action to advance in treatment. It’s been actual informative.”
University of Colorado Hospital’s Centermost for Addiction Accretion and Rehabilitation (CeDAR) does the appraisal on every new accommodating and afresh afresh aback they leave. It can accomplish all the difference, says Michael Dinneen, who leads CeDAR’s extended-care treatment. One client, a assistant by profession, accumulated Benadryl and several added drugs to aftermath a accurate high. The appraisal spotted them. “It would accept gone beneath the alarm of all of the added tests that we do,” Dinneen says.
Lab administrator Kim Plath prepares the ascendancy samples at CU Toxicology.
Image: Mashable Chloe Coleman
In accession to addiction and recovery, the appraisal has begin adherents in UCH’s affliction administration and abiding affliction ranks. Jason Krutsch, M.D., a CU School of Anesthetic anesthesiologist who directs the university hospital’s interventional affliction clinic, says the appraisal helps “confirm and quantify not abandoned metabolites of drugs of abuse, but additionally those assigned in affliction management. It’s advantageous to us to see if patients are demography the meds we appoint for them.”
Consider additionally that the aforementioned capabilities enabling multiplexing biologic assays can – and are – acclimated to appraise the actinic markers of all array of action in the animal body. Christians has a 50-compound console that tests for the all-embracing bloom of the kidneys and claret barge linings. It includes amino acerbic profiles, oxidative accent markers, lipids, claret sugars and more.
The CU Toxicology appraisal is ultimately a new array of medical tool, and so its appulse could ability into realms as assorted as primary affliction to obstetrics. A broad-spectrum appraisal could authorize what medications a accustomed aged accommodating is absolutely demography – as against to what they say they’re taking, says Kennon Heard, M.D., a CU School of Anesthetic toxicology specialist and emergency physician.
“My ambition in 10 years is that we’re not action to bother allurement what they’re taking,” he says. “We’re action to booty a urine sample.”
Those acclimation urine tests can now affordably attempt into the clandestine habits and close actual apparatus of their targets like never before. It's affiliated to NSA spying, but for borer into bloodstreams rather than abstracts centermost lines.
Within the HIPAA-protected physician-patient relationship, that could able-bodied be a acceptable thing, accouterment a snapshot of actual action and pharmacological influence, bitter adverse biologic interactions in the bud.
But alike so, the technology raises ethical and acknowledged questions, says Ben Rich, administrator of the Department of Bioethics at the University of California Davis. Will physicians face corruption apparel for missing some borderline award of a ample multiplexing assay? Will the payer (an allowance company, say) assert on admission to the results, too? Will there be complete acknowledgment to the accommodating of the abounding ambit of these tests and abreast accord by the accommodating afore the biologic appraisal is given? Will patients on abiding analgesic assay absolutely accept an advantage to abatement the test?
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“What are the implications for me, vis-à-vis our relationship, if I say no?” Rich asks.
The questions become alike added agitating – and extensive – with account to employment-related biologic testing. Should administration apperceive if you’re demography claret burden or anti-seizure meds? If you’re on antidepressants? If you’re demography low doses of assigned painkillers because you pulled a beef in your back? If you accept prediabetes? Should they apperceive if you charge a little dejected bolus to get it up? The technology is there now, and the hundred or so bucks is a bead in the brazier compared to the $4,000 it costs, on average, to alter a U.S. worker.
Fortunately, some safeguards are in place. The Division of Workplace Programs for the federal Substance Corruption and Mental Bloom Services Administration (SAMHSA) clearly sets the standards for employment-related biologic testing beyond controlling annex entities. Unofficially, it sets the accent for ample swath of federal, accompaniment and clandestine area biologic testing.
Ron Flegel, the division’s director, says the bounden guidelines are actual bright both on how one can appraisal (the accustomed pee cup is still the appropriate aboriginal step, with mass-spec confirmation) and what one can appraisal for. Admitting clandestine area administration are not appropriate by law to chase the SAMHSA guidelines, they may acquisition themselves on all-a-quiver acknowledged arena if they don’t.
“It’s actual austere in the faculty that it’s abandoned activated for the drugs of corruption we accept in the guidelines,” Flegel says. “You can’t do DNA testing, abundance testing, analytic testing, genome testing – that sample is accurately accustomed abandoned for the drugs of corruption testing aural our program.”
An agent trims added leaves from pot plants at Anesthetic Man marijuana dispensary, in Denver, Colo., on Dec. 27, 2013
Things do change, though. Designer drugs like aroma accept been added to the U.S. Biologic Enforcement Administration account of controlled substances, he says, and an advising lath has appropriate abacus constructed opiates (oxymorphone, oxycodone, hydrocodone, hydromorphone) to SAMHSA’s bounden guidelines list. They’re because abacus articulate aqueous testing and, conceivably ancient later, beard testing to the menu. Would they accede auctioning the immunoassay and action beeline to a broad-based accumulation spectrometry test?
“You accept to acquiesce technology to move you forward,” Flegel says. “You could, possibly, accept a screening apparatus that could do it all-in-one.”
Existing employment-related law could accommodate a firmer backstop, says Matt Elliott, a activity law specialist and accomplice with Beckman Lawson in Fort Wayne, Ind. The Abiogenetic Advice and Nondiscrimination Act (GINA) of 2008 prohibits bigotry based on someone’s genes or abiogenetic history, “so administration are not accustomed to alike access that advice except beneath bound circumstances, and if they do access it, they’re not accustomed to use it to hire, blaze or actuate benefits,” Elliott says.
Also, the Americans with Disabilities Act (ADA) is ample abundant that aberrant corpuscle advance or alike accomplished biologic addiction are covered beneath the act, and administration can be accountable if they discriminate on such bases, he says. The aforementioned goes for decree drugs.
“How do you acquaint if it’s illicit?” Elliott asks. “It’s apparently one of those things that you as an employer don’t appetite to know, because you’re aperture your doors to accountability if you do appraisal for it.”
For his part, Whitaker is accommodating to let giants like LabCorp and Quest Diagnostics action for the application market.
“We can do application stuff, but you know, philosophically, I’d abundant rather be in aggravating to advice bodies than apprehension ‘em,” he says.
But it’s aboveboard to accept that multiplexing drug-screening assays won’t anon be in the testing giants’ – and their abounding clients’ – hands. CU Toxicology may be advanced of the pack, but its scientists aren’t the abandoned ones able of authoritative this ambition a reality. ARUP Laboratories already has a mass-spec claret appraisal accoutrement 67 compounds, and a urine appraisal accoutrement 37.
The columnist Todd Neff (left) with acquaintance Louie one day afterwards smoker Ogre, in Aurora, Colo.
Nearly a anniversary afterwards carrying my samples to CU Toxicology, Blair Whitaker called.
“You’re not action to accept this,” he said. “You were negative.”
He emailed me the .pdf of my biologic appraisal after-effects – my pre- and post-smoking tests on Friday, Jan. 24 and circadian follow-ups through the afterward Wednesday, seven in all. The Friday afternoon pre-test best up the debris of the 100 mg naproxen bolus I had popped that morning and the distinct beer I had sipped afterwards my Thursday night calm soccer game. But there was no adumbration of THC in my system, admitting the average pee cup positive.
Whitaker, acutely abundant added absorbed and aflame than worried, came by to aces up a bud of Ogre for actinic appraisal over at CannLabs. He wondered if the Ogre was all non-psychoactive CBD, a.k.a. cannabidiol, a hardly altered chemical. The mass-spec, acquainted for THC, would accept been dark to it. The less-choosy pee cup immunoassay could accept aloof accumulated CBD in with added cannabinoids of its accustomed appearance and appear out positive.
But CannLabs begin about no CBD in the bud. There was adored little THC, either – about 5%, as compared to the 15-20% in best strains they test. Heather Despres, who directs the lab, said the Ogre sample was a somewhat abate than the 180 mgs they usually set as a minimum for analysis, but that the after-effects were apparently solid.
Whitaker says 9% of CU Toxicology’s best contempo 3,058 tests came aback absolute for THC carboxy, one of two metabolites (the added actuality a hydroxy) that his and added marijuana mass-spec tests attending for. His appraisal has anesthetized every annual federal accomplishment awning (the admiral accelerate urine) for the drug. The association could be that accidental users everywhere abort their pee cup immunoassays but afresh canyon the accurately bounden mass-spec tests, he said.
“Are we missing them? I do apperceive we accept the best acute appraisal for THC carboxy,” Whitaker says. “The catechism for us is, if we get this abounding and we don’t get them all, what are we missing?”
It’s action to be boxy to acquisition out. Efforts to map out the metabolic pathways of meandering cannabinoids are bedridden by their adjournment to the DEA’s agenda I list, with rogues like LSD and heroin. Winning federal allotment – the aspect of basal medical appraisal – to abstraction agenda I drugs the DEA describes as accepting “no currently accustomed medical use” is awfully difficult, Whitaker says. The irony that medical marijuana is acknowledged in 20 states and the District of Columbia is adamantine to miss. Crystal meth and cocaine, agenda II drugs, are easier to study.
No agnosticism an accessible adaptation of the CU Toxicology awning will accommodate CBD metabolites, prednisone and added drugs. Probably, added companies will follow. How far will this new urine-scouring technology booty us? How far will we let it booty us?
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Regardless, the bodies who adjustment these tests are action to apperceive an abominable lot about us.
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