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Wednesday 21 November 2018
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The Latest in DUI and DUID Toxicology

Exploring Novel Psychoactive Substances We are excited to present the third NMS Intelligence podcast in our great series in collaboration with NMS Labs! Please let us know how you like it! 

OUR GUEST  Aya Chan-Hosokawa, Forensic Toxicologist at NMS Labs, joined the show for the purpose of educating us on the Latest in DUI and DUID Toxicology. Specifically, we discuss the following with Aya on this episode:

  1. What drives your passion for DUID testing?
  2. What are the latest improvements to your DUI testing?
  3. What are the latest trends you have seen in DUID testing?
  4. How do you normally interact with the law enforcement agencies?
  5. Once you’re identifying trends, and you are seeing new trends, are you working back with the law enforcement agency to tell them or are you seeing it together or how does that work?
  6. What is the most numbers of drugs NMS has reported in a single DUID case?
  7. What are the benefits of the changes to DUID testing?
  8. What have I missed, what about the importance of testing would you like our audience to know?

Check out NMS Labs on the Web and follow them on Twitter and LinkedIN!

 

Prior Episodes of NMS Intelligence

Exploring Novel Psychoactive Substances

The Solution to Proper Medication Disposal

 

About Aya Chan-Hosokawa

The Latest in DUI and DUID Toxicology Ayako (Aya) Chan-Hosokawa is a forensic toxicologist with NMS Labs in Willow Grove, PA. She earned her Bachelor of Science in Chemistry from Stockton University in 2004 and her Master of Science in Chemistry from the University of Minnesota in 2006. Ms. Chan-Hosokawa is also certified as a Diplomate through the American Board of Forensic Toxicology (ABFT) and is a member of the Society of Forensic Toxicologists (SOFT), the American Academy of Forensic Sciences (AAFS), and the International Association of Forensic Toxicologists (TIAFT). Ms. Chan-Hosokawa received specialized training at The Robert F. Borkenstein Courses on Alcohol & Highway Safety and DUID, The Center for Forensic Sciences Research and Education certificate programs on analytical toxicology, postmortem interpretive toxicology, and forensic pharmacology and Thomas Jefferson Graduate School of Biomedical Sciences class on general pharmacology. Professionally, Ms. Chan-Hosokawa’s primary area of interest is drug-impaired driving; she evaluates positivity data, the changes in drug trends and observed blood drug concentrations. Her focus is to help maintain NMS’s leadership role in forensic toxicology testing by developing an appropriate scope of analysis at the sensitivity required for purpose of DUID investigations. She also serves as a faculty member for The Pennsylvania District Attorneys Institute for their annual training of prosecutors and investigators.

About NMS Labs 

NMS Labs brings you the innovative tests and services that meet the ever-changing world of drugs and diagnostics.

Developed under the direction of experts renowned throughout the medical, forensic and legal fields, NMS Labs provides a unique and impressive menu of more than 2,500 tests—all readily available to clients ranging from hospitals and universities to law enforcement, attorneys, and medical examiners. They turn to us for our expertise, service, and innovation they simply can’t find anywhere else.

In addition, NMS Labs…

  • Has more than 200 highly trained technicians and 18 Ph.D. scientists and toxicologists on staff with decades of experience to help you
  • Uses a world-class, full-service facility including a dedicated and secure crime laboratory to provide you with the finest testing services available
  • Meets the rigorous standards of such industry organizations as ABFT, ASCLD/LAB-International ISO 17025, CAP ISO 15189, CAP-LAP and NYS DOH

Our adherence to rigorous accreditation and licensure programs reflects our commitment to improve patient safety, promote consistently excellent testing, and advance the quality of our work. It’s your assurance that our laboratory meets or exceeds the standards set by leaders in our fields. You can always test with us with confidence. Because the demands of the medical, forensic and legal fields evolve at an increasing pace all the time, we work hard to connect the needs of your world with that of the most innovative testing available in laboratory science. It’s why we’re always improving and expanding our test menu, capabilities, instrumentation and expertise. (from http://www.nmslabs.com/about-overview/)

Transcript

NMS Labs is an international forensic and clinical reference laboratory that has unsurpassed in its scope of toxicology test, accuracy of results, scientific expertise and innovation. Our state of the art headquarters includes clinical, forensic and research facilities. A dedicated and secure crime laboratory, and is staffed by more than 350 highly trained professionals. NMS Labs is passionate about promoting public health and safety, and we’re proud to bring you our thought leading podcast NMS Intelligence.

Joe Lavelle: Welcome to NMS Intelligence, an exciting podcast series from NMS Labs. I’m your host Joe Lavelle, and I’m really looking forward to this conversation with another trailblazing innovator. We’re going to get right to it today. We’re joined by Aya Chan-Hosokawa. Aya is a forensic toxicologist with NMS, Aya, welcome to NMS Intelligence.

Aya Chan-Hosokawa: Thank you, Joe. Thank you for having me here today.

Joe Lavelle: Thanks so much for joining us. Could you take a couple of minutes and tell the audience what you do as a forensic toxicologist with NMS Labs?

Aya Chan-Hosokawa: Sure. So, as a forensic toxicologist, my responsibilities include toxicological case review, expert testimonies and writing expert opinion reports. I also do client communication and education for toxicological matters, prepare allegation document review, and analytical specification for a new and redeveloped testing. So, what it is pretty much is that every time we have a new testing or we need a little more work to redevelop testing, I will give certain criteria for our research and development department, so that they have something to go with when it comes to reporting limits or scopes or things like that.

Joe Lavelle: Great, thank you so much for that Aya. One of the things we’ve learned on a previous podcast is that you guys do DUID Testing, what is it that drives your passion for DUID Testing?

Aya Chan-Hosokawa: Driving under the influence of drugs is a serious crime, which is often considered or treated like minor crimes, especially when there’s no injury, damage to the properties or a death involved. However, most often it is not the first or last time the driver who is under the influence of drugs gets behind a wheel, and it’s also multiple people get affected by one single instance, not only the driver but also victims, and families of victims and driver. So, by providing the toxicology service and the specific discipline we are playing a very important role in public safety, and that’s what my passion is.

Joe Lavelle: Perfect. What are some of the latest improvements to your DUI testing?

Aya Chan-Hosokawa: It’s not the latest, but I just wanted to mention a couple of things that we did in the last past couple of years first. In 2015, we made a significant improvement to all our DUID by redesigning the immunoassay screen, which is used by most of the toxicological laboratory for basic screening, and we improved the sensitivity and improved the scope. This improvement actually resulted in a dramatic increase of specific drug class called Benzodiazepine, positivity from 14% in 2014 to over 21% in 2017. That made Benzodiazepine the second most prevalent drug class after cannabinoid in DUID basic panel. So then in 2018 another improvement was made to include the certain compound to both basic panels as well as the expanded panel.

We included the three-opioid compounds, fentanyl, tramadol and buprenorphine to our basic panel, and as for the expanded panel, we have added the novel psychoactive compounds known as NPS compound such as designer opioid, fentanyl analogs, designer benzodiazepines, substituted cathinone, and mitragynine. So, by including these compounds we were hoping to increase our positivity rate equivalence to our cases that come into our door.

Joe Lavelle: Perfect. What are some of the latest trends you’ve seen in DUID testing?

Aya Chan-Hosokawa: As for the basic panel which includes cannabinoid and cocaine, like in regular drugs that you see, the trends are pretty similar, so I just talked about we were hoping to increase our positivity. That actually happened, we were reporting 71% positive in January, now it’s around 90% in May and June. So, including those new compounds really helped us to actually show somebody who is under the influence were really using some of the drugs. As for the type of compound that we see, a cannabinoid is still number one, it’s over 56%, and I just talked about benzodiazepine has been high since our last improvement, so that’s at 16%. And located East Coast and specifically outside of Philadelphia, we got a lot of cocaine cases. So, we have a lot of cocaine and 13%. Methamphetamine, that’s also becoming pretty popular in this area as well. And we have a new comer, fentanyl, that’s over 10%, that’s even surpassing other opioids, that’s 9%. So, we have pretty consistent trend as far as the basic drugs of abuse in basic panel.

As for the designer compound, we have a variety of compound that we have reported so far. We have the fentanyl analogs, that is known as FIBF, Methoxybutyrfentanyl, Cyclopropylfentanyl, free muscle fentanyls, we have designer benzodiazepine, etizolam, flubromazolam and N-Ethylpentylone and mitragynine and we reported multiple cases of those. So, I guess the key is that those drugs come and go so that laboratories really have to be keeping up with what’s coming on the street and testing for the right compounds.

Joe Lavelle: Right. And how do you work then with the law enforcement agencies to make that happen? How do you normally interact with the law enforcement agencies?

Aya Chan-Hosokawa: We have a really great relationship with a lot of our DREs and arresting officers, often they are the ones who give us input of what they’ve seen like the package looks like, we also work very closely with our crime department. They are the ones who usually test for the seized drugs, so they are ones who usually have an insight on what’s coming on the street, and we have a group of toxicologists who are specifically looking into the NPF compound, what’s available. So, from there my job really is to narrow down what compound is seen in a DUID and test for those compounds specifically for DUI.

Joe Lavelle: Got it. And then once you’re identifying trends, or you are seeing new trends, are you working back with the law enforcement agency to tell them or are you seeing it together or how does that work?

Aya Chan-Hosokawa: So yes, I do present at national conferences as well as to provide information to our DRE coordinators and our TSRPs, and also we’ll try to put some information through NMS either website or communication and give them some of the trends that we’ve seen. In fact, we are actually going to the DAID DRE conference in Nashville in a couple of weeks, so there we’ll also try to provide some of the insights that we have as well.

Joe Lavelle: Perfect. What’s the largest number of drugs that NMS has reported in a single DUID case?

Aya Chan-Hosokawa: I tried to get the answer, I couldn’t find what’s the largest, but we easily see DUI cases with over 7 different drugs, way more than I wish I do. So, just last few months or even a few weeks, I had a case of methamphetamine amphetamine, I said it together because that’s considered one drug. One is a parent drug and the other one is a metabolite. I had three different benzodiazepine: clonazepam, alprazolam and midazolam, which is probably given to him at the hospital, but still we reported that. Cannabinoid, cocaine and morphine, fentanyl and buprenorphine, so that’s a lot of drugs for somebody who is actually driving.

Joe Lavelle: Holy cow, holy cow. You mentioned some of the changes you guys have been making. What are the benefits that changes, what are really the benefits of you guys being so connected to law enforcement over the last couple of years and the changes you’ve been able to make to combat the drug crisis, the opioid crisis, all these drugs that are being used for people that are operating vehicles or just walking the streets?

Aya Chan-Hosokawa: Sure. One thing I should probably mention is that we have resources, it’s coming from the National Safety Council specifically in the Alcohol Drugs and Impairment Division, it’s NSC ADID. They published these recommendations and guidelines for the toxicological laboratory for testing of suspected drug-impaired driving cases. So, that’s like a one way for anybody, not just NMS, to reference what should be testing at what reporting limits. And we do really have a great relationship with our clients, so they’ll give us insights in what they’re seeing. If they really believe that somebody is definitely impaired, but we report a non-detected, that’s something that we will look into to see whether we are missing some scopes or maybe sensitivity is not good enough.

So, the benefit of having these changes are that I believe the forensic toxicology testing is performed to confirm and verify the observations made by DREs or arresting officers, and also to provide the toxicological evidence that drugs suspected are in fact present. So, to do that efficiently, it is really important to have appropriate scopes of analysis at the sensitivity that is really required and customized to the DUID.

It might not be the same reporting limit for the post-mortem concentration, which you’re looking at overdose cases. We’re looking at drivers, they are impaired and not necessarily overdosed. So, scopes and sensitivities can be, I’m not saying it’s always, but it can be different depending on what type of casework you may have.

Joe Lavelle: Perfect. All right, so what have I missed, what about the importance of testing would you like our audience to know?

Aya Chan-Hosokawa: I guess the one thing is that once drivers are saying I just used this drug. They might think that’s what they used, but it might not be the case. The common thing I can think about, and which is the problem now, is a lot of people admit that they are using heroin, and when we test their blood specimen, there’s no morphine, no 6-monoacetyl morphine, those are the markers for heroin in many cases, it turns out it was a fentanyl in the blood. So, it’s not that they are lying, but they might not know what they’re using either.

So, the officers would have really have to be open to other information. But also believe that if their, I guess assessment, the DRE or SFST assessment pointing towards the opioid or a narcotic then go after that, don’t just stop the testing from the basic analysis that might not include the fentanyls. That also can be said about tramadols or buprenorphine. So those drugs might not be included in some of the testing that is performed in another laboratory.

So open to other information, but also stick to their evaluation to believe what drug class they’re really going after. Also, the trends are very different depending on different parts of the country. We still have PCP included in our scope, because we have a client that’s based in a certain part of the country that’s pretty heavy on using, the region still sees a lot of PCP. Some areas might not be like that, so they might not have to test for those compounds.

The same thing can be said about other compounds that they may see more than what we’re seeing here. So, each laboratory really should have their own trending and stats and should be able to provide that information to the client. That way they’re really testing for the right scope and right sensitivities, and I guess the key is really is the scopes and the correct, like appropriate cut off, those are the really most important things for a DUID testing.

Joe Lavelle: Well, that last little bit is amazing, and that’s I think really what our listeners want to hear. So, thank you so much for that. I also want to take this time to thank the great folks at NMS Labs for connecting us with Aya and for helping make this interview happen. While I have everybody’s attention, why don’t you go out to https://www.nmslabs.com, bookmark that site, see what other great things they’re doing to fight drug addiction, the opioid crisis, etcetera. Aya, it was so great to have you on the show. Thanks for stopping by and sharing your wisdom with us.

Aya Chan-Hosokawa: Thank you.

Joe Lavelle: Thank you! And that wraps this podcast. On behalf of our guest, Aya Chan-Hosokawa, I’m Joe Lavelle and we’ll see you soon on NMS Intelligence.

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Joe Lavelle

Editor-in-Chief, Healthcare at intrepidNow
JOE LAVELLE is a Healthcare Management and Technology Consultant with a record of successfully meeting the business and technology challenges of diverse organizations including health plans, health delivery networks, and health care companies for 25 years. Joe worked his way up through Cap Gemini and Andersen Consulting to the partner/VP level of at First Consulting Group, Technology Solutions Group and Santa Rosa Consulting. After running his own company, Results First Consulting, for 12 years Joe Co-Founded intrepidNow with Todd Schnick to create incredible content to dramatically improve the sales and marketing efforts of their clients.
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JOE LAVELLE is a Healthcare Management and Technology Consultant with a record of successfully meeting the business and technology challenges of diverse organizations including health plans, health delivery networks, and health care companies for 25 years. Joe worked his way up through Cap Gemini and Andersen Consulting to the partner/VP level of at First Consulting Group, Technology Solutions Group and Santa Rosa Consulting. After running his own company, Results First Consulting, for 12 years Joe Co-Founded intrepidNow with Todd Schnick to create incredible content to dramatically improve the sales and marketing efforts of their clients.


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