Oral fluid (OF) is a valuable specimen for Driving under the influence of drugs (DUID) applications. This study demonstrates the implementation of the first comprehensive OF drug testing program in the United States, including approved roadside screening OF devices for law enforcement and validated LC–MS-MS confirmation methods. Three roadside OF screening devices were evaluated: the Dräger DrugTest® 5000, Abbott SoToxa®, and Randox Evidence MultiSTAT™. Two qualitative LC–MS-MS confirmation methods were validated per ASB Standard 036. The first method utilized an automated Dispersive Pipette Extraction (DPX) extraction using Integra and Hamilton STARlet platforms for drugs of abuse. The second method used a liquid-liquid extraction to detect cannabinoids. The prevalence of drugs in blood and OF was monitored over five years of casework. Calibration curves were analyzed with each batch to monitor OF concentrations for research purposes. Three roadside OF screening devices were deemed fit for purpose. Devices demonstrated appropriate sensitivity, specificity, positive and negative predictive values, and accuracy above 80% for targeted drugs except for benzodiazepines (DrugTest® 5000) and amphetamine (SoToxa®). The validated LC–MS-MS OF confirmation methods met the National Safety Council recommended cutoffs for 18/21 (86%) of the targets. Over five years of casework, THC and cocaine were detected at a positivity rate of 90% and 97% in OF versus 75% and 44% in blood, respectively. OF: blood ratios exceeded unity for parent drugs. Median concentrations of THC in OF and blood were 31 and 3.5 ng/mL, respectively. OF is a viable alternative or supplemental specimen for DUID investigations. Collecting OF close to the driving event increases the opportunity to identify pharmacologically active substances, and when combined with blood analysis results, an elevated OF: blood ratio provides valuable information for DUID investigation purposes.

中文翻译：

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实施第一个综合性国家口腔液体药物检测计划，用于 DUID 病例的路边筛查和实验室检测 - 五年回顾

口腔液 (OF) 是药物影响下驾驶 (DUID) 应用的宝贵样本。本研究展示了美国第一个全面 OF 药物测试计划的实施，包括批准的用于执法的路边筛查 OF 设备和经过验证的 LC-MS-MS 确认方法。我们评估了三种路边 OF 筛查设备：Dräger DrugTest® 5000、Abbott SoToxa® 和 Randox Evidence MultiSTAT™。根据 ASB 标准 036 验证了两种定性 LC-MS-MS 确认方法。第一种方法采用自动分散移液管萃取 (DPX)，使用 Integra 和 Hamilton STARlet 平台对滥用药物进行萃取。第二种方法使用液-液萃取来检测大麻素。经过五年的个案工作，对血液和 OF 中药物的流行情况进行了监测。分析每批的校准曲线以监测 OF 浓度以用于研究目的。三个路边 OF 筛查设备被认为适合用途。设备对除苯二氮卓类药物 (DrugTest® 5000) 和安非他明 (SoToxa®) 之外的靶向药物表现出适当的灵敏度、特异性、阳性和阴性预测值以及超过 80% 的准确度。经过验证的 LC-MS-MS OF 确认方法符合国家安全委员会建议的 18/21 (86%) 目标的临界值。经过五年的案例研究，OF 中 THC 和可卡因的检出率分别为 90% 和 97%，而血液中的检出率分别为 75% 和 44%。OF：血液比率超过母药的统一值。OF 和血液中 THC 的中位浓度分别为 31 ng/mL 和 3.5 ng/mL。OF 是 DUID 调查的可行替代或补充样本。在驾驶事件附近收集 OF 增加了识别药理活性物质的机会，并且当与血液分析结果结合时，升高的 OF：血液比率为 DUID 调查目的提供了有价值的信息。