Performance characteristics of the Cozart RapiScan Oral Fluid Drug Testing System for opiates in comparison to ELISA and GC/MS following controlled codeine administration

Oral fluid is an interesting alternative matrix for drug testing in many environments, including law enforcement, workplace drug testing, and drug treatment facilities. Performance characteristics of the FDA-cleared, qualitative, Cozart RapiScan Opiate Oral Fluid Drug Testing System (Opiate Cozart RapiScan System or Opiate CRS) were compared to the semi-quantitative Cozart Microplate EIA Opiate Oral Fluid Kit (Opiate ELISA) and to gas chromatography/mass spectrometry (GC/MS). The following oral fluid opiate cutoffs were evaluated: the GC/MS limit of quantification (LOQ) of 2.5 mg/l; 15 microg/l currently used for oral fluid testing in the United Kingdom (UK); 30 microg/l (Opiate CRS cutoff); and 40 microg/l, the proposed Substance Abuse and Mental Health Services Administration (SAMHSA) cutoff. Subjects provided informed consent to participate in this IRB-approved research and resided on the closed research ward throughout the study. Three oral codeine doses of 60 mg/70 kg were administered over a 7-day period. After a 3-week break, subjects received three doses of 120 mg/70 kg within 7 days. Oral fluid specimens (N = 1273) were analyzed for codeine (COD), norcodeine (NCOD), morphine (MOR) and normorphine (NMOR) by GC/MS with an LOQ of 2.5 microg/l for all analytes. MOR and NMOR were not detected in any sample; 26.5% of the specimens were positive for COD and 13.7% for NCOD. Opiate CRS uses a preset, qualitative cutoff of 10 microg/l; this is equivalent to 30 microg/l in undiluted oral fluid as the oral fluid collection process involves a 1:3 dilution with buffer. Sensitivity, specificity, and efficiency of Opiate CRS compared to Opiate ELISA were 98.6, 98.1, and 98.2% at a 30 microg/l cutoff and 99.0, 96.2, and 96.6% at a 40 microg/l cutoff. Compared to the much lower GC/MS LOQ of 2.5 microg/l, sensitivity, specificity and efficiency were 66.8, 99.3 and 90.7%. Increasing the GC/MS cutoff to the current UK level yielded performance characteristics of 81.5% (sensitivity), 99.3% (specificity), and 95.4% (efficiency). Using a GC/MS cutoff identical to the preset Opiate CRS cutoff yielded sensitivity, specificity, and efficiency of 88.5, 99.2, and 97.5%, respectively. At the proposed SAMSHA confirmation cutoff of 40 microg/l, sensitivity increased with little change in specificity and efficiency (91.3% sensitivity, 98.9% specificity, and 97.5% efficiency). Oral fluid is a suitable matrix for detecting drugs of abuse. Opiate CRS, with a 30 microg/l cutoff, is sufficiently sensitive, specific and efficient for oral fluid opiate analysis, performing similarly to Opiate ELISA at the same cutoff, and having performance characteristics >91% when compared to GC/MS at the proposed SAMHSA cutoff.     

Sisterly conduct: Do feminists need guidelines for ethical behavior with one another?

Feminists who actively participate in the contemporary women's movement find a plethora of dilemmas that cause great pain and conflict. One of these involves the negative ways in which we reportedly interact and behave with one another.Accounts of unsisterly conduct are recounted by feminists who themselves have felt under attack by other feminists, by feminists who have observed seemingly brutal interaction, or by feminists who have defended themselves after a perceived hostile confrontation by other feminists.Both written and oral reports of unsisterly conduct led me to ask questions about the need for ethics in the women's movement. This paper reports on how the idea evolved and on responses by participants at two feminist conferences held in California in 1982.     

Age differences in eyewitness testimony

This study examined age differences in eyewitness testimony. Children, three and six years of age, and adults interacted with an unfamiliar man for 5 minutes. Four or five days later, the witnesses answered objective and suggestive questions, recalled what happened, and tried to identify the confederate from a target-present photo line-up. The adults and 6-year-olds did not differ in their ability to answer objective questions or identify the confederate, but 6-year-olds were more suggestible than adults and recalled less about the event. Compared to the older age groups, the 3-year-olds answered fewer objective questions correctly, recalled little about what happened, and identified the confederate less frequently. In addition, they were the most suggestible. The experiment extends our knowledge of children's ability to provide accurate eyewitness reports to a very young age group and to a situation in which participants are not merely bystander witnesses but instead directly interact with the confederate.     

The aftermath of child sexual abuse of African American and white American women: The victim's experience

Several aspects of the victim's personal experience in the aftermath of child sexual abuse are described. Subject recruitment involved a multi-stage stratified probability sample of 126 African American and 122 White women, ages 18 to 36 years in Los Angeles County, matched on education, marital status, and the presence of children. Few ethnic differences were related to the initial response and short-term effects of the victim's experiences. Lasting effects of sexual abuse included sexual problems for women of both ethnic groups, but avoidance of men resembling the perpetrator was identified among African American women. Ethnicity may be a contributing factor to other adjustment related problems that African American women encounter in addition to their child sexual victimization. The implications of these findings and issues in the assessment of the aftermath are discussed.     

The rise and rise of fentanyl in postmortem casework

Forensic toxicology laboratories are navigating a period of time with increasing drug overdose deaths, an opioid epidemic, the impact of the COVID-19 pandemic, and the illicit drug market flooded with novel psychoactive substances. In New York City, the Department of Forensic Toxicology has experienced a 56% increase in postmortem casework in the past decade with fentanyl detected in 80% of all overdose deaths. Over a period of 2.5 years, 15,638 postmortem cases were tested for the presence of fentanyl and fentanyl analogs using liquid-chromatography tandem mass spectrometry (LCMSMS). Fentanyl was detected in approximately one third of cases and of these 4447 cases with femoral blood. A twofold increase in cases with high concentrations of fentanyl (>100 ng/mL) was observed between 2021 and 2022. The minor metabolite and precursor chemical, 4-ANPP (4-anilino-N-phenethylpiperidine) may help differentiate between illicit and licit fentanyl. 4-ANPP blood concentrations were <10 ng/mL in 98% of the cases and the 4-ANPP:fentanyl ratio was <0.67 for 99.1% of blood specimens. Only six cases had 4-ANPP concentrations higher than the corresponding fentanyl blood concentration. This study also highlights, the changing fentanyl analogs found in postmortem cases since 2016 in NYC with the emergence of fluorofentanyl initially identified in 2020 and continuing to dominate in comparison with the prevalence of other analogs, many of which are no longer detected in casework. The detection of one of the latest drugs to be mixed with fentanyl, namely xylazine, has also increased in prevalence by 36.7% in 2022 compared with 2021.     

Ecological socialism and human needs∗

The proposed Sardar Sarovar Project (SSP) is the keystone of India's Narmada Valley Project, consisting of 30 large, 130 medium, and 3000 small dams. Backed by the Indian government and the World Bank (the tatter to the tune of $450 million in loans), the SSP has generated unprecedented opposition from farmers and others whose lands would be submerged by the project, as well as from many Indian environmentalists and environmental and human rights groups around the world. In 1990, under tremendous pressure, former World Bank President Barber Co noble called for the Bank to make an independent review of the project. The Team's Report of the Independent Review, which evaluated the resettlement and environmental impacts of the SSPt backed up the criticisms of the projecfs opponents. One of India's best known engineers, CNS Editorial Consultant KM. Datye, his associates, and other scientists working on sustainable development alternatives have produced a wealth of critical studies of large dam projects including the SSP project in India. Their conclusion is that there are technical alternatives to the project which better serve the interests of democratic control of water and energy resources, economic and social equity, and economic efficiency.