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.     

Lifetime and six-month prevalence of psychiatric disorders among sentenced female offenders

The authors determined the six-month and lifetime prevalence of psychiatric disorders among 100 consecutively admitted female offenders to a prison, using Diagnostic Interview Schedule (DIS Version III) and found high prevalence rates of schizophrenia, major depression, substance use disorders, psychosexual dysfunction, and antisocial personality disorders. The prevalence rates of these disorders were significantly higher than those of the general population. The authors note the implications of their findings for treatment of women within the correctional system.     

Detection of malingering in competency to stand trial evaluations

A simulation design with multiple contrast groups was used to test the effectiveness of two instruments, the Structured Interview of Reported Symptoms (SIRS) and the Georgia Court Competency Test—Mississippi State Hospital (GCCT-MSH) in detecting malingering of competency to stand trial. Thirty simulators were compared with 23 incompetent defendants, 25 competent defendants, 30 offender controls, and 7 suspected malingerers on both instruments. Results revealed that the simulators and suspected malingerers scored significantly higher on all of the SIRS primary scales and significantly lower on the GCCT-MSH than the three comparison groups. The SIRS had an overall hit rate of 97.8% using three or more primary scales as the criterion for malingering. Information concerning the simulator's strategies of deception is presented.     

‘A confession of ignorance’: deaths from old age and deciphering cause-of-death statistics in Scotland, 1855–1949

A large amount of the research undertaken in an attempt to discover the reasons underlying the late nineteenth- and early twentieth-century mortality decline in Britain has relied on the statistics published by the Registrars General. The processes by which individual causes of death are recorded and then processed in order to create the statistics are not, however, well understood. In this article, the authors build on previous work to piece together a time series of causes of death for Scotland, which removes many of the discontinuities encountered in the published statistics that result from the Registrar General deciding to update the nosology, or classification system, which was being used to compile his figures. Having regrouped individual causes of death to ‘smooth’ the time series, the authors use the new groups to examine the changing causes of death in Scotland for selected age groups, before turning to undertake a detailed examination of mortality amongst those aged 55 or more. The authors find that when deaths from ‘old age’ in the latter age group are separated from other ‘ill-defined’ causes, it becomes obvious that there was a ‘rebranding’ of cause of death. The authors then use individual-level data from two Scottish communities to further dissect the roles played by ‘informants’ and ‘doctors’ in this rebranding, in order to see how these roles may have altered over time and what the consequences might be for one's view of how mortality changed in Scotland between 1855 and 1949. Finally, the authors argue that their findings have important implications for some of historical demography's most prominent theories: the McKeown thesis and the theory of epidemiological transition.     

Crisis in the Philippines Left: Implications for the Asia Pacific

The struggles of poor communities to negotiate development processes have been documented increasingly in recent years. However, recognition of the agency of the poor should not preclude attention to patterns of oppression that may be intensifying in the face of top-down development processes imposed by increasingly well co-ordinated elites. Examination of patterns of violence in border areas across the Greater Mekong Sub-region suggests that integration facilitates the collusion of state actors in the dispossession of the poor in a manner that is deleterious to ethnic minorities, internal migrants and other vulnerable populations. National political processes are not offering mechanisms by which such populations can seek to contest this trend.     

Suicide by cop among female subjects in officer-involved shooting cases

An analysis of suicide by cop (SBC) among female subjects in a large sample (n = 707) of officer-involved shootings (OIS) is reported. Women represented 3% of the total sample (n = 21) and 5% (n = 12) of the 256 SBC cases. Therefore, 57% of the women (n = 12) were classified as SBC, and 81% of the women (n = 17) behaviorally evidenced some suicidal motivation. The results underscore that when a female subject becomes involved in a situation leading to an OIS, there is a very high likelihood that she is motivated to be intentionally killed. She is almost guaranteed to have a diagnosed mental disorder, has been prescribed psychiatric medications, and is abusing a substance at the time, most likely alcohol. Nevertheless, she also poses a serious risk of injury to both police officers and civilians during the encounter and will possess a firearm half the time. The wish for suicide is often precipitated by serious relationship issues. Comparisons are made to the male subjects in our previous study.