Main Article Content

Monique Moller
Joey Gareri
Gideon Koren


Drug testing, hair, meconium, prenatal, toxicology, urine screen, infant, child, drug


As drug abuse in our society escalates, child protection workers face mounting challenges in accurately assessing parental substance abuse in the interest of effective child protection. The impartial evaluation of substance use and abuse is fundamental, requiring objective and sensitive methods. A variety of biological specimens, some applicable to short-term and some to long-term monitoring, have been successful when applied to a child protection and drug abuse monitoring of caregivers. This article explores the complementary features of drug testing in urine, hair, and meconium, among other alternative matrices and discusses the practicality, basic science, and applicability of each to substance abuse monitoring in the context of child protection.

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1. Drug Situation in Canada - 2007 [Internet]. cited 2/8/2010; http://www.rcmp-grc.gc.ca/drugsdrogues/ pdf/drug-drogue-situation-2007-eng.pdf
2. Marques PR, Tippetts AS, Branch DG. Cocaine in the hair of mother-infant pairs: Quantitative analysis and correlations with urine measures and self-report. Am J Drug Alcohol Abuse. 1993;19(2): 159-75.
3. Ostrea EM, Jr., Knapp DK, Tannenbaum L, Ostrea AR, Romero A, Salari V, Ager J. Estimates of illicit drug use during pregnancy by maternal interview, hair analysis, and meconium analysis. J Pediatr. 2001Mar;138(3):344-8.
4. Hall FS, Sora I, Uhl GR. Sex-dependent modulation of ethanol consumption in vesicular monoamine transporter 2 (VMAT2) and dopamine transporter (DAT) knockout mice. Neuropsychopharmacology. 2003 Apr;28(4):620-8.
5. Onaivi ES, Leonard CM, Ishiguro H, Zhang PW, Lin Z, Akinshola BE, Uhl GR. Endocannabinoids and cannabinoid receptor genetics. Prog Neurobiol. 2002 Apr;66(5):307-44.
6. Uhl GR, Liu QR, Walther D, Hess J, Naiman D. Polysubstance abuse-vulnerability genes: Genome scans for association, using 1,004 subjects and 1,494 single-nucleotide polymorphisms. Am J Hum Genet. 2001 Dec;69(6):1290-300.
7. Uhl GR, Liu QR, Naiman D. Substance abuse vulnerability loci: Converging genome scanning data. Trends Genet. 2002 Aug;18(8):420-5.
8. Pichini S, Altieri I, Zuccaro P, Pacifici R. Drug monitoring in nonconventional biological fluids and matrices. Clin Pharmacokinet. 1996 Mar;30(3):211-28.
9. Henderson GL, Harkey MR, Zhou C, Jones RT, Jacob P,3rd. Incorporation of isotopically labeled cocaine into human hair: Race as a factor. J Anal Toxicol. 1998 Mar-Apr;22(2):156-65.
10. Ciccarone D, Unick GJ, Kraus A. Impact of South American heroin on the U.S heroin market 1993- 2004. Int J Drug Policy. 2009 Feb 5
11. Darke S, Hall W, Weatherburn D, Lind B. Fluctuations in heroin purity and the incidence of fatal heroin overdose. Drug Alcohol Depend. 1999 Apr 1;54(2):155-61.
12. Ruttenber AJ, Luke JL. Heroin-related deaths: New epidemiologic insights. Science. 1984 Oct 5;226(4670):14-20.
13. Giraudon I, Bello PY. Monitoring ecstasy content in France: Results from the national surveillance system 1999-2004. Subst Use Misuse. 2007;42(10):1567-78.
14. Sherlock K, Wolff K, Hay AW, Conner M. Analysis of illicit ecstasy tablets: Implications for clinical management in the accident and emergency department. J Accid Emerg Med. 1999 May;16(3): 194-7.
15. Jenkins AJ, Cone EJ. Pharmacokinetics: Drug absorption, distribution and elimination In: Karch SB, editor. Drug Abuse Handbook. Boca Raton, Florida: CRC Press; 1998; p. 187.
16. Gray T, Huestis MA. Bioanalytical procedures for monitoring in utero drug exposure. Anal Bioanal Chem. 2007 Aug;388(7):1455-65.
17. Huestis MA, Oyler JM, Cone EJ, Wstadik AT, Schoendorfer D, Joseph RE Jr. Sweat testing for cocaine, codeine, and metabolites by gas chromatography-mass spectrometry. J Chromatogr. B Biomed.Sci.Appl. 1999; Oct 733(1-2) 247-64.
18. Chawarski MC, Fiellin DA, O'Connor PG, Bernard M, Schottenfeld RS. Utility of sweat patch testing for drug use monitoring in outpatient treatment for opiate dependence. J Subst Abuse Treat. 2007 Dec;33(4):411-5.
19. Uemura N, Nath RP, Harkey MR, Henderson GL, Mendelson J, Jones RT. Cocaine levels in sweat collection patches vary by location of patch placement and decline over time. J Anal Toxicol. 2004May-Jun;28(4):253-9.
20. Cone EJ, Weddington WW, Jr. Prolonged occurrence of cocaine in human saliva and urine after chronic use. J Anal Toxicol. 1989 Mar- Apr;13(2):65-8.
21. Kato K, Hillsgrove M, Weinhold L, Gorelick DA, Darwin WD, Cone EJ. Cocaine and metabolite excretion in saliva under stimulated and nonstimulated conditions. J Anal Toxicol. 1993 Oct;17(6): 338-41.
22. Thompson LK, Yousefnejad D, Kumor K, Sherer M, Cone EJ. Confirmation of cocaine in human saliva after intravenous use. J Anal Toxicol. 1987 Jan-Feb;11(1):36-8.
23. Speedy T, Baldwin D, Jowett G, Gallina M, Jehanli A. Development and validation of the cozart DDS oral fluid collection device. Forensic Sci Int. 2007 Aug 6;170(2-3):117-20.
24. Verstraete AG. Oral fluid testing for driving under the influence of drugs: History, recent progress and remaining challenges. Forensic Sci Int. 2005 Jun 10;150(2-3):143-50.
25. Drummer OH. Drug testing in oral fluid. Clin Biochem Rev. 2006 Aug;27(3):147-59.
26. Pil K, Verstraete A. Current developments in drug testing in oral fluid. Ther Drug Monit. 2008 Apr;30(2):196-202.
27. Halstead AC, Godolphin W, Lockitch G, Segal S. Timing of specimen collection is crucial in urine screening of drug dependent mothers and newborns. Clin Biochem. 1988 Jan;21(1):59-61.
28. Wolff K, Farrell M, Marsden J, Monteiro MG, Ali R, Welch S, Strang J. A review of biological indicators of illicit drug use, practical considerations and clinical usefulness. Addiction. 1999 Sep;94(9): 1279-98.
29. Fraser AD, Zamecnik J. Substance abuse monitoring by the correctional service of Canada. Ther DrugMonit. 2002 February;24(1):187-91.
30. Pragst F, Balikova MA. State of the art in hair analysis for detection of drug and alcohol abuse. Clin Chim Acta. 2006 Aug;370(1-2):17-49.
31. Henderson GL. Mechanisms of drug incorporation into hair. Forensic Sci Int. 1993 Dec;63(1-3):19- 29.
32. Mieczkowski T. Distinguishing passive contamination from active cocaine consumption: Assessing the occupational exposure of narcotics officers to cocaine. Forensic Sci Int. 1997 Jan 17;84 (1-3) :87-111.
33. Jurado C, Kintz P, Menendez M, Repetto M. Influence of the cosmetic treatment of hair on drug testing. Int J LegalMed. 1997;110(3):159-63.
34. Nakahara Y, Takahashi K, Kikura R. Hair analysis for drugs of abuse. X. effect of physicochemical properties of drugs on the incorporation rates into hair. Biol Pharm Bull. 1995 Sep;18(9):1223-7.
35. Cirimele V, Kintz P, Mangin P. Drug concentrations in human hair after bleaching. J Anal Toxicol. 1995 Sep;19(5):331-2.
36. Skopp G, Potsch L, Moeller MR. On cosmetically treated hair--aspects and pitfalls of interpretation. Forensic Sci Int. 1997 Jan 17;84(1-3):43-52.
37. Gareri J, Klein J, Koren G. Drugs of abuse testing in meconium. Clin Chim Acta. 2006 Apr;366(1- 2):101-11.
38. Ostrea EM Jr., Romero A, Knapp DK, Ostrea AR, Lucena JE, Utarnachitt RB. Postmortem drug analysis of meconium in early-gestation human fetuses exposed to cocaine: Clinical implications. J Pediatr. 1994Mar;124(3):477-9.
39. Moore C, Negrusz A, Lewis D. Determination of drugs of abuse in meconium. J Chromatogr B Biomed Sci Appl. 1998 Aug 21;713(1):137-46.
40. Kacinko SL, Jones HE, Johnson RE, Choo RE, Huestis MA. Correlations of maternal buprenorphine dose, buprenorphine, and metabolite concentrations in meconium with neonatal outcomes. Clin Pharmacol Ther. 2008 Nov;84(5):604-12.
41. Gourley GR, Kreamer B, Arend R. Excremental studies in human neonates. Identification of zinc coproporphyrin as a marker for meconium. Gastroenterology. 1990 Dec;99(6):1705-9.
42. Ostrea EM Jr., Parks PM, Brady MJ. Rapid isolation and detection of drugs in meconium of infants of drug-dependent mothers. Clin Chem. 1988 Nov;34(11):2372-3.
43. Verma A, Dhanireddy R. Time of first stool in extremely low birth weight (< or = 1000 grams) infants. J Pediatr. 1993 Apr;122(4):626-9.
44. Ostrea EM, Jr. Understanding drug testing in the neonate and the role of meconium analysis. J Perinat Neonatal Nurs. 2001 Mar;14(4):61,82; quiz 105-6.
45. Ebrahim SH, Gfroerer J. Pregnancy-related substance use in the United States during 1996- 1998. Obstet Gynecol. 2003 Feb;101(2):374-9.
46. Derauf C, LaGasse LL, Smith LM, Grant P, Shah R, Arria A, Huestis MA, Haning W, Strauss A, Della Grotta S, Liu J, Lester BM. Demographic and psychosocial characteristics of mothers using methamphetamine during pregnancy: Preliminary results of the infant development, environment, and lifestyle study (IDEAL). Am J Drug Alcohol Abuse. 2007;33(2):281-9.
47. Arria AM, Derauf C, Lagasse LL, Grant P, Shah R, Smith L, Haning W, Huestis M, Strauss A, Della Grotta S, Liu J, Lester B. Methamphetamine and other substance use during pregnancy: Preliminary estimates from the infant development, environment, and lifestyle (IDEAL) study. Matern Child Health J. 2006May;10(3):293-302.
48. Forman R, Klein J, Meta D, Barks J, Greenwald M, Koren G. Maternal and neonatal characteristics following exposure to cocaine in Toronto. Reprod Toxicol. 1993 Nov-Dec;7(6):619-22.
49. Gareri J, Lynn H, Handley M, Rao C, Koren G. Prevalence of fetal ethanol exposure in a regional population-based sample by meconium analysis of fatty acid ethyl esters. Ther Drug Monit. 2008 Apr;30(2):239-45.
50. Huestis MA, Choo RE. Drug abuse's smallest victims: In utero drug exposure. Forensic Sci Int. 2002 Aug 14;128(1-2):20-30
51. Addis A, Moretti ME, Ahmed Syed F, Einarson TR, Koren G. Fetal effects of cocaine: An updated meta-analysis. Reprod Toxicol. 2001 Jul- Aug;15(4):341-69.
52. LaGasse LL, Seifer R, Lester BM. Interpreting research on prenatal substance exposure in the context of multiple confounding factors. Clin Perinatol. 1999 Mar;26(1):39,54, vi.
53. Franck L, Vilardi J. Assessment and management of opioid withdrawal in ill neonates. Neonatal Netw. 1995 Mar;14(2):39-48.
54. LevyM, Spino M. Neonatal withdrawal syndrome: Associated drugs and pharmacologic management. Pharmacotherapy. 1993 May-Jun;13(3):202-11.
55. Sharpe TT, Alexander M, Hutcherson J, Floyd RL, Brimacombe M, Levine R, Mengel M, Stuber M. Report from the CDC. Physician and allied health professionals' training and fetal alcohol syndrome. J Womens Health (Larchmt). 2004 Mar;13(2):133- 9.
56. Stade B, Ali A, Bennett D, Campbell D, Johnston M, Lens C, Tran S, Koren G. The burden of prenatal exposure to alcohol: Revised measurement of cost. Can J Clin Pharmacol. 2009 Winter;16(1): e91-102.
57. May PA, Fiorentino D, Gossage JP, Kalberg WO, Hoyme HE, Robinson LK, Coriale G, Jones KL, del Campo M, Tarani L, Romeo M, Kodituwakku PW, Deiana L, Buckley D, Ceccanti M. Epidemiology of FASD in a province in Italy: Prevalence and characteristics of children in a random sample of schools. Alcohol Clin Exp Res. 2006 Sep;30(9):1562-75.
58. Sampson PD, Streissguth AP, Bookstein FL, Little RE, Clarren SK, Dehaene P, Hanson JW, Graham JM, Jr. Incidence of fetal alcohol syndrome and prevalence of alcohol-related neurodevelopmental disorder. Teratology. 1997 Nov;56(5):317-26.
59. Autti-Ramo I, Fagerlund A, Ervalahti N, Loimu L, Korkman M, Hoyme HE. Fetal alcohol spectrum disorders in Finland: Clinical delineation of 77 older children and adolescents. Am J Med Genet A. 2006 Jan 15;140(2):137-43.
60. Hoyme HE, May PA, Kalberg WO, Kodituwakku P, Gossage JP, Trujillo PM, Buckley DG, Miller JH, Aragon AS, Khaole N, Viljoen DL, Jones KL, Robinson LK. A practical clinical approach to diagnosis of fetal alcohol spectrum disorders: Clarification of the 1996 institute of medicine criteria. Pediatrics. 2005 Jan;115(1):39-47.
61. Kartin D, Grant TM, Streissguth AP, Sampson PD, Ernst CC. Three-year developmental outcomes in children with prenatal alcohol and drug exposure. Pediatr Phys Ther. 2002 Fall;14(3):145-53.
62. Sood B, Delaney-Black V, Covington C, Nordstrom-Klee B, Ager J, Templin T, Janisse J, Martier S, Sokol RJ. Prenatal alcohol exposure and childhood behaviour at age 6 to 7 years: I. doseresponse effect. Pediatrics. 2001 Aug;108(2):E34.
63. Streissguth AP, Barr HM, Sampson PD, Bookstein FL. Prenatal alcohol and offspring development: The first fourteen years. Drug Alcohol Depend. 1994 Oct;36(2):89-99.
64. Huestis MA, Cone EJ. Alternative testing matrices In: Karch SB, editor. Drug Abuse Handbook. Boca Raton: CRC Press; 1998; p. 799.
65. Koren G, Hutson J, Gareri J. Novel methods for the detection of drug and alcohol exposure during pregnancy: Implications for maternal and child health. Clin Pharmacol Ther. 2008 Apr;83(4): 631-4.
66. Bailey B, Klein J, Koren G. Noninvasive methods for drug measurement in pediatrics. Pediatr Clin North Am. 1997 Feb;44(1):15-26.
67. Gareri J, Koren G. Prenatal hair development: Implications for drug exposure determination. Forensic Sci Int. 2010 Mar 20;196(1-3):27-31.
68. Vinner E, Vignau J, Thibault D, Codaccioni X, Brassart C, Humbert L, Lhermitte M. Neonatal hair analysis contribution to establishing a gestational drug exposure profile and predicting a withdrawal syndrome. Ther Drug Monit. 2003 Aug;25(4):421-32.
69. Vinner E, Vignau J, Thibault D, Codaccioni X, Brassart C, Humbert L, Lhermitte M. Hair analysis of opiates in mothers and newborns for evaluating opiate exposure during pregnancy. Forensic Sci Int. 2003 Apr 23;133(1-2):57-62.
70. Bar-Oz B, Klein J, Karaskov T, Koren G. Comparison of meconium and neonatal hair analysis for detection of gestational exposure to drugs of abuse. Arch Dis Child Fetal Neonatal Ed. 2003Mar; 88(2):F98-F100.
71. Jansson LM, Choo RE, Harrow C, Velez M, Schroeder JR, Lowe R, Huestis MA. Concentrations of methadone in breast milk and plasma in the immediate perinatal period. J Hum Lact. 2007May; 23(2):184-90.
72. Lozano J, Garcia-Algar O, Vall O, de la Torre R, Scaravelli G, Pichini S. Biological matrices for the evaluation of in utero exposure to drugs of abuse. Ther DrugMonit. 2007 Dec;29(6):711-34.
73. Cairns T, Hill V, Schaffer M, Thistle W. Removing and identifying drug contamination in the analysis of human hair. Forensic Sci Int. 2004 Oct 29;145(2-3):97-108.
74. Smith FP, Kidwell DA, Cook F. Cocaine in children’s hair when they live with drug dependent adults. In: Proceedings of the SOFT Conference on Hair Testing ; 1994 October 29-30, 1994; Tampa, Florida. 1994
75. Garcia-Bournissen F, Nesterenko M, Karaskov T, Koren G. Passive environmental exposure to cocaine in Canadian children. Paediatr Drugs. 2009;11(1):30-2.
76. Heidemann SM, Goetting MG. Passive inhalation of cocaine by infants. Henry Ford Hosp Med J. 1990;38(4):252-4.
77. Kharasch SJ, Glotzer D, Vinci R, Weitzman M, Sargent J. Unsuspected cocaine exposure in young children. Am J Dis Child. 1991 Feb;145(2):204-6.
78. Rosenberg NM, Meert KL, Knazik SR, Yee H, Kauffman RE. Occult cocaine exposure in children. Am J Dis Child. 1991 Dec;145(12):1430- 2.
79. Rosenberg NM, Meert KL, Marino D, Yee H, Kauffman RE. Occult cocaine and opiate exposure in children and associated physical findings. Pediatr Emerg Care. 1995 Jun;11(3):167-9.
80. Bateman DA, Heagarty MC. Passive freebase cocaine ('crack') inhalation by infants and toddlers. Am J Dis Child. 1989 Jan;143(1):25-7.
81. Mirchandani HG, Mirchandani IH, Hellman F, English-Rider R, Rosen S, Laposata EA. Passive inhalation of free-base cocaine ('crack') smoke by infants. Arch Pathol Lab Med. 1991 May;115 (5):494-8.
82. Mott SH, Packer RJ, Soldin SJ. Neurologic manifestations of cocaine exposure in childhood. Pediatrics. 1994 Apr;93(4):557-60.
83. Lewis D, Moore C, Morrissey P, Leikin J. Determination of drug exposure using hair: Application to child protective cases. Forensic Sci Int. 1997 Jan 17;84(1-3):123-8.
84. Lustbader AS, Mayes LC, McGee BA, Jatlow P, Roberts WL. Incidence of passive exposure to crack/cocaine and clinical findings in infants seen in an outpatient service. Pediatrics. 1998 Jul;102(1) :e5.
85. Riordan M, Rylance G, Berry K. Poisoning in children 5: Rare and dangerous poisons. Arch Dis Child. 2002 Nov;87(5):407-10.
86. Bedford Russell AR, Schwartz RH, Dawling S. Accidental ingestion of 'ecstasy' (3,4- methylenedioxymethylamphetamine). Arch Dis Child. 1992 Sep;67(9):1114-5.
87. Chang YJ, Lai MW, Kong MS, Chao HC. Accidental ingestion of ecstasy in a toddler. J FormosMed Assoc. 2005 Dec;104(12):946-7.
88. Cooper AJ, Egleston CV. Accidental ingestion of ecstasy by a toddler: Unusual cause for convulsion in a febrile child. J Accid Emerg Med. 1997 May;14(3):183-4.
89. Garcia-Algar O, Lopez N, Bonet M, Pellegrini M, Marchei E, Pichini S. 3,4- methylenedioxymethamphetamine (MDMA) intoxication in an infant chronically exposed to cocaine. Ther Drug Monit. 2005 Aug;27(4):409- 11.
90. Garland JS, Smith DS, Rice TB, Siker D. Accidental cocaine intoxication in a nine-monthold infant: Presentation and treatment. Pediatr Emerg Care. 1989 Dec;5(4):245-7.
91. Havlik DM, Nolte KB. Fatal "crack" cocaine ingestion in an infant. Am J Forensic Med Pathol. 2000 Sep;21(3):245-8.
92. Taguchi N, Mian M, Shouldice M, Karaskov T, Gareri J, Nulman I, Verjee ZH, Koren G. Chronic cocaine exposure in a toddler revealed by hair test. Clin Pediatr (Phila). 2007 Apr;46(3):272-5.
93. Jurado C, Rodriguez-Vicente C, Menendez M, Repetto M. Time course of cocaine in rabbit hair. Forensic Sci Int. 1997 Jan 17;84(1-3):61-6.
94. Oyler J, Darwin WD, Preston KL, Suess P, Cone EJ. Cocaine disposition in meconium from newborns of cocaine-abusing mothers and urine of adult drug users. J Anal Toxicol. 1996 Oct;20(6): 453-62.
95. Felli M, Martello S, Marsili R, Chiarotti M. Disappearance of cocaine from human hair after abstinence. Forensic Sci Int. 2005 Nov 25;154(2- 3):96-8.
96. Garcia-Bournissen F, Moller M, Nesterenko M, Karaskov T, Koren G. Pharmacokinetics of disappearance of cocaine from hair after discontinuation of drug use. Forensic Sci Int. 2009 Aug 10;189 (1-3):24-7.

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