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Employers and Toxicology

Abstracts

Ruth E. Winecker, Edward J. Cone, David J. Kuntz, Brian Dorsey, Martin Jacques, Melanie Senter, Ronald R. Flege4, and Eugene D. Hayes. Prevalence of Cannabidiol and Tetrahydrocannabinol in Non-Regulated Workplace Drug Testing Urine Specimens.  Submitted to SOFT Annual Meeting, San Diego, CA.

Edward J. Cone, Tory R. Spindle, George E. Bigelow, Ruth E. Winecker, John M. Mitchell, David Kuntz, Ronald R. Flegel and Ryan Vandrey.  Cannabidiol (CBD) Does Not Covert to Delta-9-Tetrahydrocannabinol (Delta-9-THC) in the Body But the THC-Contaminated CBD May Produce Positive Marijuana Drug Tests. Submitted to SOFT Annual Meeting, San Diego, CA.

Martin Jacques and David J. Kuntz. Identification and Separation of Opioid Metabolites in Urine by LC-MS/MS. SOFT Annual Meeting, Minneapolis, MN. October 7, 2018.

Michael J. Herrera, David J. Kuntz, and Martin E. Jacques. Determination of an Alternate Source of Methcathinone in a Patient Sample. SOFT Annual Meeting, Atlanta, GA. October 21, 2015.

Michael Herrera and David Kuntz. Novel Conversion of an Extraction Method to Dilute and Shoot Procedure for the Quantitation of 16 Benzodiazepines in Human Urine Using UPLC/MS/MS. SOFT Annual Meeting, Orlando, FL October 30, 2013.

Michael Herrera and David J. Kuntz.  Quantitative Chiral Determination of the d– and l-Enantiomers of Amphetamine & Methamphetamine in Oral Fluid using HPLC/MS/MS. SOFT Annual Meeting, Boston, MA July 4, 2012.

Kuntz, M. Meixner, and M.J. Coffing. Performance Evaluation of DAT Oral Fluid Barbiturate Assay on Roche Hitachi. AACC Annual Meeting, Atlanta, GA July 24-28, 2011.

MJ Coffing, D. Kuntz, M. Meixner, K. Armstrong, B. Masters. Performance Evaluation of DAT Oral Fluid Amphetamine, Methamphetamine, Opiates, and PCP.  SOFT Annual Meeting, Richmond, VA October 2010.

D. Kuntz, M. Meixner, K. Armstrong, and MJ Coffing. Performance Evaluation of DAT Amphetamine, Methamphetamine, and Opiates Assays on Roche Hitachi. AACC Annual Meeting, Anaheim, CA , July 2010.

A. Gantverg, D. Kuntz, M. Feldman, and L. Wang. Ethylglucuronide and Ethyl Sulfate as Markers of Ethanol Consumption. S.O.F.T. Meeting, Austin, TX, October 3-7, 2006.

Newsletters

David J. Kuntz. “Pure CBD and CBD plus THC Metabolism Study.”  MROALERT Vol XXXI, No 5 June 2020, Pages 1-2.

David J. Kuntz. “Fentanyl in the Workplace.”  What’s the Buzz. May 2020, Pages 8-9.

David J. Kuntz. Synthetic Cannabinoid Use in the Workplace. Drug Testing 2011-2015: Use Patterns and Prevalence. DATIA Focus. Spring 2016: pages 28-33.

David J. Kuntz. “Synthetic Cannabinoids are Constantly Evolving.” Drug Screen Compliance Newsletter. May 2015.

David J. Kuntz. “Synthetic Cannabinoids in the Workplace: Analysis of Three Years of Data.” DATIA Focus. Spring 2015: pages 58-62.

David J. Kuntz. “Synthetic Cannabinoids Continues to be Abused.” Drug Screening Compliance Blog. August 2014.

David J. Kuntz. “Testing for Alcohol Abuse in the Non-Regulated Workplace—Old and New Tests.” DATIA Focus. Summer 2014: pages 44-45.

David J. Kuntz. “Detecting Synthetic Urine – Team Approach Required.” DATIA Focus. Winter 2014: pages 36-41.

David J. Kuntz. “Emerging Alcohol Biomarkers.” Clinical & Forensic Toxicology News. September 2013.

David J. Kuntz. “Synthetic Cannabinoids Prevalence in the Workplace: A Twelve-Month Evaluation by Clinical Reference Laboratory.” DATIA Focus. Winter 2013: pages 18-22.

Book Chapters

Advanced Analytical Techniques for the Confirmation of Drugs. Medical Review Officer Handbook. 10th Edition 2014. Published by AAMRO.

Confirmation: Traditional and Newer Analytical TechniquesCo-Author. Handbook of Workplace Drug Testing. Second Edition, 2008.  AACC Press.

We are active members within the workplace drug testing community through training, discussions, and other programs in effort to advance our industry. Please contact us for additional information and resources.

SCIENTIFIC AND SCHOLARLY PUBLICATIONS

Sholler, D.J., Spindle, T.R., Cone, E.J., Goffi, E., Kuntz, D., Mitchell, J.M., Winecker, R.E., Bigelow, G.E., Flegel, R.R., and Vandrey, R. (2021) Urinary Pharmacokinetic Profile of Cannabidiol (CBD), Δ9-Tetrahydrocannabinol (THC), and their Metabolites Following Oral and Vaporized CBD and Vaporized CBD-Dominant Cannabis Administration, Journal of Analytical Toxicology.

Tory R. Spindle, Edward J. Cone, David Kuntz, John M. Mitchell, George E. Bigelow, Ronald Flegal, and Ryan Vandrey.  Urinary Pharmacokinetic Profile of Cannabinoids Following Administration of Vaporized and Oral Cannabidiol and Vaporized CDB-Dominant Cannabis. J.Anal. Toxicol. 2020;109-125.

A.K. Chaturvedi, J.L. Sershon, K.J. Craft, P.S. Cardona, J.W. Soper, D.V. Canfield, K.M. Dubowski, J.E. Whinnery, M.J. Leyva, C.E. Aston, S.M. Blevins, J.E. Wright, A.D. Fraser and D.J. Kuntz (2013) Effects of Fluid Load on Human Urine Characteristics Related to Workplace Drug Testing. J. Anal. Toxicol. 37:5-10.

David Day, David J. Kuntz, Michael Feldman, and Lance Presley. Detection of THCA in Oral Fluid by GC-MS-MS. J. Anal. Toxicol. 30:645-650, 2006.

Moore C, Feldman M, Harrison E, Rana S, Coulter C, Kuntz D, Agrawal A, Vincent M, Soares J. Disposition of Hydrocodone in Hair. J. Anal. Toxicol. 30:353-359, 2006.

Kielman, MF, Rindapaa, M, Gaspar, C, van Poppel, N, Breukel, C, van Leeuwen, S, Taketo, MM, Roberts, S, Smits, R, Fodde, R. (2002 ) Apc modulates embryonic stem-cell differentiation by controlling the dosage of beta-catenin signaling, 32(4):594-605. Nature Genetics. Download PDF

Stout, RL (1998) Hepatitis C Prevalence and the significance of liver enzymes elevations in the insurance population,Vol. 30, No. 1 J Insurance Medicine.

Oda, RP, Prasad, R, Stout, RL, Coffin, D, Patton, WP, Kraft, DL, O’Brien, JE, Landers, JP (1997) Capillary electrophoresis-based separation of transferrin sialoforms in patients with carbohydrate-deficient glycoprotein syndrome, 18, 1819-1826, Electrophoresis.

Prasad, R, Stout, RL, Coffin, D, Smith, JO (1997) Analysis of carbohydrate deficient transferrin by capillary zone electrophoresis, 18, 1814-1818, Electrophoresis.

Prasad, RP, Stout, RL, Smith, JO (1993) Carbohydrate Deficient Transferrin, Vol. 25, No. 4, J. Insurance Medicine.

Thurman, EM, Pedersen, MJ, Stout, RL, Martin T (1991) Distinguishing Sympathomimetic Amines from Amphetamine and Methamphetamine in Urine by Gas Chromatography/Mass Spectrometry, J. Analytical Toxicology.

Stout, Robert L. (1990) Update-Urine HIV Statistics, Vol. 22, No. 4, J. Insurance Medicine.1980 – High Density Lipoproteins as a tool in Risk Evaluation of Coronary Heart Disease. Transactions of the Association of Insurance Medical Directors of America, Vol 64, pgs. 238-245.

Stout, Robert L. (1989) Laboratory Analysis of Cocaine, Vol. 21, No. 3, J. Insurance Medicine.

Stout, Robert L. (1989) Antibodies to HIV in Urine, Vol 21, No. 3, J. Insurance Medicine.

Insurers

INSURANCE TESTING AND RISK ASSESSMENT PUBLICATIONS

CRL researchers are always at the forefront of technology and scientific advancements for insurance testing and risk assessment. A comprehensive list of research articles are listed below by topic.

CRL Researchers: Robert L. Stout, PhD; Michael Fulks, MD; Vera F. Dolan, MSPH; Mark E. Magee, MS MBA; Luis Suarez, MLT

ALBUMIN

Urine Protein and Urine Albumin

Low Cholesterol & Low Albumin Levels
On The Risk – Journal of the Academy of Life Underwriting. 2015; 31(4):65-69

Albumin and All-Cause Mortality Risk in Insurance Applicants
J. Insurance Medicine. 2010;42:11-17

BILIRUBIN

Mortality Associated with Bilirubin Levels in Insurance Applicants
J. Insurance Medicine. 2008;41:49-53

BLOOD PRESSURE

Changing the “Normal Range” for Blood Pressure from 140/90 to 130/Any Improves Risk Assessment
J. Insurance Medicine. 2015;45:28-33

2014 CRL Blood Pressure Study of Life Insurance Applicants
J. Insurance Medicine. 2015;45:17-27

BUILD

2014 CRL Build Study of Life Insurance Applicants
J. Insurance Medicine. 2016;46:13-19

CDT

CDT and Serum Alcohol: What Is the Risk?
On The Risk – Journal of the Academy of Life Underwriting. 2011;27(1):45-48

CEA

Association of Carcinoembryonic Antigen with Mortality in an Insurance Applicant Population
J. Insurance Medicine. 2019;48(1):24-35

Underwriting Implications of Elevated Carcinoembryonic Antigen
On The Risk – Journal of the Academy of Life Underwriting. 2009;25(3):42-9

Increased Mortality Associated with Elevated Carcinoembryonic Antigen in Insurance Applicants
J. Insurance Medicine. 2007;39:251-8

COCAINE

Mortality Associated with Positive Cocaine Test Results
On The Risk – Journal of the Academy of Life Underwriting. 2010;26(1):46-52

COTININE

Improvements in Cotinine Testing of Insurance Applicants
On The Risk – Journal of the Academy of Life Underwriting. 2006;22(2):58-61

CREATININE

Adjusting Measured Creatinine for Low Serum Glucose to Improve Mortality Prediction
On The Risk – Journal of the Academy of Life Underwriting. 2015; 31(3):66-70

Beware that Low Urine Creatinine!
On The Risk – Journal of the Academy of Life Underwriting.
 2014;30(1):48-53

EGFR

Which eGFR Calculation Offers the Best Mortality Prediction for Insurance?
On The Risk – Journal of the Academy of Life Underwriting.
 2015; 31(2):58-61

GLUCOSURIA

Glucosuria as a Mortality Risk Predictor When Blood Is Not Collected
On The Risk – Journal of the Academy of Life Underwriting. 2010;26(2):46-51

HBA1C

Hemoglobin A1c and Mortality in Insurance Applicants: A 5-Year Follow-Up Study
On The Risk – Journal of the Academy of Life Underwriting. 2009;25(1):42-9

Relationship of Hemoglobin A1c to Mortality in Nonsmoking Insurance Applicants
J. Insurance Medicine. 2007;39:174-81

Using Urine Protein Creatinine Ratio Alone or Reflexing to Urine Albumin in the Applicant with HbA1c Elevation
On the Risk – Journal of the Academy of Life Underwriting. 2015; 31(1):62-54

HEMATURIA

Isolated Hematuria as a Mortality Risk Predictor
On The Risk – Journal of the Academy of Life Underwriting. 2011;27(4):30-5

HEMOGLOBIN

Hemoglobin Screening Independently Predicts All-Cause Mortality
J. Insurance Medicine 2015; 45:75-80

HEPATITIS C & B RESULTS

Mortality Associated with Positive Hepatitis C and B Results
On The Risk – Journal of the Academy of Life Underwriting. 2010;26(3):68-71

HIV

Trends in Mortality of Insurance Applicants with HIV Infection
J. Insurance Medicine. 2012;43:67-75

LIPIDS

Letter to the Editor: Modeling Total Cholesterol as Predictor of Mortality – The Low-Cholesterol Paradox
J. Insurance Medicine. 2012;43(1):50

Association of Cholesterol, LDL, HDL, Cholesterol/HDL and Triglyceride with All-Cause Mortality in Life Insurance Applicants
J. Insurance Medicine. 2009;41:244-25

LIVER ENZYMES

Using Liver Enzymes as Screening Tests to Predict Mortality Risk
J. Insurance Medicine. 2008;40:191-203

MARIJUANA

Mortality Associated with Testing Positive for Marijuana at an Insurance Examination
On The Risk – Journal of the Academy of Life Underwriting. 2020;36:60-64

Mortality Associated with Testing Positive for Marijuana at an Insurance Examination
On The Risk – Journal of the Academy of Life Underwriting. 2016;32(3):67-69

NT-PROBNP

NT-proBNP as a Predictor of All-Cause Mortality in a Population of Insurance Applicants
J. Insurance Medicine. 2014;44:7-16.

Using NT-proBNP to Improve Risk Assessment for Applicants with Heart Disease
On The Risk – Journal of the Academy of Life Underwriting. 2017;33(2):75-77

NT-proBNP Predicts All-Cause Mortality in a Population of Insurance Applicants, Follow-up Analysis and Further Observations
J. Insurance Medicine. 2017;47:107-113.

P/C RATIO

Evaluating the Risk of Renal Disease Using Urine Proteinuria or Urine Albuminuria in the Applicant with HbA1c Elevation
On the Risk – Journal of the Academy of Life Underwriting. 2014;30(4):55-59

Urine Protein/Creatinine Ratio as a Mortality Risk Predictor in Non-Diabetics with Normal Renal Function
J. Insurance Medicine. 2012;43:76-83

PHYSICAL ACTIVITY

Activity Level as a Mortality Predictor in a Population Sample after Typical Underwriting Exclusions and Laboratory Scoring
J. Insurance Medicine. 2020;48:124-135

Physical Activity and Laboratory Assessment
On The Risk – Journal of the Academy of Life Underwriting. 2020;2020;36:22-26

PSA

PSA: What Values Predict Increased Mortality Risk?
On The Risk – Journal of the Academy of Life Underwriting. 2012;28(2):32-7

SARS-COV-2

Comparison of SARS-CoV-2 viral load in saliva samples in symptomatic and asymptomatic cases
medRxiv.2021.02.12.21251229

Seroprevalence of SARS-CoV-2 Antibodies in the US Adult Asymptomatic Population as of September 30, 2020
JAMA. 2021;4(3):e211552.doi:10.1001/jama.2020.1382

SARS-CoV-2 Antibody Prevalence and Association with Routine Laboratory Values in a Life Insurance Applicant Population 
medRxiv. 2020.09.09.20191296

SERUM GLOBULIN

Serum Globulin Predicts All-Cause Mortality for Life Insurance Applicants
J. Insurance Medicine 2014;44:93-98

SMART SCORE

Scoring Life Insurance Applicants’ Laboratory Results, Blood Pressure and Build to Predict All-Cause Mortality Risk
J. Insurance Medicine. 2012;L43:169-177

TOBACCO

Non-Cigarette Tobacco Use – What Is the Risk?
On The Risk – Journal of the Academy of Life Underwriting. 2009;25(2):56-9