A Recovery Court Podcast: Drug Testing Strategies

A Recovery Court Podcast: Tennessee Association of Recovery Court Professionals (TARCP)

What are the advantages of adding the PharmChek® Sweat Patch to your drug testing strategies? Listen to Judge Greg Pinski, a retired judge from Montana, discuss how the sweat patch was used in his adult and veterans treatment courts. And hear from Sean Shea as he answers some of the product questions a recovery court professional might have when considering the sweat patch. If you use PharmChek® in your program, are considering it, or just want to be more educated about what's available in drug testing, this conversation is both fun and educational.

Full Transcript:

Marie Crosson (00:15):

Hello, listeners. Welcome to podcast number 11 from the Tennessee Association of Recovery Court Professionals. I am your host, Marie Crosson. This podcast is a resource for recovery courts to provide them with information, inspiration, and illumination on topics of interest to them. You can access all of our episodes on our website as well as Apple, Spotify, Google Podcasts, TuneIn, Alexa, and others. If you have an idea for a podcast, please reach out to me at marie.crosson@tarcp.org. Today, we are talking with Sean Shea, who is with PharmChem and the company that produces, among many other things, the Sweat Patch that our next guest will talk about today. Judge Greg Pinski, a retired district judge from Montana, is going to speak about his experience using the Sweat Patch in his, we call them recovery courts, but in Montana, they call them treatment courts, is what I'm told. Thank you both for being here.

Sean Shea (01:15):

Thank you. It's a pleasure.

Marie Crosson (01:15):

And so before we really get started in the patch, Judge, I wanted to ask you if you would just give us a brief overview of your experience in the field so that we can get an idea of where you come from.

Judge Greg Pinski (01:29):

Well, sure. Absolutely. Thank you, Marie, for having Sean and I here today, and hopefully we're able to provide some useful information for the treatment court professionals in Tennessee and beyond. My background, a retired district judge from Montana. I was a district judge for eight years. During that time, I founded a veteran's treatment court. I also presided over a drug treatment court. In Montana, a district judge is a judge of general jurisdiction. We oversee a wide variety of cases from civil cases to family law matters to felony criminal cases, probate matters, and in my case, two treatment courts, which I found to be the most rewarding, both personally and professionally, part of being a judge. During that time that I was a district judge, I also sat by designation on the Montana Supreme Court. I served on Montana's Drug Treatment Court advisory Committee.

Judge Greg Pinski (02:34):

Over the course of the eight years that I was a judge, my veterans treatment court at one point had about 60 participants in it, my drug court had about 100 participants in it. And during the time that I presided over those courts, I was able to secure over $5 million in public and private grants to expand treatment court programs. I did a lot of work not only with expanding access to veterans treatment courts, but also focusing on ways that the drug treatment courts could better serve the American Indian population in Montana. And so I also had some initiatives as it relates to treatment courts serving that population as well. And as a result of that work, became a consultant, a training consultant to NADCP and Justice for Vets, where I helped train your veterans treatment court in Nashville and also to start a drug treatment court in Harriman, Tennessee. So have some connections to Tennessee in that regard as well. So thank you again for having me here.

Marie Crosson (03:49):

I love it. So some of the folks that are going to hear you on the podcast will know you from the trainings that you've done in Tennessee already.

Judge Greg Pinski (03:58):

Yeah. And like I said, that was the most rewarding aspect of being a judge to me. And since I've left the bench, continuing to be involved in the treatment court community where I'm a frequent speaker, author, trainer. I've helped train drug treatment courts and veterans treatment courts in three dozen states, so it is something that is a personal and professional passion of mine.

Marie Crosson (04:23):

So an obvious expert I would say in the field, and coming from what I think happens to be one of the most beautiful states too, I might add. I love Montana. And before we start talking about specifically what we're here to talk about, which is the Sweat Patch, Sean, thank you for being here. Would you go ahead and give us an overview of what the Sweat Patch is so that while we start talking about it, we have an idea about how it works?

Sean Shea (04:48):

Absolutely. Thank you, Marie, thank you, Judge Pinski, for having me today. I'll give you a brief history of what the Sweat Patch is and what it does. When I talk to people, I find it's an education piece. Most people don't know that it's been around as long as it has. It's from 1992 that it received an FDA market approval as a collection device for drug testing, that it's been around that long. And when I talk to people about the modalities of Sweat Patch and what it does, I explain to them it's we're looking for it insensible sweat. So you get in a quick conversation about what is insensible compared to sensible sweat? Meaning the sweat that you'd see for temperature regulation, versus the insensible, which is the water vapor. Which it's a collection device, and you can't see it here on the podcast, but I can show you [inaudible 00:05:30] out there. You wear it on your skin for as little as 24 hours, up to seven to 10 days.

Marie Crosson (05:34):

Looks like a heavy-duty bandaid.

Sean Shea (05:36):

It's a little bandaid. You put it on there, you take it off. So it simply sits on there. You wear it underneath your clothing on your upper arm, on your upper back so that you're wearing it 24 hours a day. So the difference is you're being continuously monitored through your insensible perspiration. The drugs are simply being trapped in the cellulose pad, where at the end of the wear time, be it 24 hours or seven to 10 days, everything gets sent into the lab for an LCMS confirmation. So anything that comes from the lab is going to be something you can use in court, that's something you can have a discussion with them about. And the nice part is you're capturing both the parent drug and the metabolites of the drug. So you can have that conversation with your participants. If you're using heroin, you would see both 6-MAM and the morphine. It's methamphetamine, you'd see both.

Sean Shea (06:21):

So it's a collection device that allows you to have a modality to free people up. If they're having to travel in long distances in rural areas, getting tested a couple times a week, well, if you're wearing a Sweat Patch, you can simply don't have to do that. You can alleviate that. And there's different ways we can talk about later about what it happens for ways to adulterate it and how simple it is. It's just you don't have to worry about things like water loading and pH levels and things like that, and not being gender specific. You're just putting the patch on, you wear it, and at the end of it you can see it visibly, you can see what they've done to adulterate it. And I know we'll get into a conversation about that, but I always like to tell people from the beginning, it's as simple as looking at it. You don't have to do some diagnostic tests to see if they've done something, and you're not having to do anything with gender specific to put it on or to take it off.

Marie Crosson (07:05):

And if I remember correctly, you just said it needs to be on at least 24 hours, and the outset is 10 days, seven to 10 days.

Sean Shea (07:13):

You should about seven to 10 days, depending on the jurisdiction, because a lot of people want to make an informed decision on this. So if they... The longer you wait, you've got to balance in between when I want to make a decision on what they're doing versus how long should I have them wear it. But it gives you the ability to do two things. If someone needed to leave your jurisdiction on a travel pass, you could have them monitored the time they're there. If you're working with children and families, I want to make sure that whatever adult is interacting with them was drug free the whole time they were there. So you get these abilities. In today's day and age with gas prices in life, I don't have to come in two to three times and you can keep your job, save your money, and not have to come in, but you're being monitored the entire time that you're wearing the patch. So it frees them up to live their lives.

Marie Crosson (07:53):

Excellent. So Judge Pinski, tell us why you chose to use the Sweat Patch.

Judge Greg Pinski (07:59):

Well, at the outset, it was due to the issues related to dilute urine tests. And I know from my trainings that this is an issue that every treatment court professional faces. What do we do about a dilute? What does it mean? When you go to the national conference and you see the overflow from the sessions on dilutes, you know that this is an issue. And it's an issue that, for the most, part is unique to the criminal justice population. I know one time we had a conversation with a physician where a participant was claiming that they had a kidney disorder that was resulting in the dilution of their drug tests. And when I talked to the person's physician, the doctor was completely dumbfounded that someone would intentionally load water into their system to dilute their drug tests.

Judge Greg Pinski (09:02):

That concept was foreign, because in the ordinary medical context, when someone shows up for a lab test, the medical professionals aren't worried that they have drank three liters of water before they showed up. But in the criminal justice context, particularly in the treatment court context, we see that all the time, and especially because you're having folks that are being drug tested, at least from a best practice standpoint, at least twice a week. And so you see it frequently. Dealing with those dilute issues and trying to find a way to address that problem that everyone faces was the catalyst that led me to exploring using the drug patch as an adjunct method of testing.

Marie Crosson (09:48):

That's awesome. And the whole dilute thing, you are not wrong about that. It's talked about at every single conference, I would say. If there's an opportunity for drug court or recovery court professionals to get together and talk about drug screens, dilution of drug screens is one of the things that we're talking about, right?

Judge Greg Pinski (10:07):

I certainly never anticipated, before I became a judge and particular treatment court judge, how much I would know about human urine and the ways in which people adulterate, tamper with their urine in the criminal justice context. And so this is something that is an issue that everyone faces.

Marie Crosson (10:28):

It is pretty amazing for sure.

Judge Greg Pinski (10:30):

That...

Marie Crosson (10:31):

So your initial experience when you started using this Sweat Patch? What was that like? How did the participants handle it? Or how receptive were they?

Judge Greg Pinski (10:41):

Well, it dramatically decreased the problem that we were facing, which was the dilution. Because, of course, on the Sweat Patch it can't be diluted. And, of course, there's means put into the patch to know whether it has been tampered with, so it all but eliminated the issues that we were facing with the dilution of the urine tests. And so from that point forward then, it took off and we used it in our treatment courts, not only to address those issues, but for many other issues too. We used it for participants who were remote. One of our grants was to expand our treatment court populations to rural areas. The patch helped us in that regard. The patch helped us during times that folks were on travel permits and they couldn't UA. It helped us during times, for instance, with our veterans treatment court participants where some of our participants that were on active duty with the National Guard and they weren't able to test, they could have the patch on there. There was a variety of areas where beyond that initial use for dilution purposes, it really expanded into and helped us with our program.

Marie Crosson (12:01):

That makes sense to me. It seems like it would take fewer resources. Like if you were at a period of time in your program that, I don't know, maybe your truck screener is going on vacation. I don't even know, but that was one of my first thoughts is it can help you sort of get through those kinds of things if you have less capacity during periods of time too.

Judge Greg Pinski (12:24):

That's a good point, Marie, because that actually happened in my court. We used a private vendor for urinalysis testing, and they had one of the female observers leave. And as many businesses have faced in terms of hiring workers, for that particular job, that can be a challenging job to hire for. So there was a period of time where a vendor didn't have a female observer to observe the urine tests. And so we used the Sweat Patch during that time as well. So in terms of having a tool in your tool belt, it really isn't an invaluable adjunct to your standard urinalysis testing.

Marie Crosson (13:06):

Makes sense. So what about the benefits to your participants and to your program?

Judge Greg Pinski (13:11):

A lot of benefits. The participants, of course, found the patch much less invasive in a variety of ways. Less invasive in terms of time. During the points in time where they used the drug patch, they were on a travel permit, they didn't have to show up two or three times a week to do their urinalysis testing. It was much less invasive from a privacy standpoint. Virtually in every respect, the patch was well received by the participants in the treatment court.

Marie Crosson (13:46):

I would imagine, since we are talking about treatment court, that you had, at least at the beginning, some folks trying to figure out how to circumvent the system. And you've mentioned some tech about it, some tech that lets you know that they're tamper-proof or whatever, if they've been tampered with. Sean, can you speak to that?

Sean Shea (14:05):

I'll talk about that for a second. Basically, what we say about the Sweat Patch is everything is tamper-evident, that you can see what they do. The only thing they could do to is something visually, something you're physically going to do to the patch. And part of our process for both certification for that is to be able to go through the training and then we do follow-ups so they know what to look for with this, so when you're trained and ready to go on board, you're an expert and you're comfortable to have those discussions and you don't have to worry about data from an outside source. And again, it can lead to further conversations with your donor. Why did you make this decision? What happened here? So it's very much going to be something you can see.

Marie Crosson (14:40):

I guess that makes some sense. Is it possible to accidentally tamper with your Sweat Patch?

Sean Shea (14:47):

Like Judge Pinski said, [inaudible 00:14:50] more years, but everything accidental I guess would depend on what they're doing. If you have [inaudible 00:14:57] that I hit the end of a building and it ripped it off. So say something on the outside edge [inaudible 00:15:01]. But usually, when you wear it, it's under the arm, it's under clothing, it's something protected. It's not going to accident... It's not going to fall off. But it's usually going to have something, I'm going to have to rub it or take it off. You can perform your normal duties of the day, you can take showers, you can go swimming. It's not going to interrupt your life.

Marie Crosson (15:17):

So we didn't talk about this question, but I assume that there would be some sort of rules or regulations that would be specific too. Like you might say during the summer, do not go play volleyball with your shirt off. Leave your shirt on dudes, right? That kind of thing? Or keep it protected so that there aren't those kind of accidents. Have you implemented or did you implement rules around the Sweat Patch that were specific for that screening type?

Judge Greg Pinski (15:46):

Yes. And just like urinalysis testing, I mean many of the things that the participants are required to do are proximal expectations. So if we're talking about urinalysis testing, we have proximal expectations that our participants are going to show up, that they're going to provide a urine specimen, that the urine specimen is not going to be adulterated or tampered with. And that's the start of it, right? And it's the same issues as it relates to proximal expectations that exist with the patch. You're going to show up, you're going to have it put on your responsible for making sure that that patch stays on your arm.

Judge Greg Pinski (16:29):

I had participants who worked construction jobs during the summer, and they were able to maintain that patch. Now, it might need to be replaced more frequently than someone who has a more sedentary lifestyle. But be that as it may, when it is time to get it replaced, you're going to show up, you're not going to be injecting things into it, or you're not going to be picking at it or things like that. So in terms of what our expectations are, it goes back to the very basics of treatment court 101, which is proximal and distal expectations. Then in this sense, they're all proximal.

Marie Crosson (17:11):

I love that you added that proximal piece in there, Judge. That's great.

Judge Greg Pinski (17:16):

In the treatment court world, that's the basis of everything that we do. And if you're going to modify human behavior, you have to have an understanding of what those two concepts mean in that respect.

Marie Crosson (17:28):

Yeah, and around conversations about what those expectations are. Absolutely. So from a judge's perspective, what do you think people should know or need to know about the Sweat Patch and its use, its benefits, its downsides, whatever? What do people need to know?

Judge Greg Pinski (17:48):

Well, first, I think that there is an absolute ease of use that is associated with this. In my treatment courts, when we used the patch with participants, our coordinators were the ones who were doing the installation and collection and chain of custody as it relates to those Sweat Patches. So it doesn't require a toxicology degree. You don't have to have a lab tech certificate. Doesn't require any of those things. They went through the training that PharmChem provides which teaches them all about the proper ways to install the patch, collect the patch, complete all the chain of custody forms, send it into the lab for processing, obtain the lab reports. And so it was very simple. There was not a huge learning curve that was associated with it, so ease of use was at the forefront, right? I mean every treatment cord coordinator is stretched beyond their limits, and so to add another duty to their jobs is very difficult to do. And so I think I want everybody to know that this is not a burdensome task for someone to be able to use.

Judge Greg Pinski (19:03):

Beyond ease of use I talked about some of the benefits to participants in terms of their ability to be able to do more things. And we talked about proximal and distal goals, and along with that are incentives and sanctions that go with treatment court. And we know that that's at the heart of behavior modifications. So they're doing things like giving your participants travel permits that they've earned, that's a reward. The ability to not have to show up to do a UA while they're on that travel permit, that's a reward. Same thing as it relates to phase advancement. We know that the NADCP best practice standards say that if you have a five-phase program, you can reduce your random drug testing from what's recommended to be twice a week, to a truly random basis. And the Sweat Patch can fit into that, because again, it's an incentive for the individuals that have reached that part of the program. So the benefits were wide ranging on what we recognized with regard to this technology.

Marie Crosson (20:11):

I think those are definitely things to consider when you are adding it to a urine screen protocol. Ease of use, you don't have to have specialized staff really. Mm-hmm. And you can use it to incentivize or even sanction your participants, which is a foundational concept also in our recovery courts.

Judge Greg Pinski (20:36):

One of the other benefits, Marie, is any form of drug testing, of course, goes hand in hand with treatment and with the recovery process. I mean, it's the one way that you truly know whether the treatment is having the outcome, meaning a recovery environment, that you're trying to achieve. And so having the ability to put someone on a Sweat Patch, even unannounced as another tool... Because the cutoff levels between different testing methodologies are different. So you could certainly have a drug that goes undetected on a urinalysis test, and suddenly you randomly put a participant on a Sweat Patch and the cutoff level is lower, and so you detect a drug use that you otherwise wouldn't detect. And when you're talking about treatment and you're talking about behavior modification, having that ability to be flexible in terms of what you're doing to detect potential use by participants is important.

Marie Crosson (21:46):

Well, and one of the things that you said that struck me too is about how you can use it for passes, right? Having a pass away is one of those potential use opportunities, right? But to have the patch is not only a deterrent, but it's also a tool for the participant. Because the participant, if they're still in that place where they need that, they can say, look, I am drug screened here. I cannot go do this with you. That can be a really valuable tool for the participant as much as a deterrent. I love that idea. About the patch coming off, so what happens, Sean, when the patch comes off? What happens to that patch?

Sean Shea (22:32):

I'll answer this, and Judge Pinski probably has some real-life situations in this court with his participants. But if the patch comes off for some instance, what we talk about protocols is you cannot add to or takeaway from the Sweat Patch. Anything that you're doing that is inherently changing the [inaudible 00:22:46]. So if something comes off that participant would come in and explain to them if something happened and have that discussion with them and they put on a new patch, depending on what they're doing out there and what the situation is like. Everybody's empowered to have that discussion with the person to really learn was this something accidental, is this something that they did on purpose? Really what was the situation, to understand it and then go from there. Because you never just want to look at the hammer on anything, but you want to understand what's going off.

Sean Shea (23:10):

And most people can answer and tell you it's not going to fall off, so that's the first thing we kind of level set with people. When someone's new to the program, they're like, oh, it fell off. And then they had two other people like no, they weren't falling off. These were all fine. But the first person tried that. It's something that people use in the beginning when it's new to try to get over on someone until they're trained. But then the veterans there will tell you what works and what doesn't work. So I always answer that saying, have a meaningful conversation with the donor to see what truly happened in there. And if it came off, put on a new one and go from there.

Judge Greg Pinski (23:42):

The main, I guess, issue or participant defense or explanation that they give for a positive patch is that it was environmental exposure. We've all heard endless streams of excuses for why someone tests positive, and Google oftentimes becomes a treatment court participant's best friend in terms of developing theories, if you will, for why they have tested positive. And in the drug patch world, that seems to focus on environmental exposure. And so I had that very situation occur in my treatment court where we had a participant who was on the patch, had a host of other behavioral issues along with it, repeatedly tested positive on the patch for methamphetamine, and said, look, it was from my home, it was from someone else smoking methamphetamine, it was left over on my bedsheets, I mean a whole host of issues. And it finally got to the point where the participant was facing termination.

Judge Greg Pinski (24:56):

We held an evidentiary hearing related to her termination. During that process, an expert witness testified about this issue related to the Sweat Patch and environmental contamination. And literally you could, according to the testimony that was presented, you could take one of the patches and douse it in methamphetamine, and you would have that patch come back positive for methamphetamine, no doubt. But here's the key. With regard to this particular participant, when methamphetamine metabolizes in your body, it excretes amphetamine metabolites along with it. So if it was truly an environmental exposure, you would not have seen an amphetamine positive along with it on the test. And every single one of this participant's lab reports came back positive for both methamphetamine and amphetamine, completely debunking the excuse that this was environmental contamination. So-

Marie Crosson (26:05):

Oops.

Judge Greg Pinski (26:06):

Yeah. And those are the types of things, right, that participants don't necessarily get from Google. So the reliability factor, knowing that you can debunk myths like that is important for a judge. And then in that particular case, we were able to do it fairly easily.

Marie Crosson (26:25):

And how are results read after the 24 hours to 10 days? When the patch is removed, how are the results actually read?

Judge Greg Pinski (26:37):

Well, the report that comes back is much like a urinalysis report. It has a cutoff level, has a detection level, and it indicates whether the metabolites were detected or not detected.

Marie Crosson (26:49):

Okay.

Judge Greg Pinski (26:50):

And so the reports that you get back, other than the difference in those cutoff levels, it's going to read very much like a urinalysis-

Marie Crosson (26:58):

Like others.

Judge Greg Pinski (26:59):

Yeah, UA.

Marie Crosson (27:00):

So you're taking that patch and you're putting it in a bag or something and putting it in the mail or somebody's-

Sean Shea (27:05):

And chain of custody as you would do for the urine or any other test. You take that, send it to the lab, it's broken down. They have the first test in there, they're running to see if it's positive for the classic drugs. Then it goes, as the gold standard, the LCMS tandem. Everything [inaudible 00:27:19] by LCMS standard, liquid chromatography mass spec. There's your answer. So once you've got that, I always like to say it's like a genetic fingerprint, because people can picture that better. But it's this and nothing else. It's not any other drug. This is what it's positive for. And then we give you the levels.

Judge Greg Pinski (27:33):

You know what Sean just said is important because oftentimes when drug court participants have urinalysis testing, it's a screening test, right? And so then if the screening test is positive and the participant denies use, needs to be sent out for confirmation. Here, it's a confirmed test that you get back as it relates to the patch result.

Marie Crosson (27:58):

Makes sense. We probably don't have any more time, but, Sean, is there something specific that you want to make sure you say as part of the podcast?

Sean Shea (28:07):

The one thing I'd like to let people know as I talk to everybody, and Judge Pinski has actually mentioned this a couple times, it's a tool for your tool belt. This is meant to help address the gaps in your testing so that it's not an end all for everything. Nothing is. Every test has a certain focus that you should use it for it. My job is to help people identify where this could be helpful. So I guess I would most be thinking about your program, where this could have benefit, and that's where you'd look at it. So that's the one snippet I'd want people to know, is picture where you could see this helping you and your donors.

Marie Crosson (28:36):

Yeah, that makes sense to me. So with that, thank you, Judge, and thank you, Sean for speaking with us today. The views and opinions of the hosts and guests on this show are their own and do not represent TARCP. If you haven't already, connect with us on social media, on our Facebook page, on Twitter @tadcptn.org, on Instagram, or check out our website www.tarcp.org. And to the recovery court folks listening and that includes all those community partners like Sean at PharmChem, remember recovery court's work because of you. So until next time.