Evaluation of a rapid oral fluid point-of-care test for MDMA

Cozart Bioscience Limited has developed novel lateral flow technology that allows the detection of drugs of abuse in biological fluids and suspect powders. This paper describes the application of this technology for the detection of 3,4-methylenedioxymethamphetamine (MDMA) in oral fluid. Samples (N = 370) were obtained from the analytical laboratory at Cozart Bioscience Limited following their routine analysis for drugs of abuse. Oral fluid samples were screened for the presence of MDMA and methamphetamine using the Cozart RapiScan System (CRS) and then confirmed for the presence of amphetamines (amphetamine, methamphetamine, MDA, MDMA, MDEA, and MBDB) by gas chromatography-mass spectrometry (GC-MS). In addition to the detection of MDMA and methamphetamine, the CRS cross-reacts with high levels of amphetamine to give a positive result. One hundred and twenty-one samples screened positive using the CRS. Six of these samples were confirmed negative for MDMA and methamphetamine, but contained very high levels of amphetamine. Employing a screening cutoff of 45 ng/mL for the CRS and a confirmation cutoff of 30 ng/mL for GC-MS, the sensitivity, specificity, and accuracy were 96.6, 96.8, and 96.8%, respectively. When applying the Substance Abuse and Mental Health Services Administration recommended confirmation cutoff for amphetamines of 50 ng/mL, the sensitivity, specificity, and accuracy increased marginally to 98.3, 96.9, and 97.3%, respectively.