Drug Abuse Lecrure

8/3/2019 Drug Abuse Lecrure

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ABUSED DRUGS

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RA 9165

Government forensic lab or lab accredited andmonitored by DOH

Screening and Confirmatory (Servicecapability)

Mandatory or Random (Clientele)

Valid for ONE year from date of issue

POSITIVE screening lab test must beconfirmed for it to be valid.


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Drivers license

Firearms license

Permit to carry firearms outside of

residence Officers and members of the military,

police and other law enforcementagencies

All persons who by nature of theirprofession carry firearms


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Persons charged of imprisonment of not

less than 6 years and 1 day

Any person arrested for violating RA 9165 Screened test within 24 hours

Confirmed within 15 days

Candidates for public office


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High School and College students

Officers and employees of public andprivate offices


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Examples:

Amphetamine sulfate, dextroamphetamine (Dexedrine),methamphetamine (Desoxyn, Methedrine).Metamphetamine: also known as Speed, Ice, Chalk, Meth,Crystal, Crank, Fire, Shabu, Poor Mans Cocaine

Medical uses:

Attention deficit disorder (hyperactivity) of childhood,narcolepsy, obesity (occasionally and for limited period)

Effects attractive to abuser:Euphoria, increased ability to concentrate, increasedalertness, heightened ability to perform intellectual andphysical tasks, appetite suppression (for weight loss).


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Ecstasy (methylenedioxymethapetamine-MDMA): also known as E, X, XTC, Adam,Clarity, Lovers Speed.The drug comes in different tablet forms andstyles to avoid recognition by authorities.

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Adverse effects: Insomnia, restlessness,irritability, palpitations, rapid heartbeat,

sweating, dilation of pupils, confusion,psychosis, convulsions, death. How abused: Pills taken orally; solution

injected intravenously; occasionally

snorted into the nose in granular form. Typical urine detection cutoff level: 300

ng/mL Period detectable after last dose: Up to

30 hours on low dose, 120 hours on highdose.


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Rush ( 20 40 minutes)

High ( 3 days )

Binge

Crash

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Discuss the implications of this experiment:Low dose ecstasy was given to an isolated rat.There was no visible effect on the rat but theanimals brain biopsy revealed minimaldamage. But when the same dose was givento 20 rats confined together in a cage, all ratsdied and brain biopsy revealed severedamage.

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Before After

The following poem was written by a young girl who was in jail for drugcharges, and was addicted to crystal meth (TIC). She wrote this

while in jail. As you will soon read, she fully grasped the horrors ofthe drug, as she tells in this simple, yet profound poem. She was

released from jail, but true to her story, the drug owned her.

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(on initial drug screen only): decongestants (ephedrine [Vatronol, Efedron],

phenylpropanolamine [Propagest, Sucrets DecongestantFormula, Rhindecon]);

"diet pills" (phenmetrazine [Preludin], phentermine [Phentrol,

Tora, Fastin, Obe-Nix, Obephen, Obermine, Obestin,Parmine, Phentamine, Phentrol 2, Unifast, Wilpowr, Adipex-P,Dapex-37.5, Ionamin, Phentrol], phenylpropanolamine[Diadax, Prolamine, Control, Dex-A-Diet, Dexatrim-15,Unitrol, Maximum Strength Acutrim, Appedrine];

blood vessel dilators (isoxuprine [Vasodilan], nylidrin [Adrin,

Arlidin]). Only confirmatory testing of the urine will determine if these

interfering drugs are present. It should be noted that someof these drugs, such as phenmetrazine and phentermine,while not technically amphetamines, have similar abusepotential and similar adverse effects.


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Phenylethylamine (a product of decomposing,unpreserved urine) may produce false-positive screens in unrefrigerated, oldspecimens which have not been treated withfluoride preservative.


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Examples:Long actingphenobarbital;intermediate-acting- amobarbital (Amytal),butabarbital, talbutal; short-acting-

secobarbital (Seconal), pentobarbital(Nembutal). Medical uses: Treatment of insomnia (short

term only, and avoided altogether by mostphysicians), long-term treatment of epilepsy

(phenobarbital), surgical anesthesia. Effects attractive to abuser: Sedation, loss of

inhibitions, induction of sleep. Generally, theshort-acting barbiturates have more abusepotential than long-acting types.


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Adverse effects: Agitation, confusion,nightmares, hallucinations, lethargy, hangover,

suppression of breathing reflexes, coma, death.Physical dependence is well known, andwithdrawal effects can be severe and dangerous,even fatal.

How abused: Pills taken orally; solution injectedintravenously.

Typical urine detection cutoff level: 300 ng/mL


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Period detectable after last dose: long-acting

7 days, intermediate-acting 2-3 days; short-acting 1-2 days.

Substances causing false positive results:None reported.


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Examples: Roxane, Dolophine Medical uses: Treatment of opiate addicts in

approved program

Effects attractive to abuser: Same as opiates(below)

Adverse effects: Same as opiates (below) but withlesser degree of physical dependency (addiction)

How abused: Pills taken orally; solution injected

intravenously.


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Period detectable after last dose: 7.5-56hours

Substances causing false positive results:doxylamine [Unisom Nighttime Sleep Aid].Presence of this substance would be ruled outby confirmatory testing.


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Examples: Morphine,heroin, codeine(as found in manyprescription coughmedicines, such as

Robitussin-AC, and pain medications, suchas Tylenol #3, Phenaphen #3 & #4, Empirin#3 & #4), oxycodone (Percodan),hydromorphone (Dilaudid), hydrocodone (asin many prescription cough medicines).

Medical uses: Relief of moderate to severepain, treatment of persistent cough(codeine), treatment of diarrhea.


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Effects attractive to abuser: Euphoria,sedation.


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Adverse effects: Drowsiness, apathy,confusion, nausea, vomiting, suppression ofbreathing reflexes, constricted pupils,

physical addiction, coma, death. How abused: Pills taken orally; solution

injected intravenously or subcutaneously;occasionally snorted into the nose in granularform.

Typical urine detection cutoff level: 300ng/mL Period detectable after

last dose: heroin,1-4 days; meperidine,

4-24 hours; morphine,84 hour minimum


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Notes: This family of drugs undergoesextensive chemical changes due to thenormal detoxification processes of the body.Therefore, the drug detected in the urinescreen may not be the same as that originallytaken by the subject. For instance, bothheroin and codeine are converted tomorphine before excretion in the urine.

Substances causing false positive results:none reported; however, foods containingpoppy seeds (the natural source of traditional

opiate drugs) will produce true positiveresults when screening the urine of anotherwise innocent subject.


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Examples: Diazepam

(Valium), chlordiazepoxide

(Librium), flurazepam (Dalmane), oxazepam(Serax), lorazepam (Ativan), clonazepam(Clonopin).

Medical uses: Treatment of anxiety disorders,

convulsions, and muscle spasms. Effects attractive to abuser: Euphoria, sedation,

relief of anxiety, induction of sleep.


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Adverse effects: Drowsiness, apathy, fatigue,decreased activity level, dizziness, fainting,impaired ability to concentrate on tasks,disturbance of vision and hearing, physicaladdiction.

How abused: Pills taken orally. Typical urine detection cutoff level: 300

ng/mL


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Period detectable after last dose: around 2-4days, but depending greatly on dose. Forinstance, a single 10 mg PO dose ofdiazepam may not ever be detected, but a 5times daily dose of 10 mg will be detectable

for 3-7 days. Substances causing false positive results:

none reported.


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Examples: Marijuana, hashish, hash oil Medical uses: Treatment of nausea

and vomiting due to cancerchemotherapy.

Effects attractive to abuser:Euphoria, intensified sensualand aesthetic perceptions.

Adverse effects: Paranoia,panic, impairment of memory

and ability to perform tasks,distorted perception of time, physical andpsychological dependence.


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MARIJUANA also known as Weed, Pot, Grass,Reefer, Ganja, Mary Jane, Blunt, Joint,

Roach, Nail

Forms of Marijuana: Dried green leaves of cannabis plant usually

rolled in cigarette paper and smoked injoint pipe or bong (larger pipe designed tosend more smoke to lungs). Roach clip is

used to hold tiny butt of joints. Marijuana issometimes baked in brownies or cookies toavoid lung irritation.

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Marijuana affects your health. Marijuanalimits your bodys ability to resist infection.

Long term use increases the risk ofdeveloping mental illness.

Marijuana smoke irritates the throat andlungs and has more tar

than cigarette smoke.

Frequent use is linked to

increase risk of lung cancer,

bronchitis, and emphysema.It speeds up heartbeat

and blood pressure.

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Hash (more potent form oftetrahydrocannabinol or THC), brownsubstance made of pressed resin from

cannabis, Hash Oil, the mostpotent condensedTHC, is distilled liquid

resin, often added toa joint. Marijuana canlaced with other

dangerous drugswithout yourknowledge.

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How abused: Smoked in cigarettes or pipe;


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How abused: Smoked in cigarettes or pipe;occasionally eaten asingredient baked into

confections.

Typical urine detection cutoff level: 100

ng/mL or 20 ng/mL (optional)

Period detectable after last dose: This ishighly variable. A one joint per week userhas detectable levels of cannabinoids form 7to 34 days, while a heavy daily user may bedetected from 6 to 81 days after last use.


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Substances causing false positive results: nonereported.

A screen detection cutoff level of 20 ng/mL,requested by some laboratory clients, mayproduce false positives due to passive inhalationof marijuana smoke, but this is controversial.

At the cutoff level of 100 ng/mL, persons exposedpassively to the smoke of others by virtue ofbeing in the same room with abusers should benegative on urine drug screen, although moresensitive chemical techniques (such as gas

chromatography/mass spectrometry, which has asensitivity of 10 ng/mL) may demonstrate thedrug in such an individual's urine.


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Cocaine hydrochloride is the typical formused by abusers who ingest the drug bysnorting the granular form into the nose;

It can also be dissolved in water andinjected intravenously.

Cocaine base is available in a waxy cakeform ("rock" or "crack") which is vaporizedwith a torch and the vapors inhaled througha tube.

Medical uses: Used almost exclusively byear, nose and throat doctors to producelocal anesthesia and control blood lossduring minor nasal surgery.


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Effects attractive to abuser: Euphoria,increased ability to concentrate,

increased alertness, heightened ability toperform intellectual and physical tasks,sexual stimulation, heightenedsociability, enhanced self-confidence.

Adverse effects: Restlessness,nervousness, tremor, convulsions,disturbances in heart rhythm,psychological dependence, myocardialinfarction, sudden death.

How abused: Snorted, injected, orsmoked (see above).



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Typical urine detection cutoff level: 300 ng/mL Period detectable after last dose: 8-48 hours

Note: The laboratory detection of cocaine is performedby analyzing the urine for the presence ofbenzoylecgonine, a substance produced by thebody's chemical detoxification of cocaine.Continuous conversion of cocaine to the metaboliteoccurs in voided, standing urine specimens (even

with fluoridation and refrigeration) unless thespecimen is kept at acid pH (


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Substances causing false positive results: nonereported

However, some legal South American herbal teas

may contain small amounts of coca leaf extract,which may trigger a positive test in an "innocent"subject. Please note that cocoa, cacao, and CocaCola are all completely unrelated to coca, which

is the source of cocaine.


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Examples: Quaalude,

Sopor

Medical uses: Once used as a sleepingpill/sedative, now methaqualone is virtually neverused for medical purposes.

Effects attractive to abuser: Same as that for

barbiturates (see above) Adverse effects: Same as that for barbiturates

(see above) How abused: Pills taken orally.


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Period detectable after last dose: up to 90 hours,depending on dose

Substances causing false positive results: nonereported.


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Examples: PCP, "angel dust" Medical uses: Veterinary tranquilizer; not

used in human medicine.

Effects attractive to abuser: Hallucinogeniceffects Adverse effects: Lethargy, loss of

coordination; unpredictable psychosis,sometimes with criminally violent behavior;

death. How abused: Taken orally, smoked in

cigarette (often mixed with marijuana),injected intravenously as a solution, snortedinto the nose in granular form.


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Typical urine detection cutoff level: 75 ng/mL Period detectable after last dose: 5-10 days

Substances causing false positive results:Thioridazine (Mellaril), an antipsychotic drug, hasbeen reported to cause false positive results, ashas the insecticide parathion.


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Examples: Beer, wine, distilledspirits

Medical uses: Rarely, if

ever, used for medical purposes. Effects attractive to abuser:

Release of social inhibitions,euphoria, sedation

Adverse effects: Same as that for barbiturates(see above).


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% Ethanol

(grams/

100 ml

Dose

(ml)

Ethanol

(grams)

Number of

drinks per day

Toxic Threshold

WINE 12% 120 ml 11.5 g Men- 4Women- 1 to 2

BEER 4% 360 ml 11.5 g Men- 4

Women- 1 to 2

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ETHANOL IN ALCOHOL IS DANGEROUS!ANYONE TAKING MORE THAN SIX DRINKS ADAY IS RISKING PERMANENT LIVER DAMAGE

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Ethanol is absorbed in the stomach into the

bloodstream and is delivered to the liverwhere it is broken down

If the liver is regularly overloaded withalcohol, liver cells are damaged

Damage to the liver cells results toCIRRHOSIS, a permanent liver damageleading to total failure and death.

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H b d D k i b P i d


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How abused: Drunk in beverage Perioddetectable after last dose: 8-10 hours

Note: Alcohol is the only drug of abuse (otherthan tobacco) that is legal for all adults to use.

Illegal use (as in driving while intoxicated) isdefined by the presence of a blood alcohollevel of greater than 100 mg/dL (0.10% byvolume) in Texas (lower in some other states).

It is impossible to determine if a subject islegally intoxicated by measurement of theurine alcohol level. A blood specimen must becollected for this determination to be made bya clinical laboratory.


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Clinical pathologist Physician trained in laboratory management

and quality assurance program

Licensed physician, chemist, medical

technologist, pharmacist, or chemicalengineer drug testing lab is a division,section, unit of a clinical lab

Administrative and technical functions


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Chemist Medical Technologist

Pharmacist

Chemical Engineer

Verifies completeness of CCF

Prepares specimen for analyses

Examines, processes and analyzes specimen

Interprets, records, releases and signs out lab reports


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A trained individual who instructs, assists a

donor at collection sit, receives and makesan initial inspection of specimen for drugtesting and initiates and completes the CCF

At least high school graduate

Must have undergone training in specimencollection

Ensures specimen integrity at collection site

Performs correct specimen collection

Ensures security of procedure

Accomplishes CCF correctly

Performs initial specimen validity


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Employer of client/ donor/ subject

Investigator at crime scene

Complainant

Owner/ administrator of establishment


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Within the laboratory Hand washing facility outside of toilet

Toilet coloring agent

All mandatory tests except for crime sceneand post accident


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Workplace, school, jail, rehab, site of crime Critically ill/ disabled

PERMIT from BHFS 10 days prior

Minimum of 20 tests

No testing should be done at the site

30 or 60 ml, polyethylene bottle, wide mouth withscrew cap


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Photo ID drivers license, employee ID,passport

Identification by authorized agencyrepresentative

And other ID allowed by agencys workplacedrug testing plan


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Id by a co-worker Id by another donor

Use of a single, non photo ID credit card,voters registration card


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Check ID of donor Explains collection procedure

Fill up step 1 of CCF

asks donor to remove outer garments

Examines pockets etc

Asks donor to wash hands

Asks donor to select specimen bottle and

label


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Reasons for conducting validity test:

Unobserved urine collection Suspicion that the urine specimen has been

tampered


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Reasons for conducting validity test:

Unobserved urine collection Suspicion that the urine specimen has been

tampered


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Adulterated, substituted or diluted Improperly collected, handled and stored

Improperly documented


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Adulterated pH less than 3 or greater than 11

Nitrite greater than 500

Diluted

Specific gravity of less than 1.003 Creatinine less than 1768 umol/L

Substituted pH less than 2 or greater than 9

Specific gravity less than 1.033 or greater than 1.020 Creatinine less than 442 umol/L


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Results should be issued within 15 days Positive screening results should be subjected

to confirmatory testing

Screening laboratory is the ONLY one

authorized to release the FINAL report Results cannot be relayed through the

telephone


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CCF for the confirmatory lab (form DT-oo2D)

Request for confirmatory Drug Testing

Uploaded result of DTOMIS

Sample properly labelled and sealed


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THANK YOU!

Date post:	07-Apr-2018
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