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Drugs of Abuse Testing Drugs of Abuse Testing Dr Charles Appleton Q l dM di lLb QueenslandMedicalLaboratory RCPA AACB Chemical Pathology Conference 2013 RCPA AACB Chemical Pathology Conference 2013 Toxicology
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Page 1: Drugs of Abuse Testing - AACB

Drugs of Abuse TestingDrugs of Abuse TestingDr Charles Appleton

Q l d M di l L bQueensland Medical Laboratory

RCPA AACB Chemical Pathology Conference 2013RCPA AACB Chemical Pathology Conference 2013

Toxicology

Page 2: Drugs of Abuse Testing - AACB

Where does drug testing “pop up” in laboratory practice?laboratory practice?

• Drug‐rehab programs, suspected overdose or misused d k k• Suspected drink spiking

• Mum finds “tablet” in son’s room O ti l t ti d i id t l t d• Occupational testing – random, incident‐related, pre‐employment

• Court‐ordered testingCourt‐ordered testing• DoCS‐ordered testing• Sports drug testingSports drug testing

Toxicology

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Drugs of Abuse Testingg g

Learning outcomes• Briefly review major considerations of testing in this field• Allude to challenges of reporting to medical and non‐medical requestors

• Recognise shortcomings of current testing

Toxicology

Page 4: Drugs of Abuse Testing - AACB

Drugs of Abuse Testingg g

What matrix?• Urine• Oral fluid• Hair• Blood• Sweat• Breath

Toxicology

• others

Page 5: Drugs of Abuse Testing - AACB

Drugs of Abuse Testingg g

Relevant Standards define procedures for – Collection– Transportation– Analysis, and– Reporting

AS/NZS 4308:2008 for urine/

Toxicology

Page 6: Drugs of Abuse Testing - AACB

Drugs of Abuse Testing

Toxicology

Page 7: Drugs of Abuse Testing - AACB

Drugs of Abuse Testingg g

Methods of analysis:• Immunoassay – ward/workplace/laboratory• Extraction, chromatography and detection• Other separative techniques• Chemical methods e.g. ethanolg

Toxicology

Page 8: Drugs of Abuse Testing - AACB

Drugs of Abuse Testingg gImmunoassay:• Generally a “class” method

– Cannabinoids 4308, 4670

– Opiates 4308, 4670

S th i ti A i 4308 4670– Sympathomimetic Amines 4308, 4670

– Cocaine 4308, 4670

– Benzodiazepines 4308p– Barbiturates– Phencyclidine

h d– Methadone– and many others

Toxicology

Page 9: Drugs of Abuse Testing - AACB

Drugs of Abuse Testingg gImmunoassay: Thresholds differ from Country to Country

Recommended by:  Standards Australia                       SAMHSA(AS/NZS 4038)

Cannabinoids 50 50Cocaine metabolites 300 300S th i ti A i 300 1000Sympathomimetic Amines 300 1000Opiates 300 2000Benzodiazepines 200pPhencyclidine 25

Toxicology

Page 10: Drugs of Abuse Testing - AACB

Toxicology

Page 11: Drugs of Abuse Testing - AACB

Drugs of Abuse Testingg g

Chromatographic procedures• Sample cleanup/extraction• Chromatographic separation of different drugs and 

metabolites of those drugs– gas, high performance liquid, thin layer

• Identification (and possibly quantitation) of the individual parent and metabolite peaks– Mass spectrography

Toxicology

Page 12: Drugs of Abuse Testing - AACB

Drugs of Abuse Testingg g

Limitations of MS• specificity• isomers

Toxicology

Page 13: Drugs of Abuse Testing - AACB

Drugs of Abuse Testingg g

Cannabis• Derived from plant – Cannabis sativa• Sedation, euphoria, hallucinations, temporal distortion• Historical positives ‐ detection window depends on nature of use • False positives ‐ uncommon• Innocent positives ‐ uncommon• Passive positives ‐ exceptionalp p

Toxicology

Page 14: Drugs of Abuse Testing - AACB

Fig. 1 Chemical structure of main cannabinoids in Cannabis sativa.

ToxicologyCopyright © 2008 The Royal College of Psychiatrists

ASHTON, C. H. Br J Psychiatry 2001;178:101-106

Page 15: Drugs of Abuse Testing - AACB

Cases – Cannabinoids Non negative initial urine screenNon‐negative initial urine screen

GCMS ASSAY - URINE THC CONFIRMATION

Date Lab No d9-THCA U.Creat Ratio

ug/L mmol/L

08/12/09 223 33.2 7

d9-THCA: 11 nor delta tetrahydrocannabinol-9-carboxylic acid (assayed according to AS/NZS 4308:2008 requirements)according to AS/NZS 4308:2008 requirements)

The AS/NZS 4308:2008 cut-off for this compound is 15 ug/L.

Toxicology

Page 16: Drugs of Abuse Testing - AACB

Cases – Cannabinoids Non negative initial urine screenNon‐negative initial urine screen

GCMS ASSAY - URINE THC CONFIRMATION

Date Lab No d9-THCA U.Creat Ratio

ug/L mmol/L

10/12/09 375 12.2 30

Th bj t i fli ht tt d t h l i th t h tt d d t i hi h bi h bThe subject is a flight attendant who claims that she attended a party in which cannabis may have been used 2 days prior to sample collection.

Toxicology

Page 17: Drugs of Abuse Testing - AACB

Cases – Cannabinoids Non negative initial urine screenNon‐negative initial urine screen

GCMS ASSAY - URINE THC CONFIRMATION

Date Lab No d9-THCA U.Creat Ratio

ug/L mmol/L

23/12/09 45 14.8 3.0

Th i iti l it tiThe initial on‐site screen was non‐negative.The subject reports use of hemp oil skin care products.

Toxicology

Page 18: Drugs of Abuse Testing - AACB

Drugs of Abuse Testingg gOpiates• Natural, semisynthetic and synthetic derivatives of morphine 

i ll f ifcommercially from Papaver somniferum • Morphine and its close relatives• Analgesic cough suppressantAnalgesic, cough suppressant• Detection window 3‐4 days  • No historical positives• False positives – common seasonally• Innocent positives – common • Passive positives rare• Passive positives – rare

Toxicology

Page 19: Drugs of Abuse Testing - AACB

Drugs of Abuse Testingg gOpiate/opioid family – detection on “standard” immunoassay

InvisibleHigh dose only“Standard” InvisibleHigh dose onlyStandard

buprenorphinenaltrexone codeine4308methadoneoxycodonemorphine4308

fentanylpholcodinepethidinenaloxoneheroin4308 (6‐mam)

p p

propoxyphenedihydrocodeinehydromorphone

Toxicology

Page 20: Drugs of Abuse Testing - AACB

The metabolic pathway of the opiates.XII‐Biotech‐C‐Opiate Chemistry‐3

Toxicology

Page 21: Drugs of Abuse Testing - AACB

Cases – Opiates Non negative initial urine screenNon‐negative initial urine screen

MS ASSAY - URINE OPIATE CONFIRMATION

Date Codeine Morphine U Creat Cod/Crea Mor/CreaDate Codeine Morphine U.Creat Cod/Crea Mor/Crea

(ug/L) (ug/L) (mmol/L) Ratio Ratio

18/12/09 315 556 18.7 17 30

Toxicology

Page 22: Drugs of Abuse Testing - AACB

Cases – Opiates Non negative initial urine screenNon‐negative initial urine screen

MS ASSAY - URINE OPIATE CONFIRMATIONDate Codeine Morphine U Creat Cod/Crea Mor/CreaDate Codeine Morphine U.Creat Cod/Crea Mor/Crea

(ug/L) (ug/L) (mmol/L) Ratio Ratio17/11/08 1576 >2000 3.0 525 >667

GCMS confirms the positive opiate screen and also reveals the presence of a small amount of 6-monoacetyl morphine (13 ug/L).

The presence of 6 MAM is indicative of probable use of heroin within eightThe presence of 6-MAM is indicative of probable use of heroin within eight hours of sample collection.

Additional to this, the subject appears to have used a codeine-containing medication as well. This may be done in an attempt to "mask" the use of ed cat o as e . s ay be do e a atte pt to as t e use oheroin but the presence of 6-MAM defeats this.

Toxicology

Page 23: Drugs of Abuse Testing - AACB

Cases – Opiates Non negative initial urine screenNon‐negative initial urine screen

MS ASSAY - URINE OPIATE CONFIRMATIONC d i hi C C d/C /CDate Codeine Morphine U.Creat Cod/Crea Mor/Crea(ug/L) (ug/L) (mmol/L) Ratio Ratio

13/01/10 <50 413 19.6 <3 21(27)

MS confirms the initial opiate screen and reveals the presence of a small amount of morphine as well as a trace of codeine.

Although it is not possible to exclude the possibility that this mayAlthough it is not possible to exclude the possibility that this may reflect use of morphine or of heroin recently with use of codeine some days prior to that, this is the pattern typically seen after ingestion of foodstuffs containing poppy seed.

There is no absolute indication of use of illicit opiates.

Toxicology

Page 24: Drugs of Abuse Testing - AACB

Toxicology

Page 25: Drugs of Abuse Testing - AACB

Toxicology

Page 26: Drugs of Abuse Testing - AACB

Drugs of Abuse Testingg gSympathomimetic amines (now referred to as “Amphetamine‐

type Stimulants” or “ATS”)type Stimulants  or  ATS )• Natural and synthetic relatives of epinephrine (adrenalin)• Stimulant, decongestant, appetite suppressantg pp pp• Detection window 3‐4 days but depends on pH of urine • No historical positives• False positives – interesting • Innocent positives – frequent (depends of source population)

Passi e positi es rare• Passive positives – rare 

Toxicology

Page 27: Drugs of Abuse Testing - AACB

Drugs of Abuse Testingg gSympathomimetic amine family – immunoassay detection

InvisibleLess sensitive“Standard”

methylphenidatepseudoephedrine4308amphetamine4308phenylephrinephentermine4308methamphetamine4308

tyramineMDA4308

ephedrine4308MDMA4308methylphenidatepseudoephedrine4308amphetamine4308

phenylethylaminebenzylpiperazine*4308

4‐bromo‐2,5‐dimethoxy amphetamine and other

Toxicology

amphetamine and other “designers”

Page 28: Drugs of Abuse Testing - AACB

Sympathomimetic Amines – the facesy p

Toxicology

Page 29: Drugs of Abuse Testing - AACB

Sympathetic Amines – the familyy p y

Toxicology

Page 30: Drugs of Abuse Testing - AACB

Toxicology 30

Page 31: Drugs of Abuse Testing - AACB

Cases – Sympathomimetic Amines Non negative initial urine screenNon‐negative initial urine screen

MS ASSAY - URINE SYMPATHOMIMETIC AMINE CONFIRMATION

Cut-off

Amphetamine 1600 ug/L 150 ug/L

Methamphetamine 6100 ug/L 150 ug/L

MDMA Not detected 150 ug/L

MDA Not detected 150 ug/L

Phentermine Not detected 500 ug/L

Ephedrine Not detected 500 ug/L

P d h d i N t d t t d 500 /LPseudoephedrine Not detected 500 ug/L

Creatinine 14.8 mmol/L

Toxicology

Page 32: Drugs of Abuse Testing - AACB

Cases – Sympathomimetic Amines Non negative initial urine screenNon‐negative initial urine screen

MS ASSAY - URINE SYMPATHOMIMETIC AMINE CONFIRMATION

Cut-off

Amphetamine 917 ug/L 150 ug/L

Methamphetamine 3040 ug/L 150 ug/L

MDMA Not detected 150 ug/L

MDA Not detected 150 ug/L

Phentermine Not detected 500 ug/L

Ephedrine Not detected 500 ug/L

P d h d i N t d t t d 500 /LPseudoephedrine Not detected 500 ug/L

Creatinine 12.6 mmol/L

Subject has Parkinson disease

Toxicology

Subject has Parkinson disease.

Page 33: Drugs of Abuse Testing - AACB

Cases – Sympathomimetic Amines Non negative initial urine screenNon‐negative initial urine screen

MS ASSAY - URINE SYMPATHOMIMETIC AMINE CONFIRMATION

Cut-off

Amphetamine Not detected 150 ug/L

Methamphetamine 232 ug/L 150 ug/L

MDMA Not detected 150 ug/L

MDA Not detected 150 ug/L

Phentermine Not detected 500 ug/L

Ephedrine >1500 ug/L 500 ug/L

P d h d i >1500 /L 500 /LPseudoephedrine >1500 ug/L 500 ug/L

Creatinine 6.1 mmol/L

Ephedrine 62700 ug/LEphedrine 62700 ug/L

Pseudoephedrine 490000 ug/L

Toxicology

Page 34: Drugs of Abuse Testing - AACB

Drugs of Abuse TestingBenzodiazepines• Chemically derived from fusion of benzene and diazepine• Sedative, anxiolytic, anticonvulsant, muscle relaxant• Detection window depends on nature of use ‐ historical positives• False positives – relatively common but depends on population• Innocent positives – prescription usep p p• Passive positives – not a consideration• This group typically has complex metabolite patternsThis group typically has complex metabolite patterns 

Toxicology

Page 35: Drugs of Abuse Testing - AACB

Metabolite patterns of benzodiazepines(Source – taken & amended from www nature com/clpt/jpurnal/v76/n6/fig tab/clpt2005539ft html)(Source – taken & amended from www.nature.com/clpt/jpurnal/v76/n6/fig_tab/clpt2005539ft.html)

Most simply inactivated by demethylation/hydroxylation/amination/conjugation but:

Toxicology

Page 36: Drugs of Abuse Testing - AACB

Drugs of Abuse Testingg gBenzodiazepine family – MS confirmation

Not listed in StandardListed in 4308:2008

ClobazamTemazepamLorazepamDiazepam

BromazepamNitrazepamMidazolamClonazepamTriazolamOxazepamoba ae a epa

FlunitrazepamBromazepamNitrazepam

Alprazolam

Toxicology

Page 37: Drugs of Abuse Testing - AACB

Cases – Benzodiazepines Non negative initial urine screenNon‐negative initial urine screen

MS ASSAY - URINE BENZODIAZEPINE CONFIRMATION

Cut-off

Oxazepam 151 ug/L 200 ug/L

Temazepam 215 ug/L 200 ug/L

Diazepam Not detected 200 ug/L

Nordiazepam <50 ug/L 200 ug/L

7-Aminoclonazepam Not detected 100 ug/L

7-Aminoflunitrazepam Not detected 100 ug/L

7 A i it N t d t t d 100 /L7-Aminonitrazepam Not detected 100 ug/L

Alpha OH-alprazolam Not Detected 100 ug/L

Creatinine 11.0 mmol/L

Subject reports prescribed Valium.

Toxicology

Page 38: Drugs of Abuse Testing - AACB

Cases – Benzodiazepines Non negative initial urine screenNon‐negative initial urine screen

MS ASSAY - URINE BENZODIAZEPINE CONFIRMATION

Cut-off

Oxazepam 470 ug/L 200 ug/L

Temazepam 4900 ug/L 200 ug/L

Diazepam Not detected 200 ug/L

Nordiazepam Not detected 200 ug/L

7-Aminoclonazepam Not detected 100 ug/L

7-Aminoflunitrazepam Not detected 100 ug/L

7 A i it N t d t t d 100 /L7-Aminonitrazepam Not detected 100 ug/L

Alpha OH-alprazolam Not Detected 100 ug/L

Creatinine 10.9 mmol/L

Subject reports prescribed Temaze.

Toxicology

Page 39: Drugs of Abuse Testing - AACB

Cases – Benzodiazepines Non negative initial urine screenNon‐negative initial urine screen

MS ASSAY - URINE BENZODIAZEPINE CONFIRMATION

Cut-off

Oxazepam 7390 ug/L 200 ug/L

Temazepam Not detected 200 ug/L

Diazepam Not detected 200 ug/L

Nordiazepam Not detected 200 ug/L

7-Aminoclonazepam Not detected 100 ug/L

7-Aminoflunitrazepam Not detected 100 ug/L

7 A i it N t d t t d 100 /L7-Aminonitrazepam Not detected 100 ug/L

Alpha OH-alprazolam Not Detected 100 ug/L

Creatinine 15.2 mmol/L

Subject reports prescribed Serepax.

Toxicology

Page 40: Drugs of Abuse Testing - AACB

Cases – Benzodiazepines Non negative initial urine screenNon‐negative initial urine screen

MS ASSAY - URINE BENZODIAZEPINE CONFIRMATION

Cut-off

Oxazepam Not detected 200 ug/L

Temazepam Not detected 200 ug/L

Diazepam Not detected 200 ug/L

Nordiazepam Not detected 200 ug/L

7-Aminoclonazepam Not detected 100 ug/L

7-Aminoflunitrazepam 80 ug/L 100 ug/L

7 A i it N t d t t d 100 /L7-Aminonitrazepam Not detected 100 ug/L

Alpha OH-alprazolam Not Detected 100 ug/L

Creatinine 6.6 mmol/L

Brought by parent to doctor after party on weekend

Toxicology

Page 41: Drugs of Abuse Testing - AACB

Cases – Benzodiazepines Non negative initial urine screenNon‐negative initial urine screen

Toxicology

Page 42: Drugs of Abuse Testing - AACB

Drugs of Abuse Testingg gCocaine• Naturally derived from Erythroxylon coca• Naturally derived from Erythroxylon coca• Stimulant, local anaesthetic• Detection window 2 3 days• Detection window 2‐3 days  • No historical positives

False positi es rare• False positives – rare • Innocent positives – rare 

P i iti i ti• Passive positives – rare in practice

Toxicology

Page 43: Drugs of Abuse Testing - AACB

Toxicology

Courtesy of Bio‐Rad Laboratories Ltd

Page 44: Drugs of Abuse Testing - AACB

Cases – Cocaine Non negative initial urine screenNon‐negative initial urine screen

MS ASSAY - URINE COCAINE METABOLITE CONFIRMATION

Cut-offCut off

Cocaine Not detected Unspecified

Benzoylecgonine 1390 ug/L 150 ug/L

Ecgonine methyl ester 320 ug/L 150 ug/LEcgonine methyl ester 320 ug/L 150 ug/L

Creatinine 17.9 mmol/L

Assayed to AS/NZS 4308:2008Assayed to AS/NZS 4308:2008.

Toxicology

Page 45: Drugs of Abuse Testing - AACB

Toxicology

Page 46: Drugs of Abuse Testing - AACB

Toxicology

Page 47: Drugs of Abuse Testing - AACB

Drugs of Abuse Testingg gThe “invisible” substances of abuse• Opioids – fentanyl, pethidine, oxycodone, methadone, buprenorphine p y , p , y , , p p• Some designer sympathomimetic amines• Ethanol • ‐hydroxybutyrate• ‐hydroxybutyrate• Ketamine• Propofol

P il bi d th l t h ll i• Psilocybin and other plant hallucinogens• Lysergic acid diethylamide• Phencyclidine

And the “new” drugs

Toxicology

Page 48: Drugs of Abuse Testing - AACB

Drugs of Abuse Testingg gRecent “invisible” substances of abuse• Synthetic cannabinoids – over 800 developedSynthetic cannabinoids  over 800 developed• Synthetic cathinones e.g. MDPV, mephedrone• Synthetic hallucinogens e.g. 25I‐NBO Me, Bromo‐Dragonfly, PMA

S th ti i• Synthetic cocaines

Reference source – European Monitoring Centre for Drugs and Drug p g g gAddiction (EMCDDA)

Toxicology

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Toxicology 49

Page 50: Drugs of Abuse Testing - AACB

Synthetic CannabinoidsSubstances which• Are at least partially man made• Are at least partially man‐made• Bind to CNS CB1 receptor with a medium to high 

ffi iaffinity• When binding to CB1, act as agonist• Minimally interact with CB2 receptor• Are commonly marketed so as to avoid detection

Toxicology

Are commonly marketed so as to avoid detection of unlawful drug use

Page 51: Drugs of Abuse Testing - AACB

Synthetic CannabinoidsyScope:• History• Chemical nature• Chemical nature • Manufacture considerations• Legality• Analytical aspects

Toxicology

Page 52: Drugs of Abuse Testing - AACB

Synthetic Cannabinoids

History:• 1965 THC synthesised• 1965 THC synthesised• 1980 Cannabinoid receptors recognised• 1984 John W Huffman’s group commenced synthesising substances for medical usey g

• 2004 “Spice” herbal mixtures sold in Germany2008 CP 47 497 & JWH 018 id tifi d i “S i ”• 2008 CP‐47,497 & JWH‐018 identified in “Spice”

Toxicology

Page 53: Drugs of Abuse Testing - AACB

Synthetic Cannabinoids

History ‐ Australia:d• 2010 use increasing in WA mining industry

• January 2011 my first Australian enquiryJanuary 2011 my first Australian enquiry • 7 Australian laboratories offering MS testing• Antibody screening test available 2012

Toxicology

Page 54: Drugs of Abuse Testing - AACB

Synthetic Cannabinoids

Toxicology

Page 55: Drugs of Abuse Testing - AACB

Synthetic CannabinoidsyScope:• History• Chemical nature• Chemical nature• Manufacture considerations• Legality• Analytical aspects

Toxicology

Page 56: Drugs of Abuse Testing - AACB

Synthetic CannabinoidsyChemical nature – The Classes• Classical cannabinoids e.g. THC, HU‐210• Nonclassical cannabinoids e g CP 47 497• Nonclassical cannabinoids e.g. CP‐47,497• Hybrid cannabinoids e.g. AM‐4030• Aminoalkylindoles e.g. JWH‐018, JWH‐073• Eicosanoids e.g. methanandamide

Toxicology• Others

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Synthetic CannabinoidsyChemical nature – The Classes

Toxicology

Page 58: Drugs of Abuse Testing - AACB

Synthetic CannabinoidsTh N G iThe Next Generation

Toxicology

Page 59: Drugs of Abuse Testing - AACB

Synthetic CannabinoidsyScope:• History• Chemical nature• Chemical nature • Manufacture considerations• Legality• Analytical aspects

Toxicology

Page 60: Drugs of Abuse Testing - AACB

Synthetic CannabinoidsyManufacture and supply:• Impure substances imported• Solution sprayed onto herbs• Dried down, packaged and sold• No quality control of dosage or distribution• No continuity of composition – manufacturer attempts to “keep 

ahead” of detectionC ith f t i difi ti

Toxicology

• Concerns with manufacturing modifications

Page 61: Drugs of Abuse Testing - AACB

Synthetic CannabinoidsyScope:• History• Chemical nature• Chemical nature • Manufacture considerations• Legal considerations• Analytical aspects

Toxicology

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Synthetic CannabinoidsyLegal considerations:• Worldwide variation in banning these• In Australia• In Australia...... 

Toxicology

Page 63: Drugs of Abuse Testing - AACB

Synthetic CannabinoidsyScope:• History• Chemical nature• Chemical nature • Manufacture considerations• Legal considerations• Analytical aspects

Toxicology

Page 64: Drugs of Abuse Testing - AACB

Synthetic CannabinoidsyThe Standard –• Collection and handling• On site screening• On site screening• Within laboratory screening• MS confirmation/characterisation/quantitation

Toxicology

Page 65: Drugs of Abuse Testing - AACB

Synthetic Cannabinoidsy

Toxicology

Page 66: Drugs of Abuse Testing - AACB

Synthetic Cannabinoidsy

Analytical considerations –– JWH‐018 JWH‐073 JWH‐122 AM‐2201– JWH‐018, JWH‐073, JWH‐122, AM‐2201, UR‐144 & potentially others

h h ld /– Detection threshold 10 ug/L

Toxicology

Page 67: Drugs of Abuse Testing - AACB

Synthetic CannabinoidsyAnalytical considerations – laboratory screening– No consistency with the metabolites sought– No consistency with detection thresholds– No certainty that confirmation laboratories are testing for the same substances

– All test for JWH‐018 & JWH‐073 metabolites if no others– Do not cross‐react with cannabis metabolites

Toxicology

Page 68: Drugs of Abuse Testing - AACB

Synthetic CannabinoidsyAnalytical considerations – MS testing• At least 7 Australian laboratories offering MS detection and quantitationq

• Apply considerations from AS/NZS 4308• Standards expensive and difficult to obtain• Standards expensive and difficult to obtain• Deuterated standards remain difficult to obtain

Toxicology

• Commercial controls not available yet

Page 69: Drugs of Abuse Testing - AACB

Synthetic CannabinoidsyAnalytical considerations – MS testing (cont)• Laboratories test for a limited number of substances – range differs from lab to labg

• Sensitivities determined by individual laboratory decision which is based at least in part ondecision which is based at least in part  on analytical considerations 

• “Menu” continually expandingToxicology

• Menu  continually expanding

Page 70: Drugs of Abuse Testing - AACB

Synthetic CannabinoidsyAnalytical considerations – what is QML finding?• Testing for JWH‐018, JWH‐073, JWH‐122, JWH‐200 & JWH‐250 parent and metabolitesp

• Detection threshold 5 ug/L• Positive finding in approx 2% of samples• Positive finding in approx. 2% of samples• JWH‐018 metabolite and JWH‐073 metabolite 

i h l fi diToxicology

remain the prevalent findings

Page 71: Drugs of Abuse Testing - AACB

Synthetic CannabinoidsyAnalytical considerations – recent developments• Importation of AM‐2201 found in mid‐2012

• subsequently added to MS panelq y p

• Importation of UR‐144 and XLR‐11 found in late 20122012• Subsequently added to MS panel

Toxicology

Page 72: Drugs of Abuse Testing - AACB

Synthetic Drug ConclusionsFuture considerations – where are we heading?

y g

• No sign of diminishing requirement for testing• No sign of falling use• No court challenge to findings yet• No challenge to action taken on positive finding yet

Toxicology

Page 73: Drugs of Abuse Testing - AACB

Synthetic Drug ConclusionsFuture considerations – what’s missing?

y g

• Detailed pharmacokinetics and detection characteristics• Clinical toxicology

• Short term clinical effects• Long term clinical effects• Acute toxicity

Toxicology

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Toxicology


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