The 10 Most CommonDrugs of Abuse

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Clinical Reference Laboratory’s mission is to offer clientsa competitive advantage through a unique combinationof quality testing and personalized service. In drugtesting, this means results you can rely on when makingdifficult hiring and disciplinary decisions.

Since 1989, we have been certified by the Departmentof Health and Human Services Substance Abuse andMental Health Services Administration (SAMHSA#0007) without interruption. For non-regulated testing,we are certified by the College of AmericanPathologists-Forensic Urine Drug Testing (CAP-FUDT)program. We are also licensed to perform testing in allstates including Florida and New York, which have theirown certification programs.

Both regulated and non-regulated specimens arescreened on Bayer ADVIA 2400 analyzers using thesame protocols and procedures. Screen positives areconfirmed by Gas Chromatography/Mass Spectrometry(GC/MS), which identifies unknown drugs by theirunique fingerprints and compares them to known drugs.

In drug testing, quality service is gauged by turnaroundtime, flexibility, and responsiveness. Our turnaroundtimes are among the fastest in the industry. Screennegatives are available the day following collection, inmany areas by 8:00am. Samples requiring GC/MSconfirmation require an additional day or two.

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NON-DOT DRUG CATEGORIES TO BE TESTED AND CUTOFFS

DRUG NAME SCREENING CONFIRMATIONCUTOFF CUTOFF

Amphetamines 1000 NG/ML 500 NG/ML

Barbiturates 300 NG/ML 300 NG/ML

Benzodiazepines 300 NG/ML 300 NG/ML

Cannabinoids 50 NG/ML 15 NG/ML

Cocaine 300 NG/ML 150 NG/ML

Methadone 300 NG/ML 300 NG/ML

MDMA/Ecstacy 500 NG/ML 500 NG/ML

Opiates 2000 NG/ML 2000 NG/ML

Phencyclidine 25 NG/ML 25 NG/ML

Propoxyphene 300 NG/ML 300 NG/ML

Standard Cutoff Levels

A "cutoff" is the concentration of analyte (drug) in aurine sample at or above which the sample is consid-ered positive for that drug. The purpose of the cutoff isto insure consistency and reliability throughout thetesting process. The screening cutoff level may be dif-ferent than the confirmation cutoff when the screeningtest is detecting all forms of the drug and the confir-mation cutoff is measuring only one form (metabolite) ofthe drug in question. For instance, in testing formarijuana, the screening test looks for all forms ofcannibinoid while the confirmation test looks only atthe major metabolite – delta 9-tetrahydrocannabinolcarboxylic acid (D9 THCA). Test results in excess of theconfirmation cutoff levels are consistent with recentingestion of the analyte or an analyte-producingmedication.

Amphetamines

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Drug Methamphetamine, Amphetamine

Trade Names Desoxyn, Dexedrine

Street Names Uppers, pep pills, bennies, moth, crank, speed, meth, crystal, dexies, hearts, whites, black beauties

Classification Central nervous system stimulants

Physical/ Possible/highPsychologicalDependence

Methods of Swallowed or injectedAdministration

Physical Coarse powders, crystals, "chunks,"Appearance capsules, or tablets of various sizes

and colors

Approximate 24 hours to 48 hoursDetection Timein Urine

Clinical Effects/ Palpitations, tachycardia,Symptoms hypertension, restlessness,

dizziness, insomnia, loss ofappetite, and hallucinations

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The BasicsAmphetamines are strong central nervous systemstimulants with high abuse potential. They produce aninitial state of euphoria (high) followed by restlessness,agitation, irritability and sometimes extreme paranoia.Tolerance develops rapidly and, although physicaldependence has not been proved, psychologicaldependence is very high. Amphetamines may be used inthe treatment for obesity, attention disorder,hyperactivity and narcolepsy, but, because of the highabuse potential, these compounds are used as a lastresort in these treatments.

SampleRandom urine specimen in a properly sealed andlabeled urine container.

Method and InstrumentPreliminary screening for drugs of abuse in urine isperformed by immunoassay, Bayer ADVIA 2400.Confirmation by Gas Chromatography/ Mass Spectroscopy.

StabilityAfter proper collection, neither amphetamine normethamphetamine concentration in urine will changesignificantly for ten days at room temperature, forseveral weeks at refrigerated temperature or indefinitelywhen frozen.

PurposeUrine positive indicates recent usage.

Normal ResultsNegative.

Abnormal ResultsThe original immunoassay has been confirmed byGC/MS. The screening cutoff for amphetamines is1000 ng/mL. The confirmation cutoff for either dextro-amphetamine or methamphetamine in those samples is500 ng/mL. This confirmation is consistent withingestion of the analyte or the analyte-producingmedication sometime within the 48-hour periodpreceding the urine collection.

InterferencesThough no compounds have been tested which cannotbe separated from amphetamine and methamphet-amine by GC/MS analysis, there are medications, whichactually contain these analytes or cause them to beproduced by the body. The list of these medicationsincludes, but is not limited to: Biphetamine, Dexedrine,Desaxyn, Didrex, Eldepryl.

Barbiturates

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Drug Phenobarbital, Secobarbital, Pentabarbital, Amobarbital, Butalbital

Trade Names Seconal, Nembutal, Amytal, Fiorinal, Luminal, Phenobarbital

Street Names Barbs, downers, goofballs, reds, yellow jackets, blue devils

Classification Depressants/sedative-hypnotic

Physical/ High/moderatePsychological Dependence

Methods of Swallowed or injectedAdministration

Physical Tablets, capsules, liquid (injectable), Appearance white powder

Approximate Short acting (e.g., secobarbital) – 1 day;Detection Time long acting (e.g., phenobarbital) – in Urine 2 to 3 weeks

Clinical Effects/ Confusion, slurred speech,Symptoms drowsiness, deep sleep, coma,

respiratory depression

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The BasicsThere is a variety of these major sedative-hypnotic drugs.However, all are derivatives of barbituric acid.Depending on the derivation, the particular drug may belong acting, as is phenobarbital or short acting, as inpentobarbital. The long-acting barbiturate phenobarbitalselectively reduces the excitability of rapidly firingneurons and is therefore an effective anticonvulsantdrug. The short and ultra-short drugs inhibit arousal,hence their sedative and hypnotic effects. Low dosesproduce sedation, drowsiness, sleep and also impairedjudgment. At high doses, anesthesia is produced. Veryhigh doses can cause stupor, convulsions and death.

SampleRandom urine specimen, in a properly sealed andlabeled urine container.

Method and InstrumentPreliminary screening for drugs of abuse in urine isperformed by immunoassay, Bayer ADVIA 2400.Confirmation by Gas Chromatography/ Mass Spectroscopy.

StabilityAll types are stable ten days at room temperature, twoweeks when refrigerated, indefinitely when frozen.

PurposeUrine metabolite positive indicates recent usage.

Normal ResultsNegative.

Abnormal ResultsThe original immunoassay has been confirmed byGC/MS. The screening cutoff and confirmation cutoffsfor barbiturates is 300 ng/mL. This concentration isconsistent with ingestion of the analyte sometime withinthe 48-hour period preceding the urine collection.

InterferencesThough no compounds have been tested which cannotbe separated from barbiturates by GC/MS analysis, thereare medications, which contain these analytes or causethem to be produced by the body.

Drug Chlordiazepoxide, Diazepam, Oxazepam, Lorazepam, Flurazepam, Clorazepate

Trade Names Librium, Valium, Serax, Ativan, Dalmane, Tranxene

Street Names Tranks, downers, blues, yellows

Classification Minor tranquilizers,anti-anxiety/sedative

Physical/ ModeratePsychologicalDependence

Methods of Swallowed or injectedAdministration

Physical White or pale yellow crystallineAppearance powders, tablets, capsules, liquid

(injectable)

Approximate 3 days (therapeutic dose)DetectionTime in Urine

Clinical Effects/ Hypnotic, anti-anxiety, anticonvulsant/Symptoms drowsiness, confusion, stupor, coma

Benzodiazepines

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The BasicsAmong this group of drugs, the most prominent isValium. Benzodiazepines are used therapeutically as so-called minor tranquilizers. Doses between 2.5 and 10mg produce a calming effect while higher dosesproduce muscle-relaxing effects. Drug addicts utilizeValium in high doses to counter the excitatory effects ofother drugs or as a means of inducing tranquil states.Acutely, benzodiazepine overdose may producesomnolence, confusion, seizures, and coma. Rarely,hypertension, respiratory depression, and cardiac arrestmay occur. Chronically, physical and psychologicaldependence occur. Sudden discontinuance of the drugmay lead to anxiety, sweating, irritability, hallucination,diarrhea, and seizures.

SampleRandom urine specimen, in a properly sealed andlabeled urine container.

Method and instrumentPreliminary screening for drugs of abuse in urine isperformed by immunoassay, Bayer ADVIA 2400.Confirmation by Gas Chromatography/ Mass Spectroscopy.

StabilityAfter proper collection, benzodiazepines concentrationin urine will not change significantly for ten days atroom temperature, for several weeks at refrigeratedtemperature or indefinitely when frozen.

PurposeUrine positive indicates recent usage.

Normal ResultsNegative.

Abnormal ResultsThe original immunoassay has been confirmed byGC/MS. The screening cutoff for benzodiazepines is 300ng/mL. This concentration is consistent with ingestion ofthe analyte sometime within the 72-hour periodpreceding the urine collection.

InterferencesThough no compounds have been tested which cannotbe separated from benzodiazepines by GC/MS analysis,there are medications which contain these analytes orcause them to be produced by the body.

Cannabinoids

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Drug Marijuana, Hashish, Hashish Oil

Street Names Grass, pot, joint, weed, ragweed,Thias sticks, Columbian, Sinsemilla, Acapulco gold, ace, Hash, Lebanese blond, Nepalese fingers, black Afghan

Classification Hallucinogen

Physical/ Unknown/moderatePsychological Dependence

Methods of Swallowed or smokedAdministration

Physical Dry crushed leaves (marijuana), hand-Appearance rolled cigarettes (joints), hard chunks

of resin of various colors (hashish), dark viscous liquid (hashish oil)

Approximate Acute dosages of 1 or 2 joints – 2 to 3 Detection days; chronic use of more thanTime in Urine 5 joints/day – 14 to 18 days; oral

ingestion (20ng) – 1 to 5 days

Clinical Effects/ Hallucinations, euphoria,Symptoms relaxed inhibitions

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The BasicsMarijuana consists of the dried leaves and flowering topsof the Cannabis sativa plant and is a source ofpsychoactive agents, a major one being delta9-tetrahydrocannabinol (D9-THC). The gastrointestinaltract and the respiratory system rapidly absorb thisdrug after oral or inhalation routes of ingestion. Thedrug is extensively and rapidly metabolized and canbe detected in the urine within a couple of hours andfor as long as several days after use. Regular usersreport feelings of euphoria, hallucinations, and relaxedinhibitions.

SampleRandom urine specimen in a properly sealed andlabeled urine container.

Method and InstrumentPreliminary screening is performed by immunoassay, BayerADVIA 2400. Confirmation by Gas Chromatography/ Mass Spectroscopy.

StabilityAfter proper collection, the concentration of cannabinoidin urine does not change significantly for several days atroom temperature, for several weeks at refrigeratedtemperature or indefinitely when frozen.

PurposeTo detect recent usage.

Normal ResultsNegative.

Abnormal ResultsThe original immunoassay has been confirmed byGC/MS. This concentration is consistent with ingestion ofmarijuana sometime within the 72-hour periodpreceding the urine collection. The screening cutoff formarijuana is 50 ng/mL. The confirmation cutoff forD9-THCA in those samples is 15 ng/mL.

InterferencesNo compounds have been tested which cannot beseparated from D9-THCA by GC/MS analysis.

Drug Cocaine

Trade Names

Street Names Coke, snow, nose candy, toot, crack, stardust, flake, white lady, blow, cola, Bolivian rock, mother of pearl

Classification Stimulant/local anesthetic

Physical/ Possible/highDependencePsychological

Methods of Sniffed, swallowed or injectedAdministration

Physical Odorless, white crystalline powder Appearance with bitter numbing taste.

Approximate 2 to 4 daysDetectionTime in Urine

Clinical Effects/ Euphoria, motor and verbal Symptoms hyperactivity, mood elevation, inflated

self-esteem, grandiose delusions

Cocaine

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The BasicsCocaine is a central nervous system stimulant. It usuallyappears in the form of a fine crystal-like powder,although it can come in larger pieces called rocks. Itmay be injected, snorted or smoked as the free base. Theeffects of the drug begin within minutes and peak within15 to 20 minutes. The effects include dilated pupils,increase in blood pressure, heart rate, breathing rate,and body temperature. The dangers associated withcocaine use vary depending on how the drug is taken,the dose, and the individual. Feelings of restlessness,irritability, anxiety, and sleeplessness are reported bysome regular users. Even low doses of cocaine maycreate psychological problems. Use of high doses ofcocaine over a prolonged period of time may lead toparanoia, commonly called cocaine psychosis, whichincludes hallucinations of touch, sight, taste, and smell.

SampleRandom urine specimen in properly sealed and labeledurine container.

Method and InstrumentEnzyme immunoassay measured spectrophotometri-cally,Bayer ADVIA 2400. Confirmation by Gas Chromatography/Mass Spectroscopy.

StabilityAll sample types are stable ten days at roomtemperature, two weeks when refrigerated, indefinitelywhen frozen.

PurposeUrine and saliva metabolite positive indicate recent usage.

Normal ResultsNegative.

Abnormal ResultsThe original enzyme immunoassay has been confirmedby GC/MS. The screening cutoff is different than theconfirmation cutoff because the screening test detectsall forms of the drug whereas the confirmation testmeasures only one form (metabolite) of the drug inquestion. The screening cutoff for cocaine metabolites is300 ng/mL. The confirmation cutoff for the metabolitebenzoylecgonine is 150 ng/mL. This concentration isconsistent with ingestion of cocaine within a 48-hourperiod preceding the urine collection.

InterferencesNo compounds have been tested which cannot beseparated from benzoylecgonine by GC/MS analysis.

Methadone

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Drug Methadone

Trade Names Dolophine, Methadone

Street Names Dolly

Classification Narcotic, opioid, analgesic

Physical/ High/highPsychologicalDependence

Methods of SwallowedAdministration

Physical White crystalline powder, tablets,Appearance liquid (injectable)

Approximate 3 daysDetectionTime in Urine

Clinical Effects/ Euphoria, drowsinessSymptoms

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The BasicsMethadone is a nonbicyclic drug, which bindscompetitively with morphine to receptors in the brain.Although it can become addictive, the effects are lessthan those of equivalent concentrations of heroin.Thus, administration of methadone to heroin addictsallows them to experience the effects of heroin but in amodulated manner. A gradual lowering of the dosereduces the physical dependence, however addictionto methadone can also occur. Methadone is also usedas a pain medication.

SampleRandom urine specimen in a properly sealed andlabeled urine container.

Method and instrumentPreliminary screening for drugs of abuse in urine isperformed by immunoassay, Bayer ADVIA 2400.Confirmation by Gas Chromatography/Mass Spectroscopy.

StabilityAfter proper collection, methadone concentration inurine will not change significantly for ten days at roomtemperature, for several weeks at refrigeratedtemperature or indefinitely when frozen.

PurposeUrine positive indicates recent usage.

Normal ResultsNegative.

Abnormal ResultsThe original immunoassay has been confirmedby GC/MS. The screening cutoff for methadone is300 ng/mL. The confirmation cutoff for methadonein those samples is 300 ng/mL. This concentrationis consistent with ingestion of the analyte sometimewithin the 48-hour period preceding the urine collection.

InterferencesNo compounds have been tested which cannot beseparated from methadone by GC/MS analysis.

MDMA-Ecstacy

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Drug (MDMA-ECSTACY) Methylene dioxy methamphetamine

Trade Names MDMA

Street Names Hug Drug, Ecstasy, XTC, clarity, essence, Adam

Classification Stimulant/psychedelic

Physical/ Possible/highPsychological Dependence

Methods of SwallowedAdministration

Physical Tablets/capsulesAppearance

Approximate 1 – 3 daysDetectionTime in Urine

Clinical Effects/ Short term: Euphoria, Empathy, Symptoms reduction of inhibition, Hyperthermia

Long term: Selective and permanent brain damage, confusion, depression

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The BasicsMDMA is 3,4-methylenedioxymethamphetamine. It wasoriginally manufactured as a weight loss product, butwas never marketed because of its side effects. Thewhite powder/solid is supplied in the form of capsules ortablets, which are easy to counterfeit, which in turnleads to contaminated or substituted products being soldas ecstasy and a true ‘buyers beware’ market. MDMAeffects last three to six hours and the doses are often‘piggy-backed’, leading to cases of severe over-heatingand cardiac emergencies. Depression, anxiety, disruptionof sleep and paranoia have been reported to occur daysor weeks after use. Symptoms of toxicity can includeconfusion, agitation, hallucinations, seizures, hyperpyrexia,coma and hypotension. Large doses can causemalignate hyperthermia, leading to muscle breakdownas well as kidney and cardiovascular failure. As a realcapper, MDMA is neurotoxic and can cause irreversiblebrain damage.

SampleRandom urine collected and sealed in a proper urine container.

Method and InstrumentPreliminary screening for drugs of abuse in urine isperformed by immunoassay, Bayer ADVIA 2400.Confirmation by Gas Chromatography/Mass Spectroscopy.

StabilityDrug is stable in urine for at least two weeks at roomtemperature and one year when frozen.

PurposeDrug and/or metabolite detection is indicative of recent(1-3 days) ingestion.

Normal ResultsNegative

Abnormal ResultsThe original immunoassay has been confirmed by GC/MS.The screening cutoff for MDMA is 500 ng/mL. Theconfirmation cutoff for MDMA is 500 ng/mL. Thisconcentration is consistent with ingestion of the analytesometime within the 48-hour period preceding the urinecollection.

InterferencesMDMA and its metabolite, MDA, can be detected by GC/MSwithout interference from any other known compounds.

Opiates

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Drug Morphine, Heroin, Codeine, Hydromorphone, Hydrocodone

Trade Names Morphine Sulphate, Codeine, Dilaudid

Street Names M, morph, Miss Emma, smack, junk, horse, H, gum, dust, Mexican brown, China white, schoolboy Juice, dillies, D’s, No. 2’s, No. 4’s, Percs

Classification Narcotic analgesic

Physical/ Morphine-high; Heroin-high;Psychological Codeine-moderate; hydromorphone-Dependence high

Methods of Swallowed or injectedAdministration

Physical White, brown, or black powder, Appearance liquids (injectable), tablets, capsules

of various sizes and colors

Approximate 3 daysTime in UrineDetection

Clinical Effects/ Euphoria, analgesia, drowsiness,Symptoms respiratory depression

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The BasicsOpiates are drugs such as heroin, codeine andmorphine, which can produce a very high physicaland/or psychological dependence by their users.Samples may be tested for codeine and morphine (ametabolite of both codeine and heroin), and follow-uptesting for 6-acetylmorphine, also a metabolite ofheroin, is allowed on morphine-positive samples.Testing for the opiates, hydrocodone (Vicodin, Lortabs),hydromorphone (Dilaudid), is performed on non-regulated samples. Feelings of euphoria, analgesia,drowsiness, and respiratory depression are reported byusers.

SampleRandom urine specimen in a properly sealed andlabeled urine container.

Method and InstrumentPreliminary screening for drugs of abuse in urine isperformed by immunoassay, Bayer ADVIA 2400.Confirmation by Gas Chromatography/Mass Spectroscopy.

StabilityAfter proper collection, concentration of codeine,morphine or other opiates in urine will not changesignificantly for several days at room temperature, forseveral weeks at refrigerated temperature or indefinitelywhen frozen.

Purpose:Urine positive indicates recent usage.

Normal ResultsNegative.

Abnormal ResultsThe original immunoassay has been confirmed byGC/MS. The screening cutoff for opiates in regulatedsamples is 2000 ng/mL. The confirmation cutoff foreither codeine or morphine in these samples is2000 ng/mL. This concentration is consistent withingestion of the analyte or the analyte-producingmedication sometime within the 72-hour periodpreceding the urine collection.

InterferencesThough no compounds have been tested that cannot beseparated from codeine and morphine by GC/MSanalysis, there are numerous prescription medicationswhich contain codeine. In addition, poppy seedscontain morphine and codeine in varying amounts, socareful evaluation of confirmed opiate-positive samplesby an experienced professional can be essential inavoiding a false accusation of drug abuse.

Drug Phencyclidine

Trade Names

Street Names PCP, angel dust, killer weed, supergrass, hog, peace pill

Classification Hallucinogen, dissociative anesthetic

Physical/ Unknown/highPsychological Dependence

Methods of Smoked, swallowed or injectedAdministration

Physical PCP encountered on street as pills, Appearance capsules, powders of various colors,

white crystalline powder

Approximate 2 days, 8 days (overdose)DetectionTime in Urine

Clinical Effects/ Psychedelic reaction, hallucinations, Symptoms catatonia, combativeness

Phencyclidine

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The BasicsPhencyclidine is almost exclusively seen as a drug ofabuse. It has numerous effects on a variety of differentneural pathways and hence a wide array of bizarresymptoms can be seen in the same patient. Itsphysiological effects appear to be analgesic, anesthetic,and, paradoxically, stimulating. Because of its variedactions, clinically acute manifestations vary fromdepression to euphoria and can induce catatonia,violence, rage and auditory and visual hallucinations.Vomiting, hyperventilation, tachycardia, shivering,seizures, coma, and death are also common oc-currences that result from abuse of this drug.

SampleRandom urine specimen in a properly sealed andlabeled urine container.

Method and InstrumentPreliminary screening for drugs of abuse in urine isperformed by immunoassay, Bayer ADVIA 2400.Confirmation by Gas Chromatography/Mass Spectroscopy.

StabilityAfter proper collection, phencyclidine concentration inurine will not change significantly for ten days at roomtemperature, for several weeks at refrigeratedtemperature or indefinitely when frozen.

PurposeUrine positive indicates recent usage.

Normal ResultsNegative.

Abnormal ResultsThe original immunoassay has been confirmed byGC/MS. The screening cutoff for phencyclidine is 25ng/mL. The confirmation cutoff for phencyclidine inthose samples is 25 ng/mL. This concentration isconsistent with ingestion of the analyte or the analyte-producing medication sometime within the 48-hourperiod preceding the urine collection.

InterferencesNo compounds have been tested which cannot beseparated from phencyclidine by GC/MS analysis.

Propoxyphene

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Drug Propoxyphene

Trade Names Darvon

Street Names

Classification Narcotic, analgesic, opioid

Physical/ High-low/high-lowPsychologicalDependence

Methods of SwallowedAdministration

Physical Capsules, tablets of various sizes Appearance and colors, white powder

Approximate 6 hours to 2 daysDetectionTime in Urine

Clinical Effects/ Analgesia, euphoria, intoxicationSymptoms

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The BasicsPropoxyphene is an analgesic drug, which has verysimilar pharmacologic properties to those of the opiateslike morphine. A major cause of drug-related deaths ispropoxyphene overdose, either alone or in com-bination with CNS depressants like barbiturates andalcohol. Toxic symptoms are similar to those seen withopiate overdoses i.e., respiratory depression, cardiacarrhythmias, seizures, pulmonary edema, and coma.

SampleRandom urine specimen in a properly sealed andlabeled urine container.

Method and InstrumentPreliminary screening for drugs of abuse in urine isperformed by immunoassay, Bayer ADVIA 2400.Confirmation by Gas Chromatography/Mass Spectroscopy.

StabilityAfter proper collection, propoxyphene concentration inurine will not change significantly for ten days at roomtemperature, for several weeks at refrigeratedtemperature or indefinitely when frozen.

PurposeUrine positive indicates recent usage.

Normal ResultsNegative.

Abnormal ResultsThe original immunoassay has been confirmed byGC/MS. The screening cutoff for propoxyphene is 300ng/mL. The confirmation cutoff for propoxyphene inthose samples is 300 ng/mL. This concentration isconsistent with ingestion of the analyte or the analyte-producing medication sometime within the 48-hourperiod preceding the urine collection.

InterferencesThough no compounds have been tested which cannotbe separated from propoxyphene by GC/MS analysis,there are medications which actually contain theseanalytes or cause them to be produced by the body.

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