Drugs of Abuse Detection By Jovana Zuccala Trident Laboratories, Inc.

DRUG TESTING PROCESS NEGATIVES J. Zuccala Sample collection Sample accession Drug screening Drug confirmation Sample reporting NEGATIVES J. Zuccala

AMPHETAMINES Adderall, Benzedrine, Dexedrine, Vyvanase Potent stimulant of central nervous system (CNS) Induces euphoria, alertness, reduced appetite and the sense of increased power and energy Reported positive on the urine screen panel if concentration exceeds 1000 ng/mL Confirmation metabolites: amphetamines and metamphetamines Window of detection 3-5 days J. Zuccala

BARBITURATES Fioricet, Luminal, Nembutal, Seconal CNS depressants Induces effects similar to those of alcohol intoxication Reported positive on the urine screen panel if concentration exceeds 200 ng/mL Confirmation metabolites: phenobarbital and butalbital Window of detection 4-6 days to 1-3 weeks J. Zuccala

BENZODIAZEPINES Xanax, Klonopin, Valium, Ativan, Rohypnol, Tamazepam Less potent CNS depressants than barbiturates Reported positive on the urine screen panel if concentration exceeds 200 ng/mL Confirmation metabolites: nordiazepam, oxazepam, alpha-hydroxy-alprazolam Window of detection up to 7 days (chronic users even longer) J. Zuccala

BUPRENORPHINE Buprenex, Suboxone, Subutex is a semi-synthetic opioid that is used to treat opioid addiction and moderate acute and chronic pain Reported positive on the urine screen panel if concentration exceeds 5 ng/mL Confirmation metabolites: buprenorphine and norbuprenorphine Window of detection 2-3 days J. Zuccala

COCAINE Potent CNS stimulant and local anesthetic Brings about extreme energy and restlessness, continuous use causes tremors, spasms, fever unresponsiveness and difficulties in breathing Reported positive on the urine screen panel if concentration exceeds 300 ng/mL Confirmation metabolites: benzoylecgonine (BE) Window of detection 1-5 days J. Zuccala

CANABINOIDS (THC) Typically detected in urine in after 1-6 days after single use, 3-10 days after chronic weekly use and up to 45 days after daily use CNS depressant causing euphoria and anxiety, followed by crashing depression feeling Reported positive on the urine screen panel if concentration exceeds 50 ng/mL Confirmation metabolites: THC-COOH J. Zuccala

METHADONE Synthetic opioid used to treat opioid dependence (Dolophine, Methadose) Easy to overdose on: low levels can cause difficulties in breathing and swallowing, low pressure, coma even death Reported positive on the urine screen panel if concentration exceeds 300 ng/mL Confirmation metabolites: methadone and EEDP Detection window 1-4 days J. Zuccala

OPIATES/OPIOIDS Avinza, Kadian, MS Contin, MSIR, Norco, Dilaudid, Vicodin CNS depressants prescribed for chronic pain, sports injuries, and cancer pain Number one abused prescription medication and number one cause of death from overdose Reported positive on the urine screen panel if concentration exceeds 300 ng/mL Confirmation metabolites: morphine, codeine, dihydrocodeine, hydrocodone, hydromorphone Window of detection 2-3 days J. Zuccala

6-AM Heroin-specific metabolite Extremely addictive Can cause respiratory and cardiac arrest, coma and death Reported positive on the urine screen panel if concentration exceeds 10 ng/mL Semi-qualitative assay Window of detection 10 hours to 10 days J. Zuccala

ALCOHOL CNS depressant Ethanol and EtG tests EtG has longer window of detection After a single drink, ethanol can be detected for 4-6 hours; EtG in 24 hrs After binge drinking ethanol usually shows positive for a day or two, while EtG for up to 80 hrs Reported positive on the urine screen panel if concentration exceeds 500 ng/mL for EtG and 100 ng/mL for ethanol J. Zuccala

OXYCODONE/OXYMORPHONE Opioid class, but there is a separate assay to screen Opana, Endocet, Oxycontin, Percocet, Roxicodone, Roxicet Secondary metabolites of morphine and hydromorphone Reported positive on the urine screen panel if concentration exceeds 300 ng/mL Window of detection 1-4 days J. Zuccala

PCP Phencyclidine Potent hallucinogen (similar to LSD) Reported positive on the urine screen panel if concentration exceeds 25 ng/mL Window of detection 1-7 days in occasional users, while in chronic users up to 4 weeks J. Zuccala

PPX Propoxyphene (Darvocet, Darvon) Opioid class (pain management, cancer pain) Reported positive on the urine screen panel if concentration exceeds 300 ng/mL Confirmation metabolites: Propoxyphene and Norpoxyphene Window of detection 6 hours-2days J. Zuccala

ECSTASY Ecstasy can induce euphoria, a sense of intimacy with others, and diminished anxiety CNS stimulant illegal in United States Reported positive on the urine screen panel if concentration exceeds 500 ng/mL Confirmation metabolites: MDA and MDMA Window of detection 1-3 days J. Zuccala

CARISOPRODOL (SOMA) Muscle relaxant Used to treat injuries and painful muscle conditions Habit-forming and often abused drug Reported positive on the urine screen panel if concentration exceeds 100 ng/mL Window of detection 1-2 days J. Zuccala

Ketamine Ketanest, Ketaset, Ketalar (street name “Special K”) Use in veterinary and human medicine for anesthesia, analgesia and sedation Similar to PCP, it induces “dissociative anesthesia” and therefore used as recreational drug Window of detection 1-2 days J. Zuccala

TRAMADOL Ultram, Tramal, Ryzolt Used as centrally acting synthetic analgesic and in opioid dependency treatments Reported positive on the urine screen panel if concentration exceeds 200 ng/mL Window of detection 2-4 days J. Zuccala

FENTANYL Actiq, Duragesic, Fentora, Sublimaze Extremely strong synthetic opioid, often prescribed in pain management clinics Reported positive on the urine screen panel if concentration exceeds 2 ng/mL Exist as a transdermal patch and lozenges (lollipop) Window of detection 1-3 days J. Zuccala

MEPERIDINE Meperitab, Demerol, Mepergen Meperidine is an opioid and a controlled substance with an abuse liability similar to morphine. Reported positive on the urine screen panel if concentration exceeds 200 ng/mL Window of detection 1-2 days J. Zuccala

Methylphenidate Ritalin, Concerta, Daytrana Psychostimulant drug approved for treatment of ADHD, lethargy, narcolepsy, depression and obesity Methylphenidate is sometimes used by students to enhance their mental abilities, improving their concentration and helping them to study Confirmation of methylphenidate in urine serves to monitor compliance in those receiving the drug therapeutically Window of detection 1-2 days J. Zuccala

TRICYCLIC ANTIDEPRESSANTS (TCA) Pamelor, Elavil, Sinequan, Trofanil Generally low abuse potential Used as antidepressants, in ADHD therapy and for chronic pain Reported positive on the urine screen panel if concentration exceeds 300 ng/mL Window of detection 2-19 days J. Zuccala

Synthetic Cannabinoids K2, Spice, Black Mamba, Fake Weed, Genie, Bombai Blue… Psychoactive designer drug derived of natural herbs sprayed with synthetic chemicals Illegal to posses or use in the U.S. Synthetic cannabinoid intoxication is associated with acute psychosis, worsening of previously stable psychotic disorders, and also may have the ability to trigger a chronic (long-term) psychotic disorder among vulnerable individuals such as those with a family history of mental illness. Window of detection up to 72 hours J. Zuccala

Bath Salts Ivory Dove, Vanilla Sky, Blue Silk, Cloud Nine, Hurricane Charlie, Drones… “Street name” for the family of designer drugs containing substituted cathinones Produce effects similar to amphetamines and cocaine Banned in at least 41 states Window of detection 2-3 days J. Zuccala

Trident Laboratories, Inc. Cotinine Metabolite of nicotine, also found in tobacco Cotinine is used as a biomarker for exposure to tobacco smoke and has also been sold as an antidepressant under the brand name Scotine. Cotinine levels <10 ng/mL are considered to be consistent with no active smoking. Values of 10 ng/mL to 100 ng/mL are associated with light smoking or moderate passive exposure, and levels above 300 ng/mL are seen in heavy smokers - more than 20 cigarettes a day. In urine, values between 11 ng/mL and 30 ng/mL may be associated with light smoking or passive exposure, and levels in active smokers typically reach 500 ng/mL or more. Window of detection in urine is up to 7 days J. Zuccala J. Zuccala

VALIDITY TESTING-pH pH test measuring acidity of urine (normal values between 4.5 and 8.9). If pH found to be lower than 4.5 or higher than 8.9, the specimen is considered adulterated Adulterants that change pH of urine- any acid or base (lemon juice, soap, house cleaning products, etc) J. Zuccala

VALIDITY TESTING-OXIDANTS Oxidants test for the presence of oxidizing agents such as bleach and hydrogen peroxide. Normal human urine should not contain oxidants or PCC Cutoff of the assay on instrument is 50 µg/mL Adulterants that change oxidant levels of urine are Pyridinium chlorochromate (sold under the brand name UrineLuck), bleach, etc. J. Zuccala

VALIDITY TESTING-NITRITES Nitrites test is testing for the presence of nitrite salts in urine sample (certain foods and meats contain nitrites) Normal humane urine doesn’t contain any nitrites Instrument cutoff is 500 µg/mL Adulterants containing nitrites are Klear, Whizzies, etc. J. Zuccala

VALIDITY TESTING-SPECIFIC GRAVITY Specific gravity tests for sample dilution. The normal range is from 1.003 to 1.020. Values outside this range may be the result of specimen dilution or adulteration. Factors affecting specific gravity are dehydration, excessive sweating, increased water intake, etc. Trident lab is currently phasing specific gravity out, due to the fact that this test can be easily manipulated with. J. Zuccala

VALIDITY TESTING-CREATININE Creatinine is a waste product of creatine; an amino-acid contained in muscle tissue and found in urine. A person may attempt to foil a test by drinking excessive amounts of water or diuretics such as herbal teas to “flush” the system. Creatinine and specific gravity are two ways to check for dilution and flushing, which are the most common mechanisms used in an attempt to circumvent drug testing. Low creatinine and specific gravity levels may indicate dilute urine. The absence of creatinine (<2mg/dl) is indicative of a specimen not consistent with human urine and is considered substituted (apple juice, etc.) J. Zuccala