DILLWORTH CENTER

DILLWORTH CENTER
Pat Pizzo, Director of Toxicology
November 2010
HARD AT WORK
INTERPERTATION OF DRUG TEST
RESULTS
3
Definitions
• Parent Compound – The actual drug. Enters and
exits as the same chemical structure
• Metabolite – breakdown product of a drug. This
occurs in the body. Enters as parent compound exits
as a metabolite
• Half – Life – The amount of time it takes for the drug
concentration in the urine or blood to decrease by
one half
4
Definitions
Window of Detection
Window of detection refers to the length of time the substances or their
metabolites can be detected in a biological matrix
It part, it depends on:
• Chemical properties of the substances for which the test is being
performed;
• Individual metabolism rates and excretion routes;
• Route of administration, frequency of use, and amount of the substance
ingested;
• Sensitivity and specificity of the test;
• Selected cutoff concentration;
• The individual’s health, diet, weight, gender, fluid intake, and
pharmacogenomic profile; and
• The biological specimen tested.
5
Window of Detection
Many factors influence the window of detection for a
substance. Factors include, but are not limited to:
• the frequency of drug use (chronic or acute),
• the amount taken,
• the rate at which the substance is metabolized
(including pharmacogenomic abnormalities, such as
mutations of CYP2D6 and other drug-metabolizing
enzymes [White & Black,2007]),
• the cutoff concentration of the test,
• the patient’s physical condition and, in many cases, the
amount of body fat.
6
MARIJUANA
THC Sources
• Marijuana
*Hashish
*Sinsemilla
*Hash Oil
Prescription sources
*Marinol
*Sativex – Canada and UK only
MARIHUANA TAX ACT OF 1937
(Act of Aug. 2, 1937, Public 238, 75th Congress) Effective Date October 1, 1937.
b) The term "marihuana" means all parts of the plant Cannabis
sativa L., whether growing or not; the seeds thereof; the resin
extracted from any part of such plant; and every compound,
manufacture, salt, derivative, mixture, or preparation of such
plant, its seeds, or resin- but shall not include the mature stalks of
such plant, fiber produced from such stalks, oil or cake made
from the seeds of such plant, any other compound, manufacture,
salt, derivative, mixture, or preparation of such mature stalks
(except the resin extracted there from), fiber, oil, or cake, or the
sterilized seed of such plant which is incapable of germination.
FOR MORE ON THE TAX ACT AND RELATED TOPICS:
http://www.druglibrary.org/schaffer/hemp/taxact/mjtaxact.htm
MARIJUANA CLEARANCE
•
•
•
•
•
•
HALF LIFE – 48 - 72 HRS
SOCIAL USE – 5-7 DAYS
MODERATE USE - 7-10 DAYS
CHRONIC USE - 4-6 WEEKS
PEAK LEVEL – 6-8 HRS mean value = 125 ng/ml
EXPEDITE - WATER, EXERCISE
PASSIVE INHALATION
• NOT A REALITY
• REALISTIC - < 5 NG/ML
SCREENING
• FORCED - < 15 NG/ML GCMS
• STATE LAWS - SOME STATES
HAVE ADDRESSED THIS
ISSUE
HEMP PRODUCTS
• NOT ALL PRODUCTS OR EVEN ALL LOTS
WILL RESULT IN POSITIVES
• HEMP OIL - POSITIVE
• HEMP BEER - NEGATIVE
• SEEDY SWEETIES - POSITIVE
New Reason for Marijuana Positive
• Cannabis Vodka
• Not legal in the U.S.
• Legal in Mexico and
Canada
• Can it result in a
positive test?
• Yes
13
Cannabis Ice Cream
• Flavors
• TRIPle Chocolate Brownie
• Banannabis Foster
• Straw-Mari Cheesecake
• Cost
• $15 per half pint
• Contains the equivalent of 2-4
joints
14
Marijuana Bakeries - More than just
cookies and brownies
•
•
•
•
•
•
•
Cake balls – 420 mg THC
Cup cake – 200 mg THC
Hard Candy – 120mg THC/oz
Rice Krispie Treats – 85mg THC
Party Mix – 60 mg THC
Sugar Free Suckers – 30 mg THC
Chocolate bouquet – 50mg THC ea
http://www.bakked.com/gallery/
15
Marijuana Sodas
• 35-65 mg THC/bottle
• $10 to $15 per bottle
• Available in California
and Colorado
• Flavors similar to:
• Dr. Pepper
• Grape
• Orange
• Lemon/Lime
• Cola
16
MARIJUANA STUFFING
Ingredients
5 cups rye bread crumbs
2 tablespoons poultry seasoning
1/2 cup each of raisins and almonds
1/2 cup celery
1/3 cup chopped onions
3 tablespoons melted butter
1/2 cup chopped marijuana buds
2 tablespoons red wine
Directions to make the marijuana stuffing
Everybody loves stuffing. Whether it is Thanksgiving or just for
nothing, marijuana stuffing is a tasty alternative that really packs a
punch. Its so easy too! Basically mix all the ingredients together and
stir it up.
17
MEDICAL MARIJUANA
• Raich v. Gonzales – Supreme court ruling upheld
federal law allowing medical marijuana users to be
charged with use.
• 18 states and DC currently allow the use of Medical
marijuana. Oregon has >15,000 card carrying users
• Can be prescribed for any reason at the discretion of
the physician.
• New Mexico working on repeal of Medical Marijuana
laws
LEGAL MARIJUANA
• For recreational use approved in the 11/6/12
election for Colorado and Washington state.
• DEA – Controlled Substances Act remains unchanged
• DOJ – Reviewing ballot initiatives
• Los Angeles estimates more medical marijuana shops
than liquor stores
• Remarkably, despite being illegal for nearly 65 years,
domestically grown marijuana is one of the top 10
cash crops in the U.S.
What is a Dilute Specimen
• When the Creatinine or the specific
Gravity are low
• Creatinine <20 mg/dl and >2 mg/dl
• Specific Gravity =1.002
WHY DOES DILUTION WORK?
• Normal urine production is 1 ml/min
• Drink 1 liter of water and the urine production goes
to 7.5 – 8.5 ml/min from 30 – 150 min post
consumption
• Drink 2 liters of water and urine production peaks at
1 hr at 16ml/min and stays as high a 6 ml/min for 4.5
hrs
• Creatinine range on a random void – 100 – 200mg/dl
• Specific Gravity is the weight or mass of a given
volume of a substance compared to water.
Normal range = 1.010 – 1.025
Creatinine Normal vs. Diabetic
Population
140
Diabetics = 1284
Normal = 9375
120
100
80
Diabetic
Normal
Creatinine
60
40
20
0
40-49
D. Barr et al,2005
50-59
60-69
70+
N. de Fine Olivarius et al., 2006
Creatinine: Random Urine Spot Checks:
• Total Number = 534 – Average = 176 mg/dl
• Total Male
= 385 – Average = 190 mg/dl
• Total Female = 149 – Average = 141 mg/dl
THC - NEW VS. RESIDUAL – 50/15
NG/ML CUT OFF
• Positive test results separated by 1 month or
more normally indicate new use.
• All results should be normalized: ngTHC/mg
Creatinine
• A ratio of 1.5 or greater between sequential
positive test results indicates new use. This
has a degree of certainty of >99%. The longer
the period between testing the higher the
degree of certainty.
NEW RESEARCH STUDY
• Social user will clear THCA from the urine in 5 days
using a 15 ng/mg cut off
• Social users will clear THCA from the system in 7 days
using a 6 ng/mg cut off
Research paper by Huestis, Smith and Barnes ;JAT
May/June 2009
Calculation
ng Drug
X 100 = ng Drug/ mg Creatinine
mg Creatinine
NEW OR RESIDUAL
483
500
450
400
389
341
350
300
ng/ml 250
200
150
255
188
118
100
152
55
24.4
50
0
THCA ng/ml
Creatinine
mg/dl
ng THCA/mg
Creatinine
11/6/2006
11/14/2006
11/20/2006
NEW OR RESIDUAL
350
325
300
250
ng/ml
200
148
150
100
50
6/14/2006
6/20/2006
77
15
10.1
23
0
THCA
ng/ml
ng
THCA/mg
Creatinine
WHAT WILL CAUSE A POSITIVE
MARIJUANA
• SCREENING
1.Protronix, Nexium
2.Aids medications
3. NSAID
4.Prilosec
GC/MS
1.Marijuana/Marinol
COCAINE
COCAINE FACTS
• Cocaine is a white powder that is usually snorted but can be
injected
• Free Basing – purifying cocaine prior to injecting
• Crack – A form of freebasing - white to tan solid called rocks
• Cocaine is used in hospitals usually topically
• Medical problems – destruction of the nasal septum and lungs
• Cocaine cost $80 - $100 per gram
• Crack cost $5 - $20 per rock
• Crack produces a faster high than cocaine
• Cocaine high last 20 – 40 minutes
• Crack high last 5 -12 minutes
COCAINE FACTS
• Cocaine – takes 6 months to two years for a user to become
addicted
• Crack – 95% of users are psychologically addicted after the first
use
• Street names – coke, blow, snow, nose candy
• Central nervous system stimulant
• What’s it feel like -no need for food or sleep
• First used by Incas in 2500BC
• Sigmund Freud first recommended its use to treat morphine
and alcohol addiction
• Sherlock Holmes was a cocaine user
• 1800 added to wines received rave reviews from Pope Pius X
and the Grand Rabbi of France
PASSIVE INHALATION
• CONTROLLED STUDIES
– DR. ED CONE - 22-123NG/ML GC/MS
• REPORTS FROM ER
– POSITIVES DETECTED ON INFANTS AND CHILDREN
NO CONTROL OF INTRODUCTION OF DRUG.
BELIEVED TO BE PASSIVE COULD BE ORAL, FORCED
INHALATION, OR ABSORPTION
DERMAL ABSORPTION
• BASELT-5 MG FREE BASE APPLIED TO SKIN RESULTED IN
GC/MS LEVEL 55 - 9 NG/ML 12 TO 84 HRS AFTER
EXPOSURE
• FREDERICK-2 MG COCAINE HCL APPLIED TO SKIN
RESULTED IN 100 - 200 NG/ML 3 HRS AFTER EXPOSURE
• ELSOHLY-HANDS AND MONEY IMMERSED IN 70%
COCAINE POWDER RESULTED IN LOW LEVEL POSITIVES.
COCA TEA
• Health Inca Tea – each tea bag contains cocaine.
• Can the use of coca teas cause a positive urine drug
screen? Yes
INGESTION OF COCAINE
• Ingestion of 1 cup of Health Inca Tea –
containing 1.87 mg of cocaine.
• 4 test subjects
• Peak urine concentration of benzoylecgonine
occurred 4-11 hrs after ingestion
• Concentration 140-280 ng/ml
• Screen Positive for 21-26 hrs after ingestion.
11/18/2012
36
Red Bull Cola
• Made with cocaleaf extract
• Health Institute
in German found
0.13 mcg of
cocaine per can
• Germany
prohibited sales
in 6 states and
any recommend
a nation-wide
ban
37
Clove
• Oil of Cloves – Often used to treat
toothaches
• Clove contains Eugenol which has a
numbing effect
• Clove Cigarettes – made from tobacco
and cloves
• Clove Cigarettes - Illegal in Utah, New
Mexico and Maryland.
• Senate Bill in 2009 to make the
cigarettes a controlled substance failed.
• CDC – 2X more dangerous than tobacco
• Nausea, Seizures, Liver and Kidney
failure
38
NARCOTICS
NARCOTICS
Naturally Occurring
Street drugs
Synthetic
FACTS FROM DTAB MEETING
• 48.3% of Americans use 1 drug daily
• Most prescription drug use over 60 yrs of age
• Enough hydrocodone prescribed in 2011 that every
person in the US should have received 27 units.
• Methadone had high increase in prescriptions
• 7M people > or = to 12 yrs of age abuse drugs
• Most illegal use of prescription drugs comes from
friends and family
• Opiates account for >40% of unintentional drug
deaths in 2008
11/18/2012
January 2012
41
Info from SOFT meeting
• 402% increase in hydrocodone prescriptions
from 1997-2011.
• US consumes 90% of Hydrocodone produced
in the world.
• Medicaid patients have 6 times more opiate
OD’s than none Medicaid patients
• 15,000 opiate OD’s annually second only to
MVA
11/18/2012
July 2012
42
NATURALLY OCCURING OPIATES
•
•
•
•
MORPHINE – Prescription medications Astramorph PF, Oramorph
SR, Infumorph solution, Duramorph, MSIR MS Contin, Roxanol
and Morphine Sulfate. Nonprescription medications contain
opium which will be detected as morphine in urine: Amogel PG,
Ciabismul, Donnagel-PG, Infantol Pink, Kaodene with Paregoric,
Paregoric and Quiagel PG.
OPIUM – Non-prescription medications Amogel PG, Ciabismul,
Donnagel-PG, Infantol Pink, Kaodene with Paregoric, Paregoric
and Quiagel PG.
HEROIN – Illicit drug obtained from the opium poppy which is
native to Turkey.
CODEINE – Non Prescription medication Kaodene with Codeine
NATURALLY OCCURING OPIATES
• CODEINE – Prescription medications: Acetaminophen and Codeine,
Codeine Phosphate Oral Solution, Phenergan VC w/Codeine Syrup,
Phosphate Oral Solution USP, Codeine Sulfate Tablet Phenergan
w/Codeine Syrup, Acetaminophen and Codeine, Promethazine
Hydrochloride, Fiortal w/Codeine Capsules, Codeine Phosphate Syrup,
Acetaminophen and Codeine, Guaifenesin Syrup w/Codeine, RMS
Suppositories CII, Halotussin AC Syrup, Robitussin A-C
Syrup,Acetaminophen and Codeine,
Halotussin DAC Syrup,
Robitussin-DAC Syrup, Kadian Capsules, Codeine Phosphate Capsules,
Soma Compound w/Codeine Tablets, Capital and Codeine Oral, TussiOrganidin, Codeine Phosphate and Acetaminophen, Tylenol w/Codeine
Elixir,Codeine Phosphate in Tubex, Phenaphen w/Codeine Capsules,
Tylenol w/Codeine Table, Actifed with Codeine, Codimal PH Syrup,
Dimetane-DC Cough Syrup, Emprin with Codeine, Triaminic with Codeine
and Tussar-2.
SOURCES OF MORPHINE
MORPHINE
CODEINE
HEROIN
POPPY SEEDS
PERILOUS PASTRIES
•
•
•
•
HIGHEST MORPHINE - 11,571 NG/ML
HIGHEST CODEINE - 4,861 NG/ML
LONGEST DETECTION - 72+ HRS
MOST STUDIES INDICATE CONCENTRATIONS
OF 200 - 3000NG/ML
• CLEARANCE - 24 HRS
SYNTHETIC or SEMI-SYNTHETIC OPIOIDS
•
•
•
•
•
•
•
•
•
•
•
•
alphaprodine (Nisentil®)
hydromorphone (Dilaudid®)
oxymorphone (Numorphan®)
hydrocodone (Hycodan®, Lorcet-HD®, Vicodin®)
dihydrocodeine (Synalgos®)
oxycodone (Percodan®, Percocet®, Tylox®)
propoxyphene (Darvon®)
methadone (Dolophine®)
meperidine (Demerol®)
fentanyl (Duragesic®, Sublimaze®)
pentazocine (Talwin®)
buprenorphine (Buprenex®, Subutex®)
The Drugs and Metabolites
Opiates: Codeine
Expected Results
Drug
Urine may be positive for any of these
combinations:
After Codeine use…
•
•
•
•
Codeine only
Codeine and Morphine
Morphine only
Hydrocodone is a trace metabolite of Codeine.
Although rarely detected, it may be present if
Codeine concentrations are
very high.
49
The Drugs and Metabolites
Opiates: Morphine
Expected Results
Drug
Urine may be positive for any of these
combinations:
After Morphine use…
•
Morphine only
•
Hydromorphone is a trace metabolite of
Morphine found only when very high levels of
Morphine are present.
•
Morphine can also be present in urine after
ingestion of poppy seeds
(Levels are typically low, but can be as high as
2000-4000 ng/mL)
50
The Drugs and Metabolites
Opiates: Hydrocodone and Hydromorphone
Expected Results
Drug
Urine may be positive for any of these combinations:
After Hydrocodone use…
•
Hydrocodone only
•
Hydrocodone and Hydromorphone
•
Hydromorphone only
•
Norhydrocodone only
•
Hydrocodone, Hydromorphone and Norhydrocodone
•
Hydromorphone and Norhydrocodone
•
Hydromorphone only
After Hydromorphone use…
51
The Drugs and Metabolites
Opiates: Oxycodone and Oxymorphone
Expected Results
Drug
Urine may be positive for any of these combinations:
After Oxycodone use…
•
•
•
•
•
•
Oxycodone only
Oxycodone and Oxymorphone
Oxymorphone only
Noroxycodone only
Oxycodone, Oxymorphone and Noroxycodone
Oxymorphone and Noroxycodone
After oxymorphone use…
•
Oxymorphone only
0.15% Hydrocodone allowed in Oxycodone production
52
SIGNIFICANCE OF 6-AM
•
•
•
•
Heroin – half life in blood – 2-6 min
6-AM – half life in blood – 6-25 min
6-AM - elimination half life in urine 10 minutes
6-AM – only 45% of a 70 mg Heroin does was recovered
in the urine and only 1.3% was as 6-AM
• 6-AM – If present you can say beyond question of a
doubt the offender used Heroin
• 6-AM – If absent it does not mean the offender did not
use Heroin
• 6-AM – Effective 10/1/2010 automatic on all federally
mandated drug test.
Synthetic Analgesics
Testing for Opiates EIA will NOT react with
synthetic narcotic analgesics such as:
• Fentanyl
• Meperidine,
• Tramadol,
• Methadone,
• Propoxyphene,
• Buprenorphine,
54
Tramadol
Narcotic - Analgesic
Drug / Metabolite
Common Drug Name
Tramadol
Ultram®, Ultracet®, Ryzolt®,
O desmethyltramadol
Tramadol Metabolite
55
Meperidine
Narcotic - Analgesic
Drug / Metabolite
Common Drug Name
Meperidine
Demerol®, Mepergan®, Meprozine®,
Normeperidine
Meperidine Metabolite
Available as: Injection, tablets, syrup
56
Tapentadol
Narcotic - Analgesic
Drug / Metabolite
Common Drug Name
Tapentadol
Nucynta®
N-desmethyltapentadol
Tapentadol Metabolite
It is the first new drug of the centrally acting analgesic class
approved in the United States in more than 25 years
Available since 2009
57
METHADONE METABOLISM
METHADONE
EDDP
2-ethylidene-1,5-dimethyl1-3,3-diphenylpyrrolidine
METHADONE
• 1st synthesized by German scientist during WWII after the allies cuff off
the opium supply to Germany
• Methadone was brought to the US in 1947 and was used mainly to treat
narcotic addictions, primarily heroin
• The late1990’s saw an increase in the use of Methadone as a pain
medication
• 2001 medical examiners begin reporting an increase in Methadone
related deaths ex. Florida a 71% increase from 2000 to 2001
• April 2005 “American Family Physician” article promoting the use of
Methadone treatment for pain
METHADONE – Why the increase in
deaths
• For a non-tolerant adult a single days maintenance dose of
methadone(50-100 mg) can be lethal
• A routine starting dose of 40 mg (with individuals beginning
MMT) has lead to death after three days of treatment.
• The lethal dose is less when taken with other opiates,
alcohol, benzodiazepines or barbiturates.
• Methadone has a tendency to build-up in a users system
because of the long half-life
• Methadone has a long half-life: 15 – 55 hours
• Users increase dose more rapidly than they are developing a
tolerance
PROPOXYPHENE METABOLISM
PROPOXYPHENE
NORPROPOXYPHENE
PROPOXYPHENE
• Propoxyphene is a centrally acting analgesic with
pharmacologic effects similar to morphine
• The most common method of abuse is oral
ingestion of a legally prescribed capsule
• Repeated high doses can produce psychological and
physical dependence of the morphine type, as well
as tolerance
• Prescribed frequently, very popular in the south
and southwest
What is Buprenorphine?
• First introduced in Ireland in 1980
• First case of abuse presented in 1986
• Heralded as the new great weapon in the treatment
of opiate addiction.
• Derived from thebaine
• Prescribed by local physicians
• Readily available at local pharmacies
• High doses can actually precipitate withdrawal
symptoms in opiate addicted individuals
Why use Buprenorphrine?
•
•
•
•
Low abuse potential
Lesser degree of sedation and respiratory depression
No significant impairment of cognitive or motor skills
Has a “ceiling effect”-increased dose does not produce
increased effects after a certain point.
• Available with naloxone (Suboxone) to deter abuse. If a user
crushes and injects or snorts the Suboxone tablet, the
naloxone will cause withdrawal symptoms.
What’s Hot on the Street
65
OPANA - OXYMORPHONE
•
•
•
•
•
Released in extended release form July 2006
Very powerful semi-synthetic opioid analgesic
Available from 5 – 40 mg dose
6-8 times more potent than morphine
Medical Examiners Offices are reporting a dramatic increase
in overdose cases from Oxymorphone since July 2006
• Oxymorphone is the natural metabolite of Oxycodone
• Increase in Oxymorphone positives in urine drug analysis
• Highly addictive
OPANA – OXYMORPHONE - User
Experiences
• Took it a 2pm and stayed high until I passed out at 10pm. I felt
blissful and euphoric, very much like a heroin high. I will
definitely do it again.
• Got mine from an old lady with a script. Only $10.00 per
tablet. Great stuff. High kicked in in about 3 minutes. Telling
all my friends.
• I have been doing opiates daily for the last year. I snort
Oxycodone, morphine and swallow Hydrocodone tablets like
they are nothing. Heard about Opana and thought, another
pain killer that does nothing for you. I was wrong. I removed
the coating with water and snorted. It felt like I had done
60mg of Oxycodone.
• Better than heroin. Will tell all my friends
Dextromethorphan
• Robotripping – drinking OTC
products with Dextromethorphan
• Street names – DXM, Robo,
Skittles, CCC
• DXM found in over 120 OTC’s
• AAPC reported 52991 cases
involving DXM in 2008
• Ideal Dose – 200-400mg results in
euphoria and hallucinations
68
CHEESE
• STARTER HEROIN – HEROIN
MIXED WITH TYLENOL PM
(ACETAMINOPHEN AND
DIPHENDRYAMINE)
• TARGETED MARKET MIDDLE AND
HIGH SCHOOL
• HIGHLY ADDICTIVE – CREATES
EUPHORIA, DISORIENTATION,
SLEEPINESS AND HUNGER
• WITHDRAWAL COULD BEGIN AS
SOON AS 12 HOURS AFTER
DISCONTINUATION OF USE
• POPULAR IN THE WEST AND
SOUTHWEST
FENTANYL
• Approximately 4 times more powerful than
morphine
• Duragesic patch – Favorite form of abuse –
eaten
• Fentanyl Lollipops – Target children
SYRUP AND SODA
• Also know as Sizzurp, Purple Drank and Lean
• Mixture of Promethazine and Codeine cough syrup, Jolly
Ranchers and Sprite
• Popularized in rap culture particularly Houston
• Texas, Louisiana, Mississippi and Florida are reporting an
increase in misuse and deaths
• Effect – Euphoria and impaired motor skill
•
+
= Sizzurp
+
Kratom
Found in Thailand and Malaysia
• Powdered extract is $66/ 2 grams
• Powdered leaf is $15/ 28 grams
Effects
• Opiate like sedation high dose 20-50 gms
to coca like stimulation low does 10
grams
Duration
• Initial effect in 5-10 minutes Max effect in
15-20 minutes, but some effects can be
felt for 2-5 hours
Tea is common delivery
72
KRYPTON
Novel use of O desmethyltramadol linked to Kratom:
Sold as Designer Drug
O-desmethyltramadol has recently been marketed as
a "legal substitute" to illegal opioid drugs of abuse,
either in powder form or mixed into various other
preparations.
One such blend sold under the brand Krypton and
containing powdered kratom leaf (Mitragyna
speciosa) laced with O-desmethyltramadol, was
reportedly linked to at least 9 accidental deaths from
overdose.
73
STIMULANTS
OVER THE
COUNTER
PRESCRIPTION
ILLICIT
METHAMPHETAMINE
• 1919:Methamphetamine is first synthesized.
• 1936:The first reported misuse of amphetamines occurs by
student subjects in a research project at University of
Minnesota testing effects of the drug. Once exposed to the
drug, students were seeking and using the drug outside the
research study.
• 1940's:Methamphetamine is regularly issued to Japanese
soldiers.
• 1950's:Earliest record of intravenous methamphetamine use;
American soldiers in Japan and Korea report injecting heroin
and methamphetamine ("Speedballing").
• 1963:Illicitly manufactured methamphetamine first appears in
California.
• 2002:5.3% of Americans aged 12 and over say that they have
used methamphetamine at some point in their lives. 0.3% say
they have used it in the past month.
D-METHAMPHETAMINE
•
•
•
•
•
•
CRYSTAL METH, CRANK, ICE
CNS STIMULANT
HIGHLY ADDITIVE
CLEARENCE 24-48 HRS
METABOLITE-AMPHETAMINE
LEGAL SOURCES-DESOXYN, and DIDREX
L-METHAMPHETAMINE
• Sources – Selegiline and Vicks stick inhaler
• Identify – D/L isomer analysis
• Performed on request for methamphetamine
positives
• Positive L = < 20% D-Methamphetamine
AMPHETAMINE
• Prescribed for ADD, ADHD and weight
control
• Metabolite of Methamphetamine
ADDERALL ABUSE
The Good Grade Drug
How – Oral, snort, inject and stuffing
Strongest effect – inject, snort, oral, stuffing
Longest effect – stuffing allows for the use of the most
drug
Teenagers say they get them from friends, buy them
from student dealers or fake symptoms to their
parents and doctors to get prescriptions
The number of prescriptions for A.D.H.D. medications
has risen 26 % since 2007, to almost 21 million yearly,
a number that experts estimate corresponds to more
than two million individuals.
Doctors and teenagers from more than 15 schools across
the nation with high academic standards estimated
that the portion of students who do Adderall ranges
from 15 percent to 40 percent.
METHYPHENIDATE
Methyphenidate
Central Nervous Stimulant
Drug / Metabolite
Common Drug Name
Methylphenidate
Ritalin®, Metadate®, Concerta®, Focalin®
Ritanilic Acid
Methyphenidate metabolite
for internal use only. not for print or
distribution
80
MDMA
•
•
•
•
•
•
MDMA, XTC, ECSTASY, ADAM, X
STIMULANT AND HALLUCINOGENIC
LEGAL IN EUROPE 1914
SCHEDULE I IN U.S.
3,4-METHYLENEDIOXY METHAMPHETAMINE
RAVE PARTIES - TEENS AND YOUNG ADULTS
MDMA
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THE HUG DRUG - EMPATHY FOR OTHERS, REDUCES INHIBITIONS
DEHYDRATION - DRINK WATER
“SHORT CIRCUIT” SIGNAL TO BRAIN CONTROLING TEMPERATURE
TEETH GRINDING - PACIFIERS
SUPPRESS NEED TO EAT OR SLEEP
OD-HYPETHERMIA BODY TEMPS OF 107-109
SIMILAR DRUGS MDA AND MDEA
GREAT BRITAIN – Because animal studies have indicated that
MDMA increases extra cellular levels of the chemical
messengers serotonin and dopamine, researchers are
investigating the use of MDMA in various treatment
regiments. .
MDA
• Psychedelic, stimulant recreational
drug
• Appeared around 1963-1964
• Reported that MDA was the Mellow
Drug of America in the 60”s
• 3,4-Methylenedioxyamphetamine
MDEA
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Psychedelic, stimulant recreational drug
Street name EVE
Hyperthermia associated with use
3,4-methylenedioxy-N-ethylamphetamine
OTC
Caffeine Products
Available on the internet
33mg – 200 mg per dose
Cost $2.99-$10.99
Effect – CNS stimulant
High doses could cause
death
ENERGY DRINKS
• Contain Caffeine
• Hard to tell which have alcohol
• Sell those with and without alcohol side by side in
store
BOURBON & COKE VS. ENERGY DRINK
• Caffeine = 13 mg
• Alcohol = 0.6 oz
• Caffeine = 87 mg
• Alcohol = 1.12 oz
STRAWBERRY METHAMPHETAMINE
• BRIGHT PINK IN COLOR WITH A STRAWBERRY
FLAVOR
• KNOW AS STRAWBERRY QUICK
• STARTED IN CALIFORNIA AND MOVING EAST
• TAGETED MARKET MIDDLE AND HIGH SCHOOL
• IF THEY START YOUNG THEY WILL BE LONGTIME BUYERS
VYVANSE
• Used to treat Attention-Deficit/Hyperactivity
Disorder (ADHD)
• Lisdexamfetamine dimesalate
• Rapidly absorbed from the GI track and converted to
D-amphetamine
• Urine drug screen for someone on this drug would
result in a positive for D-amphetamine
• Abuse Potential- High
Methyphenidate
Central Nervous Stimulant
Drug / Metabolite
Common Drug Name
Methylphenidate
Ritalin®, Metadate®, Concerta®, Focalin®
Ritanilic Acid
Methyphenidate metabolite
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DEPRESSANTS/TRANQULIZERS
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Metabolism of Benzodiazipines
Ketazolam
Loftran
Diazepam
Valium
Chloradiazepoxide
Librium
Nordiazepam
Clorazepate
Tranxene
Halazepam
Paxipam
Prazepam
Centrax
Temazepam
Restoril
Oxazepam
Serax
Camazepam
Paxor
Metabolism of Benzodiazipines
Alprazolam
Xanax
a-Hydroxyalprazolam
Lorazepam
Ativan
Clonazepam
Klonopin
7-Aminoclonazepam
Phenazepam
• Developed in Russia
• Benzodiazepine
• Not Controlled under Federal Law- this is a
a non-scheduled drug available on the
internet
• States can schedule this drug
• Louisiana and Arkansas have classified this
drug as a schedule 1
• Dosage – 0.5 mg X3 daily max 10 mg
• 1 mg phenazepam = 10 mg Diazepam
• Cost - $28.00/gram or .01 per dose
• Mr. Smiley Bars - $5.99/pack
• Not currently being tested by labs
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Tricyclic Antidepressants
Antidepressants
Drug / Metabolite
Common Drug Name
Amitriptyline
Elavil®, Endep®
Nortriptyline
Doxepin
Aventyl®, Pamelor®, Amitriptyline
metabolite
Adapin®, Sinequan®
Desmethydoxepin
Doxepin Metabolite
Imipramine
Tofranil®
Desipramine
Norpramin®, Imipramine Metabolite
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SSRI Antidepressants
Selective Serotonin Reuptake Inhibitor (SSRI)
SSRI
Drug / Metabolite
Common Drug Name
Fluoxetine
Prozac®,
Norfluoxetine
Fluoxetine Metabolite
Sertraline
Zoloft®
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Meprobamate/Carisoprodol
Tranquilizer – Muscle Relaxant
Drug / Metabolite
Common Drug Name
Meprobamate
Equanil®, Miltown®,
Carisoprodol Metabolite
Soma®
Carisoprodol
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The Z Drugs
Sedative - Hypnotic
Drug / Metabolite
Common Drug Name
Zolpidem
Ambien®
Zaleplon
Sonata ®
Zopiclone
Lunesta ®
for internal use only. not for print or
distribution
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Neuropathics
Anticonvulsive
Drug / Metabolite
Common Drug Name
Gabapentin
Neurontin®
Pregabalin
Lyrica ®
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Barbiturates
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Barbiturates: Drug Facts
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Most commonly abused barbiturates include
– Amobarbital (Amytal)
– Pentobarbital (Nembutal)
– Secobarbital (Seconal)
Medical uses
– Epilepsy
– Sleep disorders
– Relief from anxiety, nervousness, & restlessness
Generally replaced by safer alternative – benzodiazepines
Street Names: barb, black beauty, blue, downer, pink, yellow jacket
First synthesized on 1862, St. Barbara’s Day
Method of administration: orally by tablet
Clearance
– Short-acting = 24 to 48 hours
– Medium-acting = 48 to 96 hours
– Long-acting = 14 to 21 days
Barbiturates
Central Nervous Depressants
Drug / Metabolite
Common Drug Name
Butalbital
Fiorinal®, Fioricet®
Butabarbital
Butisol®, Butibel®
Amobarbital
Amytal®
Pentobarbital
Nembutal®,Thiopental®
Secobarbital
Seconal®
Phenobarbital
Luminal® , Belladonna
Primidone® (metabolite)
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HALLUCINOGENS
LSD
PCP
PSILOCYBIN
MESCALINE
PHENCYCLIDINE
PHENCYCLIDINE
• PCP-Angel dust, rocket fuel
• Commercial use as equine anesthetic
• Produces hallucinations, violent hostility, acute
anxiety, paranoia, and a feeling of impending
doom
• Inexpensive and easy to make
• Not a popular drug of abuse
MESCALINE/PEYOTE
LSD
PSILOCYBIN
Do you recognize this plant?
Morning Glory Seeds
• Active ingredient
• Lysergic Acid
Amide (LSA)
• Closely related
to LSD
• Acts as psychedelic
or hallucinogen
• Schedule III, but sold
in nurseries, etc.
• Used by the Aztec
and still popular in
southern Mexico
• Effects last 6-8 hours
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Angel’s Trumpet
• Also known as Borrachero Tree –
same family as Jimson Weed
• Called Devil’s Breath
• Contains: Belladonna alkaloids
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Atropine
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Scopolamine
• Drink as a tea in U.S. Used as
powder in Columbia
• Hallucinogenic, zombie
like reaction
• 50,000 cases reported in
Columbia – often deadly
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Smoking nutmeg
• Contains Myrista oil (similar to mescaline) and elemicin
(used to treat depression)
• Desired effect – Hallucinations and delusion
• Undesired effect – Damage to the lungs, convulsions,
fever, palpitations and death
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DMT- Psychedelic Tryptamine
• DMT =N-Ndimethyltryptamine
• DEA Schedule I
• Delivery– smoked – 15-60
mg
• Cost – Single dose -$10 - $30
• Retail - $60 - $300
• Effect – in 10-60 seconds
• Duration – 5-20 minutes
• Back to normal – 1-2 hrs
• Documented as early as the
• 700’s as snuff from grave
sites
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DMT- Psychedelic Tryptamine
• DMT can also come from your back yard.
• Directions to extract DMT from plant
material readily available on the internet
• Ingredients.....
1.Sodium Hydroxide i.e. Caustic Soda (aka
Lye)
(minimum of 5g for extracting 20g of
Mimosa root or bark)
2.Naphtha (Ronsonol Lighter Fluid /
Newport Lighter Fluid 4 Zippos or a
similar type)
3.Tap water
4 Mimosa bark (20g minimum extraction)
http://www.botanicalspirit.com
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The next controlled substance
• Sonoran Desert
Toad
• Hallucinogenic
compound secreted
on the skin 5-MeODMT
• 5 methoxy-N,N-dimethyl
tryptamine
INHALANTS
GASES
NITROUS OXIDE
AEROSOLS
SOLVENTS
INHALANTS
INHALANT FACTS
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These are chemicals which cause intoxication when sniffed or inhaled
Cause brain liver damage
Death is caused by suffocation and or heart failure
What can be inhaled? – Hair spray, butane lighters, glue, felt-tip markers,
white out gasoline, whipping cream, paint thinner, deodorants, air
fresheners, nitrous oxide (laughing gas), amyl nitrite
• How are they used? – Poured or sprayed into a bag or balloon and the
fumes are inhaled. The bag may be placed over the face. Poured or
sprayed into soda pop can and inhaled.” Huffing”- soak a rag, sock, paper
towels in an inhalant and place in the mouth
FDA Website
• http://www.fda.goc/Drugs/ResourcesForYou/Consumers/Buyi
ngUsingMedicineSafely/MedicationHealthFraud/ucm234539.
htm
• Information on drugs found in products you can purchase on
the internet.
• Examples of information
• Sexual Enhancers
• Contain either compounds chemically similar to
sildenafil (Viagra) or actually contain sildenafil
• Passion Coffee
• Black Ant
• Weight Loss Products
• Contain sibutramine
• Celerite Slimming Tea
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Where to get More Information
Websites
• Erowid
• www.erowid.org
• US DOT Office of Drug & Alcohol Policy & Compliance
• www.dot.gov/ost/dapc
• SAMHSA Division of Workplace Programs
• www.drugfreeworkplace.gov
• RTI Forensic Science Education
• www.RTI.org/forensiced
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QUESTIONS?
Thank You!
Pat Pizzo, Director of Toxicology
Alere Toxicology
pat.pizzo@alere.com
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