drug abuse lecture part 2

8/3/2019 Drug Abuse Lecture Part 2

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How abused: Smoked in cigarettes or pipe;occasionally eaten as

ingredient baked into

confections.

Typical urine detection cutoff level: 100 ng/mL or 20

ng/mL (optional)

Period detectable after last dose: This is highlyvariable. A one joint per week user has detectable

levels of cannabinoids form 7 to 34 days, while aheavy daily user may be detected from 6 to 81 daysafter last use.


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Substances causing false positive results: nonereported.

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

At the cutoff level of 100 ng/mL, persons exposedpassively to the smoke of others by virtue of beingin the same room with abusers should be negativeon urine drug screen, although more sensitive

chemical techniques (such as gaschromatography/mass spectrometry, which has asensitivity of 10 ng/mL) may demonstrate the drugin such an individual's urine.


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COCAINE

Cocaine hydrochloride is the typical form used byabusers who ingest the drug by snorting the granular

form into the nose; It can also be dissolved in water and injected

intravenously. Cocaine base is available in a waxy cake form ("rock"

or "crack") which is vaporized with a torch and the

vapors inhaled through a tube.Medical uses: Used almost exclusively by ear, nose

and throat doctors to produce local anesthesia andcontrol blood loss during minor nasal surgery.


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Effects attractive to abuser: Euphoria, increasedability to concentrate, increased alertness,

heightened ability to perform intellectual andphysical tasks, sexual stimulation, heightenedsociability, enhanced self-confidence.

Adverse effects: Restlessness, nervousness,

tremor, convulsions, disturbances in heartrhythm, psychological dependence, myocardialinfarction, sudden death.

How abused: Snorted, injected, or smoked (see

above).


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Typical urine detection cutoff level: 300 ng/mL

Period detectable after last dose: 8-48 hours

Note: The laboratory detection of cocaine is performed byanalyzing the urine for the presence of benzoylecgonine, asubstance produced by the body's chemical detoxification ofcocaine. Continuous conversion of cocaine to the metaboliteoccurs in voided, standing urine specimens (even with

fluoridation and refrigeration) unless the specimen is kept atacid pH (


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Substances causing false positive results: none

reported

However, some legal South American herbal teasmay contain small amounts of coca leaf extract,

which may trigger a positive test in an "innocent"

subject. Please note that cocoa, cacao, and CocaCola are all completely unrelated to coca, which is

the source of cocaine.


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METHAQUALONE

Examples: Quaalude,

Sopor

Medical uses: Once used as a sleeping

pill/sedative, now methaqualone is virtually never

used for medical purposes.

Effects attractive to abuser: Same as that for

barbiturates (see above)

Adverse effects: Same as that for barbiturates (see

above) How abused: Pills taken orally.


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Period detectable after last dose: up to 90 hours,

depending on dose

Substances causing false positive results: none

reported.


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PHENCYCLIDINE

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

human medicine.

Effects attractive to abuser: Hallucinogenic effectsAdverse effects: Lethargy, loss of coordination;

unpredictable psychosis, sometimes with criminallyviolent behavior; death.

How abused: Taken orally, smoked in cigarette (oftenmixed with marijuana), injected intravenously as asolution, snorted into the nose in granular form.


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Period detectable after last dose: 5-10 days

Substances causing false positive results:

Thioridazine (Mellaril), an antipsychotic drug, has

been reported to cause false positive results, as

has the insecticide parathion.


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Legal Aspects of

Drug Testing


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ALCOHOL (ETHANOL)

Examples: Beer, wine, distilled

spirits

Medical uses: Rarely, ifever, used for medical purposes.

Effects attractive to abuser:

Release of social inhibitions,euphoria, sedation

Adverse effects: Same as that for barbiturates

(see above).


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ALCOHOL CONTENT OF WINE AND BEER% Ethanol

(grams/

100 ml

Dose

(ml)

Ethanol

(grams)

Number of

drinks per day

Toxic Threshold

WINE 12% 120 ml 11.5 g Men- 4

Women- 1 to 2

BEER 4% 360 ml 11.5 g Men- 4

Women- 1 to 2

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Pregnant women, even in small ("social")

amounts may have adverse effect on the

fetus.


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ETHANOL IN ALCOHOL IS DANGEROUS!

ANYONE TAKING MORE THAN SIX DRINKS A

DAY IS RISKING PERMANENT LIVER DAMAGE

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Ethanol is absorbed in the stomach into the

bloodstream and is delivered to the liver where it isbroken down

If the liver is regularly overloaded with alcohol, liver

cells are damaged

Damage to the liver cells results to CIRRHOSIS, a

permanent liver damage leading to total failure and

death.

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How abused: Drunk in beverage Period detectable afterlast dose: 8-10 hours

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

Illegal use (as in driving while intoxicated) is defined bythe presence of a blood alcohol level of greater than 100mg/dL (0.10% by volume) in Texas (lower in some otherstates).

It is impossible to determine if a subject is legallyintoxicated by measurement of the urine alcohol level. Ablood specimen must be collected for this determinationto be made by a clinical laboratory.


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Screening DrugTesting Laboratory

Organization


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Clinical pathologist

Physician trained in laboratory management

and quality assurance program

Licensed physician, chemist, medical

technologist, pharmacist, or chemical

engineer drug testing lab is a division,

section, unit of a clinical lab

Administrative and technical functions

Head of the Laboratory


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Chemist

Medical Technologist

Pharmacist Chemical Engineer

Verifies completeness of CCF

Prepares specimen for analyses

Examines, processes and analyzes specimen

Interprets, records, releases and signs out lab reports

Analyst


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A trained individual who instructs, assists a donor at

collection sit, receives and makes an initial inspection

of specimen for drug testing and initiates and

completes the CCF

At least high school graduate Must have undergone training in specimen collection Ensures specimen integrity at collection site

Performs correct specimen collection

Ensures security of procedure Accomplishes CCF correctly

Performs initial specimen validity

Authorized Specimen Collector


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Employer of client/ donor/ subject

Investigator at crime scene

Complainant Owner/ administrator of establishment

NOT authorized to collect specimen


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Specimen

Collection


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Within the laboratory

Hand washing facility outside of toilet

Toilet coloring agent

All mandatory tests except for crime scene and

post accident

Collection site


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Workplace, school, jail, rehab, site of crime

Critically ill/ disabled

PERMIT from BHFS 10 days prior

Minimum of 20 tests

No testing should be done at the site

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

Remote collection site


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Collection

Procedure


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Photo IDdrivers license, employee ID,

passport

Identification by authorized agency

representative

And other ID allowed by agencys workplace

drug testing plan

Donor Identification


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Id by a co-worker

Id by another donor

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

Unacceptable forms of ID


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Check ID of donor

Explains collection procedure

Fill up step 1 of CCF asks donor to remove outer garments

Examines pockets etc

Asks donor to wash hands

Asks donor to select specimen bottle and label

Steps in collection


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Urine Validity


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Reasons for conducting validity test:

Unobserved urine collection

Suspicion that the urine specimen has been tampered

A test to determine the integrity of thesamples.


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Reasons for conducting validity test:

Unobserved urine collection

Suspicion that the urine specimen has been tampered

A test to determine the integrity of thesamples.


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Adulterated, substituted or diluted

Improperly collected, handled and stored

Improperly documented

Urine is considered invalid


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Adulterated pH less than 3 or greater than 11

Nitrite greater than 500

Diluted Specific gravity of less than 1.003

Creatinine less than 1768 umol/L

Substituted pH less than 2 or greater than 9

Specific gravity less than 1.033 or greater than 1.020

Creatinine less than 442 umol/L

Tampered Urine Specimen


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Recording


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Results should be issued within 15 days

Positive screening results should be subjected

to confirmatory testing

Screening laboratory is the ONLY one

authorized to release the FINAL report

Results cannot be relayed through the

telephone


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CCF for the confirmatory lab (form DT-oo2D)

Request for confirmatory Drug Testing

Uploaded result of DTOMIS

Sample properly labelled and sealed

If found positive:


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THANK YOU!

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drug abuse lecture part 2

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