DRUG TESTING 101 - Arizona State University · 2019-12-19 · Drug Testing 101 & Mythbusters Donor ‘s photo ID verified and signs log book. CCF is initiated. CST collects all supplies

DRUG TESTING 101

2

TOPICS OF DISCUSSION

Collection/Chain of Custody

Sample Media Comparison / Detection

Dilution/Adulteration/Substitution

Ethyl Glucuronide

Opiates

Benzodiazepine

THC New Usage

New Drug Trends

3

COLLECTIONSChain of Custody

Drug Testing 101 & Mythbusters 2015

4

CHAIN OF CUSTODY

Drug Testing 101 & Mythbusters

Donor verification: Picture ID Signature on CCF Signature on bottle label

TASC CST documentation: Time of Collection Collection Observed and Temperature

Checked

Signed by lab staff upon receipt into laboratory

2015

5

URINE COLLECTION


Client‘s photo ID verified and signs log book. CCF is initiated.

ID verified by CST at restroom

Restroom for visual observation

CST verifies CCF with client after sample collected

Security seal applied in client’s presence

Client signs security seal on container & CCF

Sample placed in secure storage

2015

6

HAIR FOLLICLE


Client ‘s photo ID verified and signs log book.

Client’s paperwork is filled out by donor

CST lays out all supplies & explains the procedures

CST sanitizes supplies in front of client

CST collects 90-120 strands of hair (samples from 3 different spots on the crown)

CST places samples on the foil in front of the client

2015

7

HAIR FOLLICLE


CST wraps hair sample in the foil

CST shows the client the envelope to confirm it is empty and places the hair in the envelope.

CST closes the envelope and has the client initial and date it verifying it is their sample.

CST places the chain of custody and sample into the bag and seals it in front of the client.

CST gives the client a copy of the chain of custody that was put with the sample.

Sample placed in secure storage

2015

8

ORAL FLUID


Donor ‘s photo ID verified and signs log book. CCF is initiated.

CST collects all supplies & explains testing procedures.

CST will fill out donors information on the test tube

CST opens a sealed pouch containing the oral swab, opens the red cap, hands the non absorbent end of the swab to the client to put in their mouth. CST will wait until blue line fully appears on the indicator.

CST will take the sample and place it back in the test tube and put the red cap on it.

CST will put paperwork and sample into the sample bag and seal it in front of the client.

CCF sticker is placed over top of the container and signed by client then sealed in bag. Sample placed in secure storage

2015

9

SAMPLE MEDIA / DETECTION


10

SAMPLE MEDIA


Various sample media types available to implement a drug abuse monitoring program

Hair, Oral Fluid, and Urine- most common

Blood and Sweat - uncommon

Each media type has it’s advantages/disadvantages

2015

11

HAIR FOLLICLE


Pros Effective baseline test – Unknown drug use

history

Adulteration difficult

ConsNot useful for routine monitoring since the

drug use cannot be pin-pointed

Limited test menu

Head hair may not be available/ Potential issue with treated hair

May not pick up a single drug use

Detection times are: Head hair: 14-90 days priorBody hair: 30-365 days prior

2015

12

ORAL FLUID


Pros Samples may be collected in the field and does

not require same gender collection.

If its collected correctly it is difficult to adulterate

Is recommended for clients that may be on certain medications or for medical reasons (Dialysis/catheter)

Cons Short detection period

Ineffective for THC and EtG Detection

Moderate cost

Detection time is 12-36 hours/ 6-8 hours for THC

2015

13

URINE


ProsAbility to split the sample for additional testing

Industry standard

Long history of legal acceptance

Broad, cost effective menu

ConsRequires visually observed collection to avoid

adulteration/substitution

Potential for specimen dilution/adulteration in vivo and in vitro

Detection time is 24-72 hours

2015

14

DETECTION TYPES FOR EACH MEDIA


Media Approximate Detection Period

Urine 24-72 hours

Oral Fluid 12-36 hours / 6-8 hours THC

Hair Head hair: 14-90 days priorBody hair: 30-365 days prior

Blood 8-36 hours

Sweat 1-4 weeks (period patch is worn)

2015

15

URINE DETECTION TIMES


Stimulants:Amphetamines, Cocaine, Ecstasy, 24-72 hrsBath Salts

Narcotics / Narcotic Analgesics:Methadone, Opiates, Propoxyphene 24-72 hrs

Sedative HypnoticsBarbiturates, Benzodiazepines 24-72 hrs / 2-6 wks*

Hallucinogens:Marijuana 24-72 hrs / 2-6 wks*PCP, LSD 2-5 days

Depressants:Alcohol 1-12 hoursEthyl Glucuronide (EtG) 8-72 hours

*It is always recommended to order a GCMS or a LC-MS/MS confirmation if a client is contesting the result.

2015

16

MEDIA STRATAGIES

Hair Use to establish a “baseline” at beginning of program Use if client misses over 30 continuous days of testing

Urine Random Schedule: Variable from 1x/month to 2x/week Fixed Schedule (2x/week): Every Mon/Thu or Tue/Fri Intensive: Every Mon/Wed/Fri

Oral Fluid Medical reasons (Dialysis / Catheter) Testing 2x/week recommended


17

DILUTION/ADULTERATION/SUBSTITUTION


18

DILUTED

In vivo dilution is the most common method employed to circumvent a drug test.

Principle:The ingestion of copious amounts of fluids prior to providing a urine sample in order to induce polyuria and ultimately lower the concentration of drugs in the bladder below the detectable limit.


19

EFFECTS OF WATER LOADING


20

DIURETICS


Natural diuretics are natural foods and herbs that induce the removal of excess fluids in the body by increasing urination.

Caffeine, fruits and vegetables, fruit juices, some herbs like green tea.

Diuretic drugs treat edema caused by disorders of the heart, kidneys, liver or lungs. They are used commonly in treatment of hypertension.

21

DILUTION INTERPRETATION


Is there a history of diluted samples?

Are there occurrences of missed scheduled or random testing dates?

Results of recent prior and subsequent samples “Positive” for drug(s)?

Is the donor under medical supervision that dictates use of diuretics and/or high fluid intake?

Intentional or Incidental Dilution?

22

ACTING ON DILUTED SAMPLES


Establish a procedure for handling diluted samplesDefine non-complianceDetermine ramifications

Document donors understanding of compliance

Consider Negative Dilute samples to be Non-Compliant

23

ADULTERATION


Nationwide product distribution InternetSmoke shops or “head shops”Mail order / magazine advertisements

Offer next-day delivery with money-back guarantees

Disseminate misinformation to perpetuate myths about drug testing

Make exaggerated and unsubstantiated claims as to the efficacy of their products

2015

24

COMMON METHODS


Physical Tampering - Additives

Specimen Substitution

Devices

2015

25

THE ADULTERANT INDUSTRY

Nationwide product distribution Internet, smoke shops or “head shops” and mail order / magazine advertisements

Offer next-day delivery with money-back guarantees

Will go off of myths to get people to buy their product.


26

SPECIMEN SUBSTITUTION


Dehydrated urine

Non-urine liquids

Also used in devices

2015

27

DEVICES

Concealed beneath clothing

Utilizes drug-free urine

Maintains proper urine temperature with heating pads or digital heating packs

Typically sold to males; may include prosthetic penis

Typically very expensive / single use only

TASC has a very specific monitoring system and clients are instructed to use very detailed testing procedures


28

CONFISCATED DEVICES


The Whizzinator

29

CONFISCATED DEVICES


DIY Devices

30

CONFISCATED DEVICES


Female Devices

31

VISUAL MONITORING COLLECTION


Female Restroom Male Restroom

One way mirror to view collection

Bluing agent in toilets

No hot water

No chemicals in area

Remove excessive clothing

No items allowed in restroom

2015

32

ALCOHOL TESTING

33

URINE ALCOHOL

Alcohol can be detected in the urine for approximately 12 hours.

Potential for a false positive due to sugars in urine.Diabetic individuals who are not being treated.Bacteria in urine ferments sugars into alcohol. Glucose test should be performed on a positive sample.

34

ETHYL GLUCURONIDE (ETG)Ethyl Glucuronide (EtG) is a unique biological metabolite that isformed in the body after the consumption of ethanol, typicallyfrom drinking alcoholic beverages.

Reported to be detectable in urine typically from 8-80 hours after ingestion, and 2-36 hours in blood

EtG is detectable over a period roughly 5-6 times longer than traditional urine ethanol testing

Detectable in oral fluid only a few hours longer than ethanol*

EtG has also been isolated in hair follicles*G.Heiseth, B. Yttredal, et.al. ; JATox: July 2010

35

URINE ETG

EtG is realistically detectable for approximately 6-72 hours at the industry norm 500 ng/mL cutoff limit

Peak urine detection time is approximately 8 hours after ingestion event

Normal urinary EtG levels in abstainers are

36

HOW MUCH ALCOHOL DID MY CLIENT DRINK?

• It is not possible to determine the amount of EtG that will be produced from a measure of Ethanol (or vice versa) -Retrograde extrapolation cannot be performed

• Metabolism of Ethanol and EtG and EtS is genetically determined - Variability between individuals could be a 200-fold difference!

• Age, gender, race, physical health, diet, metabolism, and time of sample collection are but a few significant variables that can affect EtG detected.

37

WHY TEST ETS?

EtG can possibly disappear (or be degraded) in urine due to certain bacterial contamination of the sample

EtS is not degraded by common bacterial contaminants

EtG can be synthesized by bacteria (such as E. coli ) in-vitro in the presence of alcohol (!)*

Presence of both EtG and EtS is a strong indicator of alcohol consumption

Presence of EtS alone may indicate alcohol consumption in conditions where the sample is contaminated (UTI infection)*A. Helander, et.al. ; ClinChem: August 2007

38

EXAMPLE ETG OBSERVATIONS

Two non-alcoholic beers EtG concentration after 12 hours: 93 ng/mL –

Negative

A teaspoon of communion wine EtG concentration after 12 hours: 77 ng/mL

Negative

Three 1 oz doses of Nyquil over 24 hoursEtG concentration after 12 hours : 246 ng/mL

Negative-

Compiled from various sources

39

EXAMPLE ETG OBSERVATIONS

• Single Beer (4.5% Alcohol) Positive EtG above the 500 ng/mL cutoff level for 16 hours Concentration peaking at 4,000 ng/mL after 4 hours

• Three glasses of wine (12% Alcohol) consumed over 3 hours Positive EtG above the 500 ng/mL cutoff level for 32 hours Concentration peaking at 68,000 ng/mL after 14 hours

• Six shots of vodka over 3 hours ETG in the range of 10,000 ng/mL –100,000 ng/mL Peaked at 16 hours and detectable for 54 hours

Compiled from various sources

40

HYGIENE PRODUCTS

Hand sanitizer applied every 15 minutes for 8 hours Maximum EtG of approx 50 ng/mL – Negative

Gargling mouthwash 3 times a day for 5 days Maximum EtG concentration of 117 ng/mL – Negative

Gargling mouthwash 4 times a day for 78 hours Maximum EtG level: 173 ng/mL - Negative

41

SUMMARY

If usage is denied, confirmation is Highly Recommended LC-MS/MS Quantification of EtG and EtS

Avoid significant sanctions when: EtG is confirmed below 500 ng/mL

Consider Medical Conditions Diabetics Clients with Urinary Tract Infections

Implement a Client Agreement to avoid incidental exposure

42

OPIATES

43

OPIATESPrescription/Drug Opiate Parent Drug/Metabolite

Heroin Diacetylmorphine 6-MAM, Morphine, Codeine

Tylenol #3, #4 Codeine Codeine, Morphine

MS Contin, Roxanol

Morphine Morphine, Hydromorphone

Vicodin, Vicoprofen, Tussionex, H-C Tussive

Hydrocodone Hydrocodone, Hydromorphone

Dilaudid Hydromorphone Hydromorphone

Oxycontin, Percodan, Percoset, Roxicet

Oxycodone Oxycodone, Oxymorphone

Opana Oxymorphone Oxymorphone

44

BENZODIAZEPINES

45

BENZODIAZEPINES

Prescription Benzodiazepine Parent Drug/Metabolite

Versed Midazolam Midazolam, Hydroxymidazolam

Prosom Estazolam Estazolam, Hydroxyestazolam

Restoril Temazepam Temazepam, Oxazepam

Rohypnol Flunitrazepam Flunitrazepam, Desalkylflunitrazepam, 7-Aminoflunitrazepam

Serax Oxazepam Oxazepam

Valium Diazepam Diazepam, Nordiazepam, Temazepam, Oxazepam

Xanax Alprazolam Alprazolam, Hydroxyalprazolam

46

BENZODIAZEPINES

Prescription Benzodiazepine Parent Drug/Metabolite

Ativan Lorazepam Lorazepam

Centrax Prazepam Prazepam

Dalmane Flurazepam Flurazepam, Hydroxyethylflurazepam

Halcion Triazolam Triazolam

Klonopin Clonazepam Clonazepam, 7-Aminoclonazepam

Librium Chlordiazepoxide Chlordiazepoxide, , Nordiazepam, Oxazepam

47

THC

48

THC DETECTION PERIOD

THC metabolites are fat-soluble, and may be retained in fatty tissue depending upon dosage and recent usage history

• May take time to produce consistent negative urine samples

Casual users: 2-5 days Chronic users: 3-6 weeks

49

DETERMINING NEW USE

THC:Creatinine (THC:CRE) ratios are commonly used to normalize sample dilution effects.

The ratios can be used directly to monitor THC abstention and elimination, or to determine the probability of a new usage event.

Most effective when interpreting GCMS analyses

50

THC:CREATININE RATIO

Ratio is calculated as:THC (ng/mL) X 100 = THC:Cre (mg/mg)

Creatinine (mg/dL)

51

THC ELIMINATION

THC Half-Life

Urinary THC excretion half-life is 1-10 days depending on usage history (mean half-life is 3.0 ± 2.3 days)‡

1 day for infrequent/casual users10 days for heavy/chronic users

‡Johansson et al, J. Anal Toxicol 13: 218-223 (1989)

52

0

50

100

150

200

250

0 4 8 12 16 20 24 28 32 36 40

THC

Con

cent

ratio

n (n

g/m

L)

Days Since Abstention

THC Elimination - Usage Comparison

Chronic

Casual

EIA Cutoff

GCMS Cutoff

Chronic User

Casual User

Chart4

000250

222225

444195

666166

888145

101010125

121212108

14141493

16161680

18181871

20202062.5

22222255

24242448

26262643

28282836.5

30303031.25

32323227

34343423

36363620

38383817

40404015.625

Casual

EIA Cutoff

GCMS Cutoff

Chronic


THC Concentration (ng/mL)


250

50

15

125

50

15

62.5

50

15

31.25

50

15

15.625

50

15

7.8125

50

15

3.90625

50

15

1.953125

50

15

0.9765625

50

15

0.48828125

50

15

0.244140625

50

15

0.1220703125

50

15

0.0610351563

50

15

0.0305175781

50

15

0.0152587891

50

15

0.0076293945

50

15

0.0038146973

50

15

0.0019073486

50

15

0.0009536743

50

15

0.0004768372

50

15

0.0002384186

50

15

Sheet1

DaysCasualChronicEIA CutoffGCMS Cutoff

02502505015

21252255015

462.51955015

631.251665015

815.6251455015

107.81251255015

123.906251085015

141.953125935015

160.9765625805015

180.48828125715015

200.24414062562.55015

220.1220703125555015

240.0610351563485015

260.0305175781435015

280.015258789136.55015

300.007629394531.255015

320.0038146973275015

340.0019073486235015

360.0009536743205015

380.0004768372175015

400.000238418615.6255015

420.00011920935015

440.00005960465015

460.00002980235015

480.00001490125015

0250

10125

2062.5

3031.25

4015.625

507.8125

603.90625

Sheet1

Casual

EIA Cutoff

GCMS Cutoff




Sheet2

Chronic

Sheet3

Casual

EIA Cutoff

GCMS Cutoff

Chronic




THC ClearanceTHC Clearance Data

0

50

100

150

200

250

300

350

400

450

0 8 16 24 32 40 48 56 64 72

Days until Clean

Num

ber o

f Clie

nts

99% of Population Negative by 6 weeks

- - -Median: 18 days

D. Kramer; TASC (2009)

Chart1

0

8

16

24

32

40

48

56

64

72

Dataset

Days until Clean

Number of Clients

THC Clearance Data

277

392

354

386

350

219

113

24

4

1

Sheet1

081624324048566472

20027.4010013.705006.852503.431251.71625.86312.93156.4678.2339.12

6177.423088.711544.36772.18386.09193.0496.5248.2624.13Half-Life of 8 Days

5345.102672.551336.28668.14334.07167.0383.5241.7620.88

4337.852168.931084.46542.23271.12135.5667.7833.8916.94DaysClients% Pop

3905.531952.77976.38488.19244.10122.0561.0230.5115.26027713.1%13.1%

3379.471689.74844.87422.43211.22105.6152.8026.40839218.5%31.6%

3286.261643.13821.57410.78205.39102.7051.3525.671635416.7%48.3%

54

DETERMINING A USAGE EVENT

Medical-Legal MethodManno, et. al. (1984)‡

If THC:Creatinine ratio between samples increases ≥ 50%,new usage on or between these dates is suspected

False Positive/Interpretation Rate: 0.1% False Negative/Interpretation Rate: 24%

‡Manno et al; The Cannabinoids: Chemical, Pharmacologic, Therapeutic Aspects; Academic Press (1984)

55

0 3 7 10 15 22THC (EIA) 170 128 88 75 40 30Creatinine 105 128 112 120 120 99THC:Cre 162 100 79 63 33 30

0

50

100

150

200

250

THC Concentration vs. THC:Creatinine Ratio

THC (EIA)CreatinineTHC:Cre

Normal Hydration

Chart11

00161.9047619048

33100

7778.5714285714

101062.5

151533.3333333333

222230.303030303

THC (EIA)

Creatinine

THC:Cre


170

105

128

128

88

112

75

120

40

120

30

99

Sheet1


02502505015

21252255015

462.51955015

631.251665015

815.6251455015

107.81251255015

123.906251085015

141.953125935015

160.9765625805015

180.48828125715015

200.24414062562.55015

220.1220703125555015

240.0610351563485015

260.0305175781435015

280.015258789136.55015

300.007629394531.255015

320.0038146973275015

340.0019073486235015

360.0009536743205015

380.0004768372175015

400.000238418615.6255015

420.00011920935015

440.00005960465015

460.00002980235015

480.00001490125015

DaysTHC (EIA)CreatinineTHC:Cre

0170105162

3128128100

78811279

107512063

154012033

22309930

Sheet1

Casual

EIA Cutoff

GCMS Cutoff




Sheet2

Chronic

Sheet3

THC (EIA)

Creatinine

THC:Cre


56


0

50

100

150

200

250


THC (EIA) 150 132 95 42 40 30

Creatinine 105 130 110 18 120 160

THC:Cre 143 102 86 233 33 19

0 3 7 10 15 22

New Usage

Diluted

Diluted Example

Chart9

00142.8571428571

33101.5384615385

7786.3636363636

1010233.3333333333

151533.3333333333

222218.75

THC (EIA)

Creatinine

THC:Cre


150

105

132

130

95

110

42

18

40

120

30

160

Sheet1


02502505015

21252255015

462.51955015

631.251665015

815.6251455015

107.81251255015

123.906251085015

141.953125935015

160.9765625805015

180.48828125715015

200.24414062562.55015

220.1220703125555015

240.0610351563485015

260.0305175781435015

280.015258789136.55015

300.007629394531.255015

320.0038146973275015

340.0019073486235015

360.0009536743205015

380.0004768372175015

400.000238418615.6255015

420.00011920935015

440.00005960465015

460.00002980235015

480.00001490125015


0150105143

3132130102

79511086

104218233

154012033

223016019

Sheet1

Casual

EIA Cutoff

GCMS Cutoff




Sheet2

Chronic

Sheet3

THC (EIA)

Creatinine

THC:Cre


57


0

50

100

150

200

250


THC (EIA) 150 128 170 75 40 30

Creatinine 105 130 190 120 120 99

THC:Cre 143 98 89 63 33 30

0 3 7 10 15 22

Dehydrated Example

Dehydration

Chart10

00142.8571428571

3398.4615384615

7789.4736842105

101062.5

151533.3333333333

222230.303030303

THC (EIA)

Creatinine

THC:Cre


150

105

128

130

170

190

75

120

40

120

30

99

Sheet1


02502505015

21252255015

462.51955015

631.251665015

815.6251455015

107.81251255015

123.906251085015

141.953125935015

160.9765625805015

180.48828125715015

200.24414062562.55015

220.1220703125555015

240.0610351563485015

260.0305175781435015

280.015258789136.55015

300.007629394531.255015

320.0038146973275015

340.0019073486235015

360.0009536743205015

380.0004768372175015

400.000238418615.6255015

420.00011920935015

440.00005960465015

460.00002980235015

480.00001490125015


0150105143

312813098

717019089

107512063

154012033

22309930

Sheet1

Casual

EIA Cutoff

GCMS Cutoff




Sheet2

Chronic

Sheet3

THC (EIA)

Creatinine

THC:Cre


58

SUMMARY

Most clients are testing negative by 1-3 weeks

99% of clients will test negative by 6 weeks

THC:CRE ratios should decrease at least 50% every 10 days

An increase in THC:CRE ratio of 50% suggests new usage

59

THC CONCENTRATES

60

PREPARATION

Made by packing a long tube with marijuana leaves

Add butane (lighter fluid)to the tube and collect the extract

Evaporate butane

Remaining oil is a concentrated THC product

62

OIL Wax

Shatter

63

DABBING

Place a ‘dab’ of concentrate on a heated surface Inhale vapors Delivers a THC hit of 50-90% ConcernsExplosions during production“Dirty Oil” containing harmful contaminantsThe possibility of overdosing

64

SYNTHETIC CANNABINOIDSSpice/K2

65

CANNABINOID RECEPTORS

Synthetic cannabinoids are substances that bind to one of the known cannabinoid receptors, i.e. CB1 or CB2, present in human cells

The CB1 receptor is located mainly in the brain and spinal cord and is responsible for the typical physiological and particularly the psychotropic effects of cannabis

The CB2 receptor is located mainly in the spleen and cells of the immune system

66

SPICE Assassin Revolution, Bizarro Blueberry, Black Magic Smoke, Cloud 10, Colorado, Darkness, Kite, Purple Diesel, Sunshine Daydream, Sunshine Nightmare, Hammerhead, Diablo

Sold in smoke shops and online

Labeled and sold as incense:“Not for Human Consumption”

Herbs and botanicals treated with synthetic cannabinoids

67

SYNTHETIC CANNABINOIDS First Generation Spice: 2009

JWH-018, JWH-073, JWH-250

Federal Ban: March 2011JWH-018, JWH-073, JWH-200, CP-47,497, CP-47,497-C8 homologue

Second Generation Spice:AM-2201, AM-2233, JWH-019, JWH-122, JWH-203, JWH-210,MPPP, RCS-8 (JWH-018, JWH-073, JWH-250 found in some products)

68

1ST & 2ND GENERATION SPICEΔ9-THC

69

THIRD GENERATION SPICE

70AB-PINACA

PB-22 5F-PB-22 AB-FUBINACA

AB-CHMINACA

FOURTH GENERATION SPICE

http://en.wikipedia.org/wiki/File:AB-FUBINACA_structure.pnghttp://en.wikipedia.org/wiki/File:AB-FUBINACA_structure.pnghttp://en.wikipedia.org/wiki/File:AB-CHMINACA.svghttp://en.wikipedia.org/wiki/File:AB-CHMINACA.svg

71

DETECTION Most compounds are not detected by standard drug screening tests

(Negative on standard THC screen)

Detection period estimated to be 24-72 hours in urine Primarily detect metabolites in urine

Shorter detection period in blood and oral fluid Parent drug detected

Testing methodology utilized ELISA Liquid Chromatography/Tandem Mass Spectrometry (LC-MS/MS) Expensive

72

TESTING CHALLENGES

Hundreds of potential compounds can be used in the manufacturing process of Spice products

Moving target – Spice industry responds to legislation, laboratories must respond to latest trend

Lack of complete understanding of metabolism for all known synthetic cannabinoids

Development of affordable screening tests that react with a wider range of synthetic cannabinoids

73

SYNTHETIC STIMULANTSBath Salts

74

Stimulant like Amphetamines

Substituted cathinones -- Methylenedioxypyrovalerone(MDPV) mephedrone, and methylone are the chemicals most often found in “bath salts”

Cathinone is a chemical derived from the Khat plant

Consumed orally or nasal administration

BATH SALTS

http://www.google.com/imgres?imgurl=http://www.shamanica.com/Botanicals/Catha%20edulis/Catha%20edulis%20small%20trees.jpg&imgrefurl=http://www.shamanica.com/Catha%20edulis.asp&h=331&w=300&sz=36&tbnid=t8mPNfNGLXDnyM:&tbnh=236&tbnw=214&prev=/search?q=picture+of+a+khat+plant&tbm=isch&tbo=u&zoom=1&q=picture+of+a+khat+plant&hl=en&usg=__9BUZm_Yb4OTJQ3FltS8OjzWy9B8=&sa=X&ei=fQVhT_fcMqXy2QWinJD8Bw&ved=0CBAQ9QEwAAhttp://www.google.com/imgres?imgurl=http://www.shamanica.com/Botanicals/Catha%20edulis/Catha%20edulis%20small%20trees.jpg&imgrefurl=http://www.shamanica.com/Catha%20edulis.asp&h=331&w=300&sz=36&tbnid=t8mPNfNGLXDnyM:&tbnh=236&tbnw=214&prev=/search?q=picture+of+a+khat+plant&tbm=isch&tbo=u&zoom=1&q=picture+of+a+khat+plant&hl=en&usg=__9BUZm_Yb4OTJQ3FltS8OjzWy9B8=&sa=X&ei=fQVhT_fcMqXy2QWinJD8Bw&ved=0CBAQ9QEwAA

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WHERE/HOW IS IT SOLD?

Sold in head shops, convenient stores and online PackagingBath SaltsPlant Food – White SnowInsect Repellent – White LightningStain Remover – Thunda Cat “NOT FOR HUMAN CONSUMPTION”

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EFFECTS Severe side effects Suicidal thoughts Agitation Combative/Violent behavior Confusion Hallucinations/psychosis Increased heart rate Hypertension Chest Pain Death or serious injury

The speed of onset is 15 minutes, while the length of the high from these drugs is four to six hours.

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INCREASING PROBLEM

TODAY | January 04, 2013 Navy’s anti-drug ad aims to scare sailorsNavy officials say a new ad aimed at a designer drug called bath salts was produced after an alarming spike in its use by sailors in 2012, but some are calling the video over the top. NBC’s Jim Miklaszewski reports.

http://www.today.com/video/today/50362252

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OVER-THE-COUNTER CONCERNSDXM

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DEXTROMETHORPHAN

OTC Cough Suppressant Found in more than 120 OTC cold medications Referred to as “Robo-tripping” or “Skittling” Medications can also contain pseudoephedrine,

acetaminophen and chlorpheniramine Abuse occurs in all age groups but is more prevalent in

youth

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DXM EFFECTS Heightened sense of perceptual awareness Altered time perception Visual hallucinations

Hyperexcitability Lethargy Ataxia Slurred Speech Sweating Hypertension Nystagmus

Reported by abusers

Clinical Presentation

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DXM EFFECTS

At high doses the pharmacology of DXM is similar to PCP and Ketamine

Impaired motor function

Numbness

Nausea/Vomiting

Increased heart rate and blood pressure

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THANK YOU FOR YOUR TIME.

Drug Testing 101Topics of DiscussionCollectionsChain of custodyUrine CollectionHair FollicleHair FollicleOral FluidSample Media / DetectionSample MediaHair FollicleOral FluidUrineDetection types for each mediaUrine detection timesMedia stratagiesdILUTion/Adulteration/�substitutionDILUTEDEffects of water loadingdiureticsDilution interpretationActing on diluted samplesadulterationCommon methodsThe Adulterant IndustrySpecimen SubstitutionDevices�Confiscated devicesConfiscated devicesConfiscated devicesVisual Monitoring Collection�Alcohol testingUrine AlcoholEthyl Glucuronide (EtG)Urine EtGHow much alcohol did my client drink?Why Test EtS?Example EtG ObservationsExample EtG ObservationsHygiene Products SummaryopiatesOpiatesbenzodiazepinesBenzodiazepinesBenzodiazepinesthcTHC Detection PeriodDetermining New UseTHC:Creatinine RatioTHC EliminationSlide Number 52THC ClearanceDetermining a Usage EventSlide Number 55Slide Number 56Slide Number 57SummaryTHC ConcentratesPreparationSlide Number 61OilDabbingSynthetic CannabinoidsCannabinoid ReceptorsSpiceSynthetic Cannabinoids1st & 2nd Generation SpiceThird Generation SpiceFourth Generation SpiceDetectionTesting ChallengesSynthetic StimulantsBath saltsWhere/how is it sold?EffectsIncreasing ProblemOver-the-Counter ConcernsDextromethorphanDXM EffectsDXM EffectsThank you for your time.

Documents

DRUG TESTING 101 - Arizona State University · 2019-12-19 · Drug Testing 101 & Mythbusters Donor ‘s photo ID verified and signs log book. CCF is initiated. CST collects all supplies