Drugs of Abuse Menu at SASSI

1. Amphetamines
2. Barbiturates
3. Benzodiazepines
4. Buprenorphine
5. Cocaine
6. Creatinine
7. Ecstasy
8. Ethyl Alcohol
9. Ethyl Glucuronide
10. Heroin
11. Methadone
12. Nitrates
13. Opiates
14. Oxycodone
15. PCP
16. THC (Marijuana)

Substance Information

Amphetamines:

Amphetamine is a prescription stimulant and schedule II drug commonly used to treat Attention-deficit hyperactivity disorder (ADHD) in adults and children. lt is also used to treat symptoms of traumatic brain injury and the daytime drowsiness symptoms of narcolepsy and chronic fatigue syndrome. Only a few brands of amphetamines are still produced in the United States, which are prescribed for narcolepsy, hyperactivity in children, or for extremely obese people. The drug is also used illegally as a recreational club drug and as a performance enhancer. The term "Amphetamine" may also refer to the class of compounds derived from Amphetamine, often referred to as the Substituted Amphetamines.

Short-term psychological effects of the drug at therapeutic levels could include alertness, euphoria, increased concentration, rapid talking, increased confidence, and increased social responsiveness. Effects of the drug when abused could include, nystagmus (eye wiggles), hallucinations, and loss of REM sleep the night after use.

Long-term amphetamine abuse can induce psychological effects that include insomnia, mental states resembling schizophrenia, aggressiveness (not associated with schizophrenia), addiction or dependence with accompanying withdrawal symptoms, irritability, confusion, and panic. Chronic and/or extensively-continuous use can lead to amphetamine psychosis, which causes delusions and paranoia, but this is uncommon when taken as prescribed. The abuse of an amphetamine is highly-psychologically addictive, and, with chronic abuse, tolerance develops very quickly. Withdrawal, although not physiologically threatening, is an unpleasant experience (including paranoia, depression, difficult breathing, dysphoria, gastric fluctuations and/or pain, and lethargia). This commonly leads chronic users to re-dose amphetamine frequently, explaining tolerance and increasing the possibility of addiction.

Our amphetamine test will show positives for amphetamine and methamphetamine, including
“crystal meth." lt will also produce a positive result for the medications Adderall, Dexedrine, and Ranitidine (Zantac).

The maximum duration of detectability is from 2 to 4 days but usually is no longer than 2 days.

Barbiturates:

Barbiturates are drugs that act as central nervous system depressants, and by virtue of this they produce a wide spectrum of effects, from mild sedation to anesthesia. Some are also used as anticonvulsants. Barbiturates were long used as anxiolytics and hypnotics. Today benzodiazepines have largely supplanted them for these purposes, because benzodiazepines have less potential for abuse and less danger of lethal overdose. Barbiturates are still widely used in surgical anesthesia. Phenobarbital is used as an anticonvulsant for people suffering from seizure disorders such as febrile seizures, tonic-clonic seizures, status epilepticus, and eclampsia.

The most commonly abused are amobarbital (Amytal), pentobarbital (Nembutal), and secobarbital (Seconal). A combination of amobarbital and secobarbital (called Tuinal) is also highly abused. Short-acting and intermediate-acting barbiturates are usually prescribed as sedatives and sleeping pills. These pills begin acting fifteen to forty minutes after they are swallowed, and their effects last from five to six hours. Veterinarians use pentobarbital to anesthetize animals before surgery; in large doses, it can be used to euthanize animals.

Barbiturates are habit forming and lead to physical withdrawal symptoms. These can include tremors, anxiety, weakness, restlessness, nausea and vomiting, delirium, tonic-c|onic or grand mal seizures, and cardiac arrest. Death can result from seizures or cardiac arrest.

Our barbiturate screening will show positives for the various barbiturate based prescriptions including Amytal, Nembutal, Seconal (Phenobarbital), Luminal, Fiorinal and Butabarbital, among others.

Most types of barbiturates are detectable up to 2 to 4 days. Phenobarbital may be detected in urine up to 30 days.

Benzodiazepines:

The benzodiazepines, or "benzos" for short, are a class of psychoactive drugs considered as minor tranquilizers with varying hypnotic, sedative, anxiolytic, anticonvulsant, muscle relaxant and amnesic properties, which are brought on by slowing down the central nervous system. This makes benzodiazepines useful in treating anxiety, insomnia, agitation, seizures, and muscle spasms, as well as alcohol withdrawal. They can also be used before certain medical procedures such as endoscopies, dental work, or other medical procedures where tension and anxiety are present and prior to some unpleasant medical procedures in order to induce sedation and amnesia for the procedure. Another use is to counteract anxiety-related symptoms upon initial use of antidepressants, or as an adjunctive treatment. Recreational stimulant users often use benzodiazepines as a means of "coming down."

All benzodiazepines have an addictive potential. Use of benzodiazepines should only commence after medical consultation. Dependence varies for the benzodiazepine used, with some reporting alprazolam dependence in as little as three days.

Benzodiazepines are drugs of abuse and activate the dopaminergic reward pathways in the central nervous system. Abuse of benzodiazepines is probably greater than the abuse of illicit drugs. Missusers of benzodiazepines develop a high degree of tolerance, coupled with dosage escalation, with misusers often increasing their dosage to very high doses. High dose misusers often develop a high degree of tolerance and dependence and are at risk of severe withdrawal syndromes. Tolerance and dependence on benzodiazepines develops rapidly with users of benzodiazepines demonstrating the benzodiazepine withdrawal syndrome after as little as 3 weeks of continuous use.

Well-known benzodiazepines arfd their primary trade names include alprazolam (Xanax), bromazepam (Lexomil/Lectopam), diazepam (Valium), lorazepam (Ativan), clonazepam (Klonopin), temazepam (Restoril), oxazepam (Serax), flunitrazepam (Rohypnol), triazolam (Halcion), chlordiazepoxide (Librium), flurazepam (Dalmane), estazolam (ProSom), and nitrazepam (Mogadon). All of these substances may produce positive screening results for benzodiazepines.

Depending on usage patterns and dosages, benzodiazepines may be detected for up to 30 days
after last usage.

Buprenorphine:

Buprenorphine, is an opioid drug with partial agonist and antagonist actions. In October 2002, the FDA additionally approved Suboxone and Subutex, buprenorphine's high-dose sublingual pill preparations for opioid addiction, and as such the drug is now also used for this purpose. It is a Schedule III drug under the Convention on Psychotropic Substances. Buprenorphine sublingual preparations are often used in the management of opioid dependence (that is, dependence on heroin, oxycodone, hydrocodone, morphine, oxymorphone, fentanyl or other opioids). Buprenorphine and methadone are both used for short-term and Iong-term opioid maintenance therapy.

Here's the rub, if you are not addicted to heroin, buprenorphine has nothing to antagonize. Which means, buprenorphine will make the non-addicted person high for upwards of eighteen hours. Abuse of Buprenorphine has been well documented in the west coast, and recently, in our neighboring counties of Lakawana and Luzerne. IVlore recently, we are hearing reports from our own donors of buprenorphine being used to replace heroin and other opioid substances due to the lack of detection in drug screening.

Recently, buprenorphine is becoming an increasing concern because of its availability and potential for abuse.

Buprenorphine (subutex/suboxone) will yield positive results even at low concentrations. At high concentrations codeine, hydrocodone, naltrexone, and tramadol will also yield positive results on our buprenorphlne assay.

Buprenorphine has a slightly longer retention time then most opiates, and may show positives as long as 7 days after use. Typically positives are detected within 2-3 days after use though.

Cocaine:

Cocaine is obtained from the leaves of the coca plant. It is a stimulant of the central nervous system and an appetite suppressant, giving rise to what has been described as a euphoric sense of happiness and increased energy. lt is most often used recreationally for this effect. Cocaine can be snorted, injected, smoked, and even eaten.

Smoking freebase or crack cocaine is most often accomplished using a pipe made from a small glass tube about one quarter-inch in diameter and on the average, four inches long. These are sometimes called "stems", "horns", "blasters" and "straight shooters," readily available in convenience stores or smoke shops. They will sometimes contain a small paper flower and are promoted as a romantic gift. Buyers usually ask for a "rose" or a "flower." An alternate method is to use a small length of a radio antenna or similar metal tube. To avoid burning the user's fingers and lips on the metal pipe, a small piece of paper or cardboard (such as a piece torn from a matchbook cover) is wrapped around one end of the pipe and held in place with either a rubber band or a piece of adhesive tape. Tire pressure gauges have also been used by breaking off their tops and removing their numbered sticks.

A small piece (approximately one inch) of clean heavy copper or occasionally stainless steel scouring pad-often called a "bril|o," from the scouring pads of the same name - is placed into one end of the tube and carefully packed down. Prior to insertion, the "brillo" is burnt off to remove any oily coatings that may be present. It then serves as a reduction base and flow modulator in which the "rock" can be melted and boiled to vapor.

Another method is to use a deep socket wrapped with electrical tape. Users typically employ high grade (very fine) speaker wire rolled into a ball as the filter medium. A Zippo lighter is often used because of its stronger flame. However, the socket is practically indestructible and inconspicuous.

A less sophisticated but common method is to use a discarded soda can and puncture several small holes on the side of the can near its bottom. The mouthpiece is the original opening of the can, creating a cost-effective alternative to a proper crack pipe.

Our cocaine screening detects only cocaine and its direct metabolites. "Cocaine is cocaine."

Cocaine is usually detectable no longer than 35 hours, but in extreme cases may be detectable
up to 72 hours.

Creatinine:

Creatinine is a substance found in predictable concentrations in human urine because it is secreted by the body at a constant rate. Creatinine is used as a determination of urine concentration and is used to screen for the possibility of a diluted urine.

Creatinine is a semi-quantitative assay used to warn of a diluted urine that may produce false negatives. Used in conjunction with other semi-quantitative assays such as THC, EtG, and Buprenorphine, it can also allow analysis of test results in order to give rough ideas of "leve|" variance over time.

Positive results for Creatinine are known as a "Possible Dilute." Such results are reported due to abnormally low Creatinine levels in a urine sample. This may be due to intentional or unintentional dilution of the urine. The best way to avoid an unintentional "Possible Di|ute" is to avoid consuming liquids, especially those containing diuretics like caffeine, in the two hours prior to a screening. Repeated results showing "Possible Dilute," even after counseling, may indicate purposeful dilution.

Creatinine does not have cross-reactivity concerns like other assays. Consuming Creatine will not affect Creatinine levels.

Ecstasy:

MDMA (3,4-methylenedioxy-N-methy|amphetamine) is most commonly known today by the street name ecstasy (commonly abbreviated as E, X, or XTC). It is considered a recreational drug, and has long had a strong association with the rave culture. It is classified as a schedule I drug in the United States, indicating that it has a high potential for abuse and no medical uses.

Ecstasy is popular in the dance and rave scenes, especially amongst younger crowds.

The ecstasy screening assay at SASSI will show positive results for Ecstasy as well as several similarly acting compounds usually sold as Ecstasy (MDA, MDEA). The drug known as Fenofibrate (aka. Tricor, Triglide, Antara) is the only substance that cross reacts with the Ecstasy assay. It is used to lower cholesterol levels in patients at risk for cardiovascular disease.

Ecstasy use can also cause positive results on the Amphetamine assay.

Ecstasy is detectable up to 4 days after usage in extreme cases, but is usually not detectable beyond 2 days.

Ethyl Alcohol (EtOH):

This is your typical drinking alcohol, also called ethanol (EtOH) or grain alcohol. Alcoholism is a disease influenced by genetic, psychological, and social factors any of which may precipitate a persistent difficulty in controlling overall alcohol consumption. More generally, alcoholism may also point to concerns such as a preoccupation with or compulsion toward the consumption of alcohol, and/or an impaired ability to recognize the overall negative effects of excessive alcohol consumption. Although not all of these definitions specify current and on-going use of alcohol as a qualifier, some do, as well as remarking on the long-term effects of consistently heavy alcohol use, including dependence and symptoms of withdrawal.

Alcoholism is a common concern for many caseworkers, and one that is very difficult to screen for. The ethyl alcohol, or EtOH, assay at SASSI will find positive results only within a small window of time following the consumption of alcohol. This window is equal to roughly 1 hour per ounce of alcohol consumed. Thus many alcoholics can drink heavily the night before a screening, and as long as they come in late the next day, will have the alcohol completely out of their system and produce a clean urine. For individuals where alcoholism is a concern, frequent screenings are the best way to monitor for drinking while simultaneously deterring the behavior.

Alcohol does not have any cross-reactivity outside of alcohol usage.

The new Ethyl Glucuronide assay is an excellent way to supplement the Ethyl Alcohol assay.

Ethyl Glucuronide (EtG):

Ethyl Glucuronide is a metabolite of ethyl alcohol. When the human body comes into contact with ethyl alcohol, it is metabolized, or converted, into ethyl glucuronide (EtG). Ethyl Glucuronide is produced in amounts proportional to the amount of alcohol consumed, and lingers in the body far longer than alcohol does. This means that a laboratory can test for the presence of EtG in urine to determine if alcohol has been consumed recently. This makes it an extremely valuable way to monitor alcohol consumption in individuals suspected of alcohol abuse. The ethyl glucuronide test can detect alcohol consumption up to 72 hours afterwards.

SASSI’s Ethyl Glucuronide assay will receive its final FDA approval in September of 2007. Until then it should not be used in a court setting without GC/MS or EtOH assay confirmation. lt will, in the meanwhile, serve as an excellent tool for evaluating particular cases.

Although the Ethyl Glucuronide assay has no cross reactivity issues to worry about, there is a small fraction of the population known as â€increased EtG producers." The bodies of these individuals overreact to the presence of alcohol and produce an increased amount of EtG. Because of this, the EtG assay at SASSI has a high cutoff, to all but eliminate the possibility of positives due to high EtG producers from something as mundane as using rubbing alcohol.

Ethyl glucuronide will detect alcohol use up to 72 hours after the fact. It is a semi-quantitative test when combined with Creatinine, and can thus be used to monitor trends in alcohol consumption.

Heroin:

Heroin is an opioid synthesized directly from the extracts of the opium poppy. The white crystalline form is commonly the hydrochloride salt form. Upon crossing the blood-brain barrier, which occurs soon after introduction of the drug into the bloodstream, heroin mimics the action of endorphins, creating a sense of well-being; the characteristic euphoria has been aptly described as an "orgasm" centered in the gut. One of the most common methods of heroin use is via intravenous injection.

Due to heroin's mimicry of endorphins, it is used as a recreational drug. Frequent administration has a high potential for causing addiction and may quickly lead to tolerance, however occasional use may not lead to symptoms of withdrawal. If a continuous, sustained use of Heroin for as little as three days is stopped abruptly, withdrawal symptoms can appear. This is much shorter than other common painkillers such as oxycodone and hydrocodone.

Some popular street names for heroin are gear, diese/, smack, B, skag, Harry, Bobby, black tar, horse, honk, junk, brok, jack, jenny, blows, brown, brown sugar, brownstone, dark, sweaty, dope, poji sam, waccocco, dragon, bitch, skurge, ron, ice cube, jim, moop, boy, sweet lady H and H. This is by no means a complete list.

SASSl's heroin metabolite assay tests for the presence of the direct metabolite of heroin and thus there is no cross-reactivity. "Heroin is heroin."

Heroin is usually detectable in urine screening up to 2 days after usage, but may be as long as 4 days in extreme circumstances.

Methadone:

Methadone is a synthetic opioid, used medically as an analgesic and in the treatment of narcotic addiction. Methadone has a slow metabolism and very high fat solubility, making it longer lasting than morphine-based drugs. Methadone has a typical half-life of 15 to 60 hours, in rare cases up to 190 hours permitting the administration only once a day in heroin detoxification and maintenance programs. The most common mode of delivery at a methadone clinic is in an oral solution. Methadone is almost as effective when administered orally as by injection. As with heroin, tolerance and dependence usually develop with repeated doses. Most methadone abuse is perpetrated by friends and family members of people who receive the drug on a prescription basis for medical conditions. "Street methadone" has a black market value of $0.20 - $1.00 per milligram. "Spit bags" are also becoming more common, where a methadone patient will take their oral dose of methadone but not swallow it, instead spitting it into a plastic bag after leaving the clinic and then selling it.

The methadone assay at SASSI tests for methadone, but may pick up several similar opiate based compounds when they are present in extreme concentrations. These concentrations usually indicate abuse of those substance, and further screenings can be done in these situations to narrow down which specific drug is being used.

Methadone can be detected in urine up to 2 days after usage in most cases, but in extreme cases as long as 4 days is possible.

Nitrates:

The nitrates assay at SASSI is a test for various nitrate based substances that can be added to a urine sample to tamper with the results. Bleach is a common substance that would fall into this category. An eye dropper of bleach used to add a few drops to a urine sample can potentially produce false negatives, but would be detected by the Nitrates assay.

This simple assay can help cut down on the chances of successful urine tampering.

There is no time frame associated with Nitrates, if the substance is present in the urine sample, it will be detected by the Nitrate screening.

Opiates:

Opiates, or more correctly opioids, includes many different drugs all derived from the opium poppy. This includes codeine, heroin, hydrocodone, morphine, and oxycodone among others.

At SASSl the Opiates assay is a general test meant to screen for the entire opiate family of drugs. This test is excellent if multiple addictions are suspected, or if medication abuse is suspect. A positive opiate assay result can be further narrowed down using the Heroin, Oxycodone, Methadone, and Buprenorphine assays or via GC/MS.

There are a wide variety of medications that fall under the purview of the opiate assay at SASSl. A careful record of the medications being taken can help explain the reason for opiate positives.

Opiates can be detected in urine up to 2-4 days after being taken.

Oxycodone:

Oxycodone is a potent and potentially addictive opioid analgesic medication. lt is effective orally for the relief of pain and is marketed in combination with aspirin (Percodan, Endodan, Roxiprin) or acetaminophen (Percocet, Endocet, Roxicet, Tylox). More recently, ibuprofen has been added to oxycodone (Combunox). It is also sold in a sustained-release form by Purdue Pharma under the trade name OxyContin (the name is actually short for Oxycodone Continuous release) as well as generic equivalents, and instant-release forms Endone, OxylR, OxyNorm, Percolone, OxyFAST, Supeudol, and Roxicodone. In the United States, oxycodone is a Schedule II controlled substance both as a single agent and in combination with products containing acetaminophen, ibuprofen, or aspirin.

The introduction of OxyContin in 1995 resulted in increasing patterns of abuse. Unlike Percocet, whose potential for abuse is limited by the presence of acetaminophen, OxyContin contains only oxycodone and inert filler. Abusers simply crush the tablets, then either ingest the resulting powder orally, intranasally, via intravenous, intramuscular or subcutaneous injection (by dissolving the powder), or rectally to achieve rapid absorption into the bloodstream. Injection of OxyContin is particularly dangerous since it contains binders which enable the time release of the drug. While high doses of oxycodone can be fatal to an opiate-naive individual in and of itself, lethal overdoses of only oxycodone rarely occur. lt was once thought that opioids would be less subject to recreational (ab)use when one or more additional analgesics are added, since, for example, the amount of paracetamol present in higher doses of Percocet causes stomach upset and liver damage. However, it has been demonstrated that abusers seeking the euphoric "high" are not deterred by these potential side effects or toxicities. Abusers soon discovered that extremely simple methods to separate the ingredients exist, particularly due to the widely disparate solubility of the alkaloids and analgesics in water ("cold water extraction").

At SASSI the Oxycodone assay has no cross-reactivity outside of oxycodone and direct oxycodone relatives such as oxymorphone (Numorphan).

Oxycodone, like many opiates, can be detected in urine up to 2 days after use, sometimes as long as 4 days in extreme circumstances.

Phencyclidine (PCP):

Phencyclidine (a contraction of the chemical name phenylcyclohexylpiperidine), abbreviated PCP, is a dissociative drug formerly used as an anesthetic agent, exhibiting hallucinogenic and neurotoxic effects. lt is commonly known as Angel Dust, but is also known as Rocket Fuel, Ashy Larry, Wack, Ozone, Hog, and Embalming Fluid, among other names. The term "embalming fluid" is often used to refer to the liquid PCP in which a cigarette orjoint is dipped (a "sherm" or "dippy"), to be ingested through smoking. Smoking PCP is known as "getting wet." There is much confusion over the practice of dipping cigarettes in "embalming fluid" leading some to think that real embalming fluid may actually be used. This is a misconception that may cause serious health consequences beyond those of consuming PCP.

In its powder form, PCP can be insufflated.

The PCP assay at SASSI does not have any cross-reactivity. “PCP is PCP."

PCP can be detected in urine up to 2-7 days after usage in most cases. In chronic abusers it can be detected up to 30 days after last usage.

Cannabis/Marijuana/THC:

The most popular drug of choice in the United States, marijuana comes in many forms and with many nicknames, far too numerous to detail here. It can be consumed through smoking, vaporization and inhalation, or by eating. There is a wide variety of paraphernalia associated with Cannabis culture which can be a sign of use.

In regards to testing for marijuana usage at SASSI, the THC assay used has only one pertinent cross-reactive substance, known as Nlarinol. Otherwise, "THC is THC."

The length in which THC remains in the human body is a common misconception when dealing with THC screening. THC can remain in the body as long as 30 days but in most cases will not. THC is a fat soluble drug. It remains in the systems of obese individuals longer than those with faster metabolisms. A thin young teenager or twenty-something may come up clean for THC just 2 days after using. Additionally, those who use recreationally or irregularly clear their systems much faster than those that use habitually. Habitual users may maintain detectable levels of THC in their urine up to 2 weeks after they have stopped using.

At SASSI the THC assay, when used in conjunction with the Creatinine assay, can be used semi-quantitatively. This means that change in THC levels over time can be monitored in a general way (aka. we can determine if "levels" are increasing, decreasing, or staying the same over time).