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NIDA 5 Panel Drug Testing Details

Detection of Cannabinoids in Urine

Marijuana is the most widely used illicit drug in the United States and Canada. Delta-9-tetrahydrocannabinol (THC) is the primary psychoactive substance, although the marijuana plant contains many related cannabinoid compounds. Marijuana is generally known by the botanical name Cannabis Sativa and consists of the flowering tops and leaves of the plant. It is distinguished from Cannabis Americana (hemp) by the psychoactive effects of delta-9-THC depending on cultivation techniques, gender of the plant and other factors. The potency of confiscated marijuana has been increasing in recent years and its use spreading throughout the population. As the use of marijuana has increased, concerns over the health of the users and effects on society have grown. Recent methods of urinary detection have indicated that between 10% and 20% of the population test positive. Of particular concern is the use of marijuana by persons in the military, in classified or security positions, and those operating machinery or driving automobiles.

Pharmacological Effects
Smoked doses of 20 mg (two potent cigarettes) of delta-9-THC will produce increases of 20 to 50 beats per minute in heart rate, impairment of short term memory and concentration, possibly mood changes such as euphoria, altered perception of time, hunger, and other effects. At higher doses, marijuana interferes with motor coordination and complex task functioning. Activities requiring a high degree of alertness such as operating machinery, driving or working in dangerous environments are contraindicated. Pharmacological effects from inhaled drugs begins almost immediately. Delta-9-THC plasma levels peak 10 to 20 minutes post inhalation and begin to decline. Effects last for two to three hours.

Studies indicate that marijuana and alcohol potentate one another more than either drug alone. Thus, smaller amounts of ethanol and marijuana may increase toxic effects. Peak levels of marijuana metabolites in the urine occur about five hours post dose and thus are not useful in predicting the degree of intoxication. Urinary presence only indicates recent exposure. Note marijuana metabolite testing is available only in urine, not hair.

Laboratory Methods
Immunoassays are used to initially screen specimens for cannabinoids (THC). Confirmation of positives is by GC/MS.

Cutoff and Detection Post Dose
The initial screening cutoff level is 50 ng/ml. The GC/MS cutoff level is 15 ng/ml. The elimination half-life of marijuana ranges from 14-38 hours. At the initial cutoff of 50 ng/ml, the daily user will remain positive for perhaps 7 to 30 days after cessation. At the confirmation level of 15 ng/ml, the frequent user will be positive for perhaps as long as 15 weeks. Marijuana metabolites' storage and slow release from lipid tissues is the reason for this long detection period.

Passive Inhalation
Urine levels of 5 ng/ml have been reported from passive inhalation. One recent survey indicated that one subject in a passive inhalation experiment achieved a level of 23 ng/ml. This is unusual, but points out the usefulness of higher cutoff levels such as 50 ng/ml. The higher 50 ng/ml level eliminates the possibility of passive inhalation, is a level of very high reliability, and indicates more recent use.

Expanded Tests
Most drug testing companies also offer an expanded test which includes a few additional drugs in the testing process. Most do not add all of these in their expanded test, but choose a different combination of 3 or 4 to add :

Detection of Cocaine in Urine

Cocaine is one of the most abused drugs in the United States and Canada. Isolated in 1859 and brought to attention through a series of papers by Dr. Sigmund Freud, cocaine was subsequently adopted as a useful topical anesthetic. Its non prescriptive use was illegalized by the Harrison Act of 1914.

Pharmacological Effects
Generally, 50-100 mg of cocaine is necessary for intranasal "snorting" associated with a "high". Cocaine injected intravenously is often mixed with heroin, referred to as "speed balling". Cocaine, in the form of a very pure free base, "crack" is smoked in a pipe. The more direct and concentrated the route of administration, the faster habituation occurs. Euphoric feelings produced by cocaine eventually give way to depression, paranoia, habituation, and other dysfunctions. Primates (monkeys), given the choice between cocaine and food, have died while continuously choosing cocaine. Clearly a dangerous drug, cocaine is not a cheap or easy high, has serious addictive properties, and societal consequences.

Laboratory Methods
Cocaine and its primary metabolite benzoylecgonine are routinely detected by a variety of laboratory techniques. Laboratories usually utilize the immunoassays for initial screening with confirmation of positives by gas chromatography/mass spectrometry (GC/MS).

Cutoff and Detection Post Dose
The initial screening cutoff level is 300 ng/ml for cocaine and its metabolite benzoylecgonine. Use of cocaine for euphoria may result in positive urines above this level for 48-72 hours post dose. Longer times will be observed in the habituated person using large quantities. The GC/MS cutoff level is 150 ng/ml.

Detection of Amphetamines in Urine

For years the immediate precursor in the synthesis of methamphetamine was tightly controlled until a clandestine chemist devised a synthesis of methamphetamine from the easily available precursor; ephedrine, a sympathomimetic amine widely used in over-the-counter drugs for colds. A stereoisomer, pseudoephedrine (Pseudofed) is a popular cold tablet, also used in the manufacture of amphetamine. This new synthesis has flooded the illicit market with cheap "crystal" or "speed" methamphetamine. Laboratories found a greatly increased number of specimens positive for methamphetamine. Amphetamines have been added to the California Health and Safety Code 11550(b) sections (including PCP, heroin, and methamphetamine) providing a mandatory 30 day sentence for being under the influence. Possession of amphetamines is a felony.

Pharmacological Effects
Amphetamine and methamphetamine are the prototypical stimulant amphetamines and are widely abused. Small chiral or structural changes in the molecule can have substantial differences in effects. A large number of compounds resemble the neurotransmitters epinephrine, norepinephrine, and dopamine (dihydroxyphenylethylamine) and are chemically of the phenylethylamine class of drugs. These are generally referred to as sympathomimetic amines including the common over-the-counter drugs ephedrine and phenylpropanolamine. They are stimulant drugs, some with central nervous stimulation and some with smooth muscle actions (antiasthmatics). The mechanism of action is probably to release the natural neurotransmitters from their storage sites along with some direct action on the neurotransmitter receptor. L-methamphetamine is also found in the Vicks inhaler and as a urinary metabolite from selegeline, an anti-Parkinson medication.

Laboratory Methods
Urinary detection of methamphetamine and its minor metabolite amphetamine is initially performed by immunoassay. Specimens screened positive are retested by gas chromatography/mass spectrometry (GC/MS) for confirmation.

Cutoff and Detection Post Dose
The screening immunoassay uses a cutoff of 1000 ng/ml. The cutoff for GC/MS is 500 ng/ml for both metabolites - amphetamine and methamphetamine. Amphetamine has a 7-32 hour half life, depending on the urinary pH. The assay is capable of detecting the use of methamphetamine or amphetamine for 24-48 hours post dose or as long as 72 hours depending on factors such as amount used, fluid intake, excretion, and urinary pH.

Detection of Opiates in Urine

Opiates are a very old class of drugs derived from the exudate of the opium poppy and used for centuries for pain relief. Morphine is the principal alkaloid in opium and the name morphine was derived from the Greek god of dreams - Morpheus. The psychological effects of opium were known to the ancient Sumerians, but the first undisputed reference to the opium poppy dates from the third century B.C. Like so many drugs, modern chemistry has extensively experimented with the drug's chemistry, resulting in more useful, potent, and addictive opioid derivatives. The invention of the hypodermic needle increased the abuse of morphine. The smoking of opium by the Chinese workers in the late 1800's, use of morphine for Civil War casualties, and lack of regulation until the first part of the 20th century all contributed to the rise of opioid abuse. Heroin, a very potent opioid, was synthesized for use during the Civil War resulting in the addiction of many Civil War soldiers.

Pharmacological Properties
Opioids are the preferred term referring to the large chemistry of exogenous substances binding to opioid receptor sites producing agonistic effects. Opioids share some of the properties of naturally present peptides called endorphins and enkephalins. Opioids have specific receptor sites causing the effects which may be specifically blocked by opioid antagonists such as naloxone or naltrexone, related chemical structures that will bind to the receptor displacing opioids. This drug is used as an antidote to opioid overdose.

Morphine, heroin, codeine, and many related synthetic opioid analogues produce their major effects on the central nervous system (CNS) and the bowel. Effects are diverse including analgesia, drowsiness (nodding), changes in mood, respiratory depression, and decreased gastrointestinal motility. Pupils are constricted and not responsive to light stimulus. Heroin, the most abused and addictive opioid, is synthesized from morphine by acetylation to diacetylmorphine. After intravenous injection, it is rapidly diacetylated to morphine and further metabolized by the liver to other urinary metabolites including codeine. Codeine is also a popular oral medication. For an opioid addict, heroin is preferable but they will use any available opioid. Methadone is a synthetic opioid which has agonistic actions, but has relatively weak effects on mood and is used to "maintain" opioid addicts. Naltrexone (Trexan) is also useful as a long term antagonistic.

Laboratory Methods
Laboratory detection of morphine and codeine is performed by immunoassay. Confirmation is by gas chromatography/mass spectrometry (GC/MS).

Cutoff and Detection Post Dose
The detection limit of the initial screen is 300 ng/ml, with a sensitivity of 20 ng/ml. This is sufficient to detect heroin use for approximately 24-48 hours post dose and codeine for somewhat longer. Positives are confirmed on GC/MS at a cutoff level of 300 ng/ml.

Detection of Phencyclidine (PCP) in Urine

Phencyclidine (PCP, Angel Dust) is a cheap and popular drug often concentrated in selected socioeconomic groups. PCP may be characterized as a hallucinogenic drug due to the wide range of bizarre behaviors associated with individuals under the influence. It was originally used as a veterinary tranquilizer and has had some human experimentation, but the bizarre recovery room effects made it useless. PCP has been illicitly used since the 1960's, but not a widely abused drug until the 1980's when it was placed on cigarettes (Sherms), and smoked. Smoking allows the user to rapidly and accurately titrate their dose. The effects of a drug ingested by smoking are quickly felt since it is rapidly absorbed by the lungs into the bloodstream and circulated to the site of action in the brain. Thus, smoking allows the user a rapid feedback on how "high" they are getting. Phencyclidine is easily manufactured from relatively common chemical precursors, is relatively potent, and long lasting. These factors combined make it a frequently abused illicit drug.

Pharmacological Effects
Phencyclidine is rapidly absorbed from the lung and easily crosses the blood/brain barrier. In an average size (150 lb.) individual, each absorbed milligram (mg) will produce approximately 10 ng/ml concentration in the blood. Symptomatic blood concentrations range from about 4 ng/ml to 100 ng/ml. Symptoms progress from barely observable/perceptible at the lower end to comatose/catatonic at 100 ng/ml. Higher concentrations have been recorded. Observable symptoms include "ether" breath (or "solvent" breath), nystagmus (vertical and horizontal) movements of the eye, "moon walk", and a diverse variety of behavior including hallucinations, catatonic rigidity, "superhuman" strength, lack of stimulus to pain, time distortions, and lack of memory and events while "stoned".

Laboratory Methods
Phencyclidine has several analogues and precursors. Most are illegal. Laboratories usually screens for phencyclidine by immunoassay and confirms by gas chromatography/mass spectrometry (GC/MS).

Cutoff and Detection Post Dose
The immunoassay technique used to detect PCP in urine has a cutoff level of 25 ng/ml. PCP is cleared from the bloodstream with a relatively long half life of 7-11 hours. Because it is a lipid (fat) soluble drug, detection in the urine is possible up to 48 hours or longer post dose. Blood levels correspond much better than urine to behavioral effects, i.e. being under the influence, but urine is a better screening fluid since drugs are concentrated for elimination. Confirmation levels on GC/MS is 25 ng/ml.

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