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PubMed1992

The validity of hair analysis for detecting cocaine and heroin use among addicts.

Radioimmunoassay of hair (RIAH) was compared with two criterion measures, confidential EMIT urinalysis and self-reporting of cocaine/heroin use, for a purposive sample of 134 persons in methadone treatment. Positive or negative RIAH was "confirmed" by urinalysis and/or self-report in 87 and 84% of the cases for cocaine and heroin (morphine), respectively. Corroborative evidence indicated that "excess" RIAH positives were attributable to the narrow window of detection for urinalysis (2 days), failure to admit drug use even to researchers, and/or inadvertent ingestion of small amounts of drug. A global self-report of cocaine use intensity was related to amount in the hair.

Adult↗

PubMed1990

The perinatal impact of cocaine, amphetamine, and opiate use detected by universal intrapartum screening.

Universal urine testing for cocaine, amphetamines, and opiates was performed on 1643 women admitted to an obstetric service for a 1-year period with 20.5% having positive results. There were 299 patients with positive toxicology results matched for race and discharge date with patients having negative toxicology and drug history. Significant differences in age, prior obstetric history, prenatal care, alcohol history, and smoking were noted between groups. There was a significant decrease in birth weight, head circumference, length, and gestational age for the drug-positive group, which was most marked in cocaine and multiple drug users. These differences persisted after we controlled for smoking, prenatal care, and prior preterm births. Differences in birth weight and head circumference remained after we controlled for gestational age. Rates of congenital anomalies and abruptio placental were similar between groups. Perinatal substance abuse is independently associated with growth retardation and prematurity. Multiple risk factors are frequently present, necessitating a comprehensive approach to prenatal care.

Adult↗

PubMed1990

[The detection of codeine abuse by hair analysis].

For the purpose of assessing possible opiate dependence (question of culpability) toxicological tests (gas chromatography; mass-spectrometry) were performed on cuttings of hair of a 30-year-old man who had within a short period committed several punishable offences 8 months previously. It was thus possible to determine opiate intake over a period of time corresponding to the length of hair. About 20 micrograms/g codeine and up to 4 micrograms/g morphine were demonstrated, in addition also 30 micrograms/g bromazepam. These results proved that amounts exceeding therapeutic levels of bromazepam and codeine-containing drugs had been taken during the period in question.

Adult↗

PubMed1996

[Drugs and occupational accident].

In a case of a fatal occupational accident (construction worker, fall from roof, urine test positive for cocaine and THC, e.g. cannabis) the question arised to what extent those drug-related occupational accidents occur. In the literature only few cases, mainly dealing with cannabis influence, have been reported, however, a higher number is suspected. Cocaine and other stimulating drugs (amphetamine) are more often used to increase physical fitness. By direct or indirect interference with vigilance these compounds may provoke accidents. Due to the lack of a legal basis proving of the influence of drugs at the working place is still very limited, although highly sensitive chemical-toxicological assay procedures are available to detect even the chronic abuse (in hair). In the general conditions of accident insurances a compensation is excluded when alcohol is involved, but drugs are not mentioned. It is indeed difficult to establish a concentration limit for drugs like that existing for alcohol (1.1%). In each case the assay of the drug involved and exact knowledge of its specific effects is in an essential prerequisite to prove the causal relationship.

Accidents, Occupational↗

PubMed1991

Clinical assessment and urine testing for anabolic-androgenic steroid abuse and dependence.

The emerging epidemic of anabolic-androgenic steroid use, no longer confined to elite athletes, is associated with adverse health consequences for which users may seek treatment. As with other forms of drug abuse, patients may deny or hide their use of steroids while seeking treatment for bothersome side effects or other problems. Thus, clinicians may increasingly, but unknowingly, see patients who are using steroids. Early detection and treatment of steroid abuse and dependence is critical in order to prevent serious and potentially fatal consequences. Therefore, it is incumbent upon clinicians to know the signs and symptoms of using steroids, and to be familiar with the clinical indications for urine testing. Using case examples, the authors review the assessment of steroid abuse and dependence in clinical practice and illustrate the role of urine testing in the assessment process.

Adult↗

PubMed2005

Toxicological findings from 1587 civil aviation accident pilot fatalities, 1999-2003.

INTRODUCTION: The prevalence of drug and ethanol use in aviation is monitored by the Federal Aviation Administration (FAA). Under such monitoring, toxicological studies for the 1989-1993 and 1994-1998 periods indicated lower percentages of the presence of controlled substances (illegal drugs) than that of prescription and nonprescription (over-the-counter) drugs in aviation accident pilot fatalities. In continuation, a toxicological assessment was made for an additional period of 5 yr. METHODS: Biosamples from aviation accident pilot fatalities submitted to the FAA Civil Aerospace Medical Institute (CAMI) are analyzed, and those findings are stored in a database. This database was examined for the 1999-2003 period for the presence of controlled substances (Schedules I-V), prescription/nonprescription drugs, and ethanol in the fatalities. RESULTS: Out of 1629 fatal aviation accidents from which CAMI received biosamples, pilots were fatally injured in 1587 accidents. Drugs and/or ethanol were found in 830 (52%) of the 1587 fatalities. Controlled substances from Schedules I-II (SI-II) and Schedules III-V (SIII-V) were detected in 113 and 42 pilots, respectively. Prescription drugs were present in 315 pilots, nonprescription drugs in 259, and ethanol in 101. SI-II substances were detected in 5 of 122 first-class medical certificate-holding airline transport pilots. In addition to the controlled substances, many of the prescription/nonprescription drugs found in the fatalities have the potential for impairing performance. CONCLUSIONS: Findings from this study were consistent with those of two previous toxicological studies and support the FAA's programs aimed at reducing the usage of performance-impairing substances.

Accidents, Aviation↗

PubMedDate not supplied

An investigation of the stability of free and glucuronidated 11-nor-delta9-tetrahydrocannabinol-9-carboxylic acid in authentic urine samples.

Preanalytical stability of a drug and its major metabolites is an important consideration in pharmacokinetic studies or whenever the analyte pattern is used to estimate drug habits. Firstly, the stability of free and glucuronidated 11-nor-delta9-tetrahydrocannabinol-9-carboxylic acid (THCCOOH, THCCOOglu) in authentic urine samples was investigated. Random urine samples of cannabis users (n = 38) were stored at -20, 4, and 20 degrees C up to 15 days and up to 5 days at 40 degrees C, and alterations of the analyte pattern during storage were followed by liquid chromatography-tandem mass spectrometry. Secondly, the influence of pH (range 5.0-8.0) on the stability of the analytes was studied using spiked urine to elucidate the results obtained from authentic samples. In authentic urine samples, the initial pH ranged from 5.1 to 8.8. The glucuronide was found to be highly labile at a storage temperature of 4 degrees C and above. Initially, 18 urine samples tested positive for THCCOOH. After 2 days storage at 20 degrees C, THCCOOH was detectable in a further 4 samples, and 7 more samples tested positive for THCCOOH (5-81 ng/mL) after 15 days. Depending on time and temperature, the glucuronide concentration decreased, resulting in an increase of THCCOOH concentration. However, a loss in mean total THCCOOH concentration was found, which was significantly higher in deteriorated samples than in samples without signs of deterioration after 15 days of storage at 20 degrees C. In the drug-free urine sample separately spiked with THCCOOglu or THCCOOH, the investigations on the stability of the target analytes at various pH values revealed that THCCOOH was stable at pH 5.0. At higher pH values, its concentration slightly decreased with time, and about 69% of the initial THCCOOH concentration was still present at pH 8.0 on day 5. THCCOOglu concentrations rapidly decreased with increasing pH value. For example, only 72% of the initial THCCOOglu concentration could be detected at pH 5.0 on day 1. Degradation of the glucuronide resulted in formation of THCCOOH, which was observed even at pH 5.0. In light of the present findings, advanced forensic interpretations based on the presence of THCCOOH or the pattern of THCCOOH and THCCOOglu in stored urine samples seems questionable.

Artifacts↗

PubMed1995

Quantitative versus qualitative urinalysis for benzoylecgonine in clinical trials for the assessment of cocaine use.

Urinalysis of benzoylecgonine (BE) concentrations is a primary outcome measure for evaluating medications for treating cocaine addiction. Using simulated BE data from a set of simple clinical models, the advantages of quantitative versus qualitative urinalysis were evaluated, as well as the advantages of once-weekly versus thrice-weekly sampling schedules. A 60 percent reduction in cocaine use, either in daily amount or in weekly frequency, was considered clinically significant. Quantitative urinalysis can detect reductions in both amount and frequency, whereas qualitative urinalysis can detect only a decrease in frequency. For quantitative urinalysis, changes are more easily detected when urine is collected three times a week than when it is collected once a week. For qualitative urinalysis, the majority rule analysis for a thrice-weekly sampling schedule yields an artificially high estimate of the percentage of positive samples, whereas a once-weekly schedule gives a highly variable estimate.

Cocaine↗

PubMed2006

Abuse of nutmeg (Myristica fragrans Houtt.): studies on the metabolism and the toxicologic detection of its ingredients elemicin, myristicin, and safrole in rat and human urine using gas chromatography/mass spectrometry.

Seeds of nutmeg are used as spice, but they are also abused because of psychotropic effects described after ingestion of large doses. It was postulated that these effects could be attributable to metabolic formation of amphetamine derivatives from the main nutmeg ingredients elemicin (EL), myristicin (MY), and safrole (SA). In a case of a suspected nutmeg abuse, neither such amphetamine derivatives nor the main nutmeg ingredients could be detected in urine. The metabolites of EL, MY, and SA were identified using gas chromatography-mass spectrometry in rat urine and their presence in human urine of the nutmeg abuser was confirmed. The identified metabolites indicated that EL, MY, and SA were once and twice hydroxylated at the side chain. In addition, EL was O-demethylated at 2 positions followed by side chain hydroxylation. MY and SA were demethylenated and subsequently methylated. In the human urine sample, the following metabolites could be identified: O-demethyl elemicin, O-demethyl dihydroxy elemicin, demethylenyl myristicin, dihydroxy myristicin, and demethylenyl safrole. As in the human urine sample, neither amphetamine derivatives nor the main nutmeg ingredients could be detected in the rat urine samples. Finally, toxicologic detection of nutmeg abuse was possible by identification of the described metabolites of the EL, MY, and SA in urine applying the authors' systematic toxicologic analysis procedure using full-scan gas chromatography-mass spectrometry after acid hydrolysis, liquid-liquid extraction of analytes, and microwave-assisted acetylation of extracted analytes.

Allylbenzene Derivatives↗

PubMed1991

[The urinary screening and identification of amphetamines in clinical toxicology laboratory--VGH].

Amphetamines abuse has recently become a problem in this country. Four case identification, we used Emit-d.a.u. amphetamine assay to screen the amphetamines in human urine, and then confirmed them by gas chromatography-ion trap detector (GC-ITD). From January 1989 to August 1990, 267 urinary samples were requested by the physicians for amphetamine identification. Six samples were accompanied with drug powders used by the patients. Among the 267 samples, 79 were confirmed for the presence for both of methamphetamine and amphetamine. Neither the presence of amphetamine nor methamphetamine itself was detected. Among the six packs of drug powder tested, methamphetamine but not amphetamine was detected in four. We found that fenfluramine and diethylpropion would have false positive amphetamine reactions in Emit-d.a.u. assay. All the samples originated from 34 hospitals were widely distributed in the country. Other drugs concomitantly used included ethanol, morphine, flunitrazepam and ephedrine. Since methamphetamine can be metabolized to amphetamine but not vers versa, our study confirmed the abuse of methamphetamine not amphetamine in this country.

Amphetamines↗

PubMed2004

Development of a screening method for the most commonly abused anticholinergic drugs in Jordan; trihexyphenidyl, procyclidine and biperiden.

A sensitive and rapid method for the simultaneous determination of three commonly abused anticholinergic drugs in Jordan; trihexyphenidyl, procyclidine, and biperiden in plasma and urine has been developed using solid phase extraction and GC-MS. Linearity was established from therapeutic to fatal concentrations of the three drugs; 5-300 ng/ml in plasma, with correlation coefficient r(2) > or = 0.9978 and 10-800 ng/ml in urine r(2) > or = 0.9993. Recoveries were in the range of 86-92% and intra-day and inter-day relative standard deviations (n = 6) were in the range of 6.6-10.3% for the three drugs at three different concentrations in plasma and urine. The base peak m/z 98 for trihexyphenidyl, m/z 84 for procyclidine, and m/z 98 and 218 for biperiden, and m/z 339 for papaverine (internal standard) were monitored at selective ion monitoring; their retention times were 8.10, 8.67 and 8.92 min, respectively, and 14.79 min for the internal standard with analysis time of 16.75 min. The limit of detection of 0.5 ng/ml was attained for trihexyphenidyl and procyclidine, while for biperiden 2.0 and 1.0 ng/ml in spiked plasma and urine, respectively. This method has been applied to forensic and authentic samples taken from abuser and patients using these drugs. The method will offer the clinicians and the legal authority the right diagnosis regarding the anticholinergic involved in any case of abuse with less than 1 h per sample (plasma or urine) from the time of receiving.

Adolescent↗

PubMed2005

New designer drug 2,5-dimethoxy-4-ethylthio-beta-phenethylamine (2C-T-2): studies on its metabolism and toxicological detection in rat urine using gas chromatography/mass spectrometry.

Studies are described on the metabolism and the toxicological analysis of the phenethylamine-derived designer drug 2,5-dimethoxy-4-ethylthio-beta-phenethylamine (2C-T-2) in rat urine using gas chromatography/mass spectrometry (GC/MS) after enzymatic cleavage of conjugates, liquid-liquid extraction and derivatization. The structures of 14 metabolites were assigned tentatively by detailed interpretation of their mass spectra. Identification of these metabolites indicated that 2C-T-2 was metabolized by sulfoxidation followed by N-acetylation and either hydroxylation of the S-ethyl side chain or demethylation of one methoxy group, O-demethylation of the parent compound followed by N-acetylation and sulfoxidation, deamination followed by reduction to the corresponding alcohol followed by partial glucuronidation and/or sulfation or by oxidation to the corresponding acid followed either by partial glucuronidation or by degradation to the corresponding benzoic acid derivative followed by partial glucuronidation. Furthermore, 2C-T-2 was metabolized by N-acetylation of the parent compound followed either by O-demethylation and sulfoxidation or by S-dealkylation, S-methylation and sulfoxidation. The authors' systematic toxicological analysis (STA) procedure using full-scan GC/MS after acid hydrolysis, liquid-liquid extraction microwave-assisted acetylation allowed the detection of an intake of a dose of 2C-T-2 in rat urine, which corresponds to a common drug users' dose. Assuming similar metabolism, the described STA procedure should be suitable for proof of an intake of 2C-T-2 in human urine.

Animals↗

PubMed2000

Amphetamine designer drugs - an overview and epidemiology.

The methylenedioxy-derivatives of amphetamine and methamphetamine represent the largest group of designer drugs. The most frequently used compounds are 3,4-methylenedioxy-methamphetamine (MDMA-ecstasy) and 3,4-methylenedioxy-amphetamine (MDA), first synthesised in 1910 (MDA) and 1914 (MDMA), respectively, to be used as an appetite suppressant. At the end of the 1960s, non-medical (recreational) use appeared in the USA, and in the middle of the 1980s in Europe. In Norway, MDMA and related compounds have been detected in forensic samples since the early 1990s. In order to bypass the legal regulations and to produce more potent substances, a number of related compounds have been synthesised, including derivatives with one or more substituents (methoxy, methyl, halogen or sulphur), attached at different positions to the phenylring of amphetamine or methamphetamine. A report from 1998 shows that 0.5-3% of the adult European population, mainly young people, has used ecstasy.

Adolescent↗

PubMed1999

Drugged driving in the Nordic countries--a comparative study between five countries.

The purpose of this study was to compare whether the high incidence of drugged driving in Norway was different to that in the other Nordic countries. All blood samples received by Nordic forensic institutes during one week in 1996, from drivers suspected by the police of driving under the influence (Denmark: n = 255, Finland: n = 270, Iceland: n = 40, Sweden: n = 86, Norway: n = 149), were analysed for alcohol and drugs (benzodiazepines, cannabinoids, amphetamines, cocaine, opiates and a number of antidepressant drugs) independent of the primary suspicion, and using the same analytical cut-off levels at the different institutes. The primary suspicion was directed towards drugs in more than 40% of the Norwegian cases, drugs were detected in more than 70% of these samples. In only 0-3% of the cases from Denmark, Finland and Iceland, were drugs suspected, while the corresponding frequency for Sweden was 17%. However, evidential breath analyses were used for about three-quarters of the Swedish drivers suspected to be influenced by alcohol. Blood alcohol concentrations (BAC's) below the legal limits were found in 32, 18 and 2% of the Norwegian, Icelandic and Finnish cases, respectively (BAC < 0.05%), in 10% of the Danish cases (BAC < 0.08%) and in 20% of the Swedish cases (BAC < 0.02%). Drugs were most frequently found in the Norwegian and Swedish cases with no alcohol (80-83%). Similar frequencies of drugs in samples with BAC's above the legal limits (19-22%), were obtained for all countries. Benzodiazepines, tetrahydrocannabinol and amphetamine represented the most commonly detected drugs. Our results show that differences between Norway and other Nordic countries with regard to drugs and driving, are connected to the selection criteria made by the police and with more focus on drugged driving in Norway.

Adult↗

PubMed2003

Prevalence of illicit drug use in plasmapheresis donors.

BACKGROUND AND OBJECTIVES: No data are presently available concerning the frequency of illicit drug use in plasmapheresis donors. We therefore examined source plasma units produced in the United States (US) and in Germany for evidence of illicit drug use among donors. MATERIALS AND METHODS: Seventy-five US plasma units from 10 different US states and 75 German plasma units that had been analysed principally for their protein composition were screened for drugs. Determinations were made, using automated immunoassays, of the presence of cannabis, cocaine, amphetamine, methamphetamine, methylenedioxymethamphetamine (MDMA), methylenedioxyethylamphetamine (MDE) and opiates. Positive results were confirmed by gas chromatography-mass spectrometry. RESULTS: Eleven US plasma units were found to be positive for cocaine (14.6%), whereas all German samples were cocaine negative (P = 0.0007). Fifteen US plasma units (20%) and one German unit (1.3%) were confirmed as positive for cannabis (P = 0.0003). Three out of 75 US plasma units were positive for both cannabis and cocaine. In none of the 150 samples were amphetamine, methamphetamine, MDMA, MDE or opiates detected. CONCLUSIONS: Our results strongly suggest differences in cocaine and cannabis consumption between US and German plasmapheresis donors. If these results are confirmed by larger-scale studies, random drug screening (including cocaine) of donors should be implemented in order to reduce the number of drug-containing plasma units, especially in the USA.

Blood Donors↗

PubMed1993

Unregulated self-medication in an ambulatory surgery population.

The objective of this study was to determine whether unregulated self-medication in an ambulatory surgery population was a significant problem in terms of the incidence and nature of drugs detected. We asked 67 consecutive patients who presented for elective ambulatory surgery at a university medical center to volunteer for serum and urine testing with the assurance of confidentiality. All patients denied nonprescription drug use. Initial testing was for amphetamines, barbiturates, benzodiazepines, cocaine, opiates, phencyclidine (PCP), tetrahydrocannabinol (THC) and alcohol. Of the 64 patients who agreed to be tested, 16 patients tested positive for at least one of the above substances; 4 patients demonstrated residua of 2 or 3 substances. No distinctive characteristic of those with evidence of drug use could be identified. We believe that the 25% of patients who tested positive in this group is a conservative estimate of possible unrecognized drug use. We have demonstrated a significant incidence of substance abuse in the ambulatory surgery environment. These findings have serious safety implications, and a higher awareness of possible nonprescription drug use in this environment is needed in medical and support personnel.

Adult↗

PubMed1990

Prevalence of use of cocaine and other substances in an obstetric population.

Increasing use of cocaine among pregnant women has been reported. This study was conducted to determine the prevalence of positive urine toxicologic screens for cocaine and other substances of patients admitted to the Sloane Hospital for Women. Urine samples were obtained from 509 women admitted to the delivery suite. The overall prevalence of cocaine was 10% (n = 51). Cocaine use was 10 times more prevalent in the clinic population (14%) than in the private population, (1.4%). In addition, women whose urine samples were positive for cocaine were more likely to have no prenatal care, previous induced abortions, to be human immunodeficiency virus-positive, and admitted previous use of cigarettes, alcohol, cocaine, and other drugs. Amphetamines were detected in 13% (n = 65) of patients. However, the screens did not distinguish between metabolites of amphetamines and other drugs such as cold medications. The medical history alone predicted only 37% (n = 19) of the cocaine-positive screens and none of the amphetamine-positive screens.

Adolescent↗

PubMed1996

Emergency department evaluation of a rapid assay for detection of cocaine metabolites in urine specimens.

We evaluated the Abuscreen ONTRAK assay for cocaine metabolites, a rapid immunoassay for the detection of cocaine metabolites in a pediatric emergency department (ED) setting. The ONTRAK uses a cutoff point of 300 micrograms/L for benzoylecgonine (BEC), cocaine's major urinary metabolite. One hundred and thirty-two urine specimens obtained from infants, children, and adolescents whose clinical findings warranted toxicology screening were evaluated. The ONTRAK identified all 15 specimens with BEC values of 300 micrograms/L, but did not detect seven additional specimens positive for cocaine metabolites at concentrations less than 300 micrograms/L. One third of the positive specimens for cocaine metabolite identified by fluorescent polarization immunoassay (FPIA), cutoff point set at 80 micrograms/L, and confirmed by gas chromatography/mass spectrometry (GUMS), cutoff point 50 micrograms/L, were not detected by the ONTRAK. These false negative specimens were seen exclusively in young children, whose concentration of cocaine metabolite was less than the ONTRAK's cutoff value. The test was sensitive to drug concentration at or around the stated cutoff values. The ONTRAK test for cocaine metabolites, although both a sensitive and specific screening test for adolescents who smoke or snort cocaine, lacks the sensitivity to be a useful screening too[ for detecting cocaine metabolites in young children. Limitations of currently performed toxicology screening tests (ie, stated cutoff levels) may cause emergency physicians to miss most young children whose symptoms may he related to cocaine exposure.

Adolescent↗