drug abuse lecture part 2
TRANSCRIPT
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How abused: Smoked in cigarettes or pipe;occasionally eaten as
ingredient baked into
confections.
Typical urine detection cutoff level: 100 ng/mL or 20
ng/mL (optional)
Period detectable after last dose: This is highlyvariable. A one joint per week user has detectable
levels of cannabinoids form 7 to 34 days, while aheavy daily user may be detected from 6 to 81 daysafter last use.
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Substances causing false positive results: nonereported.
A screen detection cutoff level of 20 ng/mL,requested by some laboratory clients, mayproduce false positives due to passive inhalation ofmarijuana smoke, but this is controversial.
At the cutoff level of 100 ng/mL, persons exposedpassively to the smoke of others by virtue of beingin the same room with abusers should be negativeon urine drug screen, although more sensitive
chemical techniques (such as gaschromatography/mass spectrometry, which has asensitivity of 10 ng/mL) may demonstrate the drugin such an individual's urine.
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COCAINE
Cocaine hydrochloride is the typical form used byabusers who ingest the drug by snorting the granular
form into the nose; It can also be dissolved in water and injected
intravenously. Cocaine base is available in a waxy cake form ("rock"
or "crack") which is vaporized with a torch and the
vapors inhaled through a tube.Medical uses: Used almost exclusively by ear, nose
and throat doctors to produce local anesthesia andcontrol blood loss during minor nasal surgery.
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Effects attractive to abuser: Euphoria, increasedability to concentrate, increased alertness,
heightened ability to perform intellectual andphysical tasks, sexual stimulation, heightenedsociability, enhanced self-confidence.
Adverse effects: Restlessness, nervousness,
tremor, convulsions, disturbances in heartrhythm, psychological dependence, myocardialinfarction, sudden death.
How abused: Snorted, injected, or smoked (see
above).
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Typical urine detection cutoff level: 300 ng/mL
Period detectable after last dose: 8-48 hours
Note: The laboratory detection of cocaine is performed byanalyzing the urine for the presence of benzoylecgonine, asubstance produced by the body's chemical detoxification ofcocaine. Continuous conversion of cocaine to the metaboliteoccurs in voided, standing urine specimens (even with
fluoridation and refrigeration) unless the specimen is kept atacid pH (
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Substances causing false positive results: none
reported
However, some legal South American herbal teasmay contain small amounts of coca leaf extract,
which may trigger a positive test in an "innocent"
subject. Please note that cocoa, cacao, and CocaCola are all completely unrelated to coca, which is
the source of cocaine.
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METHAQUALONE
Examples: Quaalude,
Sopor
Medical uses: Once used as a sleeping
pill/sedative, now methaqualone is virtually never
used for medical purposes.
Effects attractive to abuser: Same as that for
barbiturates (see above)
Adverse effects: Same as that for barbiturates (see
above) How abused: Pills taken orally.
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Typical urine detection cutoff level: 300 ng/mL
Period detectable after last dose: up to 90 hours,
depending on dose
Substances causing false positive results: none
reported.
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PHENCYCLIDINE
Examples: PCP, "angel dust"Medical uses: Veterinary tranquilizer; not used in
human medicine.
Effects attractive to abuser: Hallucinogenic effectsAdverse effects: Lethargy, loss of coordination;
unpredictable psychosis, sometimes with criminallyviolent behavior; death.
How abused: Taken orally, smoked in cigarette (oftenmixed with marijuana), injected intravenously as asolution, snorted into the nose in granular form.
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Typical urine detection cutoff level: 75 ng/mL
Period detectable after last dose: 5-10 days
Substances causing false positive results:
Thioridazine (Mellaril), an antipsychotic drug, has
been reported to cause false positive results, as
has the insecticide parathion.
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Legal Aspects of
Drug Testing
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ALCOHOL (ETHANOL)
Examples: Beer, wine, distilled
spirits
Medical uses: Rarely, ifever, used for medical purposes.
Effects attractive to abuser:
Release of social inhibitions,euphoria, sedation
Adverse effects: Same as that for barbiturates
(see above).
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ALCOHOL CONTENT OF WINE AND BEER% Ethanol
(grams/
100 ml
Dose
(ml)
Ethanol
(grams)
Number of
drinks per day
Toxic Threshold
WINE 12% 120 ml 11.5 g Men- 4
Women- 1 to 2
BEER 4% 360 ml 11.5 g Men- 4
Women- 1 to 2
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Pregnant women, even in small ("social")
amounts may have adverse effect on the
fetus.
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ETHANOL IN ALCOHOL IS DANGEROUS!
ANYONE TAKING MORE THAN SIX DRINKS A
DAY IS RISKING PERMANENT LIVER DAMAGE
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Ethanol is absorbed in the stomach into the
bloodstream and is delivered to the liver where it isbroken down
If the liver is regularly overloaded with alcohol, liver
cells are damaged
Damage to the liver cells results to CIRRHOSIS, a
permanent liver damage leading to total failure and
death.
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How abused: Drunk in beverage Period detectable afterlast dose: 8-10 hours
Note: Alcohol is the only drug of abuse (other thantobacco) that is legal for all adults to use.
Illegal use (as in driving while intoxicated) is defined bythe presence of a blood alcohol level of greater than 100mg/dL (0.10% by volume) in Texas (lower in some otherstates).
It is impossible to determine if a subject is legallyintoxicated by measurement of the urine alcohol level. Ablood specimen must be collected for this determinationto be made by a clinical laboratory.
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Screening DrugTesting Laboratory
Organization
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Clinical pathologist
Physician trained in laboratory management
and quality assurance program
Licensed physician, chemist, medical
technologist, pharmacist, or chemical
engineer drug testing lab is a division,
section, unit of a clinical lab
Administrative and technical functions
Head of the Laboratory
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Chemist
Medical Technologist
Pharmacist Chemical Engineer
Verifies completeness of CCF
Prepares specimen for analyses
Examines, processes and analyzes specimen
Interprets, records, releases and signs out lab reports
Analyst
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A trained individual who instructs, assists a donor at
collection sit, receives and makes an initial inspection
of specimen for drug testing and initiates and
completes the CCF
At least high school graduate Must have undergone training in specimen collection Ensures specimen integrity at collection site
Performs correct specimen collection
Ensures security of procedure Accomplishes CCF correctly
Performs initial specimen validity
Authorized Specimen Collector
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Employer of client/ donor/ subject
Investigator at crime scene
Complainant Owner/ administrator of establishment
NOT authorized to collect specimen
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Specimen
Collection
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Within the laboratory
Hand washing facility outside of toilet
Toilet coloring agent
All mandatory tests except for crime scene and
post accident
Collection site
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Workplace, school, jail, rehab, site of crime
Critically ill/ disabled
PERMIT from BHFS 10 days prior
Minimum of 20 tests
No testing should be done at the site
30 or 60 ml, polyethylene bottle, wide mouth withscrew cap
Remote collection site
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Collection
Procedure
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Photo IDdrivers license, employee ID,
passport
Identification by authorized agency
representative
And other ID allowed by agencys workplace
drug testing plan
Donor Identification
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Id by a co-worker
Id by another donor
Use of a single, non photo ID credit card,voters registration card
Unacceptable forms of ID
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Check ID of donor
Explains collection procedure
Fill up step 1 of CCF asks donor to remove outer garments
Examines pockets etc
Asks donor to wash hands
Asks donor to select specimen bottle and label
Steps in collection
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Urine Validity
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Reasons for conducting validity test:
Unobserved urine collection
Suspicion that the urine specimen has been tampered
A test to determine the integrity of thesamples.
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Reasons for conducting validity test:
Unobserved urine collection
Suspicion that the urine specimen has been tampered
A test to determine the integrity of thesamples.
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Adulterated, substituted or diluted
Improperly collected, handled and stored
Improperly documented
Urine is considered invalid
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Adulterated pH less than 3 or greater than 11
Nitrite greater than 500
Diluted Specific gravity of less than 1.003
Creatinine less than 1768 umol/L
Substituted pH less than 2 or greater than 9
Specific gravity less than 1.033 or greater than 1.020
Creatinine less than 442 umol/L
Tampered Urine Specimen
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Recording
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Results should be issued within 15 days
Positive screening results should be subjected
to confirmatory testing
Screening laboratory is the ONLY one
authorized to release the FINAL report
Results cannot be relayed through the
telephone
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CCF for the confirmatory lab (form DT-oo2D)
Request for confirmatory Drug Testing
Uploaded result of DTOMIS
Sample properly labelled and sealed
If found positive:
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THANK YOU!
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