Urine for screening for Drugs, Drugs abuse, Opiates, Cocaine, Marijuana, Amphetamines and other stimulants
Sample
- One of the samples is urine.
- Urine should be taken in the presence of a technician or doctor.
- Saliva test: This is detectable in saliva within one hour of use.
- Hair follicle test: This is detectable in hairs in 5 to 7 days.
- Blood test: This detectable within one hour of use.
- Urine testing advantages are:
- It is easy to get a urine sample, and this is not an invasive procedure.
- Some of the drug concentration is more in urine, which may not be detected in the blood.
- Drug metabolites are excreted for a longer period of time in the urine, indicating the drug’s past use.
- Urine test kits for drugs are more easy and cheap.
- Procedure to get a urine sample for drug abuse:
- The patient should wash their hands and wear gloves.
- Add bluing agents in the toilet to avoid adulteration of the urine sample.
- Avoid all sources of water in the toilet.
- The patient will provide a photo ID.
- The patient will leave all his belongings outside the toilet.
- Someone should be present in the toilet while the patient is giving the sample, or he can wait just outside of the door to listen to any abnormal sound.
- Check the volume of the urine (30 to 40mL) and any abnormal color.
- The sample will be all the time in the sight of the technician/doctor and the patient.
- The date and time are noted.
- Critical alert:
- Keep an eye that there is no tampering, like substitution, adulteration, or urine dilution.
- Avoid all unauthorized persons to handle the specimen.
- The urine collection may be witnessed or unwitnessed.
Precautions
- Urine will detect heroin 1 to 2 hours, maximum up to 2 to 5 hours after use.
- The minimum concentration should be 2000 ng/mL.
- Check for any dilution of the urine by measuring creatinine, pH, and specific gravity.
- The following agents will give false results:
- Sodium chloride.
- Dilute urine due to low specific gravity.
- Acidic urine due to high pH.
- Alkaline urine due to low pH.
- Blood in the urine.
- Detergents in the container.
Indications
- To diagnose drug abuse.
- Indicated in athletes, industrial workers, and professionals.
- It is used in toxicology to confirm clinical or postmortem diagnosis.
- To diagnose drug-induced signs and symptoms and differentiate from the trauma, infectious process, or metabolic disorder.
- To diagnose psychosis or drug abuse.
- It is used in the prisoners to detect drug abuse.
- It is advised in the workplace for public safety.
- In routine following drugs are tested:
- Cocaine.
- Marijuana.
- Opiates (narcotics).
- Methadone.
- Barbiturates.
- Benzodiazepines.
- Amphetamines.
- Methamphetamines.
- Sedatives.
- Analgesics.
- Sympathomimetics.
Pathophysiology
- Urine abuse by drugs is done by:
- Screening tests. These are simple, inexpensive, and rapid.
- Confirmatory tests.
- Drugs of abuse are classified into:
- CNS stimulants produce euphoria, depress the apatite, and increase heart and respiration rates.
- These are cocaine and its derivatives, amphetamines, and methamphetamines.
- CNS depressant lowers heart rates, respiratory rate and reduces pain.
- These drugs are narcotics, sedatives, hypnotics, and tranquilizers.
- Psychoactive or hallucinogenic drugs are cannabinoids and phencyclidine.
- Antidepressant drugs include lithium, tricyclic depressant, etc.
- CNS stimulants produce euphoria, depress the apatite, and increase heart and respiration rates.
- The prevalence of drug abuse is as follows.
Drug abuse | Prevalence % |
Alcohol | 75 to 80 |
Marijuana | 20 to 26 |
Cocaine | 5 to 13 |
Benzodiazepine | 1 to 5 |
Barbiturates | 0.5 to 5 |
Opiates | 0.1 to 2 |
Phencyclidine | 0.1 to 2 |
Amphetamines | 0.1 to 1 |
Other stimulants | 0.8 to 2 |
Sedatives and hypnotics | 0.6 to 2 |
There are several opiates used for addiction:
- Some of these are:
-
- Heroin.
- Morphine.
- Oxycodone (Oxycontin).
- Hydromorphone (Dilaudid).
- Fentanyl (Duragesic).
-
- Acetylcodeine, an impurity of heroin synthesis, has been suggested as an interesting biomarker of illicit heroin use.
- Codeine and heroin are metabolized to morphine, which is then excreted in the urine.
- Heroin metabolism shows that it is not an active compound but becomes active after conversion to 6-Acetylmorphine.
- 6-Acetylmorphine and morphine are pharmacologically very active substances.
- So the detection of morphine in urine can result from:
- Intake of heroin.
- Morphine.
- Codeine.
- Poppy seeds intake.
- Heroin may be present until 5 days in urine after the last dose. (Some say 3 to 4 days).
Amphetamines
-
- Amphetamine and methamphetamine are therapeutic drugs used for narcolepsy and attention deficit disorder.
- These are stimulants with a high rate of drug abuse.
Opiates
-
- These are the substances with analgesia, sedation, and anesthesia.
- There is a high potential for addiction.
- Chronic use leads to tolerance with physical and psychological dependence.
- Acute use with overdose leads to respiratory acidosis with respiratory system depression, myoglobinuria, and possibly increased myocardial infarction indicators.
- A very high dose of opiates may lead to death due to cardiopulmonary failure.
- Treatment of an overdose of opiates is antagonists like naloxone.
- This derived from the opium poppy.
- Naturally occurring modified opiates are:
- Opium.
- Morphine.
- Codeine.
- Heroin.
- Hydromorphone.
- Oxycodone.
- Chemically synthetic opiates are:
- Meperidine.
- Methadone.
- Propoxyphene.
- Pentazocine.
- Fentanyl.
Cocaine
-
- These are alkaloid salts, which can be taken by injection or insufflation or inhaled in vapors.
- The half-life of cocaine is 0.5 to 1 hour. Because of the short half-life, repeated doses are given.
- This is an effective local anesthetic with few adverse effects in a therapeutic dose.
- This is potent CNS stimulator leads to excitement and euphoria.
- Acute toxicity is associated with hypertension, seizures, arrhythmias, and myocardial infarction.
- The hepatic product of cocaine is benzoylecgonine, which is excreted in the urine.
- The presence of this metabolite in urine is a sensitive and specific indicator of cocaine intake.
- This can be detected for up to 3 days in the urine after a single intake.
- It can be detected in chronic cases up to 20 days in the urine after the last use.
Some of the drugs and their duration in the urine:Drugs Screening cut-off value Duration of detection Heroin 2000 ng/mL 1 to 2 hours Cocaine 300 mg/dL 2 to 4 days Opiates 300 ng/mL 2 to 4 days Marijuana 50 ng/mL 30 to 60 days Amphetamines 1000 ng/mL 2 to 3 days Methadone 300 ng/mL 8 to 60 hours Barbiturates 200 ng/mL up to 30 days Benzodiazepines 200 ng/mL up to 40 days Alcohol 20 ng/mL 12 hours Tricyclic antidepressant 1000 ng/mL 1 to 3 days PCP 25 ng/mL 2 to 3 days Methaqualone 300 ng/mL up to 7 days
- These are alkaloid salts, which can be taken by injection or insufflation or inhaled in vapors.
Signs and Symptoms of Opiates:
All opiates (Morphine, Codeine, Hydroxymorphine and Oxycodone, hydrocodone, hydrocodone) have the common S/S.
- Heroin action is very rapid in onset.
- These have an analgesic effect.
- Sign and symptoms are:
- Sedation.
- Pinpoint pupil.
- Constipation.
- Euphoria
- Respiratory depression.
- Orthostatic hypotension.
- Decreased intestinal motility leads to constipation.
- There are nausea and vomiting.
- Bradycardia.
- Morphine overdose (intoxication) leads to :
- Coma.
- Miosis.
- Respiratory depression.
Withdrawal Symptoms of opiates are:
- Dilated pupil.
- Tachycardia.
- Lacrimation and rhinorrhea.
- Irritability and restlessness.
- Diaphoresis.
- These symptoms can be decreased by methadone ( an opiate antagonist). Another used drug is clonidine.
Lab diagnosis of opiates, Various methods available are:
- Commercial kits are available.
- Gas chromatography.
- Latex Agglutination Inhibition.
- Thin Layer Chromatography.
- Radioimmunoassay (RIA).
- High-Performance Liquid Chromatography (HPLC).
- Mass Spectrophotometry (GC/MS).
- Radioimmunoassay (RIA) is rapid and cheap.
- Morphine and Codeine are found after heroin use.
Treatment
- Treat intoxication due to opiates with opiates antagonists like Naloxone.
- Another antagonist is Nalmefene, which is synthetic in origin.
Normal urine picture:
Physical features Chemical features Microscopic findings - Color = Pale yellow or amber
- Appearance = Clear to slightly hazy
- pH = 4.5 to 8.0
- Specific gravity = 1.015 to 1.025
- Blood = Negative
- Glucose = Negative
- Ketones= Negative
- Protein = Negative
- Bilirubin = Negative
- Urobilinogen = Negative (±)
- Leucocyte esterase = Negative
- Nitrite for bacteria = Negative
- RBCs = Rare or Negative
- WBC = Rare or Negative
- Epithelial cells = Few
- Cast = Negative (Occasional hyaline)
- Crystal = Negative (Depends upon the pH of the urine)
- Bacteria = Negative