Urine screening for Drugs Abuse, Opiates, Cocaine, Marijuana, Amphetamines and other stimulants
Drugs abuse
Sample for Drugs abuse
- 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 is 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 sight of the technician/doctor and the patient.
- The date and time are noted.
Critical alert on the patient:
- Keep an eye that there is no tampering, like substitution, adulteration, or urine dilution.
- Avoid all unauthorized persons handling the specimen.
- The urine collection may be witnessed or unwitnessed.
Precautions for Drugs abuse:
- Urine will detect heroin for 1 to 2 hours, a maximum of 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 for drugs abuse
- 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 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.
- Phencyclidine
Drugs abuse testing:
- Urine is the best sample for drugs abuse, and the following tests are advised:
- Screening tests. These are simple, inexpensive, and rapid.
- Confirmatory tests. These are laborious and expensive.
Drugs abuse is classified into:
- CNS stimulants:
- It produces euphoria, depresses the appetite, and increases heart and respiration rates.
- These are cocaine and its derivatives, amphetamines, and methamphetamines.
- CNS depressant:
- These will lower heart rates and respiratory rate and reduces pain.
- These drugs are narcotics, sedatives, hypnotics, and tranquilizers.
- Psychoactive:
- These are also hallucinogenic drugs and cannabinoids, and phencyclidine.
- Antidepressant:
- These drugs include lithium, tricyclic depressant, etc.
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:
Opiates
- These are the substances with analgesia, sedation, and anesthesia.
- There is a high potential for addiction.
- Chronic use leads to tolerance for 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 was 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.
- Some of these are:
- Heroin.
- Morphine.
- Oxycodone (Oxycontin).
- Hydromorphone (Dilaudid).
- Fentanyl (Duragesic).
- Acetylcholine, 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
- 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 the following:
- 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).
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.
- Mechanism of action:
- This is an effective local anesthetic with few adverse effects in a therapeutic dose.
- This potent CNS stimulator leads to excitement and euphoria.
- Complications:
- Acute toxicity is associated with hypertension, seizures, arrhythmias, and myocardial infarction.
- Excretion:
- 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 |
Phencyclidine | 25 ng/mL | <3 days |
LSD (Lysergic acid diethylamide | 0.5 ng/mL | <12 to 24 hours |
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.
- Signs 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. This is one of the accepted methods.
- 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.
- A single urine test is enough to diagnose various drugs like cocaine, opiates, barbiturates, amphetamines, methadone, oxycodone, benzodiazepines, cannabinoids, methadone, and tricyclic antidepressant.
Treatment of opiates
- Treat intoxication due to opiates with opiate antagonists like Naloxone.
- Another antagonist is Nalmefene, which is synthetic in origin.
Amphetamines
- Amphetamine and methamphetamine are therapeutic drugs used for:
- Narcolepsy.
- Attention deficit disorder.
- Obesity
- These are stimulants with a high rate of drug abuse.
- Route of administration are:
- Amphetamines are readily absorbed from the GIT and widely distributed throughout the body.
- In the liver, these are converted into more polar substances and easily excreted in the urine.
- These are mostly excreted in 48 hours.
- Oral.
- Injections.
- Inhalation.
- Insufflation.
- Mechanism of action:
- Amphetamines are sympathomimetic amines that stimulate the CNS and produce excitement.
- It increases the release and blocks the uptake of some of the neurotransmitters.
- It induces euphoria and alertness and boosts energy.
- It induces loss of apatite and reduces the sense of fatigue.
- Complications of amphtamine:
- It leads to addiction. One can develop psychological and physiological addiction.
- It induces irritability, anxiety, and insomnia.
- It may lead to blurred vision.
- Increases blood pressure and cardiac palpitation.
- It increases body temperature.
- It may lead to anxiety, paranoid behaviors, and psychosis.
Barbiturates
- Mechanism of action:
- These are CNS depressants.
- These are used as anxiolytic, anticonvulsants, anesthetic, and muscle relaxant drugs.
- These drugs bind to chloride channel molecules of GABA receptors and induce sedation, mood alteration, and euphoria.
- The duration of action of these barbiturates is divided into the:
- Short-acting.
- Ultra-short-acting.
- Lonf-acting.
- Intermediate-acting.
- Once absorbed, these are metabolized in the liver.
- There will be oxidation and glucuronide conjugation.
- Mode of administration:
- The most common routes are oral and parenteral.
- Complications:
- There may be drowsiness.
- Mental impairment.
- Ataxia.
- Dysarthria.
- In case of high doses may lead to coma and cardiovascular and respiratory depression.
Benzodiazepines
- Mode action:
- It is like barbiturates.
- Mode of administration
- These can be given orally or parenterally.
- Side effects:
- These are like barbiturates but are milder.
- There is physical dependence, and the patient may have withdrawal symptoms like:
- Agitation.
- Irritability
- Insomnia.
- Muscle tension.
- Psychosis and seizures.
- Metabolism:
- In the liver, benzodiazepine is converted into active and inactive forms.
- The half-life of the parent drugs is less than metabolites.
Cannabinoids
- Cannabinoids are found in the hemp plant, from which marijuana is formed.
- Mechanism of action:
- In Marijuana, THC is the psychoactive ingredient that leads to euphoria and relaxation effects, which is the reason for its abuse.
- It is highly lipophilic and is converted into more than 20 metabolites.
- Urinary metabolites 11-nor-Δ9-tetrahydrocannabinol9-carboxylic acid (THC-COOH) is used to detect in the urine.
- 70% of the THC is excreted in the feces and urine within 72 hours.
- In addicts, the half-life may be >10 days.
- Mode of administration:
- It can be used for inhalation and also can be ingested.
- THC is nonlethal when it is used alone.
- Side-effects:
- Some of the patients may have side effects like:
- Tachycardia.
- Respiratory distress.
- Behavior and mental abnormalities.
- Long-term use leads to tolerance and mild withdrawal symptoms.
Phencyclidine
- It is a potent hallucinogenic agent.
- Mechanism of action:
- It antagonizes the glutamate receptors and may block dopamine uptake as well.
- This drug is lipophilic, so it can store in the brain and adipose tissue for a longer period.
- Metabolism occurs in the liver through oxidative hydroxylation and conjugation; then, it is cleared from the kidneys.
- Other phencyclidine similar to this one are:
- Cyclohexamine.
- Phenylcyclohexylpyrrolidine.
- Thienylcyclohexylpiperidine.
- Mode of administration:
- These substances can be taken orally.
- Intravenously.
- Smoked in combination with marijuana or tobacco.
- Side effects: These patients may have:
- Tachycardia.
- Paranoia.
- Psychosis.
- Respiratory depression.
- There is mydriasis (dilatation of the pupil).
Questions and answers:
Question 1: Do you think heroin gives addiction by itself?
Question 2: What is the source of Marijuana?