NTS: Resource Center

THC - Marijuana

Can a donor test positive through passive inhalation because he was in the same room with someone smoking marijuana?
This is a question that has had a long history. It has been shown that it is possible to have minute detectable levels of THC from passive inhalation, although with the standard DOT/SAMHSA screening cutoff (50 ng/ml) this is not possible. The controversy came from studies that showed that it is possible to produce a positive urine test when an initial cutoff of 20 ng/ml is used. There are numerous scientific articles that validate this point; however, exposure conditions were so unrealistic that they were characterized as nearly intolerable certainly not passive but active participation. Since all certified labs must use the 50 ng/ml for federally covered workers, a positive due to second hand smoke is not possible.

How long is marijuana detectable on a urine test?
This is not an easy question to answer because marijuana is a fat soluble drug. If a person is a first time user, it will probably all be out of the system in about 5 days. For chronic users (several times a week for a long period of time) marijuana is stored in the fat and slowly released over time. In this case, marijuana can be detected for weeks. If one is not a first time user or a chronic user, somewhere in between days to a couple of weeks but this can vary widely from one individual to another.

Does ibuprofen interfere with the marijuana test?
No. No interference is present since 1 million ng/ml of ibuprofen has no effect on the initial test. The manufacturer of the EMIT immunoassay test changed the formulation of the reagent to eliminate any problems. This is another example of the necessity to do GC/MS which provides a molecular fingerprint of the drug.

Poppy Seeds and Other Testing Issues

I've heard that Poppy Seeds will cause a false positive test. What's the Truth?
Poppy seeds will cause a true positive test for opiates, more specifically, morphine. However this is somewhat dependent on the cutoff that is used (see next question for more info).The explanation is easy. Where do poppies come from? They come from poppy seeds. Since poppies contain morphine then poppy seeds should also contain morphine--They do!! and it doesn't take much to make a test positive. For further information, please contact our MRO.

How do you differentiate morphine in poppy seeds from other sources?
It can be very difficult. Here's how the thinking works. A medical review officer will not call a test positive unless there are clinical symptoms of use which can be difficult to prove. If the quantitation of morphine in the urine is less than 2,000 ng/ml then poppy seeds are a likely explanation. The DOT and all federal testing uses a 2000 ng/mL cutoff for this very reason! Although the possibility is unlikely, there have been cases of poppy seeds causing positives as high as 5000 ng/ml. If the morphine quantitation is greater than 2000 ng/ml, then another test, 6 monoacetlymorphine (6 MAM), is automatically performed on federal workplace samples. Monoacetylmorphine is a specific heroin metabolite and is proof of heroin use.

What are the sources of a morphine positive other than poppy seeds?
Morphine can come from heroin use, codeine (morphine is a metabolite), or from using pure morphine.

What about a methadone positive due to Elavil, Benadryl, Soma, Norflex, or Phenergan?
These compounds do not contain any methadone and do not have any effect on the test.

Will Dilantin or Phenobarbital cause a positive test for barbiturates?
Phenobarbital is a barbiturate and will cause a positive test result for barbiturates. Phenytoin (Dilantin) is not a barbiturate; however a metabolite, p-hydroxyphenytoin has minimal cross reactivity on the initial screening test. There is no interference on the confirmatory GC/MS test, therefore, Dilantin (Phenytoin) has no effect on the eventual result for barbiturates. A drug that will have an effect is Primidone (Mysoline) which is metabolized to phenobarbital which will cause a positive result for barbiturates.

What about herbal teas?
Several years ago there was an herbal Inca tea which actually contained cocaine since it was made from the coca plant. Since this product contained cocaine, it was quickly removed from the market by the DEA. There are no herbal teas currently marketed that contain cocaine. Therefore no herbal tea which is legally manufactured will cause a problem with the test for cocaine.

Over the Counter Decongestants and Amphetamine/Methamphetamine

Do over the counter cold medications interfere with a drug test and cause an error in the test?
No, if results have been confirmed by GC/MS. However, there may indeed be a problem if no confirmatory test was performed. The over-the-counter cold medications are structurally very similar to amphetamines and may cause interference in the initial screening test only, but not in the molecular fingerprint confirmation test by GC/MS which is the only approved confirmatory technique in certified laboratories. This is why it is necessary to confirm all positive screens. The compounds that were talking about are pseudoephedrine (Sudafed, Actifed, Contac Drixoral and many others), phenylpropanolamine (Robitussin, Triaminic and others) phenylephrine (Dristan, Neo Synephrine and others) and ephedrine (Primatene, Bronkaid). These compounds are present in many prescription and over the counter medications. Since certified laboratories use GC/MS, that eliminates the chance of a false positive due to these structurally similar compounds.

The Vick's Inhaler presents a special situation. There are two forms of methamphetamine which are mirror images of one another, the d-form and the l-form. The d-form is the psychoactive form and the l-form is present in the Vick's inhaler and has no psychoactive properties. These can not be differentiated by the usual GC/MS methods unless a very specific additional GC/MS test is done to differentiate the d-form and the l-form and this is not automatically done. Our MRO can guide you through this process.

Are there any other drugs that are metabolized by the body into amphetamines?
YES. There is benzphetamine (Didrex) which is metabolized to d-methamphetamine and d-amphetamine. Benzphetamine is used to treat weight loss. Selegiline also known as l-Deprenyl under the trade name Eldeprl is metabolized to l-methamphetamine and l-amphetamine. It is used for parkinsonism. There is another drug which is prescribed in Mexico but not in the U.S which is Clobenzorex (Asenlix) which is metabolized to d-amphetamine. It is used to treat weight loss. Consult our MRO if you have questions about these drugs.

Adulterants - Interfering Substances

What's the truth on Adulterants? Is there anything that will alter the outcome of the test?
Adulterants have become a very popular subject. SAMHSA certified laboratories have been given specific guidelines and are now testing for the more common adulterants, Klear, Whizzies (nitrite), and UrineLuck (earlier versions contained pyridinium chlorochromate and recent versions contain acid and/or iodine), which are generally are thought to interfere with the analysis for THC. There are many adulterants marketed on the internet and in magazines that cater to drug users. To be sure about the latest adulterants that are available contact you drug free workplace program administrator.

Many labs do tests which are non specific for adulterants such as pH (acid or alkaline), creatinine ( How dilute is the urine?), specific gravity (measures how concentrated the urine is relative to water), Chloride (present in salt and bleach). A test for pH may detect acid or alkaline adulterants such as Bleach, lye, soap, bicarbonate, vinegar, or Vanish. Even if these tests are abnormal, the test will be run anyway and reported. If the lab is unable to test for the specific adulterant, it will be reported adulterated with Low or High pH. However, most labs are now doing an adulteration panel which includes tests for specific adulterants such as nitrites, pyridine, chromate, salt, soap, bleach, or glutaraldehyde and the test will be reported as positive for the specific adulterant which would amount to the same thing as a positive test. All labs are different in this respect and it varies from lab to lab. Before implementing a drug test program you need to check with the specific laboratory doing the testing.

What does golden seal root do?
Golden seal root is used as either a tea or as a capsule. It is generally thought that golden seal acts as an interferent and also a diuretic although there is evidence that it acts as an adulterant in vitro (added to a sample) with the EMIT THC assay being particularly susceptible. The active ingredients which may cause the interference have been proposed to be hydrastine and to a lesser extent berberine although the mechanism of how it works is not known. More commonly, golden seal root is thought of as a diuretic (dilutes the urine). One could achieve the same effect on the test by drinking a large volume of water.

What about Herbal Teas?
Several years ago there was an herbal Inca tea which actually contained cocaine since it was made from the coca plant. Since this product contained cocaine, it was quickly removed from the market by the DEA. There are no herbal teas currently marketed that contain cocaine. Therefore no herbal tea which is legally manufactured will cause a problem with the test for cocaine.

Are there other commonly used drugs that interfere with the EMIT test?
Yes. The most common drug is Tolectin which is used as an anti-inflammatory drug. It causes the same effect as glutaraldehyde. Others that have been shown to have a similar effect are Amiodarone (Atlansil,Cordarone), Ciprofloxacin (Cipro), Mefanamic Acid (Ponstel, Ponstan), Metronidazole (Flagyl), Sulfasalazine (Azulfidine,Azopyrin), Griseofulvin (Grisactin), Solindac (Clinoril) and Salicyuric Acid (from high dose aspirin) . Although these have been shown to interfere, it does not mean that these drugs will cause an interference every time.

Does ibuprofen interfere with the marijuana test?
No. Although there was a problem with the initial screening test many years ago, there is no interference today since 1 million ng/ml of ibuprofen has no effect on the initial test. The manufacturer of the EMIT test changed the formulation of the reagent to eliminate this problem. This is another example of the necessity to do GC/MS which provides a molecular fingerprint of the drug.

Do over the counter cold medications interfere with a drug test and cause an error in the test?
The over-the-counter cold medications are structurally very similar to amphetamines and may cause interference in the initial screening test, but not in the confirmation test by GC /MS which is the only approved confirmatory technique in certified laboratories. It is important that all screening tests be confirmed and not all labs do confirmations. The compounds that were talking about are pseudoephedrine (Sudafed, Actifed, Contac Drixoral and many others), phenylpropanolamine( Robitussin, Triaminic and others) phenylepherine (Dristan, Neo Synephrine and others) propylhexedrine (Dristan, Benzedrex) and ephedrine (Primatene, Bronkaid). These compounds are present in many prescription and over the counter medications, It is important to do GC/MS to eliminate the chance of a false positives due to these structurally similar compounds.

The Vick's Inhaler presents a special situation. There are two forms of methamphetamine, the d-form and the l-form. The d-form is the psychoactive form and the l-form is present in the Vick's inhaler. These can not be differentiated by the usual GC/MS methods unless a very specific additional GC/MS test is done to differentiate the d-form and the l-form and this is not automatically done. It is done only on request by the MRO. The presence of l-methamphetamine is proven if there at least 80 % l-methamphetamine present in the sample.

What about a methadone positive due to Elavil, Benadryl, Soma, Norflex, or Phenergan?
These compounds do not contain any methadone and do not have any effect on the test.

Will Dilantin or Phenobarbital cause a positive test for barbiturates?
Phenobarbital is a barbiturate and will cause a positive test result for barbiturates. Phenytoin(Dilantin) is not a barbiturate; however a metabolite, p-hydroxyphenytoin has minimal cross reactivity on the initial screening test. There is no interference on the confirmatory GC/MS test , therefore, Dilantin(Phenytoin) has no effect on the eventual result for barbiturates. A drug that will have an effect is Primidone (Mysoline) is metabolized to phenobarbital which will cause a positive result for barbiturates.

Will the donor test positive for heroin due to Phenergan, Vick's Formula 44, Tonic water or poppy seeds?
None of these compounds contain Heroin. See the response under poppy seeds for a complete discussion of this issue. There is a type of Phenergan which contains codeine which is metabolized to morphine. This is a good example of the need for an MRO to review test results to verify a valid prescription to account for a positive result for morphine. Any prescription cough syrups which contain codeine also will metabolize to morphine and should require an MRO for interpretation. Tonic water contains no opiate or any compound which could lead to a positive heroin or opiate result. This myth came from the fact that quinine(present in tonic water) is also used to "cut" heroin. Obviously, the presence of quinine is not indicative of heroin use.

Are there any other drugs that are metabolized by the body into amphetamines?
YES. There is benzphetamine(Didrex) which is metabolized to d-methamphetamine and d-amphetamine. Benzphetamine is used to treat weight loss. Selegiline also known as l-Deprenyl under the trade name Eldeprl is metabolized to l-methamphetamine and l-amphetamine. It is used for parkinsonism. There is another drug which is prescribed in Mexico but not in the U.S which is Clobenzorex (Asenlix) which is metabolized to d-amphetamine. It is used to treat weight loss.

Do over the counter cold medications interfere with a drug test and cause an error in the test?
The over-the-counter cold medications are structurally very similar to amphetamines and may cause interference in the initial screening test, but not in the confirmation test by GC /MS which is the only approved confirmatory technique in certified laboratories. It is important that all screening tests be confirmed and not all labs do confirmations. The compounds that were talking about are pseudoephedrine (Sudafed, Actifed, Contac Drixoral and many others), phenylpropanolamine (Robitussin, Triaminic and others) phenylepherine (Dristan, Neo Synephrine and others) propylhexedrine (Dristan, Benzedrex) and ephedrine (Primatene, Bronkaid). These compounds are present in many prescription and over the counter medications, It is important to do GC/MS to eliminate the chance of a false positives due to these structurally similar compounds.
The Vick's Inhaler presents a special situation. There are two forms of methamphetamine, the d-form and the l-form. The d-form is the psychoactive form and the l-form is present in the Vick's inhaler. These can not be differentiated by the usual GC/MS methods unless a very specific additional GC/MS test is done to differentiate the d-form and the l-form and this is not automatically done. It is done only on request by the MRO. The presence of l-methamphetamine is proven if there at least 80 % l-methamphetamine present in the sample.

What does Vick's Inhaler Contain? How will it show up on a test?
The Vick's Inhaler contains L-methamphetamine a legal form of methamphetamine which is not psychoactive. It will show up on a test as methamphetamine even after GC/MS confirmation. It is important to do the D and L isomer test to differentiate the D (psychoactive form) from the L form (present in the Vick's inhaler).

General Drug Testing Issues

Which drugs are commonly tested?
If it is a federally mandated test through the DOT , then the urine will be tested for Marijuana(THC), Cocaine, PCP, Opiates (Codeine and Morphine and possibly 6MAM), and Amphetamines(Amphetamine and Methamphetamine), as well as tests for adulteration and specimen validity such as creatinine and specific gravity. No other drug test is allowed. Breath Alcohol is also tested under the DOT regulations.
For non regulated testing, the most common tests include the five drug classes above (the opiate class may also include tests for Hydrocodone(many brands) Hydromorphone(Dilaudid) Oxycodone (Oxycontin, Percodan or Percocet) and also tests for Barbiturates (Phenobarbital (Donnatal), Secobarbital (Seconal), Amobarbital, Pentobarbital(Nembutal), and Butalbital (Fiorinal or Fioricet), Note: Primaodone (Mysoline) is metabolized to phenobarbital. Benzodiazepines Diazepam (Valium), Oxazepam(Serax), Chlordiazepoxide(Librium), Chlorazepate(Tranxene), Midazolam (Versed), Temazepam(Restoril), Alprazolam (Xanax), Triazolam (Halcion), Flurazepam(Dalmane), Lorazepam(Ativan) Prazepam (Centrax)are the most common), Methadone, Propoxyphene ( Darvon or Darvocet), and methaqualone(Qualudes). Alcohol may or may not be tested in urine, blood , or breath according to the company policy.
Some over-the-counter preparations contain phenobarbital such as Priamtene tablets and Donnagel

What does a negative test result mean?
A negative result does not guarantee the absence of drugs, only that the specific drugs tested were either not present or may be below our ability to detect the drugs. If an employee admits to substance abuse, we recommend an evaluation by a Substance Abuse Professional (SAP) as part of an Employee Assistance Program (EAP). A repeat urine drug test or hair drug test may also be indicated.

What if the test is positive?
A positive test has been confirmed by the laboratory; however, there may be medical use of a prescription medication or other legitimate explanation for a positive test result. Our MRO is available to interpret the test result to assist you with determining whether any medications or other legitimate explanations were responsible for the positive test result.

Is there any difference in labs?
YES. There is a BIG difference in the quality of labs. The "gold" standard is a lab which is federally certified by SAMHSA which is the Substance Abuse and Mental Health Services Administration (formerly NIDA, National Institute on Drug Abuse). There are very few SAMHSA certified labs since these labs must pass a rigorous inspection process and also perform well on proficiency tests (samples sent specifically to challenge the labs competence). They must not only to get the correct answer but also the correct quantitation of each drug that was found. The next level of quality are CAP-FUDT (College of American Pathologists-Forensic Urine Drug Testing ) certified labs. If a lab is not certified by SAMHSA or CAP-FUDT then there is no check on the quality of the chain of custody process or the quality of the analytical work. We recommend using only a SAMHSA certified laboratory

Explain the testing process.

Quality laboratories use an initial (screening) test and confirm all positives by a second analytical technique. SAMHSA certified laboratories use an immunoassay as the initial test followed by GC/MS (Gas Chromatography/Mass Spectrometry) as the "gold standard" confirmation technique which is the standard process in a federally certified drug testing laboratory.

The screening immunoassay relies on an antibody present in the reagent which is directed toward the drug or its metabolite. The analogy is like a lock and key. The antibody is like the lock and the drug is like the key, and if there is a match then the initial test (immunoassay) is a presumptive positive. All presumptive positives on the initial test are repoured from the original specimen bottle for confirmation by GC/MS. In this technique the drug or its metabolite is extracted from the urine by means of a solvent or solid phase cartridge and then concentrated (dried) and converted into a stable chemical form for analysis. The GC/MS produces a molecular fingerprint which is unique and specific for each drug. There are no false positives with the GC/MS confirmation analysis.

Explain the differences in test methodology?
Every quality lab uses an initial (screening) test and confirms all positives by a second analytical technique. Most labs will use an immunoassay as the initial test followed by GC/MS (Gas Chromatography/Mass Spectrometry) as the "gold standard" confirmation technique. There are four commonly used immunoassay screening methods:

EMIT (Enzyme Multiplied Immunotransfer Technique)
FPIA (Fluorescent Polarization Immunoassay)
KIMS (Kinetic Interaction of Microparticles in Solution)
CEDIA (Cloned Enzyme Donor Immunoassay)

All of the screening immunoassays rely on an antibody present in the reagent which is directed toward the drug or its metabolite. The analogy is like a lock and key. The antibody is like the lock and the drug is like the key, and if there is a match then the initial test (immunoassay) is positive. The only difference in the theory of the assays is the "tag" which is read by the screening instrument. EMIT has an enzyme tag, FPIA a fluorescent tag. In the KIMS assay, the solution forms microparticles in the absence of drug and does not aggregate in the presence of drug.

All positives on the initial test are repoured for confirmation by GC/MS. In this technique the drug or its metabolite is extracted from the urine by means of a solvent or solid phase cartridge and then concentrated (dried) and converted into a stable chemical form for analysis. The GC/MS produces a molecular fingerprint which is unique and specific for each drug. There must be chain of custody documentation for the specimen and also each portion of urine (aliquot) taken for analysis.

What does a medical review officer(MRO) do?
Once a test is determined to be non-negative by the lab, there must be a review and also interpretation of the result. The MRO will look for a medically valid reason for the positive result. The MRO will also look for procedural errors such as chain of custody problems and also interview the donor to act as the liaison between the laboratory and the employer. It is the responsibility of the MRO to offer a split sample retest on behalf of the donor.After the donor interview is conducted, the MRO may order additional tests such as D and L isomers of methamphetamine or 6-MAM in suspected heroin use. The MRO will then interpret the results.

I'm sure that the testing laboratory made a mistake. What should the donor do?
A certified lab will maintain a positive sample in the original container for one year from the date of the test. They keep positive samples for just such a challenge. If it is a regulated sample (DOT), then the spit sample is reserved to send to another laboratory for re-confirmation. If it is a non regulated sample and there is no split, then a portion of the original specimen may be sent to another lab for re-confirmation. In all cases it should be sent to a certified lab. The MRO for the company should handle this request for the donor. For regulated samples, the donor has the right to request a retest for 72 hours from time of initial contact by the MRO.

Hair Testing Issues

What about hair tests for drugs?
Hair analysis is increasingly being used by many employers during the pre-employment process and some employers are using it for random testing also. Employers have found that hair offers the ability to stop nearly twice as many drug users at the door, before they are employed due to the longer detection window of 90 days. In addition, hair testing for drugs of abuse has been found to be a reliable tool in child custody cases.

Why use hair analysis for pre-employment testing in the workplace?
Urine pre-employment testing is often called a liquid IQ" test. Is the applicant smart enough to abstain from drug use for a week before the drug test? The most serious challenge to an effective pre-employment drug testing program is the limited detection time of drugs in urine. Amphetamine, opiate, PCP and cocaine have average limits of detection of 2 to 3 days on a urine test. Marijuana is detectable for 4-5 days in an infrequent user and up to several weeks from a heavy (chronic user) on a urine test. However, drug deposits in hair remain as long as the hair is left uncut. Hair testing laboratories testing for drugs deposited in hair over a period of approximately 90 days. Urine appears to be more susceptible to adulteration, hydration and switching. The applicant has ample time while searching for employment to plan a method to avoid a positive result in urine. Adulterants are common and easily obtained (see section on adulterants for more info) Hair analysis provides a greater challenge to these applicants for a number of reasons:
• The applicant cannot replace their hair with someone else's.
• The applicant cannot adulterate hair by placing anything in or on the sample while in the specimen collection area.
• The collector takes the hair directly from the applicant and the sample is never out of sight.
• The applicant cannot eat or drink anything that will dilute a hair sample.

There have been reports of individuals who strip, bleach and re-dye their hair to its original color. This may be effective if the applicant is an occasional user and his/her levels were at or near the cutoff. In most cases, the cutoff level used by the more sophisticated laboratories is low enough that stripping the hair will not remove all of the drug that has been deposited.

Is hair analysis appropriate for other workplace drug testing?
Because hair testing detects drug use over a long period of time, approximately 90 days, it is not an appropriate method for post-accident or reasonable suspicion testing. There is about a 7-10 day latent period following drug use in which the drug cannot be detected while waiting for the hair to grow and penetrate the scalp. Urine combined with a breath or blood alcohol specimen is the appropriate sample for this type of testing. There are employers who are using hair analysis and there has been interest in using this type of sample for abstinence monitoring post treatment. Currently, however, the vast majority of employers who use hair testing use it solely for pre-employment and use urine for random, post-accident and reasonable suspicion testing.

Do drugs deposit in or on hair?
The current scientific research indicates that drugs deposit in hair by several methods. These include transmission from the blood supply, through perspiration and skin oil. In addition, drugs are externally deposited on the hair by environmental smoke or, more reasonably, by smoke from the users own ingestion. As with the smoke from tobacco users, an individual's hair will be more susceptible to environmental smoke from his or her own drug use activity.

What are issues of environmental contamination?
Studies on environmental contamination of hair have been limited. To date, cocaine has been the principal focus of these studies and cocaine seems to be the drug most attracted to hair. Cocaine, in its smokable form, can deposit on hair. As mentioned above, the crack smoker will not only ingest cocaine, but will add more cocaine to his/her hair by mere proximity to the smoke during use. Most individuals who do not use cocaine will also not be around smoked cocaine. If an individual lives with a cocaine user, he/she could be subject to cocaine exposure in the living environment. If the donor lives with or spends time with a cocaine smoker, it is possible that the non-user may have some cocaine smoke deposited in his/her hair. If external exposure is limited, the cocaine should wash out of hair using normal hygienic methods. If the exposure is more intense, normal hygiene may not be sufficient to remove all of it. Although often speculated upon, there have been no published scientific papers proving that money is a significant source of environmental contamination of hair with cocaine. Most paper money has been exposed to cocaine, but in such small amounts, handling money and brushing your hair with your hand will not produce a cocaine positive in hair. There have been no published scientific studies of environmental contamination being a problem with other smoked drugs, such as marijuana or heroin. The wash procedures of the hair in the laboratory prior to testing appear to have eliminated the problem and caused the hair to screen negative. When metabolites of these smoked drugs are detected in the hair along with the parent compound, we can be sure that the drug entered the hair after being ingested. Since hair covers a longer period of use, however, it is reasonable that a hair sample will be positive but a urine sample may be negative. Therefore, individual interpretation is required.

The laboratories take extensive steps to remove external contamination and offer several independent procedures which rule out the possibility of a positive result through any external contamination. The first method involves extensive chemical washing of the hair specimen prior to screening, followed by analysis of the content of the wash data (wash kinetics) or provide sufficient washing steps to provide confidence in the result. The second procedure focuses on the measurement of any metabolites that may be present. Scientifically, when drugs are ingested, they are converted to specific chemical compounds called metabolites These unique metabolites are not present in the environment and their detection indicates that the individual has ingested drugs.

In addition, any positive internal contamination (e.g. from passive inhalation or even poppy seed consumption) is distinguished from deliberate use by setting confirmation cut-off levels above those which can be produced by passive internal exposure. Hair has a significant advantage over urine in that a second sample can be used to validate the initial positive result, due to the 90 day detection window.

What about hair color bias racial bias?
It has long been thought that the drugs (mainly cocaine) bind to melanin, the dark pigment containing material of hair. If this is true, then darker hair would take up more drugs than non-pigmented hair. Thus the idea formed that the testing is racially biased since African Americans, Hispanic, Oriental and Native Americans and many other ethnic groups have predominantly dark hair. This preference has been shown in vitro ( in the test tube) to be true. Studies have shown that dark hair placed in a solution of cocaine in a test tube soaked up more drug than non-pigmented hair. Also dark rat hair was shown to contain more drug than white rat hair for animals given the same amount of drug. Does this translate into a racial preference or more specifically a hair color bias in humans? The main study (T. Mieczkowski and R. Newel, An evaluation of patterns of racial bias in hair assays for cocaine: black and white arrestees compared, Forensic Science International 63: 85- 98 (1993) showed equal findings for hair tests, urine tests, and self-reported data.

Hair Urine Self-Report
% Whites Positive (Cocaine) 36.15 16.5 7.3
% Blacks positive (Cocaine) 62.50 35.9 15.0
Ratio (Black/white) 1.73 2.18 2.05

If only the hair data were presented, it would clearly suggest a bias. However, there is almost the same ratio whether it is hair or urine or self admission. Thus, there appears to be a drug of choice preference for cocaine of black vs. white. Based on one laboratory's data, there may be a preference for methamphetamine in the white population compared to black. Clearly much work needs to be done in this area. One laboratory claims to remove the melanin fraction and thus remove any pigmentation issue.

Does chemical treatment of the hair affect test results?
Commonly used hair products (shampoos, conditioners, sprays, mousses and gels) have no significant effect on test results In fact, normal hair washing helps to remove the external presence of drugs on the hair. Drug residues remain permanently entrapped in the hair.

How much hair is needed for the test?
Assuming the sample is taken from the head, the amount of hair needed is a snip about the thickness of a shoelace tip and at least 1 and _ inches long. This represents a relatively small amount of hair and should be cosmetically undetectable.

How are hair samples collected?
In order to be fair to the donor, the lab must have enough hair to repeat assays if necessary. If the hair is over 1 1/2 inches long, then the lab requires approximately 120 hairs. If placed side by side this quantity of hairs would equal about 1/2 inch on a ruler. If the hair is shorter than 1 1/2 inches in length, more hair is required (1 inch length requires 240 hairs, 1/2 inch length requires 360 hairs). The reason for this is that although the laboratory describes the sample quantity in numbers of hairs for collectors, the test requirements are actually 120 mg of hair by weight. Hair weight varies among individuals. Since collectors do not have access to sensitive scales, it is easier to visualize in numbers of hair.

Take a moment to observe the donor's hair. Many collectors have been fooled by extensions, false dreads, wigs and hair pieces. It is critical that the root ends of the cut hair are together and placed in the pointed portion of the arrow formed by the foil in the collection kit. In order to approximate time of use (prior 90+ days), the laboratory will cut and use about 1 1/2 inch from the root end.
If the donor has no head hair, the collector may use underarm, chest or leg hair. Please note the location in Collections Comments" section of the Test Request Form. This will aid in more accurate interpretation of the results. If underarm, chest or leg hair is collected, make sure to collect as much hair as possible. This hair is usually lighter in weight and therefore more hair is needed for testing.
The issues of sample tampering, adulteration and switching are not an issue for the collector since he/she is cutting the hair directly form the donor. As stated previously, the donor and the sample are never out of the view of the collector.

Can tests be conducted on individuals with little or no head hair?
Yes Hair can be collected from several locations on the head and combined to obtain the required amount of hair. If necessary, body hair such as leg or chest hair can be used as an alternative to head hair. Other sources of hair are not recommended

Will the test results really reflect 90 days use of drugs?
Approximately 90 days. Head hair grows approximately 1/2 inch per month. You would assume that if you cut the hair closely to the scalp and test the first 1 1/2 inch from the root end, you would be testing a 90 day period. The problem with this is that it takes hair approximately 7 to 10 days to grow from the hair follicle through the scalp to a level above the scalp accessible to scissors. No one recommends pulling the hair from the scalp and out of the follicle. We believe the donors would object to the pain. Therefore, a hair analysis of 1 1/2 inches covers a time span of approximately 90 days one to two weeks after drug use. Many employers find it useful to test both hair and urine for pre-employment purposes. Urine is useful for a current picture (last 3 - 5 days) of possible drug use and hair for up to a three month drug history.

What is the shortest time period that can be accurately evaluated?
In most situations the minimum time period is approximately one month. The test cannot determine drug use for any particular day or week.

How is hair analysis performed in the laboratory?
Hair, of course, is a solid sample. Urine comes to the lab in liquid form. Hair must go through additional extraction procedures in order to release the drugs from the hair before testing. From that point on, the tests are performed almost identically to urine drug testing.

1. The sample is received in the secured Specimen Processing department to be verified for complete chain of custody, adequate sample volume and computer data entry. The sample is cut and weighed. Once cut into very small pieces, the sample is mixed to create as homogeneous a sample as possible. An internal chain of custody is created and a portion of the cutting of each sample is sent to the laboratory for screening.
2. The samples are washed, prepared (digested) and the drugs are extracted into a liquid form. As with urine, the screening process is performed by immunoassay techniques. Those samples which test negative are then reported as negative. If the screening process produces a suspected positive, a request is made from the laboratory to the specimen processing department to provide a new sample from the remainder of the original cuttings.
3. The second portion of the original cuttings is then washed, prepared (digested) , extracted and subjected to confirmation testing by either gas chromatography mass spectrometry (GC/MS) or gas chromatography mass spectrometry/ mass spectrometry (GC/MS/MS). If the confirmation test is negative or less than the cutoff, the sample is reported as negative. If the sample is positive the laboratory reports the sample as positive.
4. Certifying scientists manually review all hair analysis tests before results are issued. Which drugs are commonly tested for using hair? Hair testing will recover the five drugs most often found in the workplace:
• Amphetamines (methamphetamine and amphetamine)
• Cocaine (Cocaine, and metabolites, benzoylecgonine and cocaethylene)
• Opiates ( morphine, and codeine and the heroin metabolite ,MAM)
• Phencyclidine (PCP)
• Marijuana (THC or Carboxy THC metabolite

Can you go back further than 90 days?
Theoretically it is possible to test the entire length of hair in segments beyond 90 days. Since the distribution of drugs through the hair includes sweat and body oil, it is quite possible that recent use has been absorbed down the hair shaft from brushing the oils through the length of hair. However most labs only test the first 1 1/2 inch from the root end.

Alcohol (Ethanol) Testing

What are the different tests for alcohol? How are results interpreted?
Alcohol is tested in blood, breath, saliva and urine. The results for blood and breath are equal; however, blood is not approved for federally regulated DOT tests. Saliva testing has also been approved by the DOT for screening purposes only and any positive must be confirmed by an approved breath alcohol device. Urine as a specimen is also not allowed under the DOT regulations. If testing is done in the private sector, then any of the tests may be used if consistent with the company policy and any applicable state regulations. The current DOT regulations provide for 2 decision points. If the breath alcohol is greater than 0.04 then the employee must be immediately removed from the safety sensitive duty and cannot return to duty until evaluated by a substance abuse professional (SAP) . If the breath alcohol is between 0.02 and 0.039, the employee must be removed from the safety sensitive job for 8 hours or in the case of commercial motor vehicle drivers for 24 hours.
Many private companies use different thresholds for testing, some as high as 0.100. These values can be interpreted. An approximate gauge is that a drink will cause a rise in the blood/breath alcohol of approximately 0.025 but this depends on body weight and the body metabolizes alcohol at approximately the rate of 2/3 drink per hour. If a person has a drink and waits an hour and a half, it will be metabolized. Alcohol is absorbed extremely rapidly and will hit the brain in as little as 3 minutes. It takes a very short time for maximum absorption by the small intestine so that one needs to start the metabolism "clock" after the short "lag" time.

Interpretation of saliva and urine can be more difficult. The ratio of saliva to blood is approximately 1.12 that is a 0.100 in blood would equate to a 0.112 in saliva. The urine values are approximately 1.3 times greater than blood. As an example, a 0.130 urine alcohol would correlate to 0.100. Although urine can be obtained easily, interpretation of urine alcohol values can be particularly difficult and require an MRO or toxicologist for interpretation of the result. Since urine values are influenced by the amount of fluid one drinks it can be difficult to interpret. Generally urine values are interpreted as positive or negative without regard to the quantitation. One big caution, urine contains bacteria that can ferment sugar (glucose) which can convert urine sugar into alcohol. One should always obtain a glucose value (normals are less than 15 mg/dl ) in urine in order to interpret a positive urine alcohol. If the donor is a diabetic and spilling sugar into the urine, then a urine alcohol is of no value.

Can mouthwash interfere with a breath alcohol test?
No, if it is done correctly. According to the DOT regulations, one must perform a confirmation test and wait 15 minutes to allow for the residual mouth alcohol to dissipate. The breath alcohol test measures deep lung air and the residual mouth alcohol is gone in as little as 5 minutes, so that 15 minutes is plenty of time to wait and do the confirmation. Any positive by saliva must be confirmed by a breath alcohol device.

Can the donor test positive for alcohol due to over the counter cough medications?
Yes. There are a number of brands that contain alcohol . In general one would have to consume a very large quantity in order to test positive but it is possible particularly on a urine alcohol.

Frequently Asked Questions about Drugs

What are the effects of drugs on the body?
Drugs of abuse affect the brain and either: slow down actions and reactions (depress), speed up actions and reactions (stimulate).
Drugs such as marijuana (active ingredient THC), opiates (such as codeine, morphine, heroin, methadone, propoxyphene(Darvon), benzodiazepines (for example Valium, Librium), Barbiturates (phenobarbital and Fiorinal), and alcohol are depressants while amphetamines and cocaine are stimulants.

Changes in our body chemistry alter both how our bodies work (our physiology), and how we feel about ourselves and our lives (our psychology). Drugs interfere with normal brain function and other vital body organs including the heart, lungs, liver, pancreas, stomach, and reproductive systems. These changes can range from mild to severe and overdose can result in death.

Marijuana

Can a donor test positive through passive inhalation because he was in the same room with someone smoking marijuana?
This is a question that has had a long history. It has been shown that it is possible to have minute detectable levels of THC from passive inhalation, although with the standard DOT/SAMHSA screening cutoff (50 ng/ml) this is not possible. The controversy came from studies that showed that it is possible to produce a positive urine test when an initial cutoff of 20 ng/ml is used. There are numerous scientific articles that validate this point; however, exposure conditions were so unrealistic that they were characterized as nearly intolerable certainly not passive but active participation. Since all certified labs must use the 50 ng/ml for federally covered workers, a positive due to second hand smoke is not possible.

How long does Marijuana stay in the body?
This is not an easy question to answer because marijuana is a fat soluble drug. If a person is a first time user it will probably all be out of the system in about 5 days. For chronic users (several times a week for a long period of time) marijuana is stored in the fat and slowly released over time. In this case, marijuana can be detected for weeks or in rare cases even months after smoking. If one is not a first time user or a chronic user i.e. somewhere in between is the answer in the range of a couple of weeks but this can vary from one individual to another.

How long is marijuana detectable on a urine test?
THC in marijuana is strongly absorbed by fatty tissues in various organs. Generally, traces (metabolites) of THC can be detected by standard urine testing methods several days after a smoking session. However, in heavy chronic users, traces can sometimes be detected for weeks after they have stopped using marijuana

What is marijuana? Are there different kinds?
Marijuana is a green, brown, or gray mixture of dried, shredded flowers and leaves of the hemp plant (Cannabis sativa). Before the 1960s, many Americans had never heard of marijuana, but today it is the most often used illegal drug in this country. Cannabis is a term that refers to marijuana and other drugs made from the same plant. Stronger forms of cannabis include sinsemilla, hashish ("hash" for short), and hash oil. All forms of cannabis are mind-altering (psychoactive) drugs; they all contain THC (delta-9-tetrahydrocannabinol), the main active chemical in marijuana. There are about 400 chemicals in a cannabis plant, but THC is the one that affects the brain the most. There are stronger forms of marijuana available today than there were in the 1960s. The strength of the drug is measured by the amount of average THC in test samples confiscated by law enforcement agencies.

Most ordinary marijuana has an average of 3 percent THC. Sinsemilla (made from just the buds and flowering tops of female plants) has an average of 7.5 percent THC, with a range as high as 24 percent.
Hashish (the sticky resin from the female plant flowers) has an average of 3.6 percent, with a range as high as 28 percent.
Hash oil, a tar-like liquid distilled from hashish, has an average of 16 percent. with a range as high as 43 percent.

What are the current slang terms for marijuana?
There are many different names for marijuana. Slang terms for drugs change quickly, and they vary from one part of the country to another. They may even differ across sections of a large city. Terms from years ago, such as pot, herb, grass, weed, Mary Jane, and reefer, are still used. You might also hear the names Aunt Mary, skunk, boom, gangster, kif, or ganja. There are also street names for different strains or "brands" of marijuana, such as "Texas tea," "Maui wowie," and "Chronic." A recent book of American slang lists more than 200 terms for various kinds of marijuana.

How is marijuana used?
Most users roll loose marijuana into a cigarette (called a joint or a nail). The drug can also be smoked in a pipe. One well-known type of water pipe is the bong. Some users mix marijuana into foods or use it to brew a tea. Lately, young people have a new method: They slice open cigars and replace the tobacco with marijuana, making what's called a blunt. When the blunt is smoked with a 40 oz. bottle of malt liquor, it is called a "B-40 "

What are the signs of marijuana use?
• sleepiness in later stages
• forgetfulness in conversation
• reduced concentration and coordination
• inflammation in whites of eyes
• pupils likely to be dilated
• hunger
• odor similar to burnt rope on clothing or breath
• tendency to drive cars slowly, below speed limit
• distorted sense of time passage
• use or possession of paraphernalia (rolling papers, pipes, dried plant material, roach clips)

Driving experiments show that marijuana affects a wide range of skills needed for safe driving. Thinking and reflexes are slowed, making it hard for drivers to respond to sudden, unexpected events. Furthermore, a driver's ability to "track" through curves, brake quickly, maintain proper speed and distance between vehicles, is affected. Research shows that these skills are impaired for at least four to six hours after smoking a single marijuana cigarette.

Do people who smoke marijuana are never truly free of its effects?
People who smoke marijuana are often never aware of how their actions affect the safety of others around them. Distorted space and time translates into unsafe habits. People who combine marijuana with alcohol increase the effects of both.

What are specific health risks associated with marijuana ?
The mind altering chemical in marijuana is Tetrahydrocannabinol (THC). Smoking marijuana seems to affect the structure of the brain associated with emotions, motivation, and the regulation of hormones. While permanent damage has yet to be proved, smokers often have memory problems which are caused when THC prevents the brain from transferring information from short-term to long-term memory storage. Other health risks include sore throats and upper respiratory problems such as bronchitis and shortness of breath. Marijuana smoke is also generally thought to be fifteen times more harmful to the lungs than cigarette smoke. It also contains some of the same ingredients as those in tobacco that cause emphysema and cancer. In women, THC may interfere with ovulation and other hormone-related functions. In men, studies have proven that marijuana use results in reduced testosterone levels, which causes a decrease in sperm count. Studies also indicate THC may cause cellular damage that interferes with the body's ability to fight disease, and lowers the body's resistance to infections and foreign agents.

How many people smoke marijuana ? At what age do children generally start?
A recent government survey tells us:
Over 70 million Americans over the age of 12 have tried marijuana at least once. About 10 million had used the drug in the month before the survey. More than 5 million Americans smoke marijuana at least once a week. Among teens aged 12 to 17, the average age of first trying marijuana was 13.5 years old. A yearly survey of students in grades 8 through 12 shows that by 10th grade, nearly 16 percent are "current" users (that is, used within the past month). Among 12th-graders, nearly 40 percent have tried marijuana/hash at least once, and 19 percent were current users Other researchers have found that use of marijuana and other drugs usually peaks in the late teens and early twenties, then goes down in later years.

How can I tell if my child has been using marijuana?
There are some signs you might be able to see. If someone is high on marijuana, he or she might seem dizzy and have trouble walking, seem silly and giggly for no reason, have very red, bloodshot eyes; and have a hard time remembering things that just happened. When the early effects fade, over a few hours, the user can become very sleepy.

Parents should be aware of changes in their child's behavior, although this may be difficult with teenagers. Parents should look for withdrawal, depression, fatigue, carelessness with grooming, hostility, and deteriorating relationships with family members and friends. In addition, changes in academic performance, increased absenteeism or truancy, lost interest in sports or other favorite activities, and changes in eating or sleeping habits could be related to drug use. However, these signs may also indicate problems other than use of drugs.
In addition, parents should be aware of signs of drugs and drug paraphernalia ,including pipes and rolling papers, odor on clothes and in the bedroom, use of incense and other deodorizers, use of eye drops, and clothing, posters, jewelry, etc., promoting drug use.

Does using marijuana lead to other drugs?
Long-term studies of high school students and their patterns of drug use show that very few young people use other illegal drugs without first trying marijuana. Using marijuana puts children and teens in contact with people who are users and sellers of other drugs. So there is more of a chance for a marijuana user to be exposed to and urged to try more drugs. However, most marijuana users do not go on to use other illegal drugs.

What are the effects of marijuana?
The effects of marijuana on each person depend on the type of cannabis and how much THC it contains, the way the drug is taken (by smoking or eating), experience and expectations of the user, setting where the drug is used, and whether drinking or other drug use is also going on.

Some people feel nothing at all when they first try marijuana. Others may feel high (intoxicated and/or euphoric). It's common for marijuana users to become engrossed with ordinary sights, sounds, or tastes, and trivial events may seem extremely interesting or funny. Time seems to pass very slowly, so minutes feel like hours. Sometimes the drug causes users to feet thirsty and very hungry-an effect called "the munchies."

What happens after a person smokes marijuana?
Within a few minutes of inhaling marijuana smoke, the user will likely feel, along with intoxication, a dry mouth, rapid heartbeat, some loss of coordination and poor sense of balance, and decreased reaction time. Blood vessels in the eye expand, so the user's eyes look red. For some people, marijuana raises blood pressure slightly and can double the normal heart rate. This effect can be greater when other drugs are mixed with the marijuana; but users do not always know when that happens. As the immediate effects fade, usually after 2 to 3 hours, the user may become sleepy

Can a user have a bad reaction?
Yes. Some users, especially someone new to the drug or in a strange setting, may suffer acute anxiety and have paranoid thoughts. This is more likely to happen with high doses of THC. These scary feelings will fade as the drug's effects wear off. In rare cases, a user who has taken a very high dose of the drug can have severe psychotic symptoms and need emergency medical treatment. Other kinds of bad reactions can occur when marijuana is mixed with other drugs, such as PCP or cocaine.

How is marijuana harmful?
Marijuana can be harmful in a number of ways, through both immediate effects and damage to health over time. Marijuana hinders the user's short-term memory (memory for recent events), and he or she may have trouble handling complex tasks. With the use of more potent varieties of marijuana, even simple tasks can be difficult. Because of the drugs effects on perceptions and reaction time, users could be involved in auto crashes. Drug users also may become involved in risky sex. There is a strong link between drug use and unsafe sex and the spread of HIV, the virus that causes AIDS. may find it under the influence of marijuana, students hard to study and learn. Young athletes could find their performance is off - both timing and coordination are affected by THC.
Some of the more long-range effects of marijuana use are described below.

How does marijuana affect driving?
Marijuana has adverse effects on many of the skills needed for driving a car. These effects may include difficulty in judging distances and delayed reactions to sights and sounds that drivers need to notice. There are data showing that marijuana plays a role in crashes. When users combine marijuana with alcohol, as they often do, the hazards of driving can be more severe than with either drug alone.
A study of patients in a shock-trauma unit who had been in traffic accidents revealed that 15 percent of those who had been driving a car or motorcycle had been smoking marijuana, and another 17 percent had both THC and alcohol in their blood. In Memphis, Tennessee, researchers found that, of 150 reckless drivers who were tested for drugs at the arrest scene, 33 percent showed signs of marijuana use, and 12 percent tested positive for both marijuana and cocaine.

What are the long-term effects of marijuana?
While all of the long-term effects of marijuana use are not yet known, there are studies showing serious health concerns For example, a group of scientists in California examined the health status of 450 daily smokers of marijuana but not tobacco. They found that the marijuana smokers had more sick days and more doctor visits for respiratory problems and other types of illness than did a similar group who did not smoke either substance.

Findings so far show that the regular use of marijuana or THC may play a role in cancer and problems in the respiratory, immune, and reproductive systems.

Cancer

It is hard to find out whether marijuana alone causes cancer because many people who smoke marijuana also smoke cigarettes and use other drugs. Marijuana smoke contains some of the same cancer-causing compounds as tobacco, sometimes in higher concentrations. Studies show that someone who smokes higher concentrations. Studies show that someone who smokes five joints per week may be taking in as many cancer-causing chemicals as someone who smokes a full pack of cigarettes every day. Tobacco smoke and marijuana smoke may work together to change the tissues lining the respiratory tract. Marijuana smokers contribute to early development of head and neck cancer in some people.

Reproductive system

Heavy marijuana use can affect hormones in both males and females, so it can affect sexual characteristics and reproductive function. Heavy doses of the drug may delay the onset of puberty in young men. Marijuana also can have adverse effects on sperm production. Among women, regular marijuana use can disrupt the normal monthly menstrual cycle and inhibit the discharge of eggs from the ovaries (ovulation).

Immune system

The immune system protects the body from many agents that cause disease. It is not certain whether marijuana damages the immune system of people. But both animal and human studies have shown that marijuana impairs the ability of T-cells in the lungs' immune defense system to fight off some infections. People with HIV and others whose immune system is impaired should avoid marijuana use.

Respiratory system

Someone who smokes marijuana regularly may have many of the same respiratory problems that tobacco smokers have. They have symptoms of daily cough and phlegm (chronic bronchitis) and more frequent chest colds. Continuing marijuana smoking can lead to abnormal function of the lungs and airways. Scientists have found signs of lung tissue injured or destroyed by marijuana smoke.

How does marijuana affect the brain?
THC disrupts the nerve cells in the part of the brain where memories are formed. This makes it hard for the user to recall recent events (such as what happened a few minutes ago), and so it is hard to learn while high. A working short-term memory is required for learning and performing tasks that call for more than one or two steps. Some studies show that when people have smoked large amounts of marijuana for many years, the drug takes its toll on mental functions. Among a group of long-time heavy marijuana users, researchers found that the people had great trouble when asked to recall a short list of words (a standard test of memory). People in that study group also found it very hard to focus their attention on the tests given to them.

It may be that marijuana kills some brain cells. In laboratory research, some scientists found that high doses of THC given to young rats caused a loss of brain cells such as that seen with aging. At 11 or 12 months of age (about half their normal life span), the rats' brains looked like those of animals in old age. Researchers are still learning about the many ways that marijuana could affect the brain.

Can the drug cause mental illness?
Scientists do not yet know how the use of marijuana relates to mental illness. Some researchers in Sweden report that regular, long-term intake of THC (from cannabis) can increase the risk of developing certain mental diseases, such as schizophrenia. Still others maintain that regular marijuana use can lead to chronic anxiety, personality disturbances, and depression.

Do marijuana users lose their motivation?
Some frequent, long-term marijuana users show signs of a lack of motivation (amotivational syndrome). Their problems include not caring about what happens in their lives; no desire to work regularly; fatigue; and lack of concern about how they look. As a result of these symptoms, most users tend to perform poorly in school or at work. Scientists are still studying these problems.

Can a person become addicted to marijuana?
Yes. While not everyone who uses marijuana becomes addicted, when a user begins to feel that he or she needs to take the drug to feel well, that person is said to be dependent on the drug or addicted to it. In 1993, over 100,000 people entering drug treatment programs reported marijuana as their primary drug of abuse, showing they need help to stop using.
Some heavy users of marijuana show signs of dependence because when they do not use the drug, they develop withdrawal symptoms. Some subjects in an experiment on marijuana withdrawal had such symptoms as restlessness, loss of appetite, trouble with sleeping, weight loss, and shaky hands.

What is "tolerance" for marijuana?
"Tolerance" means that the user needs increasingly larger doses of the drug to get the same desired results that he or she previously got from smaller amounts. Some frequent, heavy users of marijuana may develop tolerance for it.

Are there treatments to help marijuana users?
Up until a few years ago, it was hard to find treatment programs specifically for marijuana users. Treatments for marijuana dependence were much the same as therapies for other drug abuse problems. These include detoxification, behavioral therapies, and regular attendance at meetings of support groups, such as Narcotics Anonymous.

Cocaine "Crack"

What is the difference between "Crack" and Cocaine?
Cocaine is a local or topical anesthetic which stimulates the central nervous system. It is snorted (inhaled through the nose), injected, or, in its free-base form, smoked by inhaling its vapors. It is sometimes called coke, toot, and nose candy. In its free-base form it is sometimes called rock, crack, or base. The effects of the drug begin within minutes after entering the system and start with a brief intense euphoric feeling of well-being, which peaks within 15 to 20 minutes and is followed by depression.

What are the signs of cocaine or "crack" use?
• dilated pupils
• dry mouth and nose
• frequent lip licking
• excessive restless activity
• difficulty sitting still
• lack of interest in food or sleep
• irritable, argumentative, nervous
• talkative (conversation often lacks continuity)
• subjects change rapidly
• runny nose
• chronic cold or sinus/nasal problems
• nosebleeds and use or possession of paraphernalia (glass vials, glass pipe, white
• crystalline powder, razor blades, syringes, needle marks)
• experience severe shifts in mood.
• extremely sensitive to loud noises. This sensitivity can create paranoia which leads to an inability to concentrate on tasks.

What are some of the health risks of using "crack" or cocaine?
Cocaine over stimulates the circulatory, respiratory, and central nervous systems. Cocaine interferes with the natural chemical in the brain that stimulate and regulate the firing of nerve cells. Muscle spasms in various parts of the body can occur. Over stimulation of the nervous system can cause convulsions which can lead to respiratory collapse and death. Long term crack (rock-like bits of cocaine that can be smoked) users have also suffered permanent damage to the cortex, the part of the brain that is used to think.

Opiates (Narcotics)

What are opiate narcotics?
The opiate class of narcotics include morphine, codeine, and heroin. Synthetic opiates are hydrocodone, hydromorphone (Dilaudid), oxycodone (Percodan), meperidine (Demerol) and propoxyphene (Darvon, Darvocet) and methadone which is a synthetic opiate used for heroin detoxification. These drugs are used medicinally to relieve pain, but also have a high potential for abuse. Opiates tend to relax the user. A user will feel an immediate rush when the opiates are injected or smoked (heroin), but may soon experience other unpleasant side effects including restlessness, nausea, and vomiting.

What are the signs of opiates use?
• mental dullness
• lethargy and drowsiness
• going back and forth from alert to drowsy
• cold, moist skin or "gooseflesh"
• scratches frequently
• slurred speech
• constricted pupils that fail to respond to light
• if injected, needle tracks or scars
• paraphernalia (syringes, spoons, medical droppers, bent spoons, metal bottle caps, small glassine bags or foil packets)

What are some of the health risks of using opiates (narcotics)?
These drugs, including codeine, morphine, and common painkillers such as Demerol and Darvon are all legally manufactured from opium, which is a by-product of the poppy plant. Heroin, an illegally manufactured product, as well as those legal narcotics, all find their way into the drug marketplace. When taken outside a doctor's care, the user risks mental and physical dependence in the form of prolonged lethargy, apathy, slurring of speech, and loss of judgment and self-control. All of these may result in convulsions, coma, nausea, diarrhea, vomiting, and malnutrition as the use of the drug replaces a balanced diet.

Amphetamine and Methamphetamine

Are there any other drugs that are metabolized by the body into amphetamines?
YES. There is benzphetamine(Didrex) which is metabolized to d-methamphetamine and d-amphetamine. Benzphetamine is used to treat weight loss. Selegiline also known as l-Deprenyl under the trade name Eldeprl is metabolized to l-methamphetamine and l-amphetamine. It is used for parkinsonism. There is another drug which is prescribed in Mexico but not in the U.S which is Clobenzorex (Asenlix) which is metabolized to d-amphetamine. It is used to treat weight loss.

Do over the counter cold medications interfere with a drug test and cause an error in the test?
The over-the-counter cold medications are structurally very similar to amphetamines and may cause interference in the initial screening test, but not in the confirmation test by GC /MS which is the only approved confirmatory technique in certified laboratories. It is important that all screening tests be confirmed and not all labs do confirmations. The compounds that were talking about are pseudoephedrine (Sudafed, Actifed, Contac Drixoral and many others), phenylpropanolamine( Robitussin, Triaminic and others) phenylepherine (Dristan, Neo Synephrine and others) propylhexedrine (Dristan, Benzedrex) and ephedrine (Primatene, Bronkaid). These compounds are present in many prescription and over the counter medications, It is important to do GC/MS to eliminate the chance of a false positives due to these structurally similar compounds.

What are some of the signs of amphetamine use?
• dilated pupils
• dry mouth and nose
• bad breath
• frequent lip licking
• excessive restless activity
• difficulty sitting still
• lack of interest in food or sleep
• irritable, argumentative, nervous
• talkative (conversation often lacks continuity)
• subjects change rapidly
• alertness, wakefulness, mood elevation
• loss of appetite, exhaustion
• sense of power and a false sense of security.

What are the health risks of using amphetamines?
Amphetamines are central nervous system stimulants which tend to throw off the body's rest and repair system. Hyperactivity and mental anxiety are common. Repeated high dosage results in lethargy, exhaustion, mental confusion, and paranoia. Abnormal uncoordinated movements may persist long after chronic stimulant use stops. These can be accompanied by emotionalism which can be manifested in the form of hallucinations and, finally, blood pressure and heart problems. Abuse can lead to physical problems such as heart attacks and strokes.

PCP "Angel Dust"

What is "angel dust" or PCP?
Phencyclidine (PCP), also commonly known as "angel dust", is an outlawed animal tranquilizer which may be smoked, snorted, injected, or taken orally. PCP is known for its long term potential to create psychotic behavior, violent acts, and psychosis. For many users, PCP changes how they see their own bodies and almost everything around them.

What are some of the signs of PCP use?
• unpredictable behavior with mood swings from passiveness to violence for no apparent reason, possibly including self-destructive behavior
• symptoms of intoxication
• disorientation with agitation and violence if exposed to excessive sensory stimulation
• fear, terror, rigid muscles, strange gait
• deadened sensory perception, possibly unaware of severe injuries
• pupils may appear dilated
• non-communicative mask-like facial appearance
• floating pupils
• hallucination
• synaesthesia (see sounds, smell colors)
• comatose if large amount consumed
• inability to concentrate on tasks can cause accidents.
• users are a potential safety risk.

What are the health risks of using PCP?
PCP or "angel dust" was originally manufactured as a human, then animal, tranquilizer and can cause violent and self destructive behavior. "Dust" affects brain functions. Often it takes the user both out of reality and into a mind set that overrides the natural tendency to be cautious in dangerous circumstances. Consequently, users often place themselves in situations that may cause serious injury. They may become irrational and think themselves to be indestructible. Use may also result in blurred vision, diminished sensations, ataxia (uncoordination), muscle spasms, auditory hallucinations and variable motor depression, which may lead to other aggressive or bizarre behavior. Blood pressure rises, and there may be excessive sweating and salivation. High dose may lead to convulsions, coma, hyperpyrexia (fever), and respiratory depression or arrest (death).

Barbiturates

What are barbiturates?
Barbiturates are prescription sedative hypnotic drugs used to treat anxiety, stomach (gastrointestinal) discomfort, pain, and sleep disorders, and longer acting barbiturates such as phenobarbital used to treat epilepsy. Some are short acting such as pentobarbital (Nembutal), secobarbital (Seconal); intermediate acting such as amobarbital (Amytal), butalbital (Fiorinal, Fioricet, Esgic and others); and long acting phenobarbital (Donnatal and many others).

What are the signs of barbiturate use?
• central nervous system depressant
• mild intoxication ( similar to alcohol)
• slurred speech
• lack of coordination
• lethargy
• headaches
• sensations of numbness or tingling
• dizziness
• confusion
• drowsiness

What are some of the health risks of using barbiturates?
As with other sedative hypnotics, barbiturates can produce physical dependence and withdrawal. Barbiturates were first introduced in the early 1900's and in the 1970's barbiturate overdose was a leading cause of death. Due to the abuse and overdose potential, barbiturates can be very dangerous if taken in greater than prescribed dosages. These drugs are very dangerous when used in combination with other central nervous system depressant drugs such as alcohol. Overdose can result in depression of the central nervous system and cardiovascular system and respiratory depression which can lead to death. Other dangerous effects of overdose are: shock with cool and clammy skin, decreased blood pressure, decreased oxygen carrying capacity of the blood, and coma.

Benzodiazepines

What are benzodiazepines?
Benzodiazepines are one of the most commonly prescribed drugs in the United States. They are sedative hypnotic drugs which relieve anxiety with less harmful side effects than the barbiturates. The benzodiazepine class of drugs include: Diazepam (Valium), Oxazepam(Serax), Chlordiazepoxide(Librium), Chlorazepate(Tranxene), Temazepam(Restoril), Alprazolam (Xanax), Triazolam (Halcion), Lorazepam(Ativan) and Prazepam (Centrax).

What are the signs of benzodiazepine use?
• lethargy
• sedation
• motor incoordination
• intellectual impairment
• sleepiness
• impaired speech
• decreased anxiety
• muscle relaxation
• light headedness
• confusion
• disorganization of thought

What are some of the health risks of using benzodiazepines?
They are relatively safe even at high doses which is why they are replacing the barbiturates as sedative hypnotics. Sedation and respiratory depression at high doses are enhanced with alcohol and other central nervous system depressants. These drugs have an abuse potential.