SCREENING OF

SUBSTANCE ABUSE
 DRUGS OF ABUSE
Almost all drugs of abuse are basic drugs which
contain benzene rings; barbiturates are acidic drugs.
Many of the abused drugs act directly on
dopaminergic neurotransmitter systems, especially
the limbic system (smell brain).
A positive drug screening test cannot
differentiate casual user from chronic or habitual
user, likewise detect the time frame of using the drug
or dose of the drug taken.
Designer drugs are modified forms of established
drugs of abuse.
 AMPHETAMINES
therapeutically used for treating narcoplepsy and
attentional deficit disorder.
Increases mental alertness and physical capacity , and
has anorexic property
Structurally related to dopamine and cathecolamines
Ephedrine, pseudoephedrine phenylpropanolamine
=amphetamine-like compounds
3,4-methylenedioxymethamphetamine ( MDMA or
ecstacy), a derivative of methamphetamine is a
popular recreational abused drug.
Hyperpyrexia ( increase body temp) is a sign of acute
intoxication
Toxic effects: hypertension, cardiac arryhtmias and
convulsion, pancytopenia
 ANNABOLIC STEROIDS
They are chemically associated to the male
hormone testosterone (dihydrotestosterone and
testosterone).
It improves athletic performance by increasing
muscle mass.
Toxic effects: chronic hepatitis, atherosclerosis,
abnormal platelet aggregation and cardiomegaly
 CANNABINOIDS
the naturally occurring cannabinoids are marijuana
and hashish
tetrahydrocannabinol (THC), is the most potent
component or the psychoactive substance of
marijuana
THC a lipophilic substance, distributes in the adipose
tissue; it induces a sense of well-being and euphoria
THC is also associated wit impairment of short term
memory and intellectual functions
After a single, THC-COOH can be detected in urine for
3-5 days; up to 4 weeks for chronic user
Urinary metabolic : 11-nor-
deltatetrahydrocannabinol (THC-COOH)
Physiologic effects: reddening of the conjunctiva and
tachycardia
 COCAINE (CRACK)
Is an alkaloid salt that can be taken directly
(inssufflation of IV) or by inhalation
It is derived from coca plant (Erythroxylon) and
used as additive to some foods
Is used as local anesthetic for nasopharyngeal
surgery
A potent CNS stimulant that elicits a sense of
excitement and euphoria: increases physical
activity
It easily pass the placenta and mammary glands
Classically has not been considered as an addictive
drug
 It can cause sudden death due to direct toxicity on
myocardium (cadiac toxicity)
Overdosage of this drug may result to violent
behavior; high abuse potential
Prozac is used to inhibit the action of this elicit
drug
For single use, it can be detected in urine for up to
3 days; up to 20 days for chronic users
Toxic effects: hypertension, arrhythmias, seizures
and myocardial infarction
Urine metabolic: benzoylecgonine (sensitive and
specific indicator)
 OPIATES
They are capable of analgesia, sedation and
anesthesia
Derived chemically from opium poppy
Opium, morphine and codeine naturally
occurring substances
Heroin, hydromorphone (Dilaudid) and oxycodone
(percodan) chemically modified forms of opiates
Meperidine(Demerol), methadone (Dolophine),
propoxyphene (Daryon), pentazocine (Talwin), and
fentanyl (Sublimaze) common synthetic opiates
Heroin is highly addictive; morphine is powerful
analgesic; codeine is antitussive
 morphine binds to mu-receptors on the limbic system
(CNS) producing analgesic effect
morphine and meperidine increase liver and
pancreatic enzymes
methadone is a nonbicyclic drug that binds with
morphine in the brain
darvon overdose combine with alcohol is a major
cause of drug-related death
morphine and codeine are substances commonly
tested
major metabolites: N-acethylmorphine (heroin) and
morphine
antagonist for opiate overdose: nalaxone (narcan)
toxic effects: respiratory acidosis, myoglobinuria and
cardiopulmoray failure
PHENCYCLIDINE (angel dust or angel
hair)
is a depressant, stimulant, and has
hallucinogenic and anaesthetic
properties
it can be ingested or inhaled by smoking
about 10-15% is unchanged when
excreted in urine
major metabolite: Phencylclidine HCL
toxic effects: stupor and coma
 SEDATIVE HYPNOTICS
They have therapeutic roles and they are CNS
depressants
Examples: barbiturates and benzodiazepines
Secobarbital, pentobarbital, Phenobarbital
commonly abused barbiturates
Diazepam(Valium), chlordiazepoxide (Librium), and
lorazepam(Ativan) commonly abused
benzodiazepines
They are used also to potentiates the effects of heroin
Diazepam has a clinical used for rapid control of acute
seizure (Dilantin)
toxicity of this agents are initiated by ethanol
major metabolite: Secobarbital (barbiturates)
toxic effects: respiratory depression
 LYSERGIC ACID DIETHYLAMIDE
(LSD,Lysergide)
A semisynthetic indolalkylamine and
hallucinogen
One of the most potent pharmacologic
materials known
It produces effects at low doses - 20g
It causes blurred or undulating vision
Panic reactions bad trip are the most
common reactions
 METHAQUALONE (Quaalude)
Is a 2,3-disubstituted quinazoline with
anesthetic, antihistamine and
antitussive properties
It also has sedative-hypnotic properties
This abused drug has similar symptoms
of toxixity to barbiturates, as well as
pyramidal signs (hypertonicity,
hyperreflexia and myclonus.
 METHODS FOR IDENTIFYING AND MEASURING
ABUSED DRUGS:
Sample requirement: urine, whole blood or
plasma (alcohol), serum, hair, and nails exhaled
breath (alcohol intoxication)
Examination of blood has the advantage of
identifying currently circulating drugs and to
design treatment plan and monitoring the success
of treatment.
Urine sample for toxicology assay has the
advantage of knowing the complete composite of
drugs that have been ingested over a longer
period than blood samples.
 SPECIMEN CONSIDERATION:
1. Alcohol in blood samples may be analyzed
even after a moment of delay provided the
samples in tubes remain sealed, because
blood holds the enzyme that metabolize it.
2. Urine temperature is a vital factor to assure
that is freshly voided.
3. Aspiration of gastric contents or vomitus
may reveal tablets or capsules from which
the ingested drug can be determined.
ENZYMATIC TEST
- alcohol is measured from blood
using alcohol dehydrogenase as reagent.
- it quantitates the sum of all alcohols
present in sample.
- it does not distinguish alcohols from
its metabolites during quantitation.
 IMMUNOASSAY
- EMIT this method uses enzyme labeled
drug that can competes with the drug in the
sample.

CAPILLARY ELECTROPHORESIS
- different analyte selectivity is based on
different physicochemical principles of separation
without changes in instrumental hardware, a
distinct advantage of this technique.
- recent variant of thin layer chromatography
that includes the advantages of HPLC.
 CHROMATOGRAPHIC METHODS
Thin Layer Chromatography (TLC)
- this method uses serum, urine or gastric fluid for
analysis.
- extraction of drugs is pH dependent acidic
drugs at pH 4.5 (barbiturates) and alkaline drugs
(opiates, amphetamines) at pH 9.0
Liquid Chromatography MS
- can be used to confirm positive test results from
a screening assay (nonvolatile compounds)
- it can also be used for poisoning detection in
acute or chronic intoxication, therapeutic drug
identification and quantitation, pharmacokinetics and
drug metabolism studies.
 High Performance Liquid Chromatography (HPLC)
- allows quantitative measurement of drugs as
well as separation of these same drugs, especially
tricyclic antidepressants including its active and
inactive metabolites.
GAS CHROMATOGRAPHY
Gas Liquid Chromatography (GLC)
- is the legally accepted method for ethanol testing
Gas Chromatography Mass spectroscopy
- gold standardfor confirmation of screening
methods such as TLC and EMIT
- give rise to a fingerprint pattern of each compound
analyzed.
- allows detection of low levels of drugs.
URINE IS THE PREFERRED SAMPLE ESPECIALLY
IN DRUG TESTING BECAUSE OF THE
FOLLOWING REASONS:
1. Drugs and their metabolites are present in
higher concentrations in urine than in blood.
2. Larger sample volumes are easily collected.
3. There is no pain or discomfort when
collecting the sample.
4. The process of obtaining the sample is
noninvasive.
FACTORS RESULTING TO INCORRECT DRUG TESTING
RESULTS:

1. Detergents (alkaline pH)