Drug Testing 101 Trust No One!

Drug Testing 101
Trust No One!
Drug Testing
Helen Harberts MA,
MA JD
Austin Texas
2011
My name is…and I’m an
addict
ddi t
My brain tells me to keep using at all costs
 I take drugs to feel “less
less bad”.
bad .
 I get lonely and scared; drugs help that
 II’ve
ve worked really hard, and need a
vacation
 I have two days
y until the next test…myy
brain says I can use and you won’t
know….

You just called me to test
and I’m scared

My “friends” tell me that all I have to do is
Eatt some creatine
E
ti ffrom GNC
GNC.
 Take some stuff from the head shop
 Drink lots off water and take vitamins
 Drink mild bleach
 drink vinegar
 Sneak in some clean urine

Why
y we test:
 Like
a thermometer-it
thermometer it measures
possible continued infection
 It supports recovery
 It frames our treatment plan
 It frames sanctions and incentives
 It helps support the growth of refusal
skills.
Our participants understand….
#1 Comment from failures
“IF ONLY YOU TESTED
ME MORE”
MORE
Drugs of Abuse Testing
Discussion
some basic
b i concepts
t about
b t drug
d
ttesting
ti
 challenging collection strategies
 drug testing methods
 interpreting drug testing results
 questions & myths about drug testing
 specimen
i
ttampering
i
 The “How to Beat a Drug Test Business”
 New stuff to irritate us even more

Drug Testing
Basics
Characteristics of a Good Drug Test:

scientifically valid



therapeutically beneficial



employs proven methods & techniques
accepted by the scientific community
provides accurate profile of client’s drug use
provides rapid results for appropriate response
legally defensible



able
bl to
t withstand
ith t d challenge
h ll
established court track record
scrutinized by legal/judicial review
PO test
Message #1451 posted by hempafied (Info) November 21, 2001
10:34:16 ET
I had not smoked weed in three months and then....I smoked one to
two hits on Oct 12,13,18,24,25,30 waited a week and a half and
smoked about four hits on Nov 10 and two bongs hits on Nov 11. I
had a UA last evening (nov 19) at about 5 pm for probation. I am 5'7''
135 p
pounds average
g metabolism. From Nov 11 to yesterday
y
y I drank
white grape juice, cranberry juice, and large amounts of water. I
took a home test on Thursday the 15 and passed with a faint line.
Yesterday I took 4 aspirin four hours before my test, and drank 32
oz of gatorade mixed with a pouch of certo two hours before my
test....I took B12 to color and ate a hamburger for
creatine.......SOOOOO, what do you experts think????
Drug Testing Reality:
While planning, implementing and administering
drug testing assume that your clients know more
about drug testing than you!
It is their full time job….you have another job and
other clients. They only have 1 probation officer
(hopefully).
Goals of Drug
g Testing:
g Why
y do it?



acts as a deterrent to future drug
g use
identify participants who are maintaining
abstinence
id if participants
identify
i i
who
h h
have relapsed
l
d





rapid intervention
efficient utilization of limited resources
provides incentive, support and accountability
for participants
adjunct to treatment & frames sanction
decisions
Because it is part of the court’s
court s order..
order
Drug
g Testing
g Specimens
p

urine - current specimen of choice






generally readily available - large quantities
contains high concentrations of drugs
good analytical
g
y
specimen
p
provides both recent and past usage
EtS, EtG
other specimens





hair
sweat - patch test
saliva - oral fluids
Eye scanning devices-ugh
Breath-for ETOH, lots of breath
How to do a
drug test
Monitor your vendors, and probation. This is NOT OPTIONAL
How to conduct a urine test
This is a medical process. It should be
consistent objective
consistent,
objective, impersonal
impersonal, and like
a doctor’s office.
 Chain
Ch i off evidence
id
and
db
both
th th
the
appearance and factual existence of
fairness must
m st be present
present.

Officer & Staff safety first!
 Do
not lock yourself in the room with
a drug addict!
 No additional clothes
clothes, purses
purses, etc in
the room with you!
 Utilize
Utili universal
i
l precautions
ti
att allll
times.
Urine Sample Collection:
 pre-collection
pre collection
 site
preparation
selection
 minimize
access to water sources
 use an area with a scant floor plan
 find
fi d privacy
i
& security
it
 gather
 removal
supplies beforehand
of outer clothing
 complete custody & control form
Sample Collection:
(
(continued)
ti
d)
wash hands prior to donation
 provide proper collection receptacle
 “witness”
“ it
” collection
ll ti

additional clothing removal
 body
b d iinspection
i
 squat and cough
 Start,
St t stop,
t
start
t t
 use of the “wand”

Sample Collection:
(continued)

acceptt sample
l & inspect
i
t
temperature (90-100˚ F)
 color (no color  inappropriate)
 odor (bleach, sour apples, aromatics,
vinegar,
i
etc.))
 solids or other unusual particulates

maintain visual line-of-sight
 label sample
p correctly!!!
y

Sample Collection: (continued)





security seal
complete
p
custody
y & control form
store sample appropriately
develop
p detailed written p
policy
y
quality control collection process



don’t assume collection p
procedures are being
g done
correctly
exit interviews-if they laugh…..
sending through a fake donor
Test for alcohol & drugs!
•Poly-substance abuse is common.
•Your drug
g of choice may
y be alcohol…or
your drug of choice may be at the bottom of
yyour first beer…
•Switching to other substances in early
recovery
y is common to avoid detection
•Opiate cross-overs are common with
alcohol.
With alcohol, technology is your
friend!
Trans-dermal detection devices
Presumptive Alcohol Sensors/PBT
Home electronic monitoring with alcohol testing
Local police/jail/Sheriff testing devices
Kiosks with identification verification
Ignition interlocks
GPS systems
systems-safe
safe start type
Nextel/cell phone to communicate with TX
When to Test?






KEEP ‘EM GUESSING !
test as often as possible - twice weekly or more
effective drug testing must be random
limit time between notification & testing
consider use
se of m
multiple
ltiple specimens (hair
(hair, sali
saliva,
a ssweat)
eat)
design drug-specific testing regimes (cocaine test more
q
y)
frequently)
Understand, and do not underestimate,
the power and nature of the addicted mind.
Remember:
THAT you are going
i to test
is not a surprise: but
WHEN y
you test should be
a total surprise.
Keep it random and do field testing!
The “witnessed” collection (for
urine)



single most important aspect of effective drug
testing program
urine collections not witnessed are of little or no
assessment value
denial component of substance abuse requires
“direct observation” collections of participants
Squat and Cough…..
“Tech Rawlinson instructed the defendant to squat
to the ground with her knees and feet shoulder
width apart, and to cough as hard as she could.
Ms. Doe then squatted as instructed and
coughed with her hand over her mouth
mouth.
Tech Rawlinson heard a loud thumping
sound on the floor immediately after Ms
Ms.
Doe coughed. “
You don’t do it…
this is what gets past you.
Ask someone who knows….

here's a tip to all of you who give supervised UAs to female clients;
Make them use a "hat" (a device that fits over the toilet seat to catch the
urine) and keep both hands up in the air. I faked pee tests myself for 2
years at a major outpatient treatment facility by inserting a small bottle
of clean pee into my vagina with the opening of the bottle covered by a
single layer of aluminum foil wrapped on tightly by a rubber band. I
would then puncture a hole through
g the foil with one finger
g as I held the
cup allowing the urine to drain into it so it would sound just as if I were
actually peeing. Help people hold themselves accountable. Use a hat.
I told the treatment center eventually that I was faking every test and I
told them how to make that impossible for me to continue doing too,
too but
they still don't use hats still to this day. I hold myself accountable
nowadays, but sometimes I really wish I didn't know I had that option of
faking a test still.
Sample
p collection: who,, quality,
q
y, conflict
ttreatment,
t
t probation,
b ti
law
l
enforcement,
f
t
case manager
 probation vs. outside collectors (contract
service) quality assurance?
 specimen type (i.e. urine, hair, sweat)
 frequency of collection
 gender issues
 training
t i i iissues

The chemical testing process
&
interpretation of results
We don’t test for all drugs-limited universe
testing!
 amphetamines
h t i
((speed)
d)
 barbiturates,, benzodiazepines
p
 cannabinoids (THC, marijuana)
 cocaine (crack)
 opiates (heroin)
 phencyclidine (PCP)
 alcohol
Drug Detection Times - by Specimen


g
general
estimates
urine: 1-7 days



sweat (patch): 7-14 days





excluding
g alcohol & THC
necessitates twice weekly screening
depending on product used
saliva (oral fluids): up to 24 hours
hair: up to 90 days
breathalyzer: few hours
EtG: up to 48 hours at 500 cut off.
Drug
Testing
Methods
Two Step Testing Approach
Two-Step
screening test – designed to separate
negative samples from samples that are
“presumptively” positive
 confirmation test – follow
follow-up
up procedure
designed to validate positive test results



distinctly
y different analytical
y
technique
q
more specific and more sensitive
Confirmation tests
 gas
chromatography-mass
spectrometry (GC/MS)
drug molecules separated by physical
characteristics
 identified based on chemical “finger-print”
 considered “gold standard”

 other
chromatographic techniques
Interpreting Drug
Test Results
N
Negative
ti or N
None D
Detected
t t dR
Results
lt

indicates that no drugs or breakdown
products ((metabolites),
p
), tested for,, were
detected in the sample tested

does not mean NO drugs present
 the
probationer may be clean, or….
Negative/None Detected
Interpretation
donor is not using a drug that can be
detected by the test OR
 donor not using enough drug
 donor
donor’s
s drug use is too infrequent
 collection too long after drug use
 urine
rine is tampered
 test being used not sensitive enough

“second
second sense”
sense
If you think something else is going on,
look closer!
 Testing is no more than a good tool.

Change
g up
p the testing,
g, do a home visit,, do
what it takes to detect the problem.
 You may be seeing the first stage of relapse
before the use happens.

Positive Test Result Interpretation
 indicates
i di t
th
thatt d
drug(s)
( ) or b
breakdown
kd
products (metabolites), tested for,
were detected in the sample tested
 drug presence is above the “cutoff”
cutoff
level
 greatest
t t confidence
fid
achieved
hi
d with
ith
confirmation
What is a “cutoff” level
?
a
concentration, administratively
established to distinguish between
established,
negative and positive - “threshold”
 established
t bli h d above
b
th
the sensitivity
iti it lilimit
it
 different for screening
g & confirmation
 also referred to as threshold value
 measured
d iin ng/mL
/ L = ppb
b
Typical
yp
Cutoff Levels
screening & confirmation







amphetamines *
benzodiazepines
cannabinoids
bi id *
cocaine (crack)*
opiates (heroin) *
phencyclidine (PCP) *
alcohol

1000 ng/mL
300 ng/mL
20/50 ng/mL
/ L
300 ng/mL
300/2000 ng/mL
25 ng/mL
20 mg/dL
g
* SAMHSA (formerly NIDA) drugs
500 ng/mL
variable
15 ng/mL
/ L
150 ng/mL
variable
25 ng/mL
10 mg/dL
g
Specific
S
ifi d
drugs
and drug classes
Alcohol - Results Interpretation






screening tests specific for ethanol, ethyl alcohol
positive results indicate presence alcohol
alcohol is rapidly cleared from the body
negative results don’t necessarily document abstinence
detection time = hours
example - person intoxicated at 11:00 PM, collect second
urine sample of next day (11:00 AM), most likely test
negative for alcohol
EtG EtS
EtG…EtS
EtG [Ethyl
[Eth l glucuronide]
gl c ronide] is here.
here
 Detects a metabolite of ethyl alcohol that remains
in the system between two and five days
days.
 Requires different lab equipment and processesdetects use when standard tests do not
not.
 Highly sensitive, and very effective.
 Cut off: 500 –reveals
reveals use for 48 hour window
 SAMHSA Advisory
 EtS should
h ld come in
i att ¼ the
th EtG.
EtG
SAMHSA advisory
Cautious use of EtG is required.
 Incidental or non-consumption
non consumption exposure is
possible
 Cut-offs are still being developed and
clarified.
 Best recommendation: get an admission of
use with the test results as a tool.

Opiates - Results Interpretation






screening tests - drug class assays
positive results indicate presence of opiates
most assays not reactive toward synthetic narcotic
analgesics; meperidine (Demerol), propoxyphene
(Darvon), methadone, pentazocine (Talwin),
f t
fentanyl
l (Sublimaze)
(S bli
)
poppy seed interference- NO POPPY SEEDS!
difficult to separate legitimate use from abuse
detection time: up to 4 days following therapeutic
use off codeine
d i or morphine
hi
Cocaine - Results
Interpretation






drug specific assays
positive results indicate presence of cocaine
metabolites
virtually
i t ll no iinterferences-if
t f
if it comes b
back
k positive,
iti
it’s coke.
positive results almost always associated with
illicit drug use unless there is very recent ear,
nose, throat surgery!
detection time: up to 3 days maximum
negative result may not be clear indication of
non-use
Cannabinoids - Results
Interpretation







drug specific assays
cutoff levels: 50 ng/mL & 20 ng/mL
positive results indicate presence of
cannabinoids - virtually no interferences
difficult to separate recent from non-recent use
due to lipophilic properties
detection time: up to 10 days for heavy chronic
use; 1 - 3 days for occasional use
no passive inhalation
Marinol® usage
Recent Use versus Nonrecent use (double
sanction issue):

How do you discriminate between new drug
exposure and continued elimination from
previous (chronic) use ?
 only drug that poses concern is
Cannabinoids
 “two negative test” rule – two back-to-back
negative drug tests post clean out
Detection
e ec o times
es depend
depe d o
on cu
cut o
off
levels!
30-day detection window often exaggerates
duration
•detection time: at 50 ng/mL cutoff
• up to 3 days for occasional use
• up to 10 days for heavy chronic use
•detection time: at 20 ng/mL cutoff
• up to 7 days for
f occasional use
• up to 21 days for heavy chronic use
Many of the early cannabinoid studies often
cited as p
proof of 30+ dayy detection periods
p
suffered from . .. older research practices



unable to ensure abstinence during the
study
detection cutoffs used very low
used testing methods no longer available
- poor specificity
ifi it
Just say NO to
“levels”
levels
Drug Tests are
Qualitative




screening/monitoring dr
drug
g tests are designed to
determine the presence or absence of drugs - NOT
their concentration
drug tests are NOT quantitative
drug concentrations or levels associated with urine
testing are not useful for interpretation (i.e.
distinguishing
g
g between recent use and continued
elimination)
A confirmation test is p
positive or negative-there
g
is
no value to numeric levels.
Drug concentrations or levels
associated with urine testing
g are,,
for the most part, USELESS !
 cocaine metabolite
opiates
i t
 cannabinoids
 amphetamines

517 ng/mL
negative
ti
negative
negative
The Twins
200 mg
Wonderbarb
@ 8:00 AM
A
B
Collect urine
8:00 PM
12 hours later
The Twins - urine drug test
results
lt
A
Wonderbarb = 638 ng/mL
B
Wonderbarb = 3172 ng/mL
The Twins - urine drug test
results
lt
physiological make up
exactt amountt d
drug consumed
d
exact time of ingestion
exact time between drug
exposure and urine collection
AND YET . . . . .
A
B
The Twins - urine drug test
results
lt
Twin B’s urine drug
level is 5 times higher
than Twin A
A
Wonderbarb = 638 ng/mL
B
Wonderbarb = 3172 ng/mL
Why the difference in urine drug
concentrations between twins?

Twin A ate and drank normally during the day




consumed foods and liquids diluted urine pool
Twin B fasted - urine more concentrated = high
drug level
reduced
d
d variables
i bl associated
i t d with
ith ttwins
i tto near
zero, still could not use urine drug levels
d ’t kknow nearly
don’t
l as much
h iinformation
f
ti about
b t our
own clients regarding drug use
“But the levels of THC are
falling!...”

Simple rule to help you remember:
You
are either pregnant…or
you’re
you
re not
You are either dirty for
detectable drugs…or you’re not.
What the heck is creatinine and
why should I care ?
What is creatinine ?




creatinine is derived from the non-enzymatic
dehydration of creatine in skeletal muscle
creatinine is produced by the body at a relatively
constant rate throughout the day
creatinine is a compound that is unique to
biological material (i.e. urine, other body fluids)
creatinine can be measured to determine the
“strength” or concentration of a urine sample
How are creatinine measurements
used



?
normall h
human creatinine
ti i llevels
l will
ill vary d
during
i
the day based upon fluid intake - healthy
individuals will rarely produce urine samples with
creatinines of less than 20 mg/dL
urines with a creatinines of less than 20 mg/dL
are considered “dilute” and may not reflect an
accurate picture of recent drug use
urines with a creatinines of less than 5 mg/dL are
considered “substituted” samples - not consistent
with normal human urine
But
u what
a about
a ou normalized
o a ed
creatinine?
Interesting…yes
 Possibly
P
ibl iinstructive….yes
t ti
 Error rate: too high for my taste to sanction
 Why would you build resistance?

Creatinine Facts




incidence of creatinines less than 20 mg/dL in a
“normal” population is approximately 1%
some diseases that produce low urinary
creatinines
i id
incidence
off llow creatinines
ti i
iin a population
l ti
undergoing random drug testing is 3 - 5 times
greater than a non-drug
g
g tested p
population
p
any fluid intake dilutes the concentration of drugs
in urine (along with the creatinine)
More Creatinine
F t
Facts




rapid intake of 2 quarts of fluid routinely produces
low creatinines & negative urine drug tests within
one hour
rapid intake of 4 quarts of fluid almost always
produces low creatinines and negative urine drug
t t within
tests
ithi one h
hour
recovery time of urine creatinine and drug
concentrations can take up to 10 hours
incidence of drugs in urine of diluted specimens
is over 5 times g
greater than in samples
p
with
normal creatinine levels
Bottom Line:
Dilute tests are a sign of a
problem and need to be taken
very seriously!
So, what to do?






Begin altering your schedule
schedule-double
double back
Conduct a surprise field visit
Check your testing regimen to be certain folks are
being observed…and not being given too long to
report for testing.
First void in the AM
Refer to a physician
Offer catheter in lieu of water for shy bladder
Questions
i
& Myths
h
S
Surrounding
di
D
Drug
T ti
Testing
Myth #1
Passive inhalation of marijuana smoke can
cause a “positive” drug test result.
 NO - nott if standard
t d d cutoffs
t ff are used
d
 THC (cannabinoid) assay uses variable
cutoffs (20, 50, 100 ng/mL)
p
passive inhalation research indicates less
than 10 ng/mL in volunteer urines
 Shotgunning and hot box is not passive
 no passive inhalation for “crack”

Myth #2
 Advil
®
(ibuprofen) causes “falsepositive” drug tests for marijuana
positive
 NO!
®
 problem with EMIT method corrected
15 yyears ago
g
Myth #3






Consuming
gp
poppy
ppy seeds causes “false-positive”
p
drug tests for heroin
NO! - but?
poppy seeds contain trace amounts of both
codeine and morphine
can causes “positive”
“
iti ” d
drug ttestt results
lt ffor
“opiate” class
confirm positive opiates
Avoid the discussion: simply add “no poppy
seeds” to yyour orders…There is NO
constitutional right to poppy seeds!
Myth #4
Drinking vinegar or cranberry juice will
produce a “negative” urine drug test.
 NO!
 theory is to cause a “pH shift”, making the
urine sample acidic - altering the chemistry
of immunoassay tests
 in reality - the body detoxifies the acid &
physiological
y
g
p
pH
dilutes to p
 But lots of fluid CAN create a dilute test

Myth # 5
 It
takes 30 days to clean out the
pot!
 NO-NO-a thousand times….NO! –
contact NDCI and download
How to
“Beat”
Beat a
Drug Test
You must understand
the disease of addiction
T understand
To
d t d this,
thi
Basics of Specimen Tampering
- The Three Approaches
dilution
dil ti
adulteration
substitution
Yes, I occasionally do research…
Yes, It is the 7 step method
to “Boobstitution”! * Google
search it!
This involves two Visine bottles-you can use your
imagination to figure it out
out. It speaks to
OBSERVED testing.
There are a variety of products
on the market which take cruel
advantage of the illness that
h attacked
has
tt k d our clients
li t
Urine Specimen
Dilution
 most
common form of tampering
 pre collection dilution (hydration
(hydration, water
loading, diuretics)
 post collection dilution ( add water or
fluid))
 creatinine measurement is critical
 dilution
dil i d
detection
i ((validity
lidi checks)
h k )
Pre-Collection
Pre
Collection Dilution




high-volume ingestion of fluids (water loading,
flushing, hydrating, etc.)
may be in conjunction with products designed to
“enhance” drug elimination or removal of drugs
((Gold Seal,, Clean ‘n Clear,, Test-Free,, Naturallyy
Klean, etc.)
no evidence these products have any additional
effect
ff t on drug
d
elimination
li i ti
use of diuretics
P t C ll ti
Post-Collection
Dilution
Dil ti
 agents
added after sample
collection
ll ti d
designed
i
d tto dil
dilute
t or
“thin” drug
g concentration in urine
 diluting agents (water, clean urine,
other
th fluids)
fl id )
Urine Specimen
Adulteration





addition of foreign substances designed to
“mask” drug presence
post-collection tampering
p
p
g
low-tech adulterants that cause “pH shift” (lime,
vinegar,
g , bleach,, ammonia,, lemon,, drano))
low-tech adulterants that disrupt testing
chemistry (salt, methanol, detergent)
five common “high-tech” adulterants
Specimen Validity Tests (SVT)







creatinine,, UUN
specific gravity
pH
nitrites
gluteraldehyde
pyridine
d
chromium
Request SVT from testing laboratory or
use dip-stick SVT products for on-site
testing
Urine Specimen
Substitution

replacing donor urine sample with another
drug-free specimen
biological
bi
l i l substitution
b tit ti
- someone else’s
l ’
“clean” urine
 non-biological
non biological substitution - replacing urine
with urine “look-a-like” sample (diet Mountain
Dew, water with food coloring)
 non-biologicals can be detected with
creatinine testing
g

Addiction makes
folks do strange
things
things…..this,
this of
course is an
example of
attempted urine
substitution.
The Story of
Designer Drugs
Designer Drugs:
drugs, which are created (or
reformulated,
f
l t d if th
the d
drug already
l d
existed) to get around existing drug
l
laws
(CSA)
(CSA), usually
ll b
by modifying
dif i th
the
molecular structures of existing drugs
t varying
to
i d
degrees
Designer Drugs:





“designer drug” was first coined by law enforcement
in the 1980s
second International Opium Convention in 1925 which
specifically banned alternative esters of morphine
1960s - 1970s, new synthetic hallucinogens
(modifications of LSD & PCP)
1980s - 1990s, design of MDMA (ecstasy) &
methcathinone
2000 - 2005,
2005 derivatives of psilocybin & mescaline anabolic steroid
Designer Drugs:

most designer
g
drugs
g have been:




opioids
hallucinogens
g
anabolic steroids
2005
005 - 2010
0 0




stimulants (DMAA)
sedatives (methyl-methaqualone)
(
y
q
)
Sildenafil citrate (designer Viagra)
synthetic
y
cannabinoids
What Drives the Production
Designer Drugs ?
consumer preferences
f
 law enforcement
control

Spice/K2 and
Synthetic
Cannabinoids
No! We’re
not talking
g
about this!
What’s in these
“incense” products?
“Listed”
Listed Ingredients in Spice










Canavalia rosea: commonly known as beach bean or bay bean - vine
found in tropical and subtropical beach dunes
Nymphaea caerulea: also known as Blue Egyptian water lily
Scutellaria nana: perennial herb also known as Dwarf skullcap
Pedicularis densiflora: known commonly as Indian warrior - a perennial
herb
Leonotis leonurus: also known as Lion's Tail and Wild Dagga - a perennial
shrub native to southern Africa
Zornia latifolia: is a perennial herb
Nelumbo nucifera: known by a number of names including Indian Lotus, or
simply Lotus - aquatic perennial commonly found in China
Leonurus sibiricus: commonly called Honeyweed or Siberian motherwort,
herbaceous plant native to Asia
vanilla
honey
Preparation
p
of the
“incense”:

botanicals are sprayed with
liquid preparations of:
HU-210
 HU-211
HU 211
 CP 47,497
 JWH-018
JWH 018
 JWH-073

Where can these
Wh
th
“i
“incense”
” products
d t
be purchased?
Sources of Incense Products:
“head”
head shops/alternative medicine stores
 internet/on-line sources (2004)
 1-(800) phone ordering services
 individual distributors

Internet Sources:
Internet Sources:
Internet Sources:
Buy on ebay:
How is herbal
incense promoted?
p
The Benefits:
More
Directions:
There is 1.5g of Natural Super Puff
in each package. Super Puff incense
is an ultra strong
g aromatic incense,
and is one of the world's strongest
herbal incense blends available. It
contains an extremely potent blend
off h
herbal
b l resins, extracts, and
d
leaves. This incense is for botanical
use only and is not for human
consumption.
consumption
Terms:
TERMSANDCONDITONS:ByentrigthewbsiteofandoreingfromIntesHerbs.comyu
agre to urTemsofServic andusea xpres dbelow.Youalso firmand gre tohe
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distrbuors.Anycopyrightedmaterilsprovide onthis te(“Website”)arehldby
You affirm and agree to the following:
That you are 18 years of age or older.
NO EXCEPTIONS! You agree to use
our products for their intended purposes
only.
l You
Y waive
i without
ith t exception
ti
your right to hold Seller liable in any
way for the misuse of Seller’s products.
Buyer understands that all of Seller’s
Seller s
products are offered for scientific
research purposes only and that these
products are not intended for human
consumption. Buyer understands that
Seller’s products are not meant for oral
p
or inhalation of smoke/hot
/
consumption
vapors. The Seller does NOT supply
instructions on proper use of any product
provided.
They smoke it!!
Warnings?
What
warnings??!
g
What’s the story
behind these
synthetic THC
chemicals?
Synthetic
Cannabinoids
 HU-210
 HU-211
 CP
47,497 (and related chemicals)
 JWH-018
 JWH-073
Origins of Synthetic
Cannabinoids




HU 210 & HU-211
HU-210
HU 211 - synthesized at Hebrew
University, Israel in 1988. HU-210 is an antiinflammatory; HU-211 as an anesthetic
CP 47,497 - developed by Pfizer in 1980 as an
analgesic
JWH 018 & JWH
JWH-018
JWH-073
073 - synthesize
th i b
by a researcher
h
at Clemson (1995) for use in THC receptor
research - John W. Huffman
more than 100 different synthetic cannabinoids
have been created
Synthetic Cannabinoids Timeline:







first appearance on the Internet 2004
Europe
p was original
g
target
g market
by 2008 widespread in Europe
2008 introduced into US
widespread in US by late 2008 - 2009
late 2008 University Hospital Freiburg
Freiburg,
Germany first analysis of incense
first email Spring 2009
Pharmacological Effects of
Synthetic Cannabinoids
HU-210
 CP 47
47,497
497
 JWH-018
 JWH-073
JWH 073

 All
act as THC agonists (mimics THC and
causes similar bonding and reaction)
An agonist is a chemical that
binds to a receptor and triggers a
response – often mimicking the
action of a naturally occurring
substance.
CB Receptors:
p



CB1 and CB2
CB1 receptor influence mainly the brain (central
nervous system, CNS), but there are also
effects expressed in the lungs, liver and
kidneys
CB2 receptor effects mainly the immune
system and in certain stem cells
CB
Receptors:
Smoking Cannabinoids
What does CB1 receptor control?



BG: motor control,
control
learning
Hippo:
ppo memory,
e o y, spat
spatial
a
navigation
CB: cognitive
g
functions attention, language,
emotions
Pharmacological Effects of Synthetic
Cannabinoids are Similar to THC









increase heart rate & blood pressure
altered state of consciousness
mild euphoria and relaxation
perceptual alterations (time distortion)
intensification of sensory experiences
pronounced cognitive effects
impaired short
short-term
term memory
reduction in motor skill acuity
increase in reaction times
Dependence
Syndrome
Similar to
Marijuana
Reported Effects of Synthetic
Cannabinoids are Different to THC







production inconsistencies
herbal incense blends are harsher to inhale
effect on appetite is non-existent
increased restlessness & aggressive behavior
herbal incense produces a shorter “high”
high (perceptual
alterations & sensory effects are limited)
doesn’t mix well with alcohol (hangovers)
(
g
)
incense costs more than marijuana
What’s the legal
status off synthetic
cannabinoids?
bi id ?
Legal Status of Synthetic
Cannabinoids (DEA)
HU-210 - because it is structurally similar to
THC Schedule 1 controlled substance
THC,
 HU-211, CP 47,497, JWH-018 and JWH073 - nott currently
tl controlled
t ll d under
d th
the CSA

Prevalence of Synthetic
THC?


no national statistics
Louisiana:



9 clients “pre-selected” based upon suspicion
7 tested positive
C l bi MO
Columbia
MO:



17 clients “pre-selected” based upon suspicion
12 tested positive
5 self-admissions
Can synthetic THC
C
C
chemicals
h i l be
b
d t t d by
detected
b drug
d
testing?
Drug Testing:





NO on-site, rapid, instant tests
NO laboratory-based screening tests
Four laboratories employing
LC/MS/MS technology
$30 - $60 per sample
many
a yu
unknowns
o s regarding
ega d g tthis
s
testing
The Wild,
Wild Wild West (Issues of Concern):







What synthetic compounds (or
metabolites) are being tested by these
laboratories?
no standardized urine cutoff levels
no standardized methods (LC/MS/MS)
no independent quality control materials
no proficiency testing
detection window unknown
caveat emptor!
Are Th
A
There Control
C t l
Strategies Other Than
Testing?
Alternative
Alt
ti Control
C t l
St t i
Strategies:
 community
supervision
& seizure ((client contract)) (4
( th
A. waiver)
 search

car home
car,
home, possessions
Drug Court
Court’s
s Response:






place specific synthetic
y
cannabinoid prohibition in
your client contract
establish a date certain testing date - inform client
population
l ti
establish sanction severity
select
l t participants
ti i
t for
f testing
t ti where
h
there
th
are
indications of herbal incense use
identify positive participants in court & sanction
openly to enhance deterrent effect
provide opportunity
p
pp
y for p
participants
p
to self-report
p
Bath Salts:

The term
Th
t
bath
b th salts
lt refers
f
to
t a range
of water-soluble products designed to
be added to a bath. They are said to
i
improve
cleaning,
l
i
iimprove th
the
experience of bathing, serve as a
vehicle for cosmetic agents, and some
even claim
l i medical
di l b
benefits.
fit Bath
B th
salts have been developed which
mimic the properties of natural mineral
b th or h
baths
hott springs.
i
Sold Under the Names:
Ivory Wave
 Ivory Pure
 Ivory Coast
 Purple
P l W
Wave
 Vanilla Sky

Health Hazard?
What is Ivory
Wave:
Methylenedioxypyrovalerone (MDPV) is a
psychoactive drug with stimulant properties
which acts as both a norepinephrinedopamine reuptake inhibitor (NDRI)
(NDRI).
 MDPV has four times the potency of Ritalin
 MDPV - no history of FDA approved
medical use
 sold since 2007 as a research chemical

MDPV:
MDPV
currently popular in Europe, UK & Australia
 is usually snorted - similar to cocaine
 considered extremely
y addictive
 MDPV is “legal”
 adverse medical/psychiatric ramifications
 NO drug test available commercially

Designer Drugs:
Take home message:
 designer
g
drugs
g are here to stay
y
 evolutionary patterns
 testing will lag behind
 legal controls with be difficult
 build community supervison/expand search
& seizure efforts

New term of probation
p

You may not ingest any item marked “Not
Not for
Human Consumption”
Preventing Specimen
Tampering






develop challenging collection strategy - ie.
ie make
the testing unannounced and RANDOM!
directly observed collections is the most effective
approach to preventing adulteration and substitution
inspect sample - train collection staff
keep abreast of tampering techniques
take temperature measurements (90˚
(90 - 100
100˚ F)
use laboratory that employs specimen validity
checks & use with on-site
on site devices
SUMMARY (continued)
(
)






drug test often !
confirm positive screening results whenever
possible
k
keep
abreast
b
t off tampering
t
i techniques
t h i
challenge your program - quality assurance
develop a relationship with drug testing experts testing laboratory or on-site device vendor
understand that drug testing is only one part of
th overallll d
the
drug courtt supervision
i i process
Remember:
This is not about “gotcha”
 It is about helping folks to resist
cravings and work programs.
 It is about supporting recovery
recovery.
 It is about objectively measuring the
presence of disease
disease.

Questions?
 Helen
H l
H
Harberts
b t
 [email protected]
Porter93@msn com