For more information on the various types of drugs and their effects, Matrix Diagnostics has put together a drugs library to help. Click on the drug group to find out more:
Alcohol Acute alcohol intoxication can lead to loss of alertness, coma, and even death. Long term effects include internal organ damage and birth defects. The blood alcohol concentration (BAC) at which a person becomes impaired is variable. The United States Department of Transportation (DOT) has established a BAC of 0.02% (0.02g/dL) as the cut-off level at which an individual is considered positive for the presence of alcohol. Since urine alcohol concentration is normally higher than that in saliva and blood, the cutoff concentration for alcohol in urine is set at 0.04%.
Amphetamines are a class of potent sympathominetic agents with therapeutic applications. The most common amphetamines are d-amphetamine and d,l-amphetamine. Amphetamines are central nervous stimulants that cause the neutrotrransmitters epinephrine, norepinephrine and dopamine to be released into the brain and body giving users feelings of euphoria, alertness, and increased energy. Chronic abuse of amphetamine leads to tolerance and drug reinforcement effect. Cardiovascular responses to amphetamine include increased blood pressure and cardiac arrhythmias. More acute responses produce anxiety, paranoia, hallucinations and psychotic behavior. Amphetamine is metabolised by a number of pathways. In general, acid urine promotes excretion whereas alkaline urine retards it. In 24 hours, approximately 79% of the amphetamine dose is excreted in acid urine and about 45% in alkaline urine. Typically, about 20% is excreted as unchanged amphetamine. Unchanged amphetamine can be detected up to 1 –2 days after use.
Barbiturates are a group of prescription drugs that are frequently abused. They can depress the central nervous system. Acute higher dose induces exhilaration, sedation and respiratory depression. More acute responses produce respiratory collapse and coma. The effects of short-acting barbiturates, such as secobarbital last 3 to 6 hours. The effects of long-acting barbiturates such as phenobarbital last 10 to 20 hours. Short-acting barbiturates normally remain detectable in urine for 4 to 6 days, while long-acting barbiturates can be detected for up to 30 days. Barbiturates are excreted in the urine in unchanged forms, hydroxylated derivatives, carboxylated derivatives and glucuronide conjugates.
Benzodiazepines are a class of widely prescribed central nervous system depressants which have anxiolytic, hypnotic, anticonvulsant and muscle relaxant effects. Chronic abuse can result in addiction and tardive dyskinesia. Acute higher doses lead to drowsiness, dizziness, muscle relaxation, lethargy, coma and possible death. The effects of benzodiazepines use last 4 – 8 hours. Many of the benzodiazepines share a commonmetabolic route, and are excreted as oxazepam and its glucuronide in urine. Oxazepam is detectable in the urine for up to 7 days after drug use.
Buprenorphine a derivative of thebaine, is an opioid that has been marketed in the United States as a Schedule V parenteral analgesic Buprenex. In 2003, based on a reevaluation of available evidence regarding the potential for abuse, addiction, and side effects, the DEA reclassified buprenorphine from a Schedule V to a Schedule III narcotic. Buprenorphine resembles morphine structurally but has a longer duration of action than morphine and can be administrated sublingually as an analgesic. In October 2002, the FDA approved the use of a buprenorphine monotherapy product, Subutex, and a buprenorphine/naloxone combination product, Suboxone, for the treatment of opioid addiction. Subutex and Suboxone are the first narcotic drugs available under the US Drug Act (DATA) of 2003 for the treatment of opiate dependence that can be prescribed in the US in a physician’s work place. It has also been shown that buprenorphine has abuse potential and may itself cause dependency. In addition, a number of deaths have been recorded as a result of overdose with intravenously injected buprenorphine in conjunction with other psychotropic drugs such as benzodiazepines. Buprenorphine is metabolised primarily by n-dealkylation to form glucuronide-buprenorphine and glucuronide-norbuprenorphine.
THC The agents of Marijuana that cause various biological effects in humans are called cannabinoids. Cannabinoid is a central nervous stimulant that alters mood and sensory perceptions, produces loss of coordination, impairs short term memory, and produces symptoms of anxiety, paranoia, depression, confusion, hallucination, and increased heart rate. Large doses of cannabinoids could cause the development of tolerances and physiological dependency and lead to abuse. A tolerance to the cardiac and psychotropic effects can occur and withdrawal syndrome produces restlessness, insomnia, anorexia and nausea. D9-THC is the primary active ingredient in cannabinoids. The main metabolite excreted in the urine is 11-nor-D9-THC-9-COOH, which are found within hours of exposure and remain detectable in the urine for 3-10 days after smoking.
Cocaine Derived from the leaves of the cocoa plant, cocaine is a potent central nervous system stimulant as well as a local anesthetic. Some of the psychological effects induced by cocaine are: euphoria, confidence and a sense of increased energy accompanied by increased heart rate, dilation of the pupils, fever, tremors and sweating. Continued ingestion of cocaine could induce tolerances and physiological dependency which leads to its abuse. Cocaine is used by smoking, intravenous, intranasal or oral administration and excreted in the urine primarily as benzoylecgonine in a short period. Benzoylecgonine has a biological half-life of 5 – 8 hours, which is much longer than that of cocaine ( 0.5 – 1.5 hours), and can be generally detected for 12 – 72 hours after cocaine use or exposure.
EDDP 2-Ethylidine-1,5-dimethyl-3,3-diphenylpyrrolidine, is the primary metabolite of methadone. Methadone is a controlled substance and is used for detoxification and maintenance of opiate dependant patients. Patients on methadone maintenance may exhibit methadone (parent) levels that account for 5-50% of the dosage and 3-25% of EDDP in urinary excretion during the first 24 hours. The detection of EDDP is more beneficial than traditional methadone screening, in that EDDP exists only in urine from individuals that have ingested methadone. The tampering of specimens by spiking the urine with methadone can be prevented. Secondly, renal clearance of EDDP is not affected by urinary pH, therefore the EDDP test provides a more accurate result of methadone ingestion than the methadone parent screen.
Known for being a party drug, ecstasy is used to keep partygoers awake and dancing for long periods of time. It takes around 30 minutes for it to start to have an effect on the user and can last up to six hours. Users will feel an increased energy buzz, as well as becoming very talkative. Negative effects include dilated pupils, nausea, tightened jaw and a very dry mouth and throat, which is why users are encouraged to drink plenty of water. A user of ecstasy may also experience an increase in heart rate and high blood pressure.
The problem with the drug taking 30 minutes to start to have an effect is that many users might think they have been given a pill that does not work and take another one. This increases the effect once they both kick in, which can be very dangerous. Long-term users can also build up intolerance to the drug and, therefore, will need to take more to feel those same effects, which again can be extremely dangerous.
Users of ecstasy can suffer from very bad side effects, including anxiousness and confusion. The senses can become distorted and there can be adverse effects on the brain that can last long term. This brain damage can affect both personality and mood. It can also cause depression and memory loss. Sleep, appetite and energy can all be depleted with long term use.
Throughout Europe, ecstasy is one of the mostly widely used drugs. It has been around since the 1980s but became more common in the 1990s. It is thought that around 7.5% of the population of UK adults have tried ecstasy at some time.
Some Ecstasy that is sold does not contain any MDMA, some can have a mixture of drugs, and some contain a wide range of completely different drugs. They are widely available throughout the UK and Europe, particularly on the club scene.
Commonly linked drugs
Ketamine, which is used as a horse tranquiliser, is often mixed with amphetamine or methamphetamine and can be sold as an expensive form of ecstasy.
Heroin, also known as skag, smack brown, gear, H, horse and junk, has a sedative effect. It slows down the nervous system, and makes the user feel relaxed and warm, with less anxiety and a feeling of detachment. The time it takes for the drug to take effect depends upon the method of administration, with injection having the quickest effect.
As a very highly addictive drug, prolonged use of heroin will lead to dependence on the drug, and withdrawal symptoms can be extremely unpleasant for the user. Flu like symptoms can occur, including muscle aches and spasms, fevers and chills. If the drug is taken intravenously, there is the additional risk of causing damage to the veins. Sharing needles can also lead to a risk of contracting HIV, Hepatitis C and Hepatitis B.
It was thought that in 2010, over 15 million people used opiates, with most of those being heroin users. It is a fairly versatile drug as it can be snorted, smoked or injected. Although heroin is a white powder when it is pure, after it has been cut it is brown. Depending on how it is cut, the purity of the heroin can be in a range of 15% to 30% on average.
Around 85% of the world’s supply of heroin comes from Afghanistan. With well-established networks throughout Europe, it makes the drug easily accessible in the UK.
Commonly linked drugs
Sometimes benzodiazepines are mixed with heroin. The two drugs together are often linked with overdoses.
Ketamine is a derivative of phencyclidine. It is used medically as a veterinary and human anaesthetic. Certain doses of ketamine can cause dream-like states and hallucinatioins. In high doses, ketamine can cause delirium, amnesia, impaired motor function, high blood pressure, depression, and potentially fatal respiratory problems. Ketamine is metabolised in the liver and excreted through the kidney. The half-life of ketamine in the body is around three hours.
The effects of LSD are known as a ‘trip’ as hallucinations can occur, shapes can become distorted and colours will be intensified. Users may also experience a distortion in time, and the effects can be heightened if the user is already mentally vulnerable, such as those who suffer from depression or other emotionally triggered ailments. Some users will experience a sense of an out of body experience.
Each LSD ‘trip’ can vary, and not all of them are a pleasant experience. Some users may feel the urge to harm themselves, as it can intensify an already bad mood, while others can find the experience euphoric. The effects can last for several weeks, with flashbacks that could carry on for several months.
LSD comes naturally in a liquid form. It can be taken as it is, but often it is placed on a sheet of paper which is then left on the tongue to absorb in the system slowly. LSD can also be available in pill form.
LSD is widely available through the UK and Europe. It is taken mainly by the younger generation, although it is not used as much as some other party drugs.
Commonly linked drugs
Sometimes LSD can be mixed with amphetamines and ecstasy. It is then sold as ecstasy, but at a higher price.
MDMA Methylenedioxymethamphetamine (Ecstasy) is a designer drug first synthesised in 1914 by a German drug company for the treatment of obesity. Those who take the drug frequently report adverse effects, such as increased muscle tension and sweating. MDMA is not clearly a stimulant, although it has, in common with amphetamine drugs, a capacity to increase blood pressure and heart rate. MDMA does produce some perceptual changes in the form of increased sensitivity to light, difficulty in focusing, and blurred vision in some users. Its mechanism of action is thought to be via release of the neurotransmitter serotonin. MDMA may also release dopamine, although the general opinion is that this is a secondary effect of the drug. The most pervasive effect of MDMA occurring in almost all people who have taken a reasonable dose of the drug, is to produce a clenching of the jaws. The MDMA Ecstasy Test Strip yields a positive result when Methylenedioxymethamphetamine in urine exceeds 500ng/ml.
As this drug is relatively new, not much is known about the risks, other than those described by users. Reports have stated that there is an increase in anxiety and paranoia, a highly stimulated nervous system, and blood circulation problems. Overuse can cause insomnia and hallucinations. When the drug is combined with alcohol, the risks are increased.
Doses of between 0.5 and 1.0 gram are usual, however, up to 10 grams have been reported to have been used in a binge session. Cathinones and caffeine are sometimes mixed with mephedrone.
The drug was available online before being banned in 2010. It is now mainly bought through dealers, and its usage is increasing.
Commonly linked drugs
Mephedrone is similar to amphetamines and ecstasy on a chemical level and has a very similar effect to both of these drugs, along with cocaine.
Methadone is a synthetic opioid, clinically available. It is used clinically for the treatment of severe pain and in maintenance programs for morphine and heroine addicts. Methadone acts on the central nervous and cardiovascular systems to produce respiratory and circulatory depression. Methadone also produces miosis and increases the tone of smooth muscle in the lower gastrointestinal tract while decreasing the amplitude of contractions. Acute higher doses induce analgesia, sedation, respiratory depression and coma. After methadone administration, the major urinary excretion products are methadone and its metabolites, EDDP and EMDP. Large individual variations in the urine excretion of methadone are output of methadone from 5-22%. Typically, following a 5 mg oral dose, methadone and EDDP account for 5% of the dose in the 24-hour urine. In those individuals on maintenance therapy, methadone may account for 5 to 50% of the dose in the 24-hour urine and EDDP may account for 3 to 25% of the dose.
Methamphetamine is the most popular synthetic derivative of the amphetamines. It is a potent sympathomimetic agent with therapeutic applications. Acute large doses lead to enhanced stimulation of the central nervous system and induce euphoria, alertness, reduced appetite, and a sense of increased energy and power. More acute response produces anxiety, paranoia, psychotic behaviour, and cardiac dysrhythmias. Methamphetamine is excreted in the urine as amphetamine and oxized and deaminated derivatives. However, 10-40% of methamphetamine is excreted unchanged. Methamphetamine is generally detectable in the urine for 3 to 5 days after use
Opiate Opioid analgesics comprise of a large group of substances that control pain by depressing the central nervous system. Acute high dose used by abusers or addicts can cause depressed coordination, disrupted decision, decreased respiration, hypothermia and coma. Morphine is excreted unmetabolised and is the marker metabolic product of opiates. Morphine and morphine glucuronide is detectable in urine for several days after an opiate dose.
Propoxyphene Propoxyphene is a prescription drug for the relief of pain. Although slightly less selective than morphine, Propoxyphene binds primarily to opioid receptors and produces analgesia and other CNS effects that are similar to those seen with morphine-like opioids. It is likely that at equianalgesic doses the incidence of side effects such as nausea, anorexia, constipation, abdominal pain and drowsiness are similar to those of codeine. After oral administration, concentrations of Propoxyphene in plasma reach their highest values at 1 to 2 hours. There is great variability between subjects in the rate of clearance and the plasma concentrations that are achieved. The percentage of excreted unchanged Propoxyphene in urine is less than 1%. In humans, the major route of metabolism is N-demethylation to yield norpropoxyphene. Norpropoxyphene has a longer half-life (30 to 36 hours) than parent Propoxyphene (6 to 12 hours), and its accumulation with repeated doses may be responsible for some of the observed toxicity.
Phencyclidine commonly known as PCP, is a hallucinogen which interacts with dopamine, cholinergic and adrenergic systems. It has dose dependent stimulant, depressant, hallucinogenic and psychological effects. PCP is mostly administered orally or intravenously. Even a moderate amount of PCP, from 5 to 100 ng/ml, can result in psychotic, violent and self-destruction. At high doses, from 100 to 500 ng/ml, PCP can cause convulsions, hypertion, prolonged coma, absent peripheral sensation, and even death. PCP is metabolised via hydroxylation, oxidation, and conjugation with glucuronic acid in the liver. About 10% of the dose is excreted in urine as unchanged drug. For chronic users, PCP can be detected in the urine for 7 to 8 days after drug administration.
These drugs are synthetic and are related to male hormones such as testosterone. This means that their effects can include androgenic effects. Some users take them to increase the size of their muscles and will combine it with an intensive training programme. Steroids also have the effect of making the user aggressive which correspondingly increases physical strength.
There has been an increase among young people in the use of steroids and this is a concern as it can disrupt natural growth. They can also lead to mood swings which, in turn, can lead to violence. Hormonal imbalances are a common side effect and there have been instances of some men developing breasts. It can also have an effect on fertility for both men and women.
There is not a great deal of information available about people who use anabolic steroids, but a survey estimated that there were 50,000 users in the UK in 2010. There is also little evidence connecting regular use and dependency.
A report has suggested that most anabolic steroids that are on the market come from an illegal source, but there are still some users who obtain them from a legitimate prescription. Some products that are sold on the illicit market are not actually licensed for sale in the UK, and some are limited to use by veterinary surgeons.
Tramadol is a quasi-narcotic analgesic used in the treatment of moderate to severe pain. It is a synthetic analog of codeine, but has a low binding affinity to the mu-opioid receptors. Large doses of tramadol can develop tolerance and physiological dependency and lead to its abuse. Tramadol is extensively metabolised after oral administration. Approximately 30% of the dose is excreted in the urine as unchanged drug, whereas 60% is excreted as metabolites. The major pathways appear to be N- and O- demethylation, glucoronidation or sulfation in the liver.