Matrix Drug Library
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:
6-mono acetyl morphine (heroin metabolite) (6-MAM) or 6-acetylmorphine is one of three active metabolites of heroin (diacetylmorphine), the others being morphine and the much less active 3-monoacetylmorphine (3-MAM).6-MAM is rapidly created from heroin in the body, and then is either metabolized into morphine or excreted in the urine. Since 6-MAM is a unique metabolite to heroin, its presence in the urine confirms that heroin was the opioid used. This is significant because on a urine immunoassay drug screen, the test typically tests for morphine, which is a metabolite of a number of legal and illegal opiates/opioids such as codeine, morphine sulfate, and heroin. 6-MAM remains in the urine for no more than 24 hours so a urine specimen must be collected soon after the last heroin use, but the presence of 6-MAM guarantees that heroin was in fact used as recently as within the last day. 6-MAM is naturally found in the brain, but in such small quantities that detection of this compound in urine virtually guarantees that heroin has recently been consumed.
α-PVP (α-pyrrolidinovalerophenone) is the active ingredient in drugs commonly sold as “bath salts”, “flakka” or “gravel” which have gained popularity since the mid 2000’s due to their potency and low cost. α-PVP is a derivative of MDPV- the only difference being the removal of the 3,4-methylenedioxy group from the MDPV molecule. Bath salt blends such as α-PVP are marketed as alternatives to internationally controlled drugs that are often adulterated with other synthetic cathinones, methamphetamine or clonazepam. Reported effects of α-PVP include euphoria, increased alertness, tachycardia, hypertension, hyperthermia, diaphoresis, seizures and even cardiac arrest.
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.
TCA Tricyclic antidepressants, commonly known as TCA, are a group of antidepressant drugs. TCA are mostly administered by oral or intramascularly. The progressive symptomatology of TCA includes agitation, confusion, hallucinations, hypertonicity, seizures and EKG changes. Nortriptyline, Desipramine (Pertofran) and Imipramine (Tofranil) are the most often used TCA. TCA’s half life varies from a few hours to a few days. TCA’s are excreted with less than 1% of the unchanged drug.
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.
Benzoylecgonine (a cocaine metabolite) this compound is one of the two major urinary metabolites of cocaine, the other being ecgonine methyl ester. During the metabolism of the drug, benzoylecgonine is created in the liver of the user. It is then catalysed by carboxylesterases before being passed from the body in the urine. This substance is what is tested for in the majority of cocaine urinalyses and it can be detected in the urine after traces of the drug itself have disappeared within a few days.
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 to 10 days after smoking.
Carfentanyl This is an extremely potent synthetic drug the approved use of which is only by veterinarians as an animal tranquiliser. It is identified as a structural analog of the synthetic opioid analgesic fentanyl. When taken, the effects of this drug rapidly become apparent and they can be much greater than those experienced with heroin. The drug is used in the same way as natural opiates, either being injected, swallowed, heated and then inhaled, or sniffed. This very dangerous substance is usually cut with heroin or other drugs. It is so powerful that in some subjects even a small dose could be fatal.
Cathinones are a group of drugs (including cathinone) which are related to amphetamine compounds such as ecstasy and speed. The following drugs are part of the Cathinones family.
- Alpha-PHP – This drug is a stimulant of the cathinone class and is structurally similar to MDPV. It is usually seen as crystallised shards or a fine powder. The drug is ingested and produces euphoric feelings in the user. The effects are short-lived but if the substance is vaporised or insufflated the ‘high’ can be compared to that produced by cocaine and methamphetamine. Alpha-PHP can produce a compulsive need to quickly have another dose and creates addictive behaviour amongst many users. If taken at high levels the results can be very serious, including psychosis and delusional states.
- Alpha-PVP – Street name ‘flakka.’ Having been in use as a recreational drug since 2013, this stimulant is a norepinephrine-dopamine reuptake inhibitor (NDRI). It is a member of the pyrovalerone and cathinone classes. The user has a heightened ability to engage in physical activities such as dancing for long periods. This is often accompanied by feelings of euphoria and inflated ego; however, hallucinations and paranoia can also be experienced. This substance has been linked to suicides where a mixture of drugs has been used.
- MDPV (bath salts) – Methylenedioxypyrovalerone – street names ‘monkey dust’ and ‘bath salts’ – a designer drug of which MDPV is the active ingredient. The drug is a psychoactive stimulant that is known by many other names, including ‘magic’, ‘vanilla sky’, ‘Maddie’, ‘meow’ and ‘super coke.’ The effects of the drug are said to be similar to those experienced with cocaine and methamphetamine. Users are seeking enhanced energy levels and an altered state of mind; however, the side effects of the drug can be very dangerous. Hallucinations are common and in some cases hospitalisation is necessary. In recent times the number of deaths linked to this drug has risen dramatically.
- Cathine (Khat) – The central nervous system (CNS) stimulant, commonly known as Khat, is derived from an evergreen shrub (Catha edulis) that grows on the South West Arabian Peninsula and in East Africa. The active ingredients of the drug are cathine (norpseudoephedrine) and cathinone (ketoamphetamine). Both of the substances act as CNS stimulants. Users chew the leaves of the plant which releases the stimulants into the saliva. With a similar chemical structure to amphetamine, cathinone is somewhat less potent, but it does have similar physical and chemical properties. The compound is unstable and as the leaves of the plant dry out the decomposition causes cathinone to become cathine, a less potent substance. To gain the full effect the leaves have to be used within 36 hours of being picked.
- Mephedrone (MEP) – Being analogous to cathinone, a compound found in the leaves of the Khat plant, the synthetic stimulant drug Mephedrone is similar in chemical make up to the synthetic group of drugs known as amphetamines. This compound was first synthesized way back in 1929 and at that time it attracted little attention. The properties of the substance were later publicized by a chemist based in Israel and the drug first appeared in commercial form in 2007. Recreational use of mephedrone was first seen in the UK during the summer of 2009. Its popularity grew and the incidence of its use spread quickly. Users described the effects of what was still a legal drug as being like that of ecstasy (MDMA), amphetamine and cocaine. On the 16th April 2010, the drug was declared an illegal substance. The drug is in powder form and is usually snorted, however, it can be ingested in the form of capsules and pills. Some users even swallow wraps of paper containing the drug, and it seems that the drug is increasingly being taken via injection.
- Methcathinone – Otherwise known as MCAT is an over-the-counter cold remedies that contain pseudoephedrine or ephedrine are used to synthesise methcathinone. If potassium permanganate is used as an oxidant the result is a substance with a high level of manganese. Although an essential trace element, manganese can be neurotoxic if the exposure levels are high. Continued use of methcathinone that is contaminated with manganese can cause severe disability and neurological damage caused can be permanent. In Eastern Europe, this drug has been found to cause parkinsonism among younger users who often suffer postural reflex impairment, rigidity and tremors.
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.
The drug ecstasy, also goes by the name of E, brownies, MDMA, Rolex, dolphins, XTC, pills, and Mitsubishi, and is a Class A drug. This means that, if caught in possession of the drug, it could lead to a prison sentence of up to seven years. It could also mean an unlimited fine. Those caught supplying the drug to others could receive a life sentence and/or an unlimited fine.
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.
2-Ethylidine 1, 5-dimethyl 3, 3-diphenylpyrrolidine (methadone metabolite) EDDP, 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 to 50% of the dosage and 3 to 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.
Ethyl glucuronide (alcohol metabolite) ETG is a minor non-oxidative metabolite of ethyl alcohol formed by the in vivo conjugation of ethanol with glucuronic acid with UDP glucuronosyl transferase.ETG is a product of metabolic process about of Ingested alcohol (ethanol) rapidly metabolized in the body, which is excreted in the blood, hair and urine. By using The ETG Rapid Test Device (Urine), can detect ETG in urine, confirming the consumption of alcohol. The ETG metabolite remains in the body longer and therefore has a more useful window of detection of 8 to 80 hours. ETG testing is an excellent option for zero-tolerance alcohol consumption or rehabilitation programs
Fentanyl This drug is similar to morphine but it can be 100 times more potent. The main medical use of fentanyl is after surgery to help with pain relief. It is also used to control chronic pain in other patients. As a prescription drug, it is labelled as, Sublimaze®, Duragesic®, and Actiq® and others. It is classified as a Class A drug. On the street, the drug is referred to as, China Girl, Dance Fever, Apache, Friend, Goodfella, et al. It is very addictive and is often laced with heroin. Deaths as a result of the illegal use of fentanyl are increasing across the world.
Gabapentin (NeurontinR) The medicinal use of gabapentin is as an anticonvulsive to treat epilepsy and nerve pain. It can also be used to help with severe cases of migraine and to alleviate symptoms of the menopause, restless leg syndrome and cocaine and alcohol withdrawal. This is an addictive drug and it is subject to abuse, particularly by those already using opioids and other drugs. Users experience feelings of calmness and relaxation that helps relieve anxiety and insomnia. Euphoria can also be felt and sometimes a high is brought on by the drug that is described as being similar to the effects of marijuana.
GHB (Gamma-hydroxybutyric acid) This has come to public attention because of its use as a date rape drug. The criminal puts the substance into the drink of the intended victim who eventually becomes unconscious and has no recollection of the assault the next day. At a low dose, it produces effects of euphoria, however, at a high dose a user can experience amnesia and blackouts. The compound came into use as an anaesthetic during the 1960s. During the 1980s it began to be used as a recreational party drug in clubs and to aid with weight loss. The effects are similar to those caused by alcohol consumption but without the resultant slurred speech, unsteadiness and hangover.
Heroin, which is part of the opiates group of drugs, is a Class A drug. Possession of the drug can lead to a prison sentence of up to seven years and a large unlimited fine. If a person is found supplying the drug it can lead to a life sentence in prison, and an unlimited fine.
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.
K2-AB AB-PINACA is a synthetic cannabinoid usually sold as a herbal smoking mixture designed to mimic THC, the active chemical of cannabis. Synthetic cannabinoids are classed as ‘New Psychoactive Substances’ (NPS) which are unregulated substances that have become newly available on the market as an alternative to illegal drugs. As a reaction to prohibition, synthetic cannabinoid producers change the compounds found in designer drugs and create new generations of synthetic drugs, such as AB-PINACA. As a result, accidental overdose and severe psychiatric complications may be more likely to occur because the type and amount of active compound may vary considerably from batch to batch. Other effects may include agitation, rapid heart rate, confusion, dizziness and nausea.
K2 (Synthetic Cannabis – 1st Generation) These man-made psychoactive substances are chemicals with mind-altering properties sold in liquid form to be vaporised and used in e-cigarettes and other such devices. Users often spray the liquid onto shredded plant material that has been thoroughly dried and is then smoked. The word ‘cannabinoids’ is used because they are similar to the chemicals contained in the leaves of the cannabis plant. The compounds are often marketed as a safe alternative to marijuana – that is not the case! The effects of these cannabinoids on individuals are unpredictable and they can be more powerful than with marijuana. These drugs can in some cases be life-threatening.
1st Generation Synthetic Cannabinoids
- JWH-018 is of the naphthoylindole family, an analgesic chemical. It is a full agonist (when combined with a receptor it starts a physiological response) at both the CB1 and CB2 cannabinoid receptors. The effects on a user are like those produced by smoking marijuana. In some countries, this is used in synthetic cannabis products sold as “incense blends.” JWH in the name refers to one of the individuals that invented the substance, John W. Huffman.
- JWH-073 another synthetic cannabinoid from the same family as JWH-018. This one acts as a partial agonist at both the CB1 and CB2 cannabinoid receptors. The behavioural effects brought on by the drug have been described as similar to those seen in animals given THC. They can include analgesia, hypoactivity, hypothermia and catalepsy.
2nd Generation Synthetic Cannabinoids
- UR-144 – Invented by a company called Abbott Laboratories, UR-144 acts as a selective full agonist of the peripheral cannabinoid receptor CB2, but with much lower affinity for the psychoactive CB1 receptor.
3rd Generation Synthetic Cannabinoids
- AB-Pinaca – This compound first appeared in Japan in 2012 as a component of synthetic cannabis products. It was originally developed in 2009 by Pfizer and was intended to be used as analgesic medication. It is a potent agonist for the CB1 receptor. This is a dangerous substance and users have been hospitalised and some have died as a result of its use.
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.
LSD, which is short for lysergic acid diethylamide, is a Class A drug. It is also known as acid, dots, blotter, drop, liquid acid, L, Lucy and micro dot. Possession of LSD can lead to a prison term of seven years and/or an unlimited fine, while supplying the drug can result in a life sentence and an unlimited fine.
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.
MD-PHP (3,4-Methylenedioxy-α-pyrrolidinohexiophenone) is a psychoactive drug with stimulant properties which acts as a norepinephrine-dopamine reuptake inhibitor. The primary psychological effects have a duration of roughly 3 to 4 hours, with after effects such as tachycardia, hypertension, and mild stimulation lasting from 6 to 8 hours. Cathinones are the second largest group of new drugs monitored by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), with 118 compounds detected in total. Substances that are controlled by the law are immediately replaced by new uncontrolled derivatives that cause constant and dynamic changes on the drug market. MDPHP is one of the newer synthetic cathinones to enter the market.
Mephedrone is a controlled Class B drug. It is illegal to have possession of it and it is also illegal to supply it to anyone else. The drug is better known as MCAT, bubble, drone, meph, 4MMC and ‘Meow Meow’. It works as a stimulant and is considered to be a cross between cocaine and amphetamines.
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 to 40% of methamphetamine is excreted unchanged. Methamphetamine is generally detectable in the urine for 3 to 5 days after use
MPD Methylphenidate (RITALIN) is most commonly known by the Novartis trademark name Ritalin, which is an instant-release racemic mixture. There are also a variety of formulations and generic brand names exist. Methylphenidate is a psychostimulant drug for the treatment of attention-deficit hyperactivity disorder, Postural Orthostatic Tachycardia Syndrome, and narcolepsy. It may also be prescribed for off-label use in treatment-resistant cases of lethargy, depression, neutral insult, obesity, and rarely other psychiatric disorders such as Obessive-Compulsive Disorder. Methylphenidate like other stimulants increases dopamine levels. The abuse potential is increased when methylphenidate is crushed and snored or when it is injected producing effects almost identical to cocaine. Cocaine-like effects can also occur with very large doses taken orally. Methylphenidate has a high potential for drug dependence and additive abuse due to its similar pharmacologically to cocaine and amphetamines. Internationally, methylphenidate is a Schedule II drug under the Convention on Psychotropic Substances. In the United States, methylphenidate is classified as a Schedule II controlled substance, the designation used for substances that have a recognized medical value but present a high likelihood for abuse because of their addictive potential.
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.
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.
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.
Pregabalin (LyricaR) A prescription-only drug that is similar to Gabapentin. It is used to treat neuropathic pain, epilepsy, restless leg syndrome, fibromyalgia and anxiety. The side-effects on the user are very similar to those described for Gabapentin. Misuse is concerning because the gabapentinoids in overdose can cause depression of the central nervous system leading to death. Both the gabapentinoids are passed unchanged in the urine.
Steroids are also known as anabolic steroids and specific product names include Anavar and Dianabol. Those who have been given anabolic steroids for medical reasons are allowed to possess them, but if they then pass these on to someone else, they are breaking the law. Steroids are officially a Class C drug.
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.
Thebaine (paramorphine) This opiate alkaloid is also known as codeine methyl enol ether. It is a component of opium and is similar in its chemical make-up to codeine and morphine. Unlike the depressant effects of those substances, thebaine acts as a stimulant. In the case of an overdose, the user will have convulsions like those seen in a case of poisoning with strychnine. It is a Class A controlled drug and is not used therapeutically. Being the main alkaloid extracted from the opium poppy it can be changed into several different compounds on an industrial scale. In drug screening, the “poppy seed defence” is often put forward when morphine/thebaine is detected in a urine specimen. Poppy seeds are added to food products and this is often cited as a defence when a test is positive.
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.