10/12/2012. Kathryn Kuehnle, PhD kathrynkuehnle.com October 5, 2012

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1 1. 2. Kathryn Kuehnle, PhD kathrynkuehnle.com October 5, in 4 people between the ages of 15 and 54 have a substance abuse disorder at sometime in their life The number of pregnant women using opiates has increased five times in the last decade. Of all individuals with a substance abuse disorder, 88% have an alcohol disorder with or without other drug involvement Every hour, a baby is born addicted to prescription medication in the U.S. (13,500 each year) Understand the problems with paper and pencil assessment techniques when evaluating substance abuse/dependence Understand the current best practice assessment techniques when evaluating substance abuse/dependence New designer drugs State of consciousness Memory Emotional regulation Impulsive control 1

2 The Multidimensional Addictions and Personality profile (MAPP) The Substance Abuse Subtle Screening Inventory 3 (SASSI 3) (SASSI 3) Michigan Alcoholism Screening Test (MAST) Drug Abuse Screening Test (DAST) basic urine testing only provides a very gross and unreliable estimate of alcohol consumption. it takes the body only one hour to metabolize one standard alcoholic drink between noon and 1:00 p.m. if an individual ingested 4 standard alcoholic drinks over an hour, this alcohol would be fully excreted from the person s body by approximately 4:00 p.m. Mixed drink: 1.5 fl. oz. of 80 proof liquor Wine : 5 fl. oz. Beer : 12 fl fl. oz Wine Cooler: 12 fl. Oz. Ingesting large quantities of water is very effective for washing out the system of alcohol and creating a clean urine sample. Drink 10 average alcohol drinks with adulteration Could have a clean urine sample in 4 to 5 hours 2

3 Urine sample adulteration is a serious problem in forensic urine drug testing. Specimens for Testing for Presence of Alcohol Adulteration is usually achieved by: substitution (ask for monitoring) dilution masking agents agents sold commercially masking The use of adulterants can create false negative drug test results on urine specimens Urine Specimen Require urine testing with ETG and ETS testing ETG and ETS are metabolites of ethanol and used as alcohol biomarkers present in urine for 3 to 5 days Standard urine testing does not provide information on adulteration The body metabolizes ethanol and the metabolites remain in the body after the alcohol has been flushed out Metabolites of ethanol are not immediately flushed out with regular urination Ethanol Metabolites stay in the system and have a life up to 80 hours indicating whether an individual has ingested alcohol within 3 to 5 days prior to the testing. Ethyl Glucuronide (ETG) can be falsely elevated by incidental exposure: cold medicine, mouth wash, alcohol based hand wipes, other materials with alcohol Copious amounts of water can dilute and lower the ETG level Require Creatinine and Specific Gravity testing Creatinine is a waste product of creatine; an amino acid contained in muscle tissue and found in urine The absence of creatinine is indicative of a sample that is not consistent with human urine. If an individual is ordered to be abstinent from any consumption of alcohol: Random urine testing with ETG and ETS results and Creatine testing would be a good monitoring device Low creatinine and specific gravity suggest diluted urine. 3

4 Specimens for Testing for Presence of Alcohol Blood Specimen Phosphatidylethanol (PETH) ethanol stays in the membranes of the red blood cells present for 2 to 3 weeks Ethanol stays in the membranes of the red blood cells for approximately 50 days This blood test provides information on the level of alcohol consumption a person ingests over two to three week period of time Identifies binge drinking or consistent heavy drinking PEth is an abnormal phospholipid that is formed only in the presence of ethanol in the blood. Once formed, PEth naturally degrades with a half life half life of 4.5 days. incidental exposure to substances with alcohol: cannot create an elevated positive finding for Phosphatidylethanol (PETH) incidental exposure of alcohol does not enter the blood stream. Hair Specimen Alcohol ETG testing has a window of detection of approximately 3 months following multiple binge episodes or heavy daily drinking Finger Nail and Toe Nail Specimens Alcohol ETG testing has a window of detection of approximately 6 months It is highly unlikely that a single binge episode would generate a positive EtG in hair. EtG is detected in nail for approximately 6 months following multiple binge episodes or heavy daily drinking EtG in hair may be rendered ineffective by bleaching and dyeing. It is highly unlikely that a single binge episode would generate a positive EtG in nail or hair. 4

5 A positive Hair or Nail ETG result confirms that the donor has engaged in repeated binge drinking of excessive alcohol or excessive daily drinking over 90 days or 6 months There can not be an incidental exposure. Drug testing can include different panels of drugs (i.e., 5 to 14 drug panel) see handout panel drug analysis can use specimens of: Urine with ETG testing 3 to 5 days Finger/toe nails 6 months Body hair depends on length of hair specimen Head hair (4cm) 60 to 90 days NEW TRENDS DESIGNER DRUGS We know that a person is consuming alcohol but we want to determine if the individual is a abusing alcohol Blood Specimen with Peth testing would determine past 2 to 3 weeks of consistent heavy drinking or binge d i ki drinking a single i l bi binge would ld not trigger i a positive ii finding Nail and Hair Testing would determine past 3 to 6 months of consistent heavy drinking or binge drinking a single binge would not trigger a positive finding PETH in blood and ETG in nail/hair are in current use all over the world and has been accepted by the professionals in this specialized field. Most of the 50 statewide Medical Professional Substance Abuse Treatment programs use a combination or all 3 tests for monitoring their medical professionals. Several jurisdictions in the US as well as several European countries are using the tests to monitor repeat DWI offenders to maintain licensure. These tests are being used all over the country for family court matters as well. These new drugs Are not bath salts used for the purpose of water softening or aroma therapy Are a central nervous stimulant used as a recreational drug marketed as bath salts or plant food to avoid federal regulation Contain man made chemicals such as Methylenedioxypyrovalerone (MDPV) Mephedrone (4 MEC) Methylone 5

6 Ivory Purple Wave Vanilla Sky Bliss White Rush Blow Red Dove Aura Zeus 2 Zoom White Dove Wave Blue Silk White Lightning Ocean Charge Cosmic Blast Scarface Hurricane Charlie Cloud 9 Pure Ivory plus many others Labeled not for human consumption Sells for $25 to $75 per 50 milligram packet Available through the internet, gas station markets, and some convenience stores. Snorted (most common) Injected Smoked (similar to crack) Mixed with food Mixed with drink Airborne mist Extreme paranoia Psychotic features (reporting seeing demons, monsters, foreign soldiers, or aliens) Violent behavior Sleep depravation Agitation i i Extreme anxiety Tachycardia (rapid heartbeat) Bruxism (teeth grinding) Compulsive water drinking Motor automatisms (compulsive repeated hand washing) Tremors Seizures High similar to cocaine, methamphetamines, MDMA (Ecstasy) or LSD Users often cannot be subdued with pepper spray or Tasers Cited as an imminent threat to public safety by the DEA Currently banned in 38 states September 7, 2011 DEA used it s emergency scheduling authority to temporarily control three synthetic stimulants (mephedrone MDPV, (mephedrone, MDPV and methylone). methylone) May 31, 2012 Federal legislation to criminalize bath salts was passed in the United States Senate. It is now on its way to the House of Representatives. 6

7 7H, K2, and Spice are products containing synthetic cannabinoid chemicals resembling THC, the primary element in marijuana. Sprayed or added to dried plant material to create herbal smoking products and blends, Substances comprised p of these synthetic y cannabinoids are an emerging trend that allows marijuana users a legal substitute to the drug. Sold as herbal smoking blends, incense, or potpourri in smoke shops, gas stations, and on the internet Cannabinoids are becoming increasingly popular as a legal and readily available alternative to marijuana. Common field test kits, canines, and routine urine tests do not detect cannabinoids Since synthetic cannabinoids are several times more potent than marijuana, the adverse effects after ingesting the product can cause hallucinations, anxiety, heightened blood pressure, nausea, vomiting, in severe cases, tremors and seizures. There are few studies indicating what if any long term effects exist. Cheese is a Combination of: Black Tar Heroin Xanax Tylenol PM(or generic) Black tar heroin combined with crushed Xanax or Tylenol PM tablets It is highly addictive and very dangerous 7

8 + = Mood Swings Insomnia Headache, chills, nausea, vomiting Muscle Spasms/bone pain Anxiety, agitation, disorientation May last five to six days Heroin, morphine (heroin metabolite) and diphenhydramine HCl are all CNS and respiratory depressants Overdose or combination with other depressants (i.e. alcohol) can cause respiratory arrest and subsequent death Cheese Can be purchased for as little as $10 a gram Invented in 1932 in the United States Derivative of morphine It has sedative and analgesic effects Drug has a short half life in the body Around 8 10 times more potent than morphine Cheaper alternative to heroin $6 to $8 per injection Drug is primarily used by heroin addicts that can no longer afford heroin The drug is available in the market for a greatly reduced price The drug is easily made from codeine, codeine iodine iodine, lighter fluid, industrial cleaning fluid, paint thinner, gasoline and red phosphorus Similar to the process of making Meth from pseudoephedrine Desomorphine processed this way is highly impure and contaminated with various toxic and corrosive by products Drug is a neurotoxin that causes brain damage Drug is named for its scale like appearance of the skin on its users Has become notorious for producing severe tissue damage Phlebitis and gangrene, sometimes requiring limb amputation in long term user Deterioration of internal organs (Kidney / Liver) The amount of tissue damage is so high that addicts' life expectancies are said to be as low as two to three years 8

9 Crunk is a deceptively sweet concoction of soda or other beverage (such as Sprite_ an over the counter cough syrup crushed prescription pain killers A "Crunking high" produces an intense rush, effects speech and motor skills, can cause blackouts and breathing problems Hand sanitizer is the latest in a string of household products used to induce intoxication,, and it has p p public health officials worried, as a few squirts of hand sanitizer could equal a couple of shots of hard liquor. Overdoses can lead to difficulty breathing, loss of consciousness and death. Liquid hand sanitizer is 62 to 65 percent ethyl alcohol, or ethanol, the main ingredient in beer, wine and spirits, making it 120 proof. To compare, a bottle of vodka is 80 proof. "This is a rapidly emerging trend," Dr. Cyrus Rangan, medical toxicology consultant for Children's Hospital Los Angeles Doctors said ingesting hand sanitizer can produce the same side effects as consuming large amounts of alcohol slurred speech, unresponsiveness, possibly falling into a coma state. Long term use could lead to brain, liver and kidney damage. "Methods to distill it can be found through friends and the Internet, but straight ingestion of the product without distillation is also common," 9