Beating Drug Tests and Defending Positive Results

Beating Drug Tests and Defending Positive Results

Amitava Dasgupta Beating Drug Tests and Defending Positive Results A Toxicologist s Perspective

Amitava Dasgupta Department of Pathology and Laboratory Medicine University of Texas Health Science Center at Houston Medical School 6431 Fannin Houston TX 77030 Room 2258 USA amitava.dasgupta@uth.tmc.edu ISBN 978-1-60761-526-2 e-isbn 978-1-60761-527-9 DOI 10.1007/978-1-60761-527-9 Springer New York Dordrecht Heidelberg London Library of Congress Control Number: 2009943300 Springer Science+Business Media, LLC 2010 All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Humana Press, c/o Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks, and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. Printed on acid-free paper Humana Press is part of Springer Science+Business Media (www.springer.com)

Preface Workplace drug testing was initiated by President Ronald Reagan when he issued Executive Order Number 12564 requiring federal agencies to drug test federal employees who are involved in sensitive positions as well as positions involving public safety. In today s business practice, a majority of the Fortune 500 Companies implement some practice of workplace drug testing in their company policies. Workplace drug testing deters employees from abusing drugs. A drug free workplace can lead to increased productivity, less job related accidents as well as improved morale in the workplace. Unfortunately, drug abusers also need employment and often try to beat pre-employment drug testing by ingesting a variety of substances available through the Internet or by adding various adulterants in vitro after collecting the urine specimen. Although ingesting various substances along with drinking plenty of water has some effectiveness in producing negative results, identification of low creatinine in a urine specimen submitted for drug testing is an indication of such an attempt and the toxicology laboratory may not perform the drug testing at all on that specimen and reported the specimen as adulterated. Similarly, adding household chemicals to a urine specimen can be easily identified by using specimen integrity testing (temperature, ph, specific gravity, and creatinine concentration) prior to drug analysis. However, more recently, chemicals can be obtained through Internet sites which, when added to urine specimens cannot be detected by routine specimen integrity testing. Some of these chemicals are also effective in oxidizing the drug and or its metabolite, thus causing false negative test results not only in the immunoassay screening step but also in the gas chromatography/mass spectrometric confirmation test. The test which is most affected is the testing of marijuana as the marijuana metabolite 11-nor-9-carboxy- 9 -tetrahydrocannabinol (THC COOH). Fortunately, spot tests and various other tests are available to detect the presence of such adulterants (nitrites, pyridinium chlorochromate, glutaraldehyde, peroxidase, etc.). There is a constant battle between toxicologist and underground chemists who produce such adulterants. Fortunately, many states now ban the use of such adulterants in order to invalidate a drug test. Moreover, toxicologists are winning this battle because of the dedicated efforts of many investigators to stay one step ahead of these cheats. As a practicing toxicologist, I am involved with the pre-employment drug testing of our hospital and I wrote this book covering all major issues concerning v

vi Preface how people try to beat drug tests and defend positive test results, using my experience with pre-employment drug testing in our hospital. In each chapter, an extensive number of references are cited so that more interested readers can get more information on a particular topic that interests them. I hope this book will be helpful to toxicologists, medical technologists, pathologists, human resources professionals, and anyone who is interested in workplace drug testing. Houston, Texas Amitava Dasgupta

Acknowledgments I would like to thank Ms. Alice Wells, MT (ASCP) for critically reading and editing the entire manuscript. I also thank Professor Robert Hunter, MD, PhD, chair of our department for his support to undertake this project. I also thank American Association for Clinical Chemistry, the publisher of the Clinical Chemistry Journal, for granting permission to reprint copyrighted material for this book free of charge. I would like to thank my wife for her support during the long hours at night and at weekends I spent on this project. Proper credits are given in the references or in the text for all original sources of information including all United States Government sources where the information is in the public domain. I have made sincere efforts to list all such references and credits. If, after all these efforts, there is any omission of a source or reference brought to my attention, I will be glad to include any such omission in the subsequent reprint of this book. vii

Contents 1 Beating Drug Tests and Defending Positive Results: A General Overview... 1 1 Introduction... 1 2 CommonlyAbusedDrugsintheUnitedStates... 2 3 WorkplaceDrugTesting... 3 4 How People Try to Beat Drug Tests?..... 3 5 How People Defend Positive Results?.... 5 6 Designer Drugs/Rave Party Drugs and Workplace DrugTesting... 6 6.1 Detection of Designer/Rave Party Drugs..... 8 7 Conclusions... 8 References...... 9 2 Pharmacology of Commonly Abused Drugs... 11 1 Introduction... 11 2 Amphetamine, Methamphetamine and Related Drugs..... 11 2.1 Metabolism of Amphetamine and Methamphetamine... 12 2.2 Designer Drugs Derived from Amphetamines...... 12 2.3 Metabolism of Designer Drugs Derived from Amphetamines...... 14 2.4 Overdoses and Fatalities from Amphetamines andrelateddrugs... 15 3 Barbiturates... 15 3.1 Metabolism and Fatality from Barbiturates.... 16 4 Benzodiazepines..... 17 4.1 Pharmacology of Benzodiazepines... 17 4.2 Benzodiazepine Overdose and Fatality...... 18 5 Cannabinoids... 19 5.1 MetabolismofTHC... 19 5.2 THCOverdose... 20 6 Cocaine..... 20 6.1 Pharmacology of Cocaine... 21 6.2 Abuse of Cocaine and Alcohol..... 22 6.3 Fatality from Cocaine and Cocaethylene..... 22 ix

x Contents 7 Opiates... 22 7.1 Pharmacology of Opiates... 23 8 Methadone.... 24 8.1 Pharmacology of Methadone...... 24 9 Phencyclidine... 24 10 Propoxyphene... 25 11 Methaqualone... 26 12 Glutethimide... 26 13 Conclusions... 26 References...... 27 3 Workplace Drug Testing: SAMHSA and Non-SAMHSA Drugs.. 29 1 Introduction... 29 2 SAMHSA Mandated Drugs..... 30 3 Testing of Various SAMHSA Mandated Drugs..... 31 3.1 Testing of Amphetamines... 32 3.2 Testing of Cannabinoid (Marijuana)... 33 3.3 Testing of Cocaine Metabolites..... 34 3.4 TestingofOpiates... 36 3.5 Testing of Phencyclidine... 37 4 TestingofNon-SAMHSADrugs... 38 4.1 TestingofBarbiturates... 38 4.2 Testing of Benzodiazepines... 40 4.3 Testing of Methadone..... 40 4.4 Testing of Propoxyphene... 41 4.5 Testing of Methaqualone and Glutethimide.... 41 5 Miscellaneous Issues in Workplace Drug Testing... 42 6 Conclusions... 42 References...... 43 4 Synthetic Urine, Flushing, Detoxifying, and Related Agents for Beating Urine Drug Tests: Are They Effective?... 45 1 Introduction... 45 2 Synthetic Urine...... 46 3 Composition of Synthetic Urine... 47 4 Specimen Integrity Testing..... 47 5 Prosthetic Penis and Workplace Drug Testing..... 48 5.1 Catheterization for Substituting Urine...... 49 6 Flushing and Detoxifying Products...... 50 6.1 WaterIntoxication... 51 6.2 DilutedUrineandDrugTesting... 51 6.3 SAMHSA Criteria for Diluted/Substituted Urine..... 53 6.4 DilutedUrine:CaseStudies... 54 6.5 Do These Agents Work?... 55 7 HerbalstoBeatDrugTests... 56

Contents xi 8 Various Drugs and False Negative/Positive Screening AssayResults... 57 9 Conclusions... 58 References...... 58 5 Household Chemicals and Internet Based Products for Beating Urine Drug Tests... 61 1 Introduction... 61 2 Household Chemicals as Urinary Adulterants..... 62 2.1 Effect of Various Adulterants on Immunoassay Screening. 63 2.2 Effect of Various Household Adulterants on Specimen Integrity Testing..... 65 3 InternetBasedUrinaryAdulterants... 67 3.1 Adulteration Product Urine Luck.... 67 3.2 Adulteration Products Containing Nitrite..... 68 3.3 Adulteration with Glutaraldehyde Containing Products.. 69 3.4 StealthasaUrinaryAdulterant... 70 3.5 Papain as Urinary Adulterant...... 71 4 DetectionofInternetBasedAdulterants... 71 4.1 TestingforUrineLuck... 71 4.2 TestingforNitrite... 72 4.3 TestingforStealth... 73 4.4 TestingforGlutaraldehyde... 73 4.5 Onsite Adulteration Check and Automated Assays.... 73 5 Federal Guidelines for Additional Testing to Detect Adulterants... 75 6 ACaseStudy... 75 7 Conclusions... 76 References...... 76 6 Adulterating Hair, Oral Fluid, and Sweat Specimens for Drug Testing... 79 1 Introduction... 79 2 HairDrugTesting... 80 2.1 Hair Color and Incorporation of Drugs...... 81 2.2 Environmental Contamination and Hair Drug Testing... 81 2.3 Adulteration of Hair Specimens..... 83 3 OralFluidTestingforAbusedDrugs... 84 3.1 AdulterationofOralFluid... 85 4 SweatTesting... 86 4.1 AdulterationIssues... 86 5 Conclusions... 87 References...... 87 7 Defending Positive Opiate and Marijuana Test Results... 89 1 Introduction... 89

xii Contents 2 Poppy Seeds and Opium...... 90 2.1 Opium Content of Various Poppy Seeds..... 90 2.2 Poppy Seed and Allergy.... 91 2.3 Opiate Level After Consumption of Poppy Tea (OpiumTea)... 91 2.4 Consumption of Poppy Seed Containing Food andurinaryopiates... 92 2.5 Consumption of Poppy Seed Containing Food andopiatelevelsinothermatrix... 94 2.6 Consumption of Poppy Seed Containing Food andimpairment... 95 2.7 BrownMixtureandOpiateLevels... 95 2.8 Legal Consequence of Positive Opiate Due to Ingestion of Poppy Seed Containing Food.... 95 3 Marker for Poppy Seed Consumption in Urine..... 96 4 Defending Positive Marijuana Results.... 97 4.1 Passive Inhalation of Marijuana..... 97 4.2 Consumption of Hemp Products.... 97 5 CaseStudy... 99 6 Conclusions... 99 References...... 100 8 Defending Positive Cocaine Tests... 103 1 Introduction... 103 2 Herbal Tea and Cocaine... 104 2.1 Coca Tea and Urinary Level of Benzoylecgonine.... 105 2.2 Legal Consequence of Positive Cocaine Due to Ingestion of Coca Tea... 106 3 Mugwort and Positive Cocaine... 107 4 Procaine and Workplace Drug Testing.... 107 5 Benzocaine, Tetracaine, Lidocaine, and Workplace DrugTesting... 108 6 Paper Money Contaminated with Cocaine... 109 6.1 Handling Money Contaminated with Cocaine anddrugtesting... 110 7 Passive Inhalation/Exposure of Cocaine... 111 8 CaseStudies... 112 9 Conclusions... 112 References...... 113 9 Defending Positive Amphetamine Results... 115 1 Introduction... 115 2 OTC and Prescription Drugs that Produce False Positives with Amphetamine/Methamphetamine Immunoassays..... 116 3 Use of Vicks R Inhaler and Positive Methamphetamine Test... 117 4 Herbal Weight Loss Products and Amphetamine Assay.... 119

Contents xiii 5 Bitter Orange and Amphetamine Immunoassay.... 120 6 False Positive GC/MS Methamphetamine Due to Ephedrine or Pseudoephedrine.... 121 7 False Positive Amphetamine Due to Prescription Drug Mebeverine... 122 8 Analytical True Positive Amphetamine/Methamphetamine... 125 9 CaseStudies... 126 10 Conclusions... 127 References...... 127 10 Analytical True Positives in Workplace Drugs Testings Due to Use of Prescription and OTC Medications... 131 1 Introduction... 131 2 Prescription Medications Containing Benzodiazepines..... 132 3 Topical Use of Cocaine and Workplace Drug Testing..... 134 4 PrescriptionOpiatesandWorkplaceDrugTesting... 135 4.1 Detection of Hydromorphone After Medical Use ofmorphine... 136 4.2 Detection of Hydrocodone After Medical Use of Codeine. 137 5 OTCOpiatesandWorkplaceDrugTesting... 138 6 MarinolandWorkplaceDrugTesting... 138 6.1 Marijuana and Chocolate... 139 7 Conclusions... 139 References...... 140 Subject Index... 143