Drug Testing

I. Definition of Terms
 Almost all drugs of abuse are basic drugs (amine derivatives) which contain benzene rings; barbiturates are acidic drugs
 Many act directly on dopaminergic neurotransmitter systems, especially then limbic system (smell brain)
 Positive drug screening test cannot differentiate casual user from chronic or habitual user, likewise detect the time frame using the drug
or dose of the drug taken

II. Classes of Drugs and Drugs of Action

A. Amphetamines
o Therapeutically used for treatment of narcolepsy and attentional deficit disorder
o Increases mental alertness and physical capacity and has anorectic property
o Structurally related to dopamine and catecholamines
o Cause the release (together with cocaine) of dopamine from the brain leading to a “pleasant feeling” so called “high” among users
o 3,4-methylenedioxymethamphetamine (MDMA ) or Ecstasy is a derivative of methamphetamine is a popular recreational abused
drug (designer drug) and has psychedelic effects
o Examples: amphetamine, methamphetamine and methylphenidate (Ritalin, treatment for hyperactive children)
o Amphetamine-like compounds: ephedrine, pseudoephedrine and phenylpropanolamine
o Cause of False-positive reaction: presence of antihistamine (diphenhydramine_
o Sign of Acute intoxication: hyperpyrexia
o Acute psychotic syndromes: auditory and visual hallucinations, suicidal tendency and paranoia
o Toxic effects: palpitation, hypertension, cardiac arrhythmias, convulsions, psncytopenia, mental impairment and teeth grinding

B. Cocaine
o Aka Crack
o Alkaloid salt (ecgonine) that can be taken directly (insufflation of IV) or by inalation or snorting
o Derived from coca plant (erythroxylon) and used as additive to some foods
o Used as local anesthetic for nasopharyngeal surgery
o Potent CNS stimulant that elicits a sense of excitement and euphoria; increase physical activity
o Has not been considered as and additive drug – does not reflect the true dependence commonly seen in abusers of barbiturates and
opiates
o Easily passes through placenta and mammary gland (vertical transmission, mother to children) resulting to mental retardation, slow
mental development and drug dependence in newborns
o Causes malformations in uterus
o Cause sudden death due to direct toxicity on myocardium 9cardiac toxicity) – it induces vasoconstriction, platelet aggregation and
synthesis of plasminogen activator inhibitor
o Overdose result to violent behavior; high abuse potential
o For single use: can be detected in urine for up to 3 days; up to 20 days for chronic users
o Inhibitor: Prozac
o Treatment for cocaine addiction: Benzodiazepine
o Toxic effects: hypertension, arrhythmias, seizures and myocardial infarction
o Urine metabolite; benzoylecgonine (sensitive and specific indicator)
C. Marijuana
o This is one of the oldest and most widely used of the mind-altering drugs
o Derived from a hemp plant called Cannabis Sativa
o The principal psychoactive agent in marijuana is considered to be δ-9-tetrahydrocannabinol
o May be introduced through the lungs by smoking or through the GIT by oral ingestion in food.
o Half life: 1 week
o One third is excreted in the urine as δ-9-carboxy-THC and 11-hydroxy-δ-9-THC.
o Can be detected from 1-4 weeks(chronic users) 3-5 days(single dose) after last ingestion.
o Physiological effect of marijuana are reddening of the conjunctivae, increased pulse rate, muscle weakness & deterioration in
motor coordination
o The preponderant changes seen with cannabis intoxication are perceptual and psychic changes. Range from: euphoria,
relaxation, passiveness and altered time perception.
D. Hallucinogen
1. Lysergic acid diethylamide
 a semi synthetic indolalkylamine and a hallucinogen.
 LSD is one of the most potent pharmacologic materials known, producing effects at doses as low as 20 mcg.
 Can be injected or ingested orally.
 Street names: Lucy in the sky of diamonds, wedding bells, acid, white sugar, lighting, cues, brain eater
 A semisynthetic indolalkylamine; a hallucinogen
 Effects: Visual hallucination (undulating vision), perceptual distortion, synesthesia (overflow pf sensory input so that
colors are “heard” and music becomes “palpable”), papillary dilatation, uterine contraction,
 Most common adverse reaction: panic reaction such as “bad trip” or “acid trip”
 Usual dosage: 1-2 mcg/kg
 Experience: begins 1 hr after; peaks 2-3 hrs; lasts 8-12 hrs
 Metabolized in the liver, excretion through bile
 Treatment: frequent reassurance, quiet and calm environment, diazepam
 Deaths are usually due to suicides or accidents
2. PHENCYCLIDINE (PCP)
 Street names: “ANGEL DUST” OR “ANGEL HAIR”, CRYSTAL, KILLER WEED  A tricyclic compound.
 Numerous effects on different neural pathway
 Used exclusively as a drug of abuse
 Used of the drug is periodic
 EFFECTS: Analgesic, Anesthetic, Stimulatory
 ADMINISTRATION: mainly administered through intravenous injections.
 Parke, Davis and Company marketed the drug as Sernyl, but later withdrawn from the market.
 MODE OF ACTION: Interact with cholinergic, adrenergic, GABA-secreting, serotonergic, opiate neural receptor.
 Block NMDA receptor
 Bind to specific region in the inner chloride channels of neurons - affecting chloride receptors
 Bind strongly to sigma receptors, a class of neural receptors, this receptor binds to neuroleptic,
antipsychotic drug haloperidol (Haldol). Sigma receptors are implicated in severe psychosis found in
patients suffering from overdose with PCP
 CLINICAL ACUTE MANIFESTATION:
 Depression to euphoria
 Catatonia
 Violence
 Rage
 Auditory
 Visual hallucinations
3. Ecstasy
 Street name: XTC, Adam, Essence, E herbals
 ADMINISTRATION: Ingestion and inhalation
 CLINICAL ACUTE MANIFESTATION:
 Exaggerated emotions
 Exacerbated heart rate
 Uncontrolled movement with pupil dilation

E. Opiates
o Capable of analgesia, sedation and anesthesia
o Derived chemically from opium poppy
o Naturally occurring opiates: opium, morphine and codeine
o Chemically modified opiates: heroin, hydromorphone and oxycodone (percodan)
o Common synthetic opiates: meperidine (Demerol), methadone (Dolophine), propoxyphene (Darvon), pentazocine (Talwin) and
fentanyl (Sublimaze)
o Codeine is an antitussive drug
o Methadone is a nonbicyclic drug that binds with morphine in the brain
o Fentanyl “lollipops” or “patches” are more potent analgesics than morphine
o Commonly tested opiates: morphine and codeine
o Major cause of drug-related death: Darvon overdose combine with alcohol
 o Major metabolites of heroin: N-acetylmorphine (heroine) and morphine
o Withdrawal symptoms of heroin: cold sweats, nightmares and hypothermia
o Antagonists for opiate overdose: naloxone (narcan)
o Toxic effects: respiratory acidosis, myoglubinuria, cardiopulmonary failure and pupillary constriction (“pin-point pupils”)
o Properties of Morphine:
 Morphine is a metabolite of heroin; powerful analgesic; used in the treatment of acute congestive heart failure
 Morphine binds to mu-receptors in the limbic system (CNS) producing analgesic effect
 Morphine and meperidine increase liver and pancreatic enzymes
o Properties of Heroin:
 Heroin is highly addictive (true physical dependence)
 Heroin crosses the blood-brain barrier – elevated levels in the CNS
 Heroin is taken by IV administration

F. Designer Drugs
o Modified forms of established drugs of abuse
o Term used for those illegal drugs that are created synthetically in a lab. They are made to mimic the effects of existing drugs. Since
many are essentially homemade substances, they often contain common household ingredients, including harsh cleaning chemicals
and sometimes poisons.
G. Synthetic Drugs
o Spice or K2 (also known as Yucatan Fire, Skunk, Blaze, and Bliss): Synthetic cannabinoids, or fake weed, have an active ingredient
that is potentially over 100 times more potent than plant-based marijuana, as it more effectively binds to cannabinoid receptors in
the brain, It produces a “high” that is similar to marijuana with depressant and mellowing effects as well as altered perceptions.
o Bath salts: These are synthetic cathinones, which are stimulants, and often include the substances MDPV, methylone, or
mephedrone. snorting bath salts may be akin to snorting 10 lines of cocaine with just one dose. Heart rate, blood pressure, and body
temperature increase as well as focus and energy levels.
o Flakka or gravel: The active ingredient is alpha-PVP, a synthetic cathinone drug with stimulant and hallucinogenic effects. Even a
small grain packs a punch.
o Smiles, 2C-I-NBOMe, and 2C-C-NBOMe: This hallucinogenic drug has similar effects to LSD. Even a few salt-sized grains are enough to
create a “high.”
o DMT, AMT, Foxy, Nexus, and Blue Mystic: These tryptamines and phenethylamines are psychoactive substances that may produce
hallucinations similar to those caused by LSD and mescaline. They may be commonly abused in the club or rave scene.
o Molly: Supposedly a pure version of ecstasy, or MDMA (3,4-methylenedioxy-methamphetamine), this mind-altering drug distorts the
senses and acts as a stimulant, but it is often “cut” with other chemicals. Only 13 percent of the Molly actually contained MDMA;
other substances such as methylone and MDPV, to name a few, were commonly found instead.

III. Drug Testing

A. Specimen Collection, Processing and Handling
o Sample requirements:
 Urine, serum, hair, nails, whole blood or plasma (alcohol), sweat, saliva and exhaled breath (alcohol intoxication)
o Specimen considerations:
 Alcohol in blood samples may be analyzed even after a moment of delay provided the samples in tubes remain sealed
because blood lacks the enzyme that metabolize it
 Urine temperature is a vital factor to assure that it is freshly voided (abused drugs)
 Aspiration of gastric contents or vomitus may reveal tablets or capsules from which the ingested drug can be
determined
o Methods for identifying and measuring abused drugs:
 Urine samples for toxicology assay has the advantage of knowing the complete composite of drugs that have been
ingested over a longer period than blood samples
 Once urine specimen is collected it is subjected to concentration and extraction procedures
 In extraction procedures, acidic drugs are separated from basic ones
 Examination of blood has the advantage of identifying currently circulating drugs and to design treatment plan and
monitoring the success of treatment
 Drugs when deposited in hair, are generally present in relatively low levels
 For sweat testing, parent drug is increased than metabolites
 For saliva testing, drug concentration in it reflects the free or active fraction
 2 basic techniques for identification of drugs: Immunochemical and Chromatography
B. Laboratory Analyses and Screening
1. Enzymatic Test
 Alcohol is measured from blood using alcohol dehydrogenase as reagent
 It quantities the sum of all alcohols present in a sample
 It does not distinguish alcohols from its metabolites during quantitation
2. Capillary Electrophoresis
o Different analyte selectivity is based on different physiochemical principles of separation without changes in instrumental
hardware, a distinct advantage of this technique
o Recent variant of TLC that includes the advantages of HPLC
3. Homogenous Immunoassay
o Done in one solution without separation
4. Enzyme Mediated Immunologic Technique (EMIT)
o Uses enzyme-labeled drug that competes with the drug in the sample
o In this reaction, the active site of the enzyme is blocked with the antidrug antibody, resulting to decrease enzymatic
activity
5. Chromatographic Methods
a) Thin Layer Chromatography (TLC)
o The compound adsorb to the hydrated silicate at the different position as the nonpolar solvent migrate up the
stationary hydrated silicate
o Central to identifying drugs of abuse; allows direct qualitative detection of drugs
o This method has been packaged in the form of TOXI-LAB (Irvine, Calif) kits in which the user is supplied with
discrete strips of silicate, extraction solvents, and color developing solutions
o 10% methanol liquid phase
o Principle: For a given solvent system, the ratio of the distance transverse by the compound to the distance
transverse by the solvent front in a constant for the compound and can be used to identify the compound in the
mixture.
b) Liquid Chromatography-Mass Spectroscopy (LC-MS)
o Platinum standard
o Can be used to confirm positive test from a screening assay (nonvolatile compounds)
o For detection of poisons in acute or chronic intoxication, therapeutic drug identification and quantitation,
pharmacokinetics and drug metabolism studies
c) High Performance Liquid Chromatography (HPLC)
o Allows quantitative detection of drugs and allows sharpen separation of the same drugs
o Mainly utilized for quantitation of the tricyclic antidepressants and their metabolites
o Most commonly prescribed drugs and are also used in excess as drugs of abuse in suicide attempts
o Stationary phase
-Polar (sialic acid)
-Non polar (C-18 columns)
d) Gas Chromatography
o The gold standard technique to confirm the results obtained using screening methods such as EMIT & TLC
o Gold standard for identification of volatile compounds because of its great sensitivity and its reliability
o As it name implies, it involves 2technique:--Gas Liquid Chromatography & Mass Spectroscopyo
o In the GC, compounds are directly heated into the gas phase or are derivatized to make them labile to facilitate
heating them into the gas phase and the passed over a column containing the stationary phase
C. Confirmatory Tests
IV. R.A. 9165
o AN ACT INSTITUTING THE COMPREHENSIVE DANGEROUS DRUGS ACT OF 2002, REPEALING REPUBLIC ACT NO. 6425, OTHERWISE
KNOWN AS THE DANGEROUS DRUGS ACT OF 1972, AS AMENDED, PROVIDING FUNDS THEREFOR, AND FOR OTHER PURPOSES.
o PDEA (Philippine Drug Enforcement Agency) is the implementing arm of the Dangerous Drugs Board. (DDB).
o Dangerous Drugs Board
 The National policy-making and strategy formulation on prevention and control of DOA. Issues implementing rules and
programs
o (Other functions are on Section 81 RA 9165)
o Law Enforcement, Regulatory Compliance and Judicial and Legislative Measures
o Drug Testing Laboratory
 Classification By Ownership:
 Government
 Private
 Institutional Character:
 Institutional Based
 Freestanding
 Service Capability:
 Screening Laboratory
 Confirmatory Laboratory
o Physical Plant
– Screening Laboratory
• 20sqm (floor area)
• 10sqm (work area)
– Confirmatory Laboratory
• 60sqm (floor area)
• 30sqm (work area)

• All labs accommodate at least 5 client at a time.

 Hand washing facility
 Toilet facility
 Stall for the collection of the specimen
o Screening Test
 Potential/presumptive positive result.
 Qualitative test :TLC
o Confirmatory Test
 I.D. & Quantify the metabolite using different technique / chemical principle.
 GC-MS / HPLC - MS
– Test Levels
 NRL sets the required cut-off level
 The equipment and drug testing kit must be register to the IDTOMIS
Screening DTL
a. Licensed Physician
• Licensed Physician trained in Clin. Lab. Management can handle (10) ten screening Lab
b. Chemist, MT, Pharmacist or Chem. Engr.
Confirmatory DTL
a. Pathologist w/ 2 yrs. Active lab exp. In analytical toxicology
b. Licensed Chem. w/ MS Chem / Biochem / branch of chemist w/ 2 yrs. Active lab exp. In anal. Chem.
There are 4 Professionals who can be a Certified Drug Analyst
– Medical Technologist
– Chemist
– Chemical Engineer
– Pharmacist
o Seminars
 – East Avenue Medical Center

o Chain of Custody
(documentation of procedure)
 Control form

• Specimen tracking procedures from point of collection to final disposal.

• I.D of Donor

• Time of collection

• Time received

• Name of DTL

 Application Service Provider

 The third party entities that manage and distribute software-based services
 Storage of Laboratory Reports and Specimens
• Negative specimens: Minimum of 5 days
• Positive specimens (not challenged): 15 days
• All specimens : Minimum of 5 days to 1 year
 Client / Donor
• Sec. 36, letter d: R.A. 9165

 Any officer or employee found positive for use of Dangerous Drugs

 Ground for suspension / termination

-Article 282 of Labor Code

-Civil service law

 Laboratory Report
- Result form is prescribed by DOH
- Signed by the analyst and Head of lab.
• Manner of Reporting:
 Screening - POSITIVE OR NEGATIVE.
 Confirmatory – Analyte and Concentration
*2 two copies must be produced
o Drug Testing Result
 Validity of the test result
 A drug certificate is valid for 1 year from the date of issue.
 Which may also be used for other purpose.
 Proficiency Testing
- NRL assess DTL (Screening / Confirmatory lab)
- All DTL must participate (they must pass the testing to renew their license)
- Submit result w/in 3 weeks
 1st time failed: another chance
 2nd time failed: revocation of license
 Validity
 Screening– 1 year
 Confirmatory– 2 years
*Shall be filled 90 days before the expiration of license
*License always expires on the last day of the year.
o Monitoring of Laboratories
 *The CHD conduct a visit unannounced.

– Monitoring shall be documented the overall quality of the laboratory setting.

o Violations
 Issuance of fraudulent result
 Failure to protect the confidentiality of a drug test result
 Failure to participate in a proficiency testing
 Failure to refer a positive result to a confirmatory laboratory.
 Refusal to CHD to inspect their laboratory

• Punishment

*6 years and 1 day to 12 years Imprisonment

PLUS: Fine 100,000 – 500,000

*Revocation to license to practice shall be recommended by the PRC to the Drug Analyst