An exciting breakthrough in this technology is the development of handheld, portable Raman spectrometers. Many cocaine illicit use: addiction, overdosage, and drug testing of these devices, most notably the TruNarc device by Thermo Fisher Scientific, have been optimized for drugs of abuse detection with simple “point and shoot” action. These devices also search databases in real time at a device level and give a clear readout of what substance(s) were detected. A few studies have explored the mechanisms of nephrotoxicity of cocaine at the cellular level.
Diagnostic Tests
However, the negative effects on morbidity, mortality and health economics suggest that it is a significant problem in diabetes practice 10. The goal of therapeutic UDT is to help physicians provide the best treatment to their patients by monitoring the presence of substances in their bodies. The primary difference between the forensics model and the therapeutic model is the expectation of a positive (therapeutic) vs. negative (forensic) result. As such, therapeutic UDT must use more specific methods to provide confirmations of drug presence at extremely low levels. The therapeutic model seeks to identify drugs rather than prove their absence and is, therefore, uniquely utilitarian in the pain-management space.
- EP has a clinical background in outreach nursing and harm reduction and conducts research and evaluation studies with local harm reduction agencies.
- For adolescents receiving treatment for substance use problems or disorders, urine specimens can be collected at home under the supervision of a parent or guardian.
- However, when used in conjunction, TLC and UV can be quite powerful in identification of a wide variety of substances (including mixtures) and offer a more rudimentary quantification than the more discriminatory techniques.
- A few studies have explored the mechanisms of nephrotoxicity of cocaine at the cellular level.
- The fact that this technology is so cost-effective, easy to perform, and requires a very minute amount of substance makes it really stand out from many of the other presumptive methods 16.
In addition, in two reported cases of sublingual cocaine HCl use (following neutralization with bicarbonate to increase its absorption and to reduce acidity), a slower onset of action, a later peak effect and a longer duration of action were described when compared with an intravenous route 57. Jenkins et al. reported that tea bags containing an average of 4.86 mg (leaves from Bolivia) and 5.11 mg (leaves from Peru) of cocaine per bag, when brewed, produced teas with 4.29 mg and 4.14 mg of cocaine, respectively 58. Since 1961, the International Single Convention on Narcotic Drugs has internationally ruled the recreational use of cocaine as a crime 43.
b. Interpretation of confirmatory chromatography tests
A typical test is not sufficient for a suspected mixture or even an unsuspected mixture if there is any reason at all to have suspicion of the substance. An example battery test protocol for considerations of how to test a suspected mixture is included below. RS is rapid and non-destructive, does not require chemical reagents, can detect separate substances in mixtures, is not subject to interference from water or moisture, and importantly, can detect substances through transparent packaging (such as plastic bags and glass containers). Little or no sample preparation is required, although some sample preparation is required for substances that exhibit high fluorescence (including some cutting agents). RS is ideal for both organic and inorganic species and can be used for both qualitative and quantitative analysis. Due to the similarity to IR (detecting forms of molecular movement to identify), Raman has similar issues with quantitative analysis.
Drugs-of-abuse testing and therapeutic-drug monitoring
A severe cocaine intoxication can result in a fatal outcome if not given the necessary medical treatment 157. Given the ever-present risk of cardiorespiratory arrest, monitoring vital signs is extremely important, and cardiorespiratory resuscitation should be performed as soon as necessary. If this fails, the administration of vasopressin is recommended (this therapeutic option has demonstrated greater effectiveness than epinephrine, the first-line drug for cardiac resuscitation) 158,159. When cocaine is consumed, an exacerbated dopaminergic activity along the mesocorticolimbic pathways occurs. Neurons from these pathways are located in the ventral tegmental area and project to other brain locations, including the nucleus accumbens 78. This could explain why the drug has such an addictive potential, since it is well acknowledged that the nucleus accumbens may have an important role in the rewarding and addictive properties of cocaine and other drugs 79.
Institutional Review Board Statement
Proper specimen collection procedures are critical for ensuring an adequate urine sample for drug testing. The internet provides advice on a host of mechanisms for defeating urine drug tests that range from simple to sophisticated. A survey of practicing pediatricians found that while the large majority have ordered urine drug tests for an adolescent patient, most often these tests are collected without supervision, making it relatively easy for an adolescent to defeat a test 11. In primary care or mental health care settings, substance use by an adolescent may be suspected as underlying or complicating symptoms of depression, anxiety, inattention, hyperactivity, or other broader concerns such as a school failure or interpersonal difficulties 7,9. In these situations, voluntary drug testing (i.e., drug testing with the assent of the adolescent and the consent of a guardian) may serve as a helpful complement to a careful history.
Newer but less widely used technologies include liquid chromatography-mass spectrometry and tandem mass-spectrometry, which can be used to bypass the initial screening IA and identify a larger number of substances and metabolites 8. Bipolar disorder (BD) is a common, severe and cyclic mental illness that presents with marked and unpredictable changes in mood and activity 1. BD is a risk factor for addictions, both behavioral, such as gambling 2 and substance use disorders 3. Besides a strong association between alcohol 4 and nicotine 5 dependence and BD 4, the abuse of other drugs, such as cocaine, amphetamines, opiates, cannabis, and prescription medications is also an important health concern in people with BD. When conceptualizing this article, the authors noticed that there is a fair number of reviews on alcohol use disorder in individuals with BD, including their own recent publication 1, whereas there is a relative paucity of up-to-date, comprehensive reviews on the subject of bipolarity and illicit drugs.
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- While it is the most reliable structural determination method and can determine the structure of currently unknown molecules, it is not suitable outside of a laboratory environment.
- Although SUD is one of the most important comorbidities in BD with a significant influence on clinical outcome, there is still a lack both of basic research and clinical trials, allowing for evidence-based and specific best practices.
- There are portable IR devices on the market that have been optimized for basic to intermediate knowledge base, such as by outreach workers.
- The use of amphetamines or cocaine may induce or prolong manic periods with high levels of energy and excitement.
Sensitivity is quite high with detection in the microgram range as antibody-antigen interactions occur on a molecular level 39. TLC can detect barbiturates, benzodiazepines, GHB, heroin, morphine, opium, oxycodone, and other opiates, amphetamines, cocaine, methamphetamine, MDMA (methylenedioxymethamphetamine or Ecstasy), ketamine, LSD, marijuana, mescaline, synthetic cannabinoids, and cathinones (commonly referred to as “bath salts”). Using TLC, it may be difficult to separate and identify novel psychoactive substances 36.
Alternative Testing Methods
FAIMS is able to operate in environments with high levels of interference with minimal adjustment to operating conditions 21. IMS is non-destructive and only requires a very small sample if a quantitative method calls for destructive testing. Determination is very quick and can be accomplished in a few seconds even for a complex sample. The following methods have been validated by the Scientific Working Group for the Analysis of Seized Drugs (SWGDRUG). Scientific Working Groups consist of scientific subject-matter experts who collaborate to determine best practices and develop consensus standards.
Can NIDA assist me with interpreting or disputing the results of a drug screen?
Hair drug tests have the advantage of detecting substance use days to months, or in some cases, years, later 9,19. Drug metabolites are present in hair as early as one week after most recent use, and because metabolites remain trapped in the core of the hair as it grows, hair provides a rough timeline of use over an extended period 9,20. Hair grows at a rate of approximately one-half inch per month, and so the standard 1.5-inch hair sample obtained close to the root in most drug testing protocols gives information over past 3-month drug use 8. When substances are ingested, they are absorbed in the gastrointestinal tract and distributed to tissues of the body 9. Substances that are injected, inhaled or snorted bypass gastrointestinal absorption and are delivered immediately to tissues. Since many drugs are lipid soluble, they must undergo metabolism in the liver to render them water soluble which then allows them to be eliminated in urine.