SAMHSA Advisory: Lab Tests for Alcohol Abuse

SAMHSA has issued an Advisory that cautions licensure bodies, other monitoring organizations, and staff in criminal justice settings that a widely used test for alcohol consumption is “scientifically unsupportable” as the sole basis for legal or disciplinary action.
The EtG (ethyl glucuronide) urine test, often used to detect alcohol use among individuals legally prohibited from drinking because of their job or parole status, is “inappropriate” as the sole basis for a definitive, life-altering decision.
According to the SAMHSA Advisory, “The Role of Biomarkers in the Treatment of Alcohol Use Disorders,” the EtG urine test is one of the evolving group of highly sensitive tests for the ingestion of alcohol.
The EtG test and other similar highly sensitive tests are not able to distinguish between alcohol absorbed into the body from exposure to many common commercial and household products containing alcohol or from the actual consumption of alcohol. Calling such a test “positive” for consumption or relapse, especially at low concentrations, could have devastating consequences for someone who signs an alcohol abstinence contract or is required to be abstinent by law.
“This Advisory is a clarification,” said addiction psychiatrist Kenneth Hoffman, M.D., M.P.H., of SAMHSA’s Center for Substance Abuse Treatment Division of Pharmacologic Therapies. “The Agency wants officials to know that the EtG test, for example, is fine for use in clinical settings. But it should not be used as a stand-alone test in a forensic situation where someone’s job is at stake.”
The EtG test, identified as a “direct biomarker,” is highly sensitive, Dr. Hoffman explained. (See Alcohol Biomarkers below) “For example, there’s a popular hand sanitizer that’s about 64-percent ethanol. That alcohol can be absorbed through the skin and metabolized to EtG and EtS (ethyl sulfate),” he said. “With tests highly sensitive to detecting EtG or EtS, that might mean that these tests are reported positive for other reasons, even though no alcohol was consumed. A positive EtG or other similar highly sensitive test alone may have nothing to do with relapse or inappropriate use of alcohol.”
To order a copy of “The Role of Biomarkers in the Treatment of Alcohol Use Disorders,” call SAMHSA’s National Clearinghouse for alcohol and Drug Information (NCADI) at 1(800) 729-6686 (English and Spanish) or 1(800) 487-4889 (TDD). Ask for NCADI number MS996. Online, for more information on the Advisory or to view the full text in PDF format, visit www.kap.samhsa.gov/products/manuals/advisory.

Center for Substance Abuse Treatment. The role of Biomarkers in the Treatment of Alcohol Use Disorders. Substance Abuse Treatment Advisory. Volume 5, Issue 4, 2006.

What Are Alcohol Biomarkers?

Alcohol biomarkers are physiological indicators of alcohol exposure or ingestion. SAMHSA’s recent Advisory focuses on “indirect” and “direct” biomarkers.

Indirect biomarkers. Traditional alcohol biomarkers are generally considered “indirect.” Indirect biomarkers suggest heavy alcohol consumption by detecting the toxic effects that alcohol may have HAD ON ORGAN SYSTEMS OR BODY CHEMISTRY. Indirect measures generally screen for elevations of specific liver serum enzymes-which may result from heaving drinking-or changes in red blood cells-which reflect nutritional problems related to alcohol use.
Direct biomarkers. Breath or blood alcohol tests used by police officers to identify potentially drunk drivers are familiar examples of a direct alcohol biomarker. These tests reliably determine a motorist’s blood alcohol concentration. An evolving group of tests for alcohol-“direct” biomarkers, or analytes of alcohol metabolism-are now available through some laboratories for either clinical or forensic use. Tests for EtG (ethyl glucuronide) and EtS (ethyl sulfate), typically measured in urine, can be used to screen individuals for alcohol exposure or use. These tests may be reported positive after even low-level exposure to alcohol and may remain detectable for several days. Tests for indications of heavy alcohol use have proven helpful in clinical treatment settings and can complement self-report measures of drinking.

Over-the-Counter Drugs — Abuse Where You Least

Think that drug abuse among teens is limited to illegal substances like marijuana and club drugs such as Ecstasy? Think again.

If you're like most parents, you're probably not aware that a number of over-the-counter (OTC) products can potentially be abused by teens looking to get high. But it's important to educate yourself about the potential abuse of consumer products found right in your home. It is important to know the facts about OTC product and medication abuse and make a habit of closely monitoring the use of certain household substances. Talk with preteens and teens about the proper use of all medications (including those that are available over the counter) and the health risks associated with their abuse.

One category of products sometimes abused by teenagers that few parents know about is OTC cough and cold remedies. The OTC cough and cold medications available in your local pharmacy, supermarket or convenience store are safe and effective when used as directed. But some youth are drawn to an ingredient found in nearly half of these medications called dextromethorphan, or DXM. When taken in excessive doses, dextromethorphan can produce a high or cause psychoactive effects.

What is dextromethorphan or DXM?
Dextromethorphan is a cough-suppressing ingredient in a variety of OTC cold and cough medications. It is found in more than 125 OTC products and comes in various forms, most commonly in cough suppressants in caplet or liquid form.

News Source:

Fentanyl and Heroin A Dangerous Combo

The Substance Abuse and Mental Health Services Administration (SAMHSA) has issued an action alert to substance abuse treatment and prevention professionals about a new combination of street drugs with a potentially lethal effect. The addition of fentanyl, a powerful narcotic analgesic, to heroin or cocaine being sold on the streets is believed to be the cause of clusters of drug-related deaths and even greater numbers of overdoses in east coast and midwest cities in the past few months.

In just one week in May, an estimated 33 individuals in the Detroit are reported to have died after using this fatal drug mix. The same drug combination may have been responsible for over 100 deaths in Philadelphia/Camden, Chicago, St. Louis, and Detroit since last September.

The alert was issued by SAMHSA’s Center for Substance Abuse Treatment Director H. Westley Clark, M.D., J.D., M.P.H., to substance abuse professional organizations, treatment providers, state substance abuse authorities, and recovery community-related organizations and individuals. It highlights the growing concern about the potentially fatal effects of this street-drug combination and encloses a brief fact sheet about preventing as well as detecting and treating overdoses.

ECSTACY MARKET COLLAPSING

Use of the Drug Dramatically Down in the United States;
International Seizures Drop Dramatically

(Washington, D.C.)—John Walters, Director of the Office of National Drug Control Policy (ONDCP), today released compiled data showing dramatic changes in the illegal market for MDMA/Ecstasy in the United States and abroad. Some key findings:

The latest Monitoring the Future report has found that the use of Ecstasy (MDMA) has declined by nearly two thirds since 2001.

Current use dropped 66 percent among 8th graders (from 1.8 percent to 0.6 percent), 61 percent among 10th graders (from 2.6 percent to 1.0 percent), and approximately 64 percent among 12th graders (from 2.8 percent to 1.0 percent).

Perceived harm of using Ecstasy among high school seniors almost doubled, from 33.8 percent in 1997 to over 60 percent in 2005.

At its peak in 2001, total domestic seizures of MDMA reached 11 million tablets. In the past 2 years, however, total domestic seizures declined to less than 3 million tablets.

Dutch MDMA seizures increased from 3.6 million tablets in 2001 to an average of 5.5 million tablets a year for 2003 and 2004.

Director Walters said, "Thanks to the work of parents, communities, and law enforcement, we are seeing a dramatic decline in the threat that Ecstasy poses to our nation. Conventional wisdom from the late nineties convinced many Americans that there was nothing we could do to stop the spread of Ecstasy abuse among young people. Once again, we have proved that balanced strategies against our drug threats make the drug problem smaller."

News Source: www.WhiteHouseDrugPolicy.gov

Drugs & Violence

More kids use marijuana than any other illicit drug by far. Many of them are in search of the "natural high" their friends promised and think that marijuana use is only "harmless fun." They don't realize that the purchase and use of this illicit drug can have negative consequences that can trigger acts of terrible violence close to home, shattering lives and affecting communities-even touching the lives of people around the world.

Teens often believe marijuana use won't hurt anyone else. Sometimes though, it makes people violent. Kids who use marijuana weekly are four times more likely to engage in violent behavior than those who don't.

Americans spend billions of dollars on drugs every year. According to "What America's Users Spend on Illegal Drugs," Americans spent approximately $10.5 billion on marijuana alone in 2000. The bottom line is clear: Marijuana trafficking and use is a big, often violent business. Help the kids you know make the connection between this risky drug and acts of violence committed against innocent people where you live and around the world.

Do you understand the link between drug money and "terrible things"? Money from a drug transaction on a local street corner can end up in the hands of groups that commit violent crimes to support the drug trade. New advertisements, "Dan" and "Stacey," show viewers how money from a simple drug transaction can lead to crime and violence around the world. View the ads or read true stories of cases showing how drugs and money fueled crime and violence.

POPPY SEEDS

A minor constituent of opium, thebaine or paramorphine (C19H21NO3) is chemically similar to both morphine and codeine, but produces stimulatory rather than depressant effects. Thebaine is not used therapeutically, but is converted into a variety of compounds including codeine, hydrocodone, hydromorphone, oxycodone, oxymorphone, nalbuphine, naloxone, naltrexone, buprenorphine and etorphine. It is controlled in Schedule II of the Controlled Substances Act as well as under international law. Thebaine is listed as a Class A drug under the Misuse of Drugs Act 1971 in the United Kingdom.

Thebaine and Poppy Seeds:

The consumption of poppy seeds in various foods may lead to a positive opiate result in urine subjected to testing for drugs of abuse. As a natural constituent of poppy seeds, thebaine was investigated as a possible marker for poppy seed consumption. Poppy seeds were examined for opiate content by gas chromatography-ion trap mass spectrometry (GC-MS) after extraction with methanol. Urine samples spiked with thebaine and urine from subjects given 11 g of poppy seeds were tested for the presence of thebaine, codeine, and morphine. Street heroin, one morphine and one codeine tablet, and urine from individuals who had used heroin were also examined for thebaine. Urine specimens were screened by enzyme immunoassay (EMIT) and confirmed for thebaine by GC-MS using a solid-phase extraction method. The GC-MS assay showed a linear response over a range of 1-100 ng/mL and a limit of detection of 0.5 ng/mL. Thebaine was detectable in the urine of poppy seed eaters in concentrations ranging from 2 to 81 ng/mL. Because thebaine was absent in powdered drugs and the urine of true opiate drug users, thebaine is proposed as a direct marker for poppy seed use.

OPIATES from the Poppy
The poppy (Papaver somniferum) was grown for the opium, the latex or dried sap of the seed head and stalk, which contains a mixture of closely related alkaloids. It originates from the Balkans, Turkey and what is now Iran and Iraq. Over the centuries, however, it has been taken extensively into the Far East including India, Northern Burma and Thailand and China.
The alkaloids are now extracted from dried poppy heads and stalks (poppy straw) using ethanol and water. This technique was developed by the Hungarian, Janos Kabay, in the 1920-30s period. The alkaloids are then extracted by precipitation processes.
Two poppy forms are grown in Tasmania.
Those closest to the original wild poppy of the Balkans and the Middle East are grown for the production of MORPHINE ( C17H19NO3 ), one of the components of opium. Approximately 10% by weight of opium ( but only about 2% of poppy straw ) is morphine.

The other poppy variety which has been developed in Tasmania is a genetically different form grown to produce THEBAINE, another alkaloid of tremendous value to the pharmaceutical industry.


Within the poppy, the synthesis is thebaine to codeine to morphine. There are 3 biochemical steps converting thebaine to codeine and one step further to morphine. A second path exists, thebaine to oripavine to morphine. This pathway is not dominant in the morphine poppy but leads to substantial quantities of oripavine in the thebaine variety.
Oripavine is very similar to codeine and is actually a better starting point for many synthetic opiates. It is usually a minor chemical but the thebaine strain produces quite a large percentage of oripavine. This can easily be converted to thebaine using a "methylation" step. (The H is replaced by CH3 , methyl, off the benzene ring.)
Looking at the diagrams of thebaine, codeine, oripavine and morphine, it can be seen that the molecules have very much a common central core. Parts on the outer of the molecules differ - thebaine is more complex than codeine which again is more complex than morphine. Notice that the cyclo-hexene ring is a cyclo-hex-2-ene ring in thebaine and oripavine.



Tasmanian Alkaloid researchers used mutagenesis to isolate a plant which stopped alkaloid development at thebaine rather than morphine. They were able to work out how to check en masse the latex of many plants - 1000 plants each week - which left the plant intact and viable. They then propagated this variety.
(This is the first time a variety of poppy has been developed that stops the alkaloid development at thebaine and it has received wide acclaim.)
The thebaine strain differs from the morphine strain by one just one recessive gene.
Much of the Tasmanian crop is now given over to this variant. It is more toxic than the morphine variants and can cause fits if ingested!

Other alkaloids within the opium which are classed as opiates include noscapine and papaverine. These are not greatly used by the pharmaceutical industry but may be in the future.