Drug List

The summary below is a general guide only. Individuals may show significant variation in dose response or length of time drugs may be detected.

The list is not exhaustive and should not be relied upon as a substitute for specific medical advice or confounding conditions which may substantially effect the parameters described below.

Click on any heading to expand and view details of the selected drug. You can also use the search box to conduct full-text searches across this page.


i Amphetamines

a. Amphetamine

Attribute Description
No matching records found
Attribute Interferents - True positives arising from metabolites, medications etc. Description drugs which produce amphetamine metabolites, including :
benzphetamine
clobenzorex
DMAA
famprofazone
methamphetamine
prenylamine
selegiline
Attribute Interferents - False positives in screening tests Description Prescription amphetamine prodrugs, including : selegiline over-the counter nasal decongestants, including : Vicks (incl Vapoinhaler) iii) drugs which produce amphetamine metabolites, including : benzphetamine, methamphetamine and selegiline
Attribute Testing - Testing - Detection widow Description Oral Fluid - Less than 24 hours

Urine - up to 2 days acute/infrequent use but may be up to 4 days with chronic users

Inhibitors of liver enzyme CYP2D6 will prolong the urinary elimination half-life of amphetamines. These drugs include : fluoxetine (& most SSRI’s) & bupropion
Attribute Turn-around Time for reports Description 24 hours from receipt of sample in the laboratory.
Attribute Addiction risk Description High to very High
Attribute Class Description Powerful central nervous system stimulant of the phenylethylamine class; parent compound of the structural class
Attribute Effects Description Induces euphoria, altered libido, increased arousal, decreased reaction time, increased strength & fatigue resistance
Attribute Interactions with medication Description Antagonizes effects of sedatives, depressants, antipsychotic & antihypertensives enhances effects of stimulants & antidepressants (esp dangerous synergy with MAOI’s) amphetamine absorption in the g.i.t. and excretion in urine are pH-dependent (low pH decreases g.i.t. absorption but increases urinary excretion) – this effect is seen with concomitant use of proton pump inhibitors & H2 antihistamines
Attribute Legal status Description Schedule 8 restricted drug (Prescription only)
Attribute Legitimate / Medical use Description        • Attention deficit hyperactivity disorder (ADHD)
       • Narcolepsy

No longer used for obesity, depression, nasal congestion
Attribute Metabolism Description Amphetamine is eliminated principally via the kidneys 30–40% of the parent drug excreted unchanged at normal urinary pH) metabolised by hepatic enzyme CYP2D6; major metabolic pathways include hydroxylation, n-dealkylation & deamination
Attribute Mode of action Description Increased biogenic amine & excitatory neurotransmitter activity in CNS (esp catecholamines : noradrenaline & dopamine)
Attribute Overdose Description - moderate overdose may induce agitation, irregular heartbeat, tachycardia, confusion, painful dysuria or urinary retention, hyper- & hypo-tension, hyperthermia and myositis.
- large overdose may induce amphetamine psychosis, anuria, cardiogenic shock, cerebral haemorrhage, renal failure, rhabdomyolysis, pulmonary & peripheral
oedema, convulsion & coma
Attribute Recreational / Illicit use Description • Euphoriant
• Aphrodisiac
• Performance enhancer
Attribute Route of administration Description Oral, IV
Attribute Side-effects Description Dependence, insomnia, dysphoria, anxiety, irritability, grandiosity, psychosis at high dose, rhabdomyolysis, variable hypo- & hyper-tension, reduced seizure threshold
Attribute Street name Description Uppers, Speed, whiz

b. Dextroamphetamine

Attribute Description
No matching records found
Attribute Class Description Powerful central nervous system stimulant of the phenylethylamine class
Attribute Legitimate / Medical use Description Attention deficit hyperactivity disorder (ADHD)
Narcolepsy
Autism
Fragile X Syndrome
CVA recovery
No longer used for appetite suppression
Attribute Recreational / Illicit use Description Performance enhancer
Euphoriant
Aphrodisiac
Attribute Mode of action Description Increased biogenic amine & excitatory neurotransmitter activity in CNS (esp catecholamines : noradrenaline & dopamine)
Attribute Effects Description Induces appetite suppression, euphoria, altered libido, increased arousal, decreased reaction time, markedly increased fatigue resistance
Attribute Side-effects Description Dependence, insomnia, palpitations, tremors, tachycardia, headache, dyskinesia, hyperactivity, dysphoria, anxiety, irritability, grandiosity, psychosis at high dose, rhabdomyolysis, hyper-tension, myocardial infarction, CVA
Attribute Overdose Description as for amphetamine : large overdose may induce amphetamine psychosis, anuria, cardiogenic shock, cerebral haemorrhage, renal failure, rhabdomyolysis, pulmonary & peripheral oedema, convulsion & coma
Attribute Addiction risk Description High to very High
Attribute Route of administration Description Oral
i.v.
Inhaled
Attribute Street name Description Dex, uppers, kiddie speed
Attribute Legal status Description Schedule 8 Restricted Drug (Prescription Drug)
Attribute Interactions with medication Description Antagonizes effects of sedatives, depressants, antipsychotic & antihypertensives enhances effects of stimulants & antidepressants (esp dangerous synergy with MAOI’s) amphetamine absorption in the g.i.t. and excretion in urine are pH-dependent (low pH decreases g.i.t. absorption but increases urinary excretion) – this effect is seen with concomitant use of proton pump inhibitors & H2 antihistamines. Lisdexamphetamine is a prodrug activated by g.i.t. absorption – the process being markedly pH dependent
Attribute Metabolism Description Amphetamine is eliminated principally via the kidneys 30–40% of the parent drug excreted unchanged at normal urinary pH) metabolised by hepatic enzyme CYP2D6; major metabolic pathways include hydroxylation, n-dealkylation & deamination
Attribute Testing - Detection widow Description Oral Fluid - Less than 24 hours

Urine - up to 2 days acute/infrequent use but may be up to 3 to 4 days with chronic users

inhibitors of liver enzyme CYP2D6 (including fluoxetine & bupropion) will prolong the urinary elimination half-life of dextroamphetamine except for the prodrug Lisdexamphetamine which is activated by g.i.t. absorption not hepatic metabolism – concomitant use of proton pump inhibitor will only raise the percentage of the primary drug excreted.
Attribute Interferents - False positives in screening tests Description Prescription amphetamine prodrugs, including : selegiline over-the counter nasal decongestants, including : Vicks (incl Vapoinhaler) iii) drugs which produce amphetamine metabolites, including : benzphetamine, methamphetamine and selegiline
Attribute Interferents - True positives arising from metabolites, medications etc. Description Drugs which produce amphetamine metabolites, including : lisdexamphetamine (L-lysine-d-amphetamine) a.k.a. Vyvannse drugs which contain dextroamphetamine, including Adderall (72.7% dextroamphetamine by weight of amphetamine base)
Attribute Turn-around Time for reports Description 24 hours from receipt of sample into the Laboratory

c. MDMA (3,4-methylenedioxy-N-methylamphetamine) / Ecstasy

Attribute Description
No matching records found
Attribute Class Description Substituted amphetamine analogue
Attribute Legitimate / Medical use Description Psychotherapy (incl for PTSD) –research/restricted access.
Attribute Recreational / Illicit use Description Entheogen Euphoriant Rave-party drug
Attribute Mode of action Description Acts as releasing agent for serotonin & catecholamines like noradrenaline & dopamine enhances oxytocin release
Attribute Effects Description Induces sense of intimacy & euphoria, reduced anxiety & mild psychedelia subjective effects begin 30 – 60 minutes post-consumption; peak at 75 – 120 minutes resulting in a plateau state for ~ 3 – 3.5 hours post-usage effects : difficulty concentrating, jaw clenching / teeth grinding (bruxism) during sleep, appetite loss, thirst/dry mouth, slight dysphoria
Attribute Side-effects Description hyperthermia, dehydration and hyponatraemia (effects exacerbated by diuretics) are the principal short term side-effects along with anxiety, paranoia, irritability, depression, fatigue, confusion, hypertonia and hypertension short-term withdrawal depression (~ 3 – 5 days) after use occasional association with hepatic injury, excessive dental wear and rarely persistent hallucinogen perception disorder with chronic use Possibly significant long-term serotonergic neurotoxicity occurs (controversial)
Attribute Overdose Description depersonalization, Serotonin syndrome (esp if contaminated with PMA), agitation delusion & psychosis, memory impairment, hypertensive crisis with raised CVA risk, possible convulsions, hyperreflexia, severe hyperthermia, cardiac stress ranging from angina pectoris to myocardial infarction, renal failure, coma, death
Attribute Addiction risk Description controversial – probably low to moderate; tolerance relatively common unassociated with addiction
Attribute Route of administration Description oral (incl sublingual)
insufflation
inhalation (vaporization)
injection
rectal
Attribute Street name Description Adam, Ecstasy, Eckie, Mandy (relatively pure MDMA preparations free from adulterants), Molly, XTC
Attribute Legal status Description Schedule 9 Prohibited Substance (since 1986)
Attribute Interactions with medication Description Serious/potentially lethal interaction with serotoninergic drugs (incl Ritonavir) and many general Monoamine Oxidase Inhibitors (MAOI’s) including phenelzine, tranylcypromine & moclobemide – note MAOB inhibitors (e.g., Selegiline) do not have this interaction marked worsening of hyperthermia with concomitant use of PMA may be taken in conjunction with psychedelics (incl LSD, psilocybin) or ketamine
Attribute Metabolism Description Blood levels peak between 1.5 and 3 hr after ingestion with an elimination half-life of 8 hours (high levels in circulation persist after pharmacological effects have subsided due to induction of acute tolerance). Metabolized by O-demethylation with subsequent methylation, and by N-dealkylation through CYP2D1 and CYP3A4 activity. MDMA excreted primarily unchanged as a sulphide or glucuronide conjugate in urine (65%), with 7% excreted as MDA during 24 hrs post ingestionHigh risk death when taken with MAOI inhibitors ( phenelzine, tranylcypromine or moclobemide but not with selective MAOB inhibitors like selegiline) or with CYP450 inhibitors (ritonavir)
Attribute Testing - Detection widow Description Oral Fluid - 12 to 24 hours

Urine - commonly 48 hours, but up to 3 days when taken with CYP inhibitors** **inhibitors of liver enzyme CYP2D6 (including fluoxetine & bupropion) will prolong the urinary elimination half-life of MDMA. Note CYP2D6 inhibition by paroxetine does not markedly increased MDMA pharmacologic effects.
Attribute Interferents - False positives in screening tests Description Amineptine (Viaspra)
Benzphetamine (Didrex)
Clobenzorex (Rexigen)
Dextromethorphan (some cough medicines incuding Dimetapp)
Diethylcathinone/diethylpropion (Amfepramone)
Desoxyphedrine
Dexenfluramine (Redux)
Etafediabe
Famprofazone (Gewodin)
Fenethylline (Captagon)
Fenprovorex (Perphoxene)
Levomethamphetamine (Vicks inhaler)
Mefenorex (Anexate)
Mephentermine (Wyamine)
Mesocarb (Sydnocarb)
Methamphetamine sylphenidate (Ritalin)
Methoxyphenamine (Orthoxicol)
Morazone (orsimon)
Oxymetazine (Vicks nasal spray)
Pemoline (Betanamin, Cylert, Tradon)
Phendimetrazine (Preludil)
Phentermine (Adipex, Duromine)
Phenylpropanolamine (Accutrim, Dexatrim, Tavist-D)
Pholedrine (Veritol)
Pseudoephedrine (Claritin-D, Robitussin, Sudafed)
Selegiline (Eldepryl)
Attribute Interferents - True positives arising from metabolites, medications etc. Description Nil
Attribute Turn-around Time for reports Description 24 hours from receipt of sample into the Laboratory

d. MDA (3,4-methylenedioxyamphetamine)

Attribute Description
No matching records found
Attribute Class Description Substituted amphetamine analogue
Attribute Legitimate / Medical use Description None
Attribute Recreational / Illicit use Description Psychedelic Stimulant Weaker entheogen & euphoriant than MDMA Rave-party drug
Attribute Mode of action Description Similar to MDMA, much higher affinity for 5-HT2a receptors; acts as releasing agent for serotonin & catecholamines like noradrenaline & dopamine weaker enhancement of oxytocin release than MDMA
Attribute Effects Description Reduced anxiety & significant psychedelia; induces euphoria, but less intimacy than MDMA shorter duration of action than MDMA acting over 5 – hrs maximum.
Significantly more variation in individual response than with MDMA stronger stimulant and psychedelic effects than MDMA (higher affinity to 5-HT2A receptors), less intense empathogenic effect subjective effects begin before 60 minutes post-consumption and persist for shorter time than MDMA
post-usage effects similar to MDMA: difficulty concentrating, jaw clenching / teeth grinding (bruxism) during sleep, appetite loss, thirst/dry mouth, slight dysphoria
Attribute Side-effects Description Greater hyperthermia, hypertension (often) and dehydration than MDMA, accompanying hyponatraemia (effects exacerbated by diuretics) are the principal short term side-effects along with anxiety, paranoia, irritability, depression, fatigue, confusion and hypertonia
short-term withdrawal depression after use
Possibly significant long-term serotonergic neurotoxicity occurs (controversial)
Attribute Overdose Description Significantly more toxic than MDMA – markedly higher hypertensive effect, dramatic rise in body temperature, more frequent agitation, tachycardia; death usually from cardiac stimulatory effects with subsequent cerebral haemorrhage
Attribute Addiction risk Description Controversial – probably low to moderate; tolerance relatively common unassociated with addiction
Attribute Route of administration Description as per MDMA : oral (incl sublingual)
insufflation
inhalation (vaporization),
injection
Attribute Street name Description Molly, Sass, or Sass-a-frass
Attribute Legal status Description Schedule 9 Prohibited Substance (since 1986)
Attribute Interactions with medication Description Serious/potentially lethal interaction with serotoninergic drugs (incl Ritonavir) and many general Monoamine Oxidase Inhibitors (MAOI’s) including phenelzine, tranylcypromine & moclobemide
Attribute Metabolism Description Blood levels peak earlier than MDMA; pharmacodynamics less well-studied than MDMA and substantially greater inter-individual variability in response – peak levels in circulation occur under 3 hrs post dose but suspected non-linear dynamics so may be dose dependent.
Most of the drug load is excreted unchanged as a a sulphide or glucuronide conjugate in urine
Attribute Testing - Detection widow Description Oral Fluid - 12 to 24 hours

Urine - commonly 48 hours
Attribute Interferents - False positives in screening tests Description As per MDMA : Amineptine (Viaspra)
Benzphetamine (Didrex)
Clobenzorex (Rexigen)
Dextromethorphan (some cough medicines incuding Dimetapp)
Diethylcathinone/diethylpropion (Amfepramone)
Desoxyphedrine
Dexenfluramine (Redux)
Etafediabe
Famprofazone (Gewodin)
Fenethylline (Captagon)
Fenprovorex (Perphoxene)
Levomethamphetamine (Vicks inhaler)
Mefenorex (Anexate)
Mephentermine (Wyamine)
Mesocarb (Sydnocarb)
Methamphetamine sylphenidate (Ritalin)
Methoxyphenamine (Orthoxicol)
Morazone (orsimon)
Oxymetazine (Vicks nasal spray)
Pemoline (Betanamin, Cylert, Tradon)
Phendimetrazine (Preludil)
Phentermine (Adipex, Duromine)
Phenylpropanolamine (Accutrim, Dexatrim, Tavist-D)
Pholedrine (Veritol)
Pseudoephedrine (Claritin-D, Robitussin, Sudafed)
Selegiline (Eldepryl)
Attribute Interferents - True positives arising from metabolites, medications etc. Description Nil
Attribute Turn-around Time for reports Description 24 hours from receipt of sample into the Laboratory

e. Methamphetamine

Attribute Description
No matching records found
Attribute Class Description Substituted amphetamine; powerful central nervous system stimulant of the phenylethylamine class
Attribute Legitimate / Medical use Description ADHD (Attention deficit hyperactivity disorder) in US (Desoxyn) Nasal decongestant – levorotary methamphetamine only (Vick’s Vapoinhaler)
No longer used for obesity, depression, nasal congestion
Attribute Recreational / Illicit use Description Euphoriant
Aphrodisiac
Stimulant
Attribute Mode of action Description Increased biogenic amine & excitatory neurotransmitter activity in CNS (esp catecholamines : noradrenaline & dopamine)
Full agonist of Trace Amine-Associated Receptor 1 (TAAR-1); agonist of α2 adrenergic receptors + σ receptors
Neurotoxic against dopaminergic neurones – usage associated with shrinkage of hippocampi & gray matter loss in limbic, paralimbic and cingulate cortices
Attribute Effects Description Induces euphoria, altered libido (enhanced desire with inhibition of ejaculation), increased arousal, decreased reaction time, increased strength & fatigue resistance, anorexia, hyperactivity & agitation, pupillary dilatation, flushed skin & excessive sweating, dry mouth/bruxism, altered bowel habits (constipation or diarrhoea), variable blood pressure (hyper- and hypo- tension), hyperthermia, blurred vision, dizziness/vertigo, pallor use in pregnancy associated with mild neonatal withdrawal syndrome
Attribute Side-effects Description Dependence, dry skin & pallor, insomnia, dysphoria, anxiety, palpitations & tachy- or brady- cardia, headache, decreased ejaculation, priapism, hyperthermia, fluctuating blood pressure, tremors rhabdomyolysis, variable hypo- & hyper-tension, reduced seizure threshold bruxism (leading to “meth-mouth” syndrome in injecting users)
significant psych effects associated with use including : mood swings, dysphoria, altered libido, decreased fatiguability may lead at higher doses to frank insomnia, irritability, grandiosity, obsessive behaviour, high risk of depression, violence, psychosis at high dose, amphetamine psychosis & suicide.
Approx 5 – 15% of chronic users fail to recover from psychotic episodes. unlike amphetamine, methamphetamine is a neurotoxin (esp to dopaminergic neurons) leading to an increased risk of Parkinsonism withdrawal after heavy use associated with a ‘crash’ marked by hypersomnia
chronic use may be accompanied by a prolonged depressive withdrawal syndrome lasting months
Attribute Overdose Description Moderate overdose may induce agitation, irregular heartbeat, tachycardia, tachypnoea, confusion, painful dysuria or urinary retention, hyper- & hypo-tension, hyperreflexia, hyperthermia and myalgia, methamphetamine psychosis. large overdose may induce methamphetamine psychosis, marked hyperreflexia, anuria, adrenergic storm, cardiogenic shock, cerebral haemorrhage, renal failure, rhabdomyolysis, pulmonary hypertension, serotonin syndrome, convulsions and coma which may lead to death
Attribute Addiction risk Description High to very High
Attribute Route of administration Description Oral ingestion
i.v.
smoking
suppository
Attribute Street name Description batu, cold, crank, crystal, crystal meth, glass, ice, jib, meth, rock, shards, shabu, speed, tina, tweak, ya-ba
Attribute Legal status Description Schedule 9 Prohibited Substance
Attribute Interactions with medication Description Antagonizes effects of sedatives, depressants, antipsychotic & antihypertensives enhances effects of stimulants & antidepressants (esp dangerous synergy resulting in sustained catecholamine levels when coadministered with MAOI’s) CYP2D6 inhibitors (e.g., SSRI’s) will prolong elimination half-life of methamphetamine amphetamine absorption in the g.i.t. and excretion in urine are pH-dependent (low pH decreases g.i.t. absorption but increases urinary excretion) – this effect is seen with concomitant use of proton pump inhibitors & H2 antihistamines
Attribute Metabolism Description peak plasma levels ~ 3 – 6 ½ hours post-dose
elimination half-life variable : 5 to 12 hours metabolized by hepatic CYP2D6; eliminated principally via the kidneys, variable level of metabolism dependent on route of administration: with oral dose 30 – 50% excreted as methamphetamine, 10 – 25% as amphetamine; with i.v. dose 45% excreted as methamphetamine, 7% as amphetamine)

Withdrawal Syndrome

Rapid development of tolerance; withdrawal syndrome may develop (esp with chronic users – occurs with 87.6% cases); may develop within 24 hours of last dose
Persists for variable period – up to 3 to 4 weeks with chronic users; 1st week marked by “crash” phase : drug craving, dysphoria, fatigue, increased appetite, increased or decreased movement, apathy, disrupted sleep (insomnia or reactive hypersomnia), lucid/vivid dreaming
"Crash"-associated depression more severe than for cocaine
Attribute Testing - Detection widow Description Oral Fluid - Less than 24 hours

Urine - up to 2 days acute/infrequent use but may be up to 4 days with chronic users

inhibitors of liver enzyme CYP2D6 will prolong the urinary elimination half-life of amphetamines. These drugs include : fluoxetine (& most SSRI’s) & bupropion
Attribute Interferents - False positives in screening tests Description Prescription amphetamine prodrugs, including : selegiline over-the counter nasal decongestants, including : Vicks (incl Vapoinhaler) iii) drugs which produce amphetamine metabolites, including : benzphetamine, methamphetamine and selegiline
Attribute Interferents - True positives arising from metabolites, medications etc. Description drugs which produce amphetamine metabolites, including :
benzphetamine
clobenzorex
DMAA
famprofazone
methamphetamine
prenylamine
selegiline
Attribute Turn-around Time for reports Description 24 after receipt of sample into the Laboratory

f. Phentermine

Attribute Description
No matching records found
Attribute Class Description Phenyl-tertiary-butylamine : anorexiant stimulant functions physiologically similarly to an amphetamine
Attribute Legitimate / Medical use Description Appetite suppressant previously but now restricted
Attribute Recreational / Illicit use Description Obesity control
Attribute Mode of action Description Potent full agonist of trace amine – associated receptor 1 (TAAR1) with increased biogenic amine & excitatory neurotransmitter activity in CNS (esp catecholamines : noradrenaline & dopamine) analogous to amphetamines increased 5-HT2B activation
Attribute Effects Description Suppresses appetite, induces mild euphoria, mildly increased arousal
Attribute Side-effects Description xerostomia (dry mouth), restlessness, euphoria, agitation, arrhythmia (incl tachycardia), hypertension, diarrhea & vomiting, eadache, facial oedema, urticaria, changes in libido, dysphoria
uncommonly : primary pulmonary hypertension, valvular heart disease (in combination with dexfenfluramine and fenfluramine albeit causal relationship unclear), decreased seizure threshold for epileptics, psychosis
Attribute Overdose Description Moderate overdose may induce agitation, tremors, irregular heartbeat, tachycardia, tachypnoea severe overdose may potentially be fatal (see amphetamine) but is unlikely – death risk raised if used in combination with fenfluramine (fen-fen – a drug combination since withdrawn for health risk) post o/d extreme fatigue is common
Attribute Addiction risk Description Minimal
Attribute Route of administration Description Oral
Attribute Street name Description Duromine, Fen, Fen-fen (with mixed with fenfluramine)
Attribute Legal status Description Schedule 4 restricted substance (Prescription only)
Attribute Interactions with medication Description Severe health risk when combined with fenfluramine (Fen-fen) – induces pulmonary hypertension, aortic & mitral valve dysfunction amplifies arousal effect and sympathetic side-effects when taken with amphetamines antagonizes effects of sedatives, depressants, antipsychotic & antihypertensives enhances effects of stimulants & antidepressants (esp dangerous synergy with MAOI’s where markedly increases risk of CVA) risk of ‘serotonin syndrome’ when used with SSRI’s
Attribute Metabolism Description ~70 – 80% of oral phentermine load excreted unmetabolized at normal urinary pH half-life of elimination is 19 to 24 hrs
Attribute Testing - Detection widow Description Oral Fluid - 12 to 24 hours

Urine - up to 3 days

inhibitors of liver enzyme CYP2D6 will prolong the urinary elimination half-life of amphetamines. These drugs include : fluoxetine (& most SSRI’s). detection time increased for Metermine (delayed release formulation)
Attribute Interferents - False positives in screening tests Description Nil
Attribute Interferents - True positives arising from metabolites, medications etc. Description drugs which produce amphetamine metabolites, including :
duromine
metermine
Attribute Turn-around Time for reports Description 24 hours from receipt of sample into the Laboratory

g. PMA

Attribute Description
No matching records found
Attribute Class Description Serotoninergic psychedelic amphetamine; a.k.a. 4 – methoxyamphetamine (4 – MA)
Attribute Legitimate / Medical use Description None
Attribute Recreational / Illicit use Description Hallucinogen
Frequent additive/contaminant of MDMA pills
Very weak stimulant/euphoriant
Attribute Mode of action Description Selective serotonin releasing agent, much weaker effect on dopamine + noradrenaline transporters than MDMA – functions analogously to a reuptake inhibitor;
reversible MAO – A inhibitor
Attribute Effects Description Slow onset of effect Mild stimulatory effect, hallucinations/psychedelia, diaphoresis with marked rise in temperature, strong feelings of intoxication
Attribute Side-effects Description Dramatic rise in body temperature (possibly due MAO – A inhibition coupled with serotoninergic effects), irregular tachycardia, hypertension, blurred vision, nausea
Attribute Overdose Description Severe hyperthermia, palpitations, marked hypertension, muscle spasms, hypoglycaemia, hyperkalaemia, renal failure, rhabdomyolyis, cerebral haemorrhage, death
Attribute Addiction risk Description Undetermined – probably significantly less than MDMA
Attribute Route of administration Description As per MDMA :
oral (incl sublingual)
insufflation
inhalation (vaporization)

potentially also :
injection
rectal / suppository
Attribute Street name Description Blue transformer, chicken yellow, chicken powder, Death, Dr. Death, Euro pills, Louis Vuitton, Mitsubishi Turbo, Red/Blue Mitsubishis, Yellow Europills, 4 – MA
Attribute Legal status Description Schedule 1 banned substance
Attribute Interactions with medication Description Synergistic, potentially lethal interaction with amphetamines and their analogues (including MDMA) potentially enhanced catecholaminergic effect when taken with MAOI’s prolonged elimination half-life when coadministered with CYP2D6 inhibitors (notably Fluoxetine) antagonizes effects of antihypertensives
Attribute Metabolism Description Slow but variable onset of action metabolized by hepatic CYP2D6; eliminated principally via the kidneys, variable level of metabolism / marked interindividual variation;

O-demethylated by CYP2D6 (debrisoquine hydroxylase) followed by conjugation – 50% of ingested load excreted in urine as unmetabolized parent compound PMA
Attribute Testing - Detection widow Description Oral Fluid - possibly up to 24 hours

Urine - 36 hours post dose – up to 66 hours (marked interindividual variation – dependent on CYP2D6 genotype or coadministration of CYP2D6 inhibitors)
Attribute Interferents - False positives in screening tests Description Acacia extracts in herbal supplements (specifically : Browningia candelaris)
Attribute Interferents - True positives arising from metabolites, medications etc. Description PMA analogues :
PMMA – small percentage of ingested dose N-demethylated to PMA depending on assay, potentially : 4-ETA, 4-MTA, PMEA
Attribute Turn-around Time for reports Description 24 hours after receipt of sample into the Laboratory

h. PMMA

Attribute Description
No matching records found
Attribute Class Description Serotoninergic psychedelic amphetamine analogue of PMA; a.k.a. 4 – methoxy – 4 – methylamphetamine (4 – MMA)
Attribute Legitimate / Medical use Description Nil
Attribute Recreational / Illicit use Description Hallucinogen
Frequent additive/contaminant of MDMA pills
Weak stimulant/euphoriant (possibly slightly more potent than PMA)
Attribute Mode of action Description As per PMA
Selective serotonin releasing agent, much weaker effect on dopamine + noradrenaline transporters than MDMA – functions analogously to a reuptake inhibitor; reversible MAO – A inhibitor
Attribute Effects Description Slow onset of effect
Weak stimulatory effect, some euphoria, hallucinations/psychedelia, diaphoresis with marked rise in temperature, strong feelings of intoxication, loss of appetite
Attribute Side-effects Description Rapid rise in body temperature (possibly due MAO – A inhibition coupled with serotoninergic effects), irregular tachycardia, hypertension, restlessness, blurred vision, nystagmus, nausea
Attribute Overdose Description As per PMA
Severe hyperthermia, palpitations, marked hypertension, muscle spasms, hypoglycaemia, hyperkalaemia, renal failure, rhabdomyolyis, cerebral haemorrhage, death
Attribute Addiction risk Description Undetermined – probably significantly less than MDMA
Attribute Route of administration Description As per PMA :
oral (incl sublingual)
insufflation
inhalation (vaporization)

potentially also :
injection
rectal / suppository
Attribute Street name Description Death, Dr. Death, Happy Powder, Methyl MA, 4 – MMA
Attribute Legal status Description Schedule 1 Banned substance
Attribute Interactions with medication Description Potentially lethal serotonin syndrome when used in combination with MDMA (Ecstasy) synergistic, potentially lethal interaction with amphetamines
potentially enhanced catecholaminergic effect when taken with MAOI’s
prolonged elimination half-life when coadministered with CYP2D6 inhibitors (notably Fluoxetine) antagonizes effects of antihypertensives
Attribute Metabolism Description Slow/variable onset of action
metabolized by hepatic CYP2D6; eliminated principally via the kidneys, variable level of metabolism / marked interindividual variation; O-demethylated by CYP2D6 (debrisoquine hydroxylase) followed by hydroxylation, COMT-catalysed methylation then conjugation prior to elimination in urine – small percentage of dose N-demethylated to PMA
Attribute Testing - Detection widow Description Oral Fluid - up to 24 hours

Urine - 36 hours post dose – up to 60 hours (marked interindividual variation – dependent on CYP2D6 genotype or coadministration of CYP2D6 inhibitors)
Attribute Interferents - False positives in screening tests Description Acacia extracts in herbal supplements (specifically : Browningia candelaris)
Attribute Interferents - True positives arising from metabolites, medications etc. Description PMA
Attribute Turn-around Time for reports Description 24 hours from receipt of sample into the Laboratory
ii Barbiturates

a. Long-acting Barbiturates

Amobarbitone

Attribute Description
No matching records found
Attribute Class Description Long-acting barbiturate
Attribute Legitimate / Medical use Description Anxiolyxis
Intractable insomnia
WADA test
(rarely) as second-line anticonvulsant
Attribute Recreational / Illicit use Description As per all generic barbiturates : euphoriant, potentiator for opiates (less effective than butylbarbitone)
Attribute Mode of action Description Activates GABAA receptors (esp in ventrobasal & intralaminar neurones)
Higher affinity binding to benzodiazepine receptor than phenobarbitone (less than secobarbital & pentobarbital)
Attribute Effects Description As for phenobarbital, save for greater sedation and shorter duration of action
Attribute Side-effects Description As for butylbarbital
Attribute Overdose Description Dependence mimics delirium tremens (life-threatening)
Severe confusion, hyporreflexia, irritability, hypothermia, bradypnoea, bradycardia, disordered sleep, generalized weakness
Attribute Addiction risk Description High
Attribute Route of administration Description Oral
i.v.
Attribute Street name Description Amytal
Attribute Legal status Description Not routinely available : Schedule 8 Restricted drug (Prescription only); prohibited import under Item 18, Schedule 4 (Regulation 5) of the Customs (Prohibited Imports) Regulations 1956.
Schedule III controlled medication (UK)
Attribute Interactions with medication Description As with butylbarbital
Attribute Metabolism Description Majority of oral load excreted unchanged with remainder undergoing hydroxylation or N- glucosidation by the liver
Primarily excreted in urine unchanged and with some 3’hydroxyamobarbital &1-(B-D-glucopyranosyl) amobarbital
Attribute Testing - Detection widow Description Oral Fluid - 1 day

Urine - 3 to 4 days
Attribute Interferents - False positives in screening tests Description As for phenobarbitone
Attribute Interferents - True positives arising from metabolites, medications etc. Description As for phenobarbitone
Attribute Turn-around Time for reports Description 24 hours from receipt of sample into the Laboratory

Butalbarbitone

Attribute Description
No matching records found
Attribute Class Description Long-acting barbiturate
Attribute Legitimate / Medical use Description Tension headaches
Attribute Recreational / Illicit use Description Used as potentiator by some opiate addicts to either enhance the effects of their normal opiate dose or as means of conserving their supply
Attribute Mode of action Description Activates GABAA receptors (esp in ventrobasal & intralaminar neurones) Higher affinity binding to benzodiazepine receptor than phenobarbitone (less than amobarbital, secobarbital & pentobarbital)
Attribute Effects Description As for phenobarbital, save for greater sedation and overall shorter duration of action
Attribute Side-effects Description As for phenobarbitone – includes sedation/drowsiness, vertigo, nausea, euphoria, severe confusion, amnesia, constipation
(rare) Stevens-Johnson Syndrome
Attribute Overdose Description Dependence mimics delirium tremens (life-threatening)
Severe confusion, hyporreflexia, irritability, hypothermia, bradypnoea, bradycardia, disordered sleep, generalized weakness
Attribute Addiction risk Description High
Attribute Route of administration Description Oral
i.v
Attribute Street name Description Butterball, Sedapap
Attribute Legal status Description Not routinely available : Schedule 8 Restricted drug (Prescription only); prohibited import under Item 18, Schedule 4 (Regulation 5) of the Customs (Prohibited Imports) Regulations 1956.

Schedule III controlled medication (UK)
Attribute Interactions with medication Description As for phenobarbitone; enhances CNS depression (incl respiratory depression) of ethanol and other sedatives; synergistic enhancement of benzodiazepine effects
Attribute Metabolism Description Metabolized in liver : majority of oral load excreted as glycosylated parent compound with significant hydroxylation of the remainder
Primarily excreted in urine as parent compound & hydroxylated glucuronide conjugates
Attribute Testing - Detection widow Description Oral fluid - insufficient data

Urine - up to 7 days
Attribute Interferents - False positives in screening tests Description As for phenobarbitone
Attribute Interferents - True positives arising from metabolites, medications etc. Description As for phenobarbitone
Attribute Turn-around Time for reports Description 24 hours from receipt of sample into the Laboratory

Phenobarbitone

Attribute Description
No matching records found
Attribute Class Description Powerful central nervous system soporific, sedative/hypnotic, potentiator of GABA-ergic neurons
Attribute Legitimate / Medical use Description Anticonvulsant – partial & general tonic-clonic seizures neonatal seizures
Neonatal abstinence syndrome
Relive Cyclic Vomiting Syndrome
Sedative anxiolytic (when benzodiazepines not available)
Phenobarbitone is the only legal barbiturate available in Australia
No longer used for sleep disorder
Attribute Recreational / Illicit use Description Euphoriant
Intoxicant
Relaxant / sedative
Attribute Mode of action Description Potentiates GABA activity on GABAA receptors
Attribute Effects Description Induces wide-spectrum CNS depression, anxiolysis, sedation
Attribute Side-effects Description CNS depression with decreasing consciousness, bradycardia, bradypnoea, hypotension (rarely) Stevens – Johnson Syndrome
Attribute Overdose Description Sluggishness, incoordination, difficulty in thinking, slowness of speech, faulty judgement, drowsiness, shallow breathing, staggering; hypothermia, severe hypotension, pulmonary oedema, renal failure secondary to shock, in severe cases coma or death
Attribute Addiction risk Description High
Attribute Route of administration Description Oral
i.v.
Attribute Street name Description barbs, bluebirds, dolls, downers, goofballs, sleepers, 'reds & blues' and tooties
Attribute Legal status Description Schedule 8 Restricted drug (Prescription only)
Attribute Interactions with medication Description Elderly (>65 yrs age) at higher risk of experiencing the harmful effects of barbiturates, including drug dependence and accidental overdose
Synergistic with other CNS depressants (e.g. alcohol, opiates, benzodiazepines) due additive CNS and respiratory depressant effects.
With benzodiazepines, barbiturates increase binding affinity of the benzodiazepine binding site, leading to exaggerated benzodiazepine effects
Attribute Metabolism Description half-life of elimination ~ 92 hours
peak plasma levels 8 – 12 hours post oral dose
predominantly renal excretion, majority of oral load excreted as glucuronide of parent compound metabolised by hepatic enzyme CYP2B6; major metabolic pathways include hydroxylation and glucuronidation
Attribute Testing - Detection widow Description Oral Fluid - 1 to 2 days

Urine - 7 to 10 days
Attribute Interferents - False positives in screening tests Description Fenoprofen (Nalfon)
Phenytoin (Dilantin)
Primidone (Mysoline)*
Attribute Interferents - True positives arising from metabolites, medications etc. Description Allobarbital (Amytal)
Butabarbital (Seneryl – US release only)
Phenobarbitone (Donnatal, Luminal, Nembutal)*
Secobarbitone (Seconal sodium)
Attribute Turn-around Time for reports Description 24 hours after receipt of sample into the Laboratory

b. Short-acting Barbiturates

Pentobarbitone

Attribute Description
No matching records found
Attribute Class Description Short-acting barbiturate
Attribute Legitimate / Medical use Description Short-duration pre-operative anxiolytic
Attribute Recreational / Illicit use Description Euphoriant sedative
Attribute Mode of action Description Activates GABAA receptors (esp in ventrobasal & intralaminar neurones)
Higher affinity binding to benzodiazepine receptor than phenobarbitone (most potent anaesthetic)
Attribute Effects Description As for phenobarbital, save for greater sedation and very much shorter duration of action
Attribute Side-effects Description As for phenobarbitone – includes sedation/drowsiness, confusion (albeit significantly shorter duration than with most other barbiturates), vertigo, nausea, variable lack of appetite during withdrawal, euphoria, amnesia
(rare) Stevens-Johnson Syndrome
Attribute Overdose Description As for all generic barbiturtaes; note high respiratory depression risk
Attribute Addiction risk Description High
Attribute Route of administration Description Oral
i.v.
Attribute Street name Description Nembutal, nembies, goofballs, downers
Attribute Legal status Description Not routinely available : Schedule 8 Restricted drug (Prescription only); prohibited import under Item 18, Schedule 4 (Regulation 5) of the Customs (Prohibited Imports) Regulations 1956.
Schedule III controlled medication (UK)
Attribute Interactions with medication Description As for phenobarbitone; enhances CNS depression (incl respiratory depression) of ethanol and other sedatives; synergistic enhancement of benzodiazepine effects
Attribute Metabolism Description Metabolized in liver : majority of oral load excreted as glycosylated parent compound CYP2B6 inducer
Attribute Testing - Detection widow Description Oral Fluid - insufficient data

Urine - 3 days
Attribute Interferents - False positives in screening tests Description As for phenobarbitone
Attribute Interferents - True positives arising from metabolites, medications etc. Description As for phenobarbitone
Attribute Turn-around Time for reports Description 24 hours from receipt of sample into the Laboratory

Secobarbital

Attribute Description
No matching records found
Attribute Class Description
Attribute Legitimate / Medical use Description Pre-operative anxiolytic
Emergency anticonvulsant (incl status epilepticus)
Reduce intracranial pressure in Reye’s Syndrome
Attribute Recreational / Illicit use Description As per all generic barbiturates : euphoriant, relaxant
Assisted suicide
Attribute Mode of action Description Activates GABAA receptors (esp in ventrobasal & intralaminar neurones)
Higher affinity binding to benzodiazepine receptor than phenobarbitone (less than pentobarbital)
Attribute Effects Description As for generic barbiturates including phenobabrbital save for stronger anaesthetic effect and very much shorter duration of action
Attribute Side-effects Description As for phenobarbitone – includes sedation/drowsiness, severe confusion (greater than with phenobarbitone albeit significantly shorter duration), nightmares, vertigo, nausea, lack of appetite during withdrawal, euphoria, amnesia, constipation
(rare) Stevens-Johnson Syndrome, oedema, urticarial rash
Attribute Overdose Description Dependence mimics delirium tremens (life-threatening) Severe confusion, hyporreflexia, irritability, hypothermia, bradypnoea, bradycardia, disordered sleep, generalized weakness
In high doses causes death by respiratory arrest
Attribute Addiction risk Description High
Attribute Route of administration Description Oral
i.v.
Attribute Street name Description Reds, red devils, seconal, seccies, dolls
Attribute Legal status Description Not routinely available : Schedule 8 Restricted drug (Prescription only); prohibited import under Item 18, Schedule 4 (Regulation 5) of the Customs (Prohibited Imports) Regulations 1956.
Schedule III controlled medication (UK)
Attribute Interactions with medication Description As for phenobarbitone
Attribute Metabolism Description First pass hepatic and intestinal metabolism – majority of oral & i.v. load excreted in urine as glucuronide conjugate of parent compound
Attribute Testing - Detection widow Description Oral Fluid - insufficient data

Urine - 3 to 4 days
Attribute Interferents - False positives in screening tests Description As for phenobarbitone
Attribute Interferents - True positives arising from metabolites, medications etc. Description As for phenobarbitone
Attribute Turn-around Time for reports Description 24 hours from receipt of sample into the Laboratory
iii Benzodiazepines

a. Long-acting Benzodiazepines

Diazepam

Attribute Description
No matching records found
Attribute Class Description Psychoactive anxiolytic sedative hypnotic; segregated according to duration of action
Attribute Legitimate / Medical use Description Anxiolyss / Panic attacks
Sedation (esp for refractory insomnia)
Anticonvulsant – including for status epilepticus
Muscle relaxant – including relief of tetany, spastic muscular paresis, restless leg syndrome
Ethanol withdrawal
Opiate withdrawal
Moderation of benzodiazepine withdrawal
Ménière’s disease
Preoperative
Attribute Recreational / Illicit use Description Sedative
Hypnotic/relaxant/anxiolytic
Attribute Mode of action Description Binds to and modulates GABAA receptor in CNS inducing global depressive effect
Attribute Effects Description Induces sedation, somnolence, anxiolysis, muscle relaxation
Attribute Side-effects Description Sedation (including post-use drowsiness), disinhibition, slurred speech, impaired concentration, impaired motor function (ataxia, incoordination, impaired balance, dizziness/vertigo), depression, reflex tachycardia

Physical & psychological dependence, withdrawal syndrome with chronic use anterograde amnesia (esp among elderly) is a prominent feature, dose dependent
Attribute Overdose Description Moderate overdose may induce marked drowsiness, confusion, hypotension, motor impairment & incoordination, vertigo & sedation
Severe overdose may lead to coma; if used in conjunction with other CNS depressants death may result
Attribute Addiction risk Description Moderate to High; significant risk of withdrawal syndrome* with chronic use

*Develops after 4 to 10 days after cessation of chronic use
Tolerance occurs with weakening of sleep-promoting properties within 3–14 days of continuous use.
Loss of anxiolytic properties occurs after 4 months of continuous use.
Attribute Route of administration Description Oral
i.v.
i.m.
suppository
Attribute Street name Description Valium, vallies
Attribute Legal status Description Schedule 8 Restricted drug (Prescription only)
Attribute Interactions with medication Description CNS depressant effects amplified with contemporaneous use of any depressant or hypnotic drug (esp alcohol and opiates, sedative antihistamines, antipsychotics, anticonvulsants including valproic acid); ethanol will also synergistically enhance hypotensive effects of diazepam
Valerian synergizes GABA-ergic effects of diazepam
Drugs which affect cytochrome P450 activity will delay diazepam clearance, including : cimetidine, proton-pump inhibitors including omeprazole, azole antifungals including itraconazole & ketoconazole, erythromycin, fluvoxamine, fluoxetine, imipramine, propoxyphene, ritonavir and quinolone antibiotics like ciprofloxacin.
Drugs which increase metabolism/elimination of diazepam include : rifampicin, phenytoin, phenobarbitone, carbamazepine and St. John’s wort. Not formally listed as teratogens but use in pregnancy associated with cleft palate and behavioural disturbances
Attribute Metabolism Description Metabolized by hepatic demethylation (via CYP2C9, 2C19, 2B6, 3A4, 3A5), hydroxylation (3A4, 2C19) and glucuronidation primarily excreted in urine as pharmacologically active metabolite desmethyldiazepam (a.k.a. nordiazepam) along with minor percentages of temazepam and oxazepam glucuronides elimination half-life biphasic ~ 1-3 days for diazepam parent compound, with 2 – 7 days for active metabolite desmethyldiazepam (note : elimination half-life significantly increased for elderly)
Attribute Testing - Detection widow Description Oral Fluid - 12 hours

Urine - up to 7 days with infrequent use, regular use up to 5 to 6 days (because the patient induces liver enzymes to increase the degradation of the benzodiazepines).
Detection period may be prolonged to 4 weeks with daily use and ingestion of medications that interfere with benzodiazepine elimination
Attribute Interferents - False positives in screening tests Description Amitriptyline (Nobritol)
Diphenhydramine (Benadryl)
Clobazam – benzodiazepine derivative (Frisium)
Clorazepate – benzodiazepine derivative; prodrug for desmethyldiazepam (Tranxene)
Estrazolam – benzodiazepine derivative (Eurodin, Prosom)
Oxaprozin (Daypro)
Prazepam – benzodiazepine derivative (Praxel)
Sertraline (Zoloft)
Tung Sheuh (Black Pearls, Herb Pills)
Attribute Interferents - True positives arising from metabolites, medications etc. Description drugs which contain benzodiazepines, including :
Alprazolam (Xanax)
Bromazepam (Bromaze, Lexotan)
Clonazepam (Paxam, Rivotril)
Clordiazepoxide (Librium)
Delorazepam (Briantum, Lexotan)
Diazepam (Valium)
Flunitrazepam (Rohypnol)
Flurazepam (Dalmane, Dalmadorm)
Loprazolam / Triazulenone (Dormonoct, Somnovite)
Lorazepam (Ativan) Lormetazepam (Dilamet, Loramet, Loretam, Noctamid, Stileze)
Medazepam (Nobrium)
Nitrazepam (Alodorm, Mogadon)
Oxazepam (Murelax, Ox-pam)
Temazepam (Restoril)
Triazolam (Halcion)
Attribute Turn-around Time for reports Description 24 to 48 hours from receipt of sample into the Laboratory

b. Intermediate-acting Benzodiazepines

Alprazolam

Attribute Description
No matching records found
Attribute Class Description Psychoactive anxiolytic sedative hypnotic; segregated according to duration of action
Attribute Legitimate / Medical use Description Panic disorder With/without agoraphobia
Generalized Anxiety Disorder (GAD)
Social Anxiety Disorder
Chemotherapy-induced nausea
Attribute Recreational / Illicit use Description Relieve distress of dysphoric drug reactions (bad trip reactions to psychedelics)
Relieve insomnia & agitation of “comedown” stage after stimulant use
Enhance effect of opiates
Attribute Mode of action Description Binds to and modulates GABAA receptor in CNS inducing global depressive effect; significant suppression of hypothalamo-adrenal axis
Attribute Effects Description Induces sedation, somnolence, anxiolysis, muscle relaxation
Attribute Side-effects Description Sedation (including post-use drowsiness) with significant ‘hang-over’ effect, disinhibition, altered libido, constipation, respiratory depression, anterograde amnesia, impaired concentration, impaired motor function (ataxia, incoordination, impaired balance, dizziness/vertigo)

Rarely : hallucination, suicidal ideation, urinary retention
use in pregnancy associated with neonatal hypotonia / floppy infant syndrome + respiratory distress; potential (?) teratogen
Attribute Overdose Description Death from overdose uncommon – usually associated with polydrug use
Moderate overdose may induce marked drowsiness, confusion, hypotension, motor impairment & incoordination, vertigo & sedation; respiratory depression often prominent
severe overdose may lead to coma
Attribute Addiction risk Description High; dependence common if used at doses > 4mg/day

Withdrawal Syndrome
Develops within 4 to 8 days since cessation after chronic use. Substantially higher frequency of withdrawal syndrome than for diazepam (valium) or oxazepam (serepax) Symptomatology identical to common benzodiazepine withdrawal syndrome
Attribute Route of administration Description Oral
i.v.
Attribute Street name Description Blue footballs, Totem poles, White boys, Xanax, Zannies, Z-bars
Attribute Legal status Description Schedule 8 Restricted drug since January 2014
Attribute Interactions with medication Description CNS depressant effects amplified with contemporaneous use of any depressant or hypnotic drug (esp alcohol and opiates, sedative antihistamines, antipsychotics, anticonvulsants including valproic acid); synergy with ethanol frequently results in severe intoxication
Coadministration with kava may induce semi-comatose state (mechanism uncertain)
Strong interactions with CYP3A4 inhibitors, including : cimetidine, proton-pump inhibitors including omeprazole, azole antifungals including itraconazole & ketoconazole, erythromycin, fluvoxamine, fluoxetine, imipramine, propoxyphene, ritonavir and quinolone antibiotics like ciprofloxacin.
Drugs which increase metabolism/elimination of alprazolam include : rifampicin, phenytoin, phenobarbitone, carbamazepine and St. John’s wort.
Combined oral contraceptive pill decreases alprazolam clearance – prolongs effect, increases potential toxicity
Hypericum increases clearance and decreases efficacy of alprazolam
Not formally listed as teratogens but use in pregnancy associated with cleft palate and behavioural disturbances
Attribute Metabolism Description Metabolized by hepatic CYP 3A4
primarily excreted in urine as 4-hydroxyalprazelam + α-hydroxyalprazolam
Attribute Testing - Detection widow Description Oral Fluid - 24 hours

Urine - up to 5 days – predominantly as α-hydroxyalprazolam
Attribute Interferents - False positives in screening tests Description Amitriptyline (Nobritol)
Diphenhydramine (Benadryl)
Clobazam – benzodiazepine derivative (Frisium)
Clorazepate – benzodiazepine derivative; prodrug for desmethyldiazepam (Tranxene)
Estrazolam – benzodiazepine derivative (Eurodin, Prosom)
Oxaprozin (Daypro)
Prazepam – benzodiazepine derivative (Praxel)
Sertraline (Zoloft)
Tung Sheuh (Black Pearls, Herb Pills)
Attribute Interferents - True positives arising from metabolites, medications etc. Description Drugs which contain benzodiazepines, including :
Alprazolam (Xanax)
Bromazepam (Bromaze, Lexotan)
Clonazepam (Paxam, Rivotril)
Clordiazepoxide (Librium)
Delorazepam (Briantum, Lexotan)
Diazepam (Valium)
Flunitrazepam (Rohypnol)
Flurazepam (Dalmane, Dalmadorm)
Loprazolam / Triazulenone (Dormonoct, Somnovite)
Lorazepam (Ativan)
Lormetazepam (Dilamet, Loramet, Loretam, Noctamid, Stileze)
Medazepam (Nobrium)
Nitrazepam (Alodorm, Mogadon)
Oxazepam (Murelax, Ox-pam)
Temazepam (Restoril)
Triazolam (Halcion)
Attribute Turn-around Time for reports Description 24 hours after receipt of sample into the Laboratory

Clonazepam

Attribute Description
No matching records found
Attribute Class Description Nitrobenzodiazepine derivative
Attribute Legitimate / Medical use Description Epilepsy (typical & atypal absence attacks, infantile myoclonic, myoclonic and akinetic seizures) – not indicated/effective for infantile spasms anxiety disorders (including panic disorders & social phobia migraines
HPPD
Hyperekplexia Parasomnia, restless-leg syndrome & rapid eye movement disorder
Acute & chronic akathisia ALS associated spasticity
Alcohol withdrawal
Attribute Recreational / Illicit use Description Sedative
Hypnotic/relaxant/anxiolytic
Note : second most commonly abused benzodiazepine in US
Attribute Mode of action Description Binds to and modulates GABAA receptor in CNS inducing global depressive effect
Attribute Effects Description Induces sedation, somnolence, anxiolysis, euphoria (more commonly than other readily-available benzodiazepines), muscle relaxation
Attribute Side-effects Description As for other intermediate-acting benzodiazepines
Drowsiness, motor impairment/incoordination and euphoria are prominent features
Significant “hangover” effect reported; variable induction of transient amnesia
Occasionally : thrombocytopenia, ataxia, paradoxical behavioural disinhibition use in pregnancy associated with neonatal hypotonia / floppy infant syndrome if used in 3rd Trimester; other associated findings include reluctance to suck, cyanosis, impaired response to cold stress;
Possible (?) teratogen increased susceptibility for elderly to develop motor impairment/incoordination markedly aggravates hepatic porphyria
Attribute Overdose Description Moderate overdose may induce marked drowsiness, confusion, hypotension, motor impairment & incoordination, vertigo & sedation; respiratory depression.
Severe overdose may lead to coma – frequently cyclic in nature (alternating from comatose to hyperalert)
no known incidence of clonazepam-associated death
Attribute Addiction risk Description Moderate; popularly abused benzodiazepine (increased addiction risk if taken regularly with alcohol or in presence of psychiatric comorbidities)

Withdrawal syndrome
As for other intermediate-acting benzodiazepines
Anxiety/irritability/tremors prominent
Delirium tremens – like seizures may develop with withdrawal after long-term, high-dose use
Attribute Route of administration Description Oral
i.v.
Attribute Street name Description Klonopin, K-pin, super-valium
Attribute Legal status Description Schedule 4 controlled drug*
Attribute Interactions with medication Description CNS depressant effects amplified with contemporaneous use of any depressant or hypnotic drug (esp alcohol, barbiturates, opiates, SSRI’s & multiple reuptake inhibitors, tricyclic antidepressants, nonselective MAOI’s, phenothiazines & antipsychotics).
Significant interaction with CYP3A4 inhibitors (albeit less strong than for Alprazolam); drugs include : cimetidine, proton-pump inhibitors including omeprazole, azole antifungals including itraconazole & ketoconazole, erythromycin, fluvoxamine, fluoxetine, imipramine, propoxyphene, ritonavir and quinolone antibiotics like ciprofloxacin.
Significant interaction with anticonvulsants
Attribute Metabolism Description Peak plasma concentration 2 up to 4 hours post-dose metabolized principally by CYP2C19 (and 3A4 to a lesser degree)
half-life of elimination ~ 19 – 60 hours
Primarily excreted in urine as parent compound and 7-aminoclonazepam (+ small, variable amounts of 7-acetaminoclonazepam & 3-hydroxyclonazepam)
Attribute Testing - Detection widow Description Oral Fluid - 12 to 24 hours

Urine - up to 5 days
Attribute Interferents - False positives in screening tests Description Amitriptyline (Nobritol)
Diphenhydramine (Benadryl)
Clobazam – benzodiazepine derivative (Frisium)
Clorazepate – benzodiazepine derivative; prodrug for desmethyldiazepam (Tranxene)
Estrazolam – benzodiazepine derivative (Eurodin, Prosom)
Oxaprozin (Daypro)
Prazepam – benzodiazepine derivative (Praxel)
Sertraline (Zoloft)
Tung Sheuh (Black Pearls, Herb Pills)
Attribute Interferents - True positives arising from metabolites, medications etc. Description Drugs which contain benzodiazepines, including :
Alprazolam (Xanax)
Bromazepam (Bromaze, Lexotan)
Clonazepam (Paxam, Rivotril)
Clordiazepoxide (Librium)
Delorazepam (Briantum, Lexotan)
Diazepam (Valium)
Flunitrazepam (Rohypnol)
Flurazepam (Dalmane, Dalmadorm)
Loprazolam / Triazulenone (Dormonoct, Somnovite)
Lorazepam (Ativan)
Lormetazepam (Dilamet, Loramet, Loretam, Noctamid, Stileze)
Medazepam (Nobrium)
Nitrazepam (Alodorm, Mogadon)
Oxazepam (Murelax, Ox-pam)
Temazepam (Restoril)
Triazolam (Halcion)
Attribute Turn-around Time for reports Description 24 hours from receipt of sample into the laboratory

Flunitrazepam

Attribute Description
No matching records found
Attribute Class Description Fluorinated methylamino derivative of nitrazepam
Attribute Legitimate / Medical use Description Short-term therapy for sleep maintenance in insomnia (incl early waking variant)
Anxiolysis
Muscle relaxant
Attribute Recreational / Illicit use Description Sedative
Hypnotic/relaxant/anxiolytic
Date-rape drug
Attribute Mode of action Description Binds to and modulates GABAA receptor in CNS inducing global depressive effect
Attribute Effects Description Induces sedation, somnolence, anxiolysis, muscle relaxation
Attribute Side-effects Description Sedation (including post-use drowsiness) with significant ‘hang-over’ effect,
disinhibition, slurred speech, impaired concentration, impaired motor function (ataxia, incoordination, impaired balance, dizziness/vertigo), depression, reflex tachycardia rebound effects not uncommon 4+ days after usage
Significant anterograde amnesia (esp among elderly) is a prominent feature,
Dose dependent use in pregnancy associated with neonatal hypotonia / floppy infant syndrome
Attribute Overdose Description Moderate overdose may induce marked drowsiness, confusion, hypotension, motor impairment & incoordination, vertigo & sedation; respiratory depression often prominent
Severe overdose may lead to coma; flunitrazepam associated with higher incidence of overdose-associated death (suspected Flunitrazepam more toxic than most other commonly available benzodiazepinrs)
Attribute Addiction risk Description Moderate to High
Attribute Route of administration Description Oral
i.v.
i.m.
Attribute Street name Description Date-rape drug, Hypnodorm, Rohypnol, Rowies
Attribute Legal status Description Schedule 8 Restricted drug. Unauthorized possession of large quantities punishable in NSW under Schedule 1 of Drug Misuse + Trafficking Act 1985
Attribute Interactions with medication Description CNS depressant effects amplified with contemporaneous use of any depressant or hypnotic drug (esp alcohol and opiates, sedative antihistamines, antipsychotics, anticonvulsants including valproic acid); ethanol will also synergistically enhance hypotensive effects of benzodiazepines
Coadministration of atorvastatin reduces clearance of both drugs
Grapefruit juice (active component Bergamottin) significantly prolongs clearance of drug
Drugs which affect cytochrome P450 activity will delay diazepam clearance, including : proton-pump inhibitors and azole antifungals
Not formally listed as teratogens but use in pregnancy associated with cleft palate and behavioural disturbances
Attribute Metabolism Description Metabolized by hepatic CYP 3A4 elimination half-life ~ 18 – 26 hours (active 7-amino metabolite half-life > 36 hours)
primarily excreted in urine as 7-aminoflunitrazepam
Attribute Testing - Detection widow Description Oral Fluid - 12 to 24 hours

Urine - up to 5 days
Attribute Interferents - False positives in screening tests Description Amitriptyline (Nobritol)
Diphenhydramine (Benadryl)
Clobazam – benzodiazepine derivative (Frisium)
Clorazepate – benzodiazepine derivative; prodrug for desmethyldiazepam (Tranxene)
Estrazolam – benzodiazepine derivative (Eurodin, Prosom)
Oxaprozin (Daypro)
Prazepam – benzodiazepine derivative (Praxel)
Sertraline (Zoloft)
Tung Sheuh (Black Pearls, Herb Pills)
Attribute Interferents - True positives arising from metabolites, medications etc. Description Drugs which contain benzodiazepines, including :
Alprazolam (Xanax)
Bromazepam (Bromaze, Lexotan)
Clonazepam (Paxam, Rivotril)
Clordiazepoxide (Librium)
Delorazepam (Briantum, Lexotan)
Diazepam (Valium)
Flunitrazepam (Rohypnol)
Flurazepam (Dalmane, Dalmadorm)
Loprazolam / Triazulenone (Dormonoct, Somnovite)
Lorazepam (Ativan)
Lormetazepam (Dilamet, Loramet, Loretam, Noctamid, Stileze)
Medazepam (Nobrium)
Nitrazepam (Alodorm, Mogadon)
Oxazepam (Murelax, Ox-pam)
Temazepam (Restoril)
Triazolam (Halcion)
Attribute Turn-around Time for reports Description 24 hours from receipt of sample into the Laboratory

Oxazepam

Attribute Description
No matching records found
Attribute Class Description Slow onset 3-hydroxybenzodiazepine derivative
Attribute Legitimate / Medical use Description Therapy for insomnia (incl early waking +recurrent waking variants, but not for delayed induction insomnia variant)
Alcohol withdrawal
PTSD
Social phobia
PMS
Attribute Recreational / Illicit use Description Sedative
Hypnotic/relaxant/anxiolytic
Note : slow rate onset makes Oxazepam less popular for abusers
Attribute Mode of action Description Binds to and modulates GABAA receptor in CNS inducing global depressive effect
Attribute Effects Description Slowest rate of onset of all common benzodiazepines, induces sedation, somnolence, anxiolysis, muscle relaxation
Attribute Side-effects Description As for other intermediate-acting benzodiazepines
Memory impairment involves transient retrograde amnesia but no transient global amnesia
Paradoxical excitement + headache more prominent than for most other intermediate-acting benzodiazepines use in pregnancy associated with neonatal hypotonia / floppy infant syndrome if used in 3rd Trimester; other associated findings include reluctance to suck, cyanosis, impaired response to cold stress
Attribute Overdose Description Moderate overdose may induce marked drowsiness, confusion, hypotension, motor impairment & incoordination, vertigo & sedation; respiratory depression often prominent
severe overdose may lead to coma and death; temazepam associated with higher incidence of overdose-associated coma than most other commonly available benzodiazepines
Attribute Addiction risk Description Low to Moderate; higher likelihood of addiction if taken regularly with alcohol
Relatively low potential for abuse due to slow onset of action
Attribute Route of administration Description Primarily Oral
Attribute Street name Description Alepam, Murelax, Ox-Pam
Attribute Legal status Description Schedule 4 controlled drug*
Attribute Interactions with medication Description CNS depressant effects amplified with contemporaneous use of any depressant or hypnotic drug (esp alcohol, barbiturates, opiates, SSRI’s & multiple reuptake inhibitors, tricyclic antidepressants, nonselective MAOI’s, phenothiazines & antipsychotics).
When taken with alcohol there is enhanced sedation and marked ataxia – significant respiratory depression not uncommon
Better tolerated by elderly and patients with liver disease (no hepatic oxidation, glucuronidation only) because little significant accumulation
Attribute Metabolism Description Produced during metabolism of diazepam metabolized principally by glucuronidation
half-life of elimination ~ 4 – 15 hours
primarily excreted in urine as parent compound and glucuronide conjugate
Attribute Testing - Detection widow Description Oral Fluid - 12 to 24 hours

Urine - up to 5 days
Attribute Interferents - False positives in screening tests Description Amitriptyline (Nobritol)
Diphenhydramine (Benadryl)
Clobazam – benzodiazepine derivative (Frisium)
Clorazepate – benzodiazepine derivative; prodrug for desmethyldiazepam (Tranxene)
Estrazolam – benzodiazepine derivative (Eurodin, Prosom)
Oxaprozin (Daypro)
Prazepam – benzodiazepine derivative (Praxel)
Sertraline (Zoloft)
Tung Sheuh (Black Pearls, Herb Pills)
Attribute Interferents - True positives arising from metabolites, medications etc. Description Drugs which contain benzodiazepines, including :
Alprazolam (Xanax)
Bromazepam (Bromaze, Lexotan)
Clonazepam (Paxam, Rivotril)
Clordiazepoxide (Librium)
Delorazepam (Briantum, Lexotan)
Diazepam (Valium)
Flunitrazepam (Rohypnol)
Flurazepam (Dalmane, Dalmadorm)
Loprazolam / Triazulenone (Dormonoct, Somnovite)
Lorazepam (Ativan)
Lormetazepam (Dilamet, Loramet, Loretam, Noctamid, Stileze)
Medazepam (Nobrium)
Nitrazepam (Alodorm, Mogadon)
Oxazepam (Murelax, Ox-pam)
Temazepam (Restoril)
Triazolam (Halcion)
Attribute Turn-around Time for reports Description 24 hours from receipt of sample into the Laboratory

Temazepam

Attribute Description
No matching records found
Attribute Class Description 3-hydroxybenzodiazepine derivative
Attribute Legitimate / Medical use Description Short-term therapy for severe insomnia (incl early waking and recurrent waking variants)
Anxiolysis
Muscle relaxant
Hypnotics in military “No-Go” pills
Attribute Recreational / Illicit use Description Sedative
Hypnotic/relaxant/anxiolytic
Suicide
Attribute Mode of action Description Binds to and modulates GABAA receptor in CNS inducing global depressive effect
Attribute Effects Description Induces sedation, somnolence, anxiolysis, muscle relaxation
Attribute Side-effects Description High frequency of sedation (including post-use drowsiness) with significant ‘hang-over’ effect, decreased reaction time, motor incoordination (ataxia, incoordination, impaired balance, dizziness/vertigo), blurred vision (at high doses), hyperhidrosis, hypotension, altered libido. Rarely : nystagmus, vomiting, pruritis, paradoxical restlessness + agitation
Incidence of euphoria less common than for most other benzodiazepines (<1.5%) significant anterograde amnesia (esp among elderly) is a prominent feature, dose dependent
use in pregnancy associated with neonatal hypotonia / floppy infant syndrome
Attribute Overdose Description Moderate overdose may induce marked drowsiness, confusion, hypotension, motor impairment & incoordination, vertigo & sedation; respiratory depression often prominent severe overdose may lead to coma and death; temazepam associated with higher incidence of overdose-associated coma than most other commonly available benzodiazepines
Attribute Addiction risk Description Moderate to High; highest rate of reported drug intoxication of all commonly available benzodiazepines
Attribute Route of administration Description Oral
Attribute Street name Description Eggs, Jellies, Knockouts, Norries, Oranges, Restoril, Rugby balls, T, Tams, Tammies, Temazzies, Vitamin T
Attribute Legal status Description 2004 capsules withdrawn from local market – still available overseas + via internet
10 mg capsules Schedule 4 controlled drug
20 mg capsules Schedule 8 Restricted drug (Prescription only)
Attribute Interactions with medication Description CNS depressant effects amplified with contemporaneous use of any depressant or hypnotic drug (esp alcohol, barbiturates, opiates, tricyclic antidepressants, nonselective MAOI’s, phenothiazines & antipsychotics)
Oral contraceptive pill will increase clearance of temazepam Coadministration of theophylline decreases sedative effect of temazepam
No significant interaction with CYP3A4 inhibitors (erythromycin, itraconazole etc.)
Attribute Metabolism Description Peak plasma concentration at ~ 30 minutes post-dose
no pharmacologically active metabolites
primarily excreted in urine (~80% of oral load – faeces ~20%
principally excreted as parent compound + variable levels of O-conjugate of temazepam
Attribute Testing - Detection widow Description Oral Fluid - 12 to 24 hours

Urine - up to 5 days – predominantly as 7-aminoflunitrazepam
Attribute Interferents - False positives in screening tests Description Amitriptyline (Nobritol)
Diphenhydramine (Benadryl)
Clobazam – benzodiazepine derivative (Frisium)
Clorazepate – benzodiazepine derivative; prodrug for desmethyldiazepam (Tranxene)
Estrazolam – benzodiazepine derivative (Eurodin, Prosom)
Oxaprozin (Daypro)
Prazepam – benzodiazepine derivative (Praxel)
Sertraline (Zoloft)
Tung Sheuh (Black Pearls, Herb Pills)
Attribute Interferents - True positives arising from metabolites, medications etc. Description Drugs which contain benzodiazepines, including :
Alprazolam (Xanax)
Bromazepam (Bromaze, Lexotan)
Clonazepam (Paxam, Rivotril)
Clordiazepoxide (Librium)
Delorazepam (Briantum, Lexotan)
Diazepam (Valium)
Flunitrazepam (Rohypnol)
Flurazepam (Dalmane, Dalmadorm)
Loprazolam / Triazulenone (Dormonoct, Somnovite)
Lorazepam (Ativan)
Lormetazepam (Dilamet, Loramet, Loretam, Noctamid, Stileze)
Medazepam (Nobrium)
Nitrazepam (Alodorm, Mogadon)
Oxazepam (Murelax, Ox-pam)
Temazepam (Restoril)
Triazolam (Halcion)
Attribute Turn-around Time for reports Description 24 hours after receipt of sample into the Laboratory

c. Short-acting Benzodiazepines

Flunazepam

Attribute Description
No matching records found
Attribute Class Description Psychoactive anxiolytic sedative hypnotic; segregated according to duration of action
Attribute Legitimate / Medical use Description Short-term therapy for sleep induction in onset variant insomnia (not effective for early-wakening variant insomnia)
Jet-lag
Anxiolytic for minor medical procedures (e.g., MRI scan etc.)
Attribute Recreational / Illicit use Description Sedative
Hypnotic/relaxant/anxiolytic
Attribute Mode of action Description Binds to and modulates GABAA receptor in CNS inducing global depressive effect
Attribute Effects Description Somnolence, anxiolysis, muscle relaxation, significant short-term impairment of motor function (incl impaired coordination, vertigo), confusion
Note : induce a light sleep and suppress deep-sleep stages (reduced delta wave non-REM deep sleep) – notably with elderly
Attribute Side-effects Description Relatively common (>1% of patients): somnolence, vertigo/dizziness, incordination Less common (0.9% to 0.5% of patients): reflex tachycardia, lethargy, confusion (incl mild memory impairment, commonly anterograde amnesia – much less common than with diazepam, more prominent among elderly), disturbed sleep habits (predominantly reactive insomnia) altered mood (euphoria or depression), visual disturbances

Rare (<0.5% of patients): altered bowel habits (constipation more commonly, occasional diarrhoea), nightmares, marked reactive insomnia, dry mouth & altered taste, paraesthesia, tinnitus Physical & psychological dependence, withdrawal syndrome with chronic use (note with Triazolam may occur after 10 days continuous use)
Despite short duration of action sedation (including post-use drowsiness), disinhibition, slurred speech, impaired concentration, impaired motor function (ataxia, incoordination, impaired balance, dizziness/vertigo) may persist for up to 12 – 24 hours post-dose
Attribute Overdose Description As per all benzodiazepines :
moderate overdose may induce marked drowsiness, confusion, hypotension, motor impairment & incoordination, vertigo & sedation severe overdose may lead to coma; if used in conjunction with other CNS depressants death may result
Attribute Addiction risk Description Low to Moderate; significant risk of withdrawal syndrome with chronic use (esp with co-existing alcohol dependence)
Attribute Route of administration Description Oral
i.v.
i.m.
Attribute Street name Description Reds, red devils, red dillies, halcion, dalmane
Attribute Legal status Description Schedule 8 Restricted drug (Prescription only)
Attribute Interactions with medication Description As per all benzodiazepines :
CNS depressant effects amplified with contemporaneous use of any depressant or hypnotic drug (esp alcohol and opiates, sedative antihistamines, antipsychotics, anticonvulsants including valproic acid); ethanol will also synergistically enhance hypotensive effects of diazepam
Valerian synergizes GABA-ergic effects of diazepam
Short-acting benzodiazepines will develop cross-tolerance with ethanol, other benzodiazepines, barbiturates and corticosteroids (neuroactive steroids including progesterone act as positive GABAA receptor allosteric modulators – alterations in neuroactive steroid levels during menstrual cycle & pregnancy can weaken benzodiazepine efficacy
Drugs which affect cytochrome P450 activity will delay diazepam clearance, including : cimetidine, proton-pump inhibitors including omeprazole, azole antifungals including itraconazole & ketoconazole, erythromycin, fluvoxamine, fluoxetine, imipramine, propoxyphene, ritonavir and quinolone antibiotics like ciprofloxacin.
Drugs which increase metabolism/elimination of diazepam include : rifampicin, phenytoin, phenobarbitone, carbamazepine and St. John’s wort. Not formally listed as teratogens but use in pregnancy associated with cleft palate and behavioural disturbances
Attribute Metabolism Description metabolized by hepatic demethylation (via CYP2C9, 2C19, 2B6, 3A4, 3A5), hydroxylation (3A4, 2C19) and glucuronidation metabolites pharmacologically inactive. elimination half-life ~ 2 hours
Attribute Testing - Detection widow Description Oral Fluid - 8 to 12 hours

Urine - 36 to 48 hours
Attribute Interferents - False positives in screening tests Description Amitriptyline (Nobritol)
Diphenhydramine (Benadryl)
Clobazam – benzodiazepine derivative (Frisium)
Clorazepate – benzodiazepine derivative; prodrug for desmethyldiazepam (Tranxene)
Estrazolam – benzodiazepine derivative (Eurodin, Prosom)
Oxaprozin (Daypro)
Prazepam – benzodiazepine derivative (Praxel)
Sertraline (Zoloft)
Tung Sheuh (Black Pearls, Herb Pills)
Attribute Interferents - True positives arising from metabolites, medications etc. Description Drugs which contain benzodiazepines, including :
Alprazolam (Xanax)
Bromazepam (Bromaze, Lexotan)
Clonazepam (Paxam, Rivotril)
Clordiazepoxide (Librium)
Delorazepam (Briantum, Lexotan)
Diazepam (Valium)
Flunitrazepam (Rohypnol)
Flurazepam (Dalmane, Dalmadorm)
Loprazolam / Triazulenone (Dormonoct, Somnovite)
Lorazepam (Ativan)
Lormetazepam (Dilamet, Loramet, Loretam, Noctamid, Stileze)
Medazepam (Nobrium)
Nitrazepam (Alodorm, Mogadon)
Oxazepam (Murelax, Ox-pam)
Temazepam (Restoril)
Triazolam (Halcion)
Attribute Turn-around Time for reports Description 24 hours after receipt of sample into the Laboratory
iv Cathinones

a. Cathinones

Attribute Description
No matching records found
Attribute Class Description Aminopropiophenone – a psychostimulant monoamine alkaloid β-ketone amphetamine derived from Khat shrub (Catha edulis)
Attribute Legitimate / Medical use Description None currently
Attribute Recreational / Illicit use Description Weak Euphoriant
Stimulant
Appetite control
Attribute Mode of action Description Moderate amphetamine effect – induces dopamine release from striatum in CNS
Attribute Effects Description Induces mild euphoria, general moderate stimulant, moderate appetite suppression
Attribute Side-effects Description Sustained rise in systolic and diastolic blood pressure after use (> 4 hrs), mild rise in heart rate, occasional flushing, irritability
Apathy and psychological dependence with chronic use
Attribute Overdose Description Moderate overdose may induce agitation, irregular heartbeat/palpitations, tachycardia, tremors, mydriasis, tachypnoea, confusion, flushing, hyperthermia, insomnia, headache, anorexia, occasional constipation, uncommonly mania or psychosis
chronic heavy use probably carries increased AMI risk due ephedrine / phenylpropanolamine effect
Attribute Addiction risk Description Moderately high risk of psychological dependence
Attribute Route of administration Description Oral ingestion
Attribute Street name Description Bath salts, hagigat, kat, khat, plant food, natural high
Attribute Legal status Description Schedule 9 Prohibited substance (includes analogues)
Attribute Interactions with medication Description Weakly antagonizes effects of sedatives, depressants, antipsychotic & antihypertensives enhances effects of stimulants & antidepressants (given the amphetamine nature of the drug’s actions a theoretical possibility exists of dangerous synergy with MAOI’s)
Attribute Metabolism Description Biphasic absorption kinetics (initial release peak at 10 – 15 minutes, followed by later sustained plateau at 60 – 70 minutes) – absorbed as mixture primarily of cathinone & methcathinone; peak plasma concentration of cathinone at ~ 2½ hrs post ingestion
half-life of elimination ~ 1.5 hrs cathinone subject to hepatic metabolism – converted to phenylpropanolamine (structural analogue of ephedrine) as well as variable levels of norephedrine, d-norpseudoephedrine
excreted in urine as glucuronide conjugate of parent compound(s) as well as phenylpropanolamine
Attribute Testing - Detection widow Description Oral Fluid - up to 12 hours

Urine - Variable reports in literature – from 24 to 72 hours post dose depending on amount and frequency of use

effect of inhibitors of liver enzyme CYP2D6 not experimentally verified – on theoretical grounds will probably prolong the urinary elimination half-life of cathinones. These drugs include : fluoxetine (& most SSRI’s) & bupropion
Attribute Interferents - False positives in screening tests Description Diethylcathinone (Amfepramone)
Attribute Interferents - True positives arising from metabolites, medications etc. Description Methcathinone (Ephedrone)
Herbal incense (see synthetic cannabinoids)
Attribute Turn-around Time for reports Description 24 hours after receipt of sample into the Laboratory
v Cannabinoids

a. Marijuana

Attribute Description
No matching records found
Attribute Class Description Psychoactive euphoriants binding cannabinoid receptors; classically combination of drugs derived preferentially from Cannabis sativa or indica species
Attribute Legitimate / Medical use Description Research / proposed :
Appetite enhancement (esp with cachectic patients)
Mitigate chemotherapy –associated nausea
Reduce intraocular pressure in refractory glaucoma
Attribute Recreational / Illicit use Description Euphoriant
Relaxant
Spiritual / religious
Attribute Mode of action Description Principal active agent – tetrahydrocannabinol / THC, (minor agents include : cannabidiol/CBD, cannabinol, tetrahydrocannabivarin, cannabigerol)
Cannabinoids have high lipid solubility – rapid tissue absorption THC : partial cannabinoid receptor agonist (binds CB1 receptor triggering dopamine release), allosteric opiate receptor modulator – more potent euphoriant CBD : antagonistic against cannabinoid receptors, agonist for 5-HT1A receptors THC facilitates activation of anterior cingulate cortex & frontal cortex
Attribute Effects Description Induces heightened mood / euphoria (greater with C. sativa due lower relative levels of CBD), acts as a relaxant (variable sedative effect - greater with C. indica due high CBD:THC ratios), enhanced appetite
Attribute Side-effects Description Decreased short-term memory (transient), dry mouth, impaired psychomotor coordination, conjunctival reddening, anxiety +/- paranoia (greater frequency with heavy C. sativa use; much less so with C. indica)
Attribute Overdose Description Relatively well tolerated; no confirmed reports of THC-associated deaths (taken as solitary agent)
Chronic heavy use associated with CAL (for smokers), STM impairment, apathy, suspected cannabis contributes to CVS disease, aggravates arteritis and carries increased AMI risk
Attribute Addiction risk Description Low, possible ‘gateway’ drug effect leading to further drug experimentation
Attribute Route of administration Description Oral ingestion (edibles, tea, infusion)
smoked
inhaled (via vaporizer)
Attribute Street name Description buds bhang, dope, grass, hash, hemp, jive, joint, pot, reefer, rope, spiff, stinkweed, stuff, tea weed, weed, whacky
Attribute Legal status Description Schedule 9 restricted substance under Federal law; variable enforcement laws regarding personal use vary between states
Attribute Interactions with medication Description May induce psychotic episode in potential schizophrenics (estimated < 1% population) especially among children & young adolescents – adult risk seems unlikely
Suggested minor enhancement of euphoric effects of opiates
Attribute Metabolism Description Metabolized by liver (cytochrome P450 enzymes CYP2C9, 2C19, 3A4) to psychoactive metabolite 11-hydroxy-tetrahydrocannabinol which is further metabolized to 11-nor-9delta- tetrahydrocannabinol (11-nor-9d-THC).
Principally excreted in faeces (55%) with 20% excreted in urine – in urine present principally as the 11-nor-9d-THC glucuronide ester and free 11-nor-9d-THC
Attribute Testing - Detection widow Description Oral fluid - up to 24 hours

Urine One-off use up to 72 hours (mean detection period) but in obese people up to 5 days
Moderate use ~ 4 times per week up to 5 – 7 days
Daily use up to 10 – 14 days
Heavy use long term – normal to thin body mass up to 30 days
Heavy use in an obese person up to 42 – 45 days
Attribute Interferents - False positives in screening tests Description Bayer Select Pain Relief Formula
Dronabinol (Marinol)
Efavirenz (Atipla, Sustiva)
Ethacrynic acid (Edecrin)
NSAIDs Diclofenac (Voltaren)
Diflunisal (Dolobid)
Etodolac (Lodine)
Fenoprofen (Nalfon)
Flubiprofen (Ansaid)
Ibuprofen (Advil, Excedrin IB, Indocid, Genpril, Rufin)
Ketoprofen (Orudis, Orudis KT)
Meclofenamate (Meclomen)
Naproxen (Aleve, Anaprox, Naprosyn, Novanaprox)
Piroxicam (Feldene)
Sulindac (Clinoril)
Tolmetin (Tolectin)
Promethazine (Promethegan)
Proton Pump Inhibitors, Dexlansoprazole (Doloxene)
Esomeprazole (Nexium)
Lansoprazole (Prevacid, Zoton)
Omeprazole (APO-Omeprazole, Maxor, Meprazole, Prilosec, Probitor, Zegerid)
Pantoprazole (Protonix)
Raberprazole (Aciphex, Pariet, Rabzole)
Riboflavin (Vitamin B2)
Attribute Interferents - True positives arising from metabolites, medications etc. Description None
Attribute Turn-around Time for reports Description 24 hours after receipt of sample into the Laboratory

b. Synthetic Cannabinoids

Attribute Description
No matching records found
Attribute Class Description Psychoactive THC mimic
Attribute Legitimate / Medical use Description None
Attribute Recreational / Illicit use Description Euphoriant
Relaxant
Spiritual / religious
Attribute Mode of action Description Principal active agents include THC mimics JWH-018, JWH-073, HU-210 and cannabicyclohexanol which share high lipid solubility with THC – rapid tissue absorption
Most are full cannabinoid receptor agonists (full agonists of CB1R and CB2R cannabinoid receptors; binding CB1 receptor triggering dopamine release) unlike THC which is a partial agonist, most act as an allosteric opiate receptor modulator – more potent euphoriant; situation uncertain with respect to dopamine receptor binding
Synthetic cannabinoids facilitate variable degree of activation of activation of anterior cingulate cortex & frontal cortex
Large amounts of synthetic tocopherol often present
Other ingredients found in synthetic cannabis may also include psychedelic tryptamine derivatives (incl 4-hydroxy-DET) and substituted like cathinones 4-methylbuphedrone and 4-methyl-α-PPP. Some blends also contain the anxiolytic benzodiazepine phenazepam
Attribute Effects Description Induces heightened mood / euphoria, acts as a relaxant; some appetite enhancement (high interindividual and product variability)
Attribute Side-effects Description Adverse effects more severe than THC – include marked agitation, anxiety (often full-blown panic attacks), hallucinations, psychosis, lowered seizure threshold (with significant frequency of convulsions) hypertension, marked tachycardia, myocardial infarction
May precipitate psychosis (potentially inducing long-term chronic psychosis in vulnerable individuals with genetic or psychiatric disposition) or worsen previously stable psychotic disorders at far higher frequency than natural cannabis O/D associated with death in at least one case.
Attribute Overdose Description O/D associated with death in at least one case.
High frequency CVA’s.
Withdrawal syndrome symptomatically similar to narcotic withdrawal
Attribute Addiction risk Description Not quantified – probably higher than with natural cannabis
Attribute Route of administration Description Smoked
Attribute Street name Description Black Mamba, (turnera diffusa), Blaze, Bliss, Bombay Blue, Fakeweed, Genie, herbal incense, JWH-018, JWH-250, K2, Moon rocks, spice, spice product, Zohai
Attribute Legal status Description Western Australia banned all of the synthetic cannabinoids found in already existing products, including brands such as, Kalma, Kaos, Kronic, Mango Kush and Voodoo since June 2011.
NSW banned all synthetic cannabinoids September 18, 2013 (compound family specific irregardless of specific formulation).
Interim Federal Australia-wide ban covering all synthetic cannabinoids passed June 2013, lapsed October 2013 – status pending. Classified as a Class C controlled drug in New Zealand – still available at specialty license shops
Attribute Interactions with medication Description Antagonize antipsychotic action – a possible induction of severe psychotic episode in potential schizophrenics (estimated < 1% population) especially among children & young adolescents minor enhancement of euphoriac effects of opiates enhanced benzodiazepine effect where blend already contains phenazepam
Attribute Metabolism Description JWH-018 metabolism produces multiple monohydrated CB1r receptor agonists. JWH-018 primarily excreted in faeces; also found in urine as glucuronide conjugate along with conjugates of monohydrated metabolites.
Attribute Testing - Detection widow Description Oral Fluid - 12 hours

Urine - One-off use up to 72 hours (mean detection period) but in obese people up to 4 days Moderate/heavy use Up to 7 days 
urine testing is directed at JWH-018 and cannabicyclohexanol.
Attribute Interferents - False positives in screening tests Description None. Synthetic Cannibinoids are not detected by standard THC immunoassays; detection achieved by specific LC-tandem mass spectrometry
Note : use of synthetic cannabinoids may result in a positive benzodiazepine screen
Attribute Interferents - True positives arising from metabolites, medications etc. Description Consumption of herbal products including :
Canavalia maritime
Leonotis leonurus
Leonurus sibiricus
Nelumbo nucifera
Nymphaea caerulea
Pedicularis densiflora
Scutellaria nana
Zomia latifolia
Attribute Turn-around Time for reports Description 24 hours after receipt of sample into the Laboratory
vi Cocaine

a. Cocaine

Attribute Description
No matching records found
Attribute Class Description Powerful euphoriant crystalline tropane alkaloid derived from leaves of Erythroxylon coca
Attribute Legitimate / Medical use Description Alternate local anaesthetic / local vasoconstrictor (esp for lacrimal duct & nasal surgery incl nasal cicatrisation)
Local anaesthetic for oral & pulmonary ulcers
Attribute Recreational / Illicit use Description Euphoriant stimulant
Aphrodisiac
Appetite suppressant
Attribute Mode of action Description Non-specific voltage-gated sodium channel blocker inducing anaesthesia at low doses
Triple reuptake inhibitor (serotonin – noradrenaline – dopamine)
Blockades dopamine transporter system (esp at ventral tegmental area, nucleus accumbens & prefrontal cortex)
Sigma-receptor agonist Enhances dopaminergic transmission at substantia nigra
Attribute Effects Description Induces euphoria, altered libido, augmented sensation of competence/grandiosity, vasoconstriction, hypertension, occasional arrhythmiasn
Attribute Side-effects Description Restlessness (esp post use), anxiety, paranoia, dependency chronic use may be associated with induction of tolerance, insomnia or reactive hypersomnia & lethargy (after use), rhinorrhoea, bruxism (nocturnal teeth grinding), pruritis, bronchospasm, dyspnoea, haemoptysis (uncommon), psychological damage (including paranoia & possible psychosis, depression), akathisia, increased AMI risk, fatal overdose
Attribute Overdose Description Tremors, convulsions, hyperthermia, hallucinations, hypertension, cardiac arrhythmias, sudden cardiac death syndrome (due blockage cardiac sodium channels)
Attribute Addiction risk Description High – (ranked 2nd only to heroin); acts on mesolimbic reward pathway

Withdrawal syndrome
Triphasic : initial crash developing rapidly following abrupt withdrawal after heavy use – dysphoria, irritability, anxiety, desire for sleep, exhaustion, increased appetite Effects peak in 2nd phase with increased craving for use, poor concentration, irritability and lethargy – may persist up to 10 weeks Final phase – extinction, characterized by intermittent craving for use in context of external cues
Attribute Route of administration Description Triphasic : initial crash developing rapidly following abrupt withdrawal after heavy use – dysphoria, irritability, anxiety, desire for sleep, exhaustion, increased appetite
Effects peak in 2nd phase with increased craving for use, poor concentration, irritability and lethargy – may persist up to 10 weeks
Final phase – extinction, characterized by intermittent craving for use in context of external cues
Attribute Street name Description blast, blow, booth, coke, cola, crack, jejo, mobbeles, nose candy, sow, white dust
Attribute Legal status Description Schedule 9 Prohibited drug
Attribute Interactions with medication Description If consumed with alcohol, hepatic metabolism forms cocaethylene (increased euohorigenic effect, also significant cardiotoxicity) consumption with nicotine enhances cocaine induced euphoria (by raising CNS dopamine level)
dietary zinc supplements will mask ELISA detection but not other immunoassays
Attribute Metabolism Description Extensively metabolized by liver – primarily hydrolytic ester cleavage principal metabolite is benzoylecgonine (with lesser amounts of ecgonine methylester & ecgonine present)
Attribute Testing - Detection widow Description Oral fluid - 2 to 5 days
Urine - Parent compound (original unmetabolized cocaine) up to 3 days infrequent use – but may be detected up to 5 or 6 days if other drugs interfering with cocaine metabolism are used at the same time
Attribute Interferents - False positives in screening tests Description Some lactam antibiotics – amoxicillin (Amoxil), Ampicillin (Ampicin, Austrapen, Ibimicin)
Local vasoconstrictive anaesthetics (uncommonly)
Attribute Interferents - True positives arising from metabolites, medications etc. Description Coca products – including Coca infusion, Inca Gold Tea
Attribute Turn-around Time for reports Description 24 hours after receipt of sample into the Laboratory
vii DMAA

a. DMAA

Attribute Description
No matching records found
Attribute Class Description 1,3-dimethylamylamine (a.k.a. methylhexamine or 4-methylhexan-2-amine) potent sympathomimetic drug
Attribute Legitimate / Medical use Description None
Previously used as nasal decongestant, weight control sympathomimetic stimulant
Attribute Recreational / Illicit use Description Weight control / thermogenic general stimulant
Body building supplement
Appetite control
Mild to moderate Euphoriant stimulant (used in combination with other stimulant agents)
Attribute Mode of action Description Sympathomimetic agent raises noradrenaline concentration in synaptic cleft
Attribute Effects Description Induces mild to moderate euphoria (most pronounced when insufflated; often in conjunction with other stimulant agents), thermogenic general sympathomimetic stimulant, sympathomimetic general vasoconstrictor, inhibits gastrointestinal;l peristalsis, nasal decongestion
Attribute Side-effects Description Hypertension, cardiac arrhythmias (including tachy- and infrequently brady- arrhythmias), dyspnoea, headaches, tremors
Attribute Overdose Description Hyperthermia, rhabdomyolysis, increased risk a.m.i. and haemorrhagic C.V.A., sudden cardiac death syndrome – implicated in deaths of previously fit/healthy military personel when taken in moderate dose
Attribute Addiction risk Description Low
Attribute Route of administration Description Oral ingestion

Nasal
Attribute Street name Description Dee, Dema, DMAA, Forthane, Gee, geranamine, geranium, Oxy Elite, Oxy Elite (Pro)
Attribute Legal status Description Banned substance since 2012 (simultaneously placed on Poisons List); banned in all competitive sports by WADA & ASADA
Attribute Interactions with medication Description Synergistic effects, potentially lethal effects, when consumed with other sympathomimetic agents Associated with at least one death when consumed in low dose with ethanol and caffeine
Attribute Metabolism Description Metabolized by liver – primarily by MFOS (analogous to amphetamines) excreted in urine
Attribute Testing - Detection widow Description Oral Fluid - Not available

Urine - 24 to 36 hours after a standard dose
Attribute Interferents - False positives in screening tests Description At high doses may result in False Positive immunoassay test for amphetamines
Attribute Interferents - True positives arising from metabolites, medications etc. Description Geranium extract – (present in only some geranium species (most reported cases suspected due to synthetic adulteration)
Attribute Turn-around Time for reports Description 24 hours after receipt of sample into the Laboratory
viii Designer Drugs

a. BZP (Benzylpiperazine)

Attribute Description
No matching records found
Attribute Class Description Stimulant euphoriant benzyl-substituted piperazine analogue
Attribute Legitimate / Medical use Description None
Attribute Recreational / Illicit use Description Euphoriant
Stimulant
Attribute Mode of action Description Amphetamine-like activity; mixed serotoninergic (5-HT2A agonist + partial agonist or antagonist against 5-HT2B receptors) and dopaminergic activity (like MDMA/Ecstasy), inhibiting serotonin reuptake transport; high affinity antagonist of α2 adrenoreceptor resulting in increased noradrenaline release
Attribute Effects Description Nearly identical to dextroamphetamine : induces euphoria & sense of general well-being, enhanced perception of taste, colour & music, increased sociability, increased general arousal, decreased reaction time, repetitive thought patterns, suppressed appetite, pupillary dilatation, flushed skin & excessive sweating, mild bruxism & xerostomia, mild urinary retention
Attribute Side-effects Description Nausea, fatigue, rebound thirst and hunger, insomnia, confusion, depression, palpitations/tachycardia, hypertension, blurred vision, agitation & confusion (worse at higher doses), tremor, extrapyramidal symptoms (dystonia, akathisia)
Attribute Overdose Description Moderate overdose may induce agitation, irregular heartbeat/palpitatiobns/tachycardia, tachypnoea, confusion, urinary retention, hypertension, hyperreflexia, hyperthermia and myalgia large overdose may induce marked hyperreflexia, severe agitation, anuria and renal failure, rhabdomyolysis, serotonin syndrome and convulsions no deaths reported solely attributable to BZP use – but known fatalities when used in conjunction with MDMA (Ecstasy)
Attribute Addiction risk Description Uncertain; probably moderately high but less than metamphetamine

Withdrawal

Rapid development of tolerance (within 1 – 2 week of chronic use); withdrawal syndrome may develop (esp with heavy dose users)
Persists for variable period and may resemble amphetamine crash, including marked depression
Attribute Route of administration Description Oral ingestion
i.v.
Attribute Street name Description A2, BZP, Legal E, Legal X
Attribute Legal status Description Schedule 9 Prohibited drug
Attribute Interactions with medication Description Antagonizes effects of sedatives, depressants, antipsychotic & antihypertensives enhances effects of stimulants & antidepressants (esp dangerous synergy resulting in sustained catecholamine levels when coadministered with MAOI’s) proven dangerous (potentially lethal) synergy with MDMA
Attribute Metabolism Description Excreted principally in urine; primarily as glucuronide conjugate of the metabolite para-hydroxy BZP and variable amounts of the glucuronide conjugate of the parent compound (BZP)
Attribute Testing - Detection widow Description Oral Fluid - uncertain, possibly up to 24 hours

Urine - 48 hours for a standard dose
Attribute Interferents - False positives in screening tests Description Medications which metabolize to BZP :
Befuraline
Fipexide
Piberaline
Cross-reactants : Bifeprunox
Buclizine
Chlorbenzoxamine
Imatinib
Meclozine
Piribedil
Trimetazidine
Vesnarinone
Attribute Interferents - True positives arising from metabolites, medications etc. Description Designer drugs which produce BZP or BZP-like metabolites including : MBZP (4 – Methyl – 1 – benzylpiperazine) 2C – B – BZP (4 – Bromo – 2,5 – dimethoxy – 1 – benzylpiperazine) DBZP (1,4 – Dibenzylpiperazine) MDBZP 3,4 – Methylenedioxy – 1 – benzylpiperazine)
Attribute Turn-around Time for reports Description 24 hours from receipt of sample into the Laboratory

b. NBOMe

Attribute Description
No matching records found
Attribute Class Description Psychedelic N-benzyl substituted phenylethylamine
Attribute Legitimate / Medical use Description None currently
Attribute Recreational / Illicit use Description Psychedelic hallucinogen
Entheogen
Empathogen
Attribute Mode of action Description Potent full agonist for CNS 5-HT2A receptor + some agonist activity against 5-HT2C receptor; marked sympathomimetic effects (unlike LSD)
Attribute Effects Description Induces psychedelia including strong eidetic imagery, visual after-images, synaesthesia, altered time perception, acts as an entheogen; euphoria, increased associative thought, empathogenic
Attribute Side-effects Description Pupillary dilation, paraesthesia, flushing, tachycardia, bruxism, insomnia, recursive thinking, (looping), confusion/inability to focus, vasoconstriction, nausea/vomiting (initial phase response only), paranoia/anxiety, delusional ideation, dystonia
Attribute Overdose Description Cardiovascular effects including marked tachycardia/palpitation, hyperthermia, metabolic acidosis, agitation At high doses : clonus/seizures, death
Attribute Addiction risk Description Uncertain; induction of tolerance has been observed

Withdrawal Syndrome:
between 1- 7 days post-use; dysphoria, anergy, some disorientation
Attribute Route of administration Description Blotter
Sublingual
Buccal
Nasal insufflation
Attribute Street name Description N-bomb, Cimbi-5
Attribute Legal status Description Schedule 9 Prohibited substance in Queensland (since April 2012) + NSW (since October 2013)
Attribute Interactions with medication Description Synergistic interaction with other sympathomimetics possible risk dissociative fugue if taken with lithium salts or tricyclic antidepressants psychedelic effects antagonized by SSRI’s & MAOI’s
Attribute Metabolism Description O-demethylation or N-acetylation of aromatic ring followed by glucuronidation principally excreted in urine, as both unmodified parent compound and metabolites, including 2-(2,5 – dimethoxyphenyl) – N – (2-methoxybenzyl) ethanamine, 2,5 – dimethoxy – 4 – iodophenethylamine and 1 – (2,5 – dimethoxy – 4 – ethylphenyl) – 2 – aminoethane
Attribute Testing - Detection widow Description Oral Fluid - 12 hours (possibly longer depending on pharmacogenetics)*
Urine - 24 hours, up to 48 hours (dependent on dose)*

*subject to review, small sample size only in limited studies
Attribute strong>Interferents - False positives in screening tests Description Amphetamine
Attribute Interferents - True positives arising from metabolites, medications etc. Description None
Attribute Turn-around Time for reports Description 24 hours from receipt of sample into Laboratory
ix Ethanol

a. Ethanol

Attribute Description
No matching records found
Attribute Class Description Ethanol; potent CNS intoxicant
Attribute Legitimate / Medical use Description Treatment of delirium tremens
Treatment of methanol poisoning
Attribute Recreational / Illicit use Description Social Euphoriant
Relaxant
Attribute Mode of action Description Global CNS depressant – increases GABAA receptor activity (esp δ –subunit), 5-HT3 + glycine receptor agonist, NMDA & AMPA receptor antagonist; raises CNS dopamine level by inhibiting dopamine degradation
Attribute Effects Description Dose-related – determined by B.A.L. (Blood Alcohol Level) :
BAL (gm/dL), BAC (%)
0.05 Euphoria, garrulousness, relaxation, variable level of disinhibition, increased reaction time

0.10 Impaired judgement (increased frequency violence), impaired cognition, impaired judgement, CNS depression, impaired sensorimotor function, nausea & possible vomiting, muscular relaxation

> 0.14 Decreased cerebral blood flow, drowsiness/somnolence

0.30 Stupefaction leading to full unconsciousness

0.40 Increased death risk incl respiratory depression, aspiration

> 0.55 Fatal overdose
Attribute Side-effects Description Intoxication, dehydration, enuresis (inhibits posterior pituitary ADH secretion), slurred speech, delayed/hypo-reflexia, possible hypoglycaemia (insulin secretagogue & potentiator), possible acute elevation of testosterone level teratogenic – foetal alcohol spectrum disorder, foetal alcohol syndrome increased cancer risk
Attribute Overdose Description See effects list
chronic heavy use may lead to hepatic cirrhosis, gastritis/peptic ulcer, acute & chronic pancreatitis, alcohol-related brain injury, major depressive disorder acute withdrawal after chronic heavy use potentially fatal – delirium tremens
Attribute Addiction risk Description Moderate (social/psychological factors, possible genetic predisposition); dependence & induction of tolerance observed
Attribute Route of administration Description Oral
Attribute Street name Description drink, grog, piss, plonk
Attribute Legal status Description Context – dependent; drink-driving limit (0.00% - 0.05%); work place BAC limits for the operation of machinery set by employer
Attribute Interactions with medication Description Intensifies CNS depressant effect of barbiturates, benzodiazepines, opioids, phenothiazines, & tricyclic antidepressants nicotine enhances alcohol craving if consumed with cocaine, hepatic metabolism forms cocaethylene (increased euohorigenic effect in comparison to cocaine, also significant cardiotoxicity)

Potentially dangerous interaction with metronidazole – induces disulfiram-like reaction (includes : flushing, headache, nausea/vomiting, abdominal cramps, profuse sweating)
Attribute Metabolism Description Metabolized via alcohol dehydrogenase converting ethanol to acetaldehyde which is further metabolized to acetyl CoA by acetaldehyde dehydrogenase
Attribute Testing - Detection widow Description Oral Fluid - 12 hours
Urine - ethanol may be detected in urine ~ 6 – 10 hrs post-ingestion (moderate drinkers), up to 12 – 14 hrs post-ingestion (heavy / inebriated drinkers depending on level of hepatic enzyme induction)
Attribute Interferents - False positives in screening tests Description Ethyl glucuronide urine alcohol tests highly sensitive to any ethanol contamination (including household products)
Attribute Interferents - True positives arising from metabolites, medications etc. Description None
Attribute Turn-around Time for reports Description Typically on site test only.
x GHB

a. GHB

Attribute Description
No matching records found
Attribute Class Description Natural intoxicant a.k.a. 4-hydroxybutanoic acid (or γ-hydroxybutyrate) structural analogue to ketone body β-hydroxybutyrate
Attribute Legitimate / Medical use Description Treatment of cataplexity
Treatment of EDS (excessive daytime sleepiness) in narcolepsy
Attribute Recreational / Illicit use Description Intoxicant
Aphrodisiac
Date-rape drug
Attribute Mode of action Description Agonist for excitatory GHB receptor, weak agonist of inhibitory GABAB receptor Increases slow-wave sleep; depressant with stimulatory effects at lower doses (differential dose dependent effect of binding GABAB and GHB receptors Induces transient rise hGH secretion (esp young males) – acts as agonist for muscarinic acetylcholine receptor
Chronic abuse decreases NMDA receptor expression in cerebral cortex – leads to impaired spatial & working memory
Attribute Effects Description Induces euphoria, disinhibition, enhanced sensuality, significantly empathogenic
Attribute Side-effects Description At higher doses : nausea, dizziness, agitation, visual disturbances, amnesia, drowsiness up to full unconsciousness
Attribute Overdose Description Deep unconsciousness, depressed respiration, coma, possible death (esp if taken with other sedatives, most notably alcohol)
Attribute Addiction risk Description Addictive in rats – uncertain situation with humans

Withdrawal Syndrome
With chronic/repeat use : insomnia, anxiety, tremor; in severe cases may present as delirium tremens. Develops after 48 – 72 hours – continues for variable period : 4 to 21 days (considerable interindividual variation)
Attribute Route of administration Description Oral
Attribute Street name Description Fantasy, G, GBH (Grievous Bodily Harm), Georgia Home Boy, Liquid G, Liquid X, Lollipops, Mils
Attribute Legal status Description Schedule 8 Prohibited drug; Class B illegal drug (with all related aldehydes esters & ethers)
Attribute Interactions with medication Description Severe reaction if coadministered with alcohol – synergic sedation : induced vomiting with near-unrousable sleep (significant risk lethal aspiration of vomitus) theoretically might impair activity of benzamide antipsychotics (e.g., sulpiride, amisulpride)
cAMP elevators enhance effects (probable mechanism increased natural production)
Attribute Metabolism Description Rapidly and fully metabolized by succinic dehydrogenase
half-life of elimination ~ 2 hours
principally excreted in urine, albeit detectable for short periods only (~ 8 hrs; some literature reports up to ~ 12 hours with large dose)
Attribute Testing - Detection widow Description Very short detection window – practically < 8 hours post-dose; little clinical utility served in testing for GHB
Oral Fluid - Not available 
Urine < 8 hours
Attribute Interferents - False positives in screening tests Description Fruit wines cAMP elevators :
forskolin
vipocetine
hereditary succinic dehydrogenase deficiency
Attribute Interferents - True positives arising from metabolites, medications etc. Description Sodium oxybate (Xyrem)
Attribute Turn-around Time for reports Description Not typically tested for in our Laboratory - please speak to your Safework Laboratories contact for further information.
xi Ketamine

a. Ketamine

Attribute Description
No matching records found
Attribute Class Description Dissociative, hallucinogenic anaesthetic analgesic
Attribute Legitimate / Medical use Description General anaesthetic (inductive paediatric anaesthetic; for Chronic Airwys Limitation patients)
ICU sedative
EM analgesic
Treatment of bronchospasm; (CRPS) complex regional pain syndrome; neuropathic pain
Coanalgesic supplementing epidural anaesthesia/analgesia
Attribute Recreational / Illicit use Description Club drug / Rave party drug
Dissociative hallucinogen
Entheogen
Date-rape drug (rarely)
Attribute Mode of action Description Centrally acting noncompetitive NMDA receptor antagonist (prevents central sensitization in dorsal horn neurones which disrupts spinal cord pain transmission); inhibits nitrous oxide synthetase; noradrenaline & serotonin uptake inhibitor
Attribute Effects Description Rapid onset (~10mins), short – acting [duration of action : 30 mins to 2 hrs (post i.m.); 4 – 6 hrs (post oral)], hallucinations, dissociation & depersonalization (colloquial : “K-hole”), entheogenic effects, intoxication, unsteady gait/staggering/slurred speech
Attribute Side-effects Description Hypertension, tachycardia (raised cardiac output), occasional palpitations, raised intracranial pressure, increased skeletal muscle tone, raised intraocular pressure often with diplopia, nystagmustransient mobiliform rash, nausea/vomiting, amnesia.
Emergence reactions : vivid dreams, hallucinations + delirium (~12% users) up to 24 hrs post dose. Increased frequency post-use depression in long-term users
Chronic use often associated with urinary tract problems including ketamine-induced ulcerative cystitis, ketamine-induced vesicopathy with urge incontinence, decreased bladder compliance.
Rarely – renal papillary necrosis.
Controversial whether heavy long-term use may lead to impaired memory (including visual, verbal and short-term memory recall
Attribute Overdose Description Marked hallucinations, tachycardia/palpitations, hypertension, convulsions, respiratory failure – eventual arrest (note low rate of respiratory depression in comparison to most other anaesthetics), collapse, death
Attribute Addiction risk Description Moderately high potential for dependence; short duration of action promotes bingeing; relatively rapid development of tolerance
Attribute Route of administration Description Inhaled / insufflated
Injected – iv, im
Topical
Attribute Street name Description Calvin Klein, CK-1, cat valium, jai-jai, K, Kallie, Kitty, mean green, purple
Ketamine + Ecstasy : Sitting Duck
Ketamine + Ephedrine + Selegiline : Strawberry
Attribute Legal status Description Schedule 8 Restricted Drug (Prescription only)
Attribute Interactions with medication Description Synergistic reaction with other NMDA receptor antagonists including NOx and drugs like Dextromethorphan, PCP & Tiletamine
Additive effect (esp on blood pressure) with stimulants, SNRI anti-depressants, MAOI’s
Enhanced sedation with benzodiazepines, barbiturates, opioids CYP3A4 inhibitors like diazepam raise plasma ketamine levels and delay clearance
Attribute Metabolism Description High volume of distribution – levels in circulation reflect poorly on CNS levels
Metabolized by hepatic CYP3A4 (some minor transformation gy 2B6 and 2B9) enzyme systems
Excreted principally in urine (~90% 0f ingested dose); N-demethylated to active metabolite norketamine, subsequent hydroxylation to dehydronorketamine (principle metabolite in urine, followed by norketamine) Half-life of elimination : 2.5 to 3 hours
Attribute Testing - Detection widow Description Oral Fluid 18 – 24 hours
Urine - commonly over more than 2 days (MAYO Clinic Limit of Quantitaion 25 ng/mL cutoff)
Attribute Interferents - False positives in screening tests Description Ecstasy (possible Ketamine as minor additive)
Attribute Interferents - True positives arising from metabolites, medications etc. Description None
Attribute Turn-around Time for reports Description 24 hours from receipt of sample into Laboratory
xii LSD

a. LSD

Attribute Description
No matching records found
Attribute Class Description Semisynthetic psychedelic of the ergoline family; lysergic acid diethylamide – 25
Attribute Legitimate / Medical use Description None currently; investigated for dealing with end-life anxiety in terminal cancer patients, cluster headaches, intractable pain
Attribute Recreational / Illicit use Description Psychedelic hallucinogen
Entheogen
Aphrodisia
Attribute Mode of action Description Binds all dopamine and adrenoreceptor subtypes (potent antagonist of D2 receptors), most serotonin receptors except 5-HT3 & 5-HT4 (acts as a partial agonist of 5HT2A receptors); induces glutamate release in the cerebral cortex
Attribute Effects Description Induces psychedelia including eidetic imagery, visual after-images, synaesthesia, altered time perception, acts as a potent entheogen
Attribute Side-effects Description Significant interindividual variation
Pupillary dilation, altered appetite, arousal/wakefulness followed by variable somnolence, weakness, nausea, hypo- or hyper- thermia, hyperglycaemia, tachycardia, jaw clenching, excessive salivation, & perspiration, hyperreflexia, tremors, uterine contractions, impaired judgement
Psychosis (commonly transient but infrequently may be chronic), anxiety/terror (‘bad trip’), paranoia, flashbacks (possible variant HPPD – Hallucinogen Persisting Perceptual Disorder)
Worsening of pre-existent schizophrenia or depression
Attribute Overdose Description Extremely low toxicity relative to dose – no reports of death attributable solely to LSD use / toxicity (save death from dissociative disorder or induced self-harm)
Variable hyper- or hypotension, tachycardia, marked intoxication/sedation (may infrequently require respiratory support)
Attribute Addiction risk Description Non-addictive; rapid induction of tolerance prevents regular use; cross-tolerance between LSD, mescaline, psilocybin
Attribute Route of administration Description Oral
Attribute Street name Description Acid, blaze, blotters, close, fry, gel, microdots, purple haze, pyramid, tab, trips
Attribute Legal status Description Schedule 9 Prohibited drug
Attribute Interactions with medication Description dissociative fugue if taken with lithium salts or tricyclic antidepressants LSD effects antagonized by SSRI’s & MAOI’s
Attribute Metabolism Description extensively metabolized by liver to 2-oxo-3-hydroxy LSD
principally excreted in urine, with only ~5% present as unmodified parent compound
Attribute Testing - Detection widow Description Oral Fluid - 0-3 hours
Urine - 8 hours
Attribute Interferents - False positives in screening tests Description Amitriptyline (Endep, Elavil)
Bupropion (Wellbutrin)
Buspirone (Buspar)
Cephradine (Sefril antibiotic)
Chlorpromazine (Largactil, Thorazine)
Desmethylimipramine (Desipramine, Norpramine)
Dihydroergotamine mesylate (Hydergine)
Diltiazem (Cardizem, Diltiazem, Vasocardol)
Doxepin (Deptran, Sinequan)
Ergotamine / Ergotamine tartrate (Efotamine, Ergostat / Cafergot) Fentanyl (Duragesic)
Haloperidol (Haldol)
Labetolol (Trandate)
Lisuride (Dopergin, Revanil)
Lysergol (Herbal drugs/supplements including: Claviceps, Convolvulaceae [Morning Glory], Rivea corymbosa, Argyreia nervosa)
Methysergide (Deseril)
Metoclopramide (Maxolon, Pramin)
Prochlorperazine (ProCalm, Stemazine, Stemetil)
Rixperidone (Risperdal)
Attribute Interferents - True positives arising from metabolites, medications etc. Description Methamphetamine lysergicide
Attribute Turn-around Time for reports Description Not typically tested in our Laboratory - please speak to your Safework Laboratories contact for further information.
xiii Methadone

a. Methadone

Attribute Description
No matching records found
Attribute Class Description Synthetic opioid; acyclic morphine analogue
Attribute Legitimate / Medical use Description Opiate withdrawal syndrome
Methadone maintenance therapy
Neuropathic pain analgesia
Second-line therapy for intractable chronic pain
Attribute Recreational / Illicit use Description Heroin substitute
Euphoriant
Attribute Mode of action Description Binds mu-opioid receptor (only levomethadone is agonist)
Binds NMDA ionotropic glutamate receptor (dextromethadone acts as a glutamate receptor antagonist)
Attribute Effects Description induces euphoria, somnolence, confusion
Attribute Side-effects Description Confusion (occasional hallucinations), mood changes, agitation, headaches, dizziness (occasional syncope), weakness, somnolence / fatigue / exhaustion, disrupted sleep, pupillary constriction, dry mouth, hypotension, pounding tachycardia, arrhythmias, hypoventilation, anorexia & occasional paradoxical weight gain, decreased libido & often impotence, amnesia, altered bowel habits, nausea (occasional vomiting), heat intolerance & flushing, perspiration, gynaecomastia
Withdrawal associated with mydriasis, photophobia, hyperventilation, yawning, nausea/vomiting, diarrhoea, fever, tremors & akathisia, increased pain sensitivity, hypo- or hyper- tension, depression, cravings, suicidal ideation, hallucinations, paranoia, apathy
Attribute Overdose Description Miosis, hypoventilation ranging up to respiratory shutdown, clammy pallid skin, hypotonia, drowsiness ranging to unconsciousness and coma to sudden death
Attribute Addiction risk Description Moderate; induces tolerance, including cross-tolerance to true opiates
Attribute Route of administration Description Oral ingestion – racemic solution, sublingual tablet
Attribute Street name Description Meth, Hillbilly Heroin, Physeptone, Dolophine
Attribute Legal status Description Schedule 8 Restricted drug (Prescription for Methadone Maintenance Therapy; restricted provider)
Attribute Interactions with medication Description Complex interactions with other opiates frequently enhanced effect
Synergistic with buprenorphine (Buprenex, Norspan, Suboxone, Subutex, Temagesic)
Attribute Metabolism Description Very high fat solubility; elimination half-life ~ 22 hours (but marked interindividual variability ranges from 15 – 60 hours)
Hepatic metabolism by CYP3A4, CYP2B6 & CYP2D6 to 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP)
Principally excreted in urine inhibitors of liver enzyme CYP2D6 will prolong the urinary elimination half-life of methadone. These drugs include : fluoxetine (& most SSRI’s) & bupropion
Attribute Testing - Detection widow Description Oral Fluid - 12 – 24 hours
Urine - 3 days but may be detected up to 4 days after use if drugs interfering with methadone metabolism are taken at the same time

hepatic CYP2D6 inhibitors (including fluoxetine, most SSRI’s & bupropion) will significantly prolong the urinary elimination half-life of methadone; other drugs affecting general cytochrome P450 activity will also delay methadone clearance albeit to a lesser extent, including : cimetidine, proton-pump inhibitors including omeprazole, azole antifungals including itraconazole & ketoconazole, erythromycin, fluvoxamine, fluoxetine, imipramine, propoxyphene, ritonavir and quinolone antibiotics like ciprofloxacin.
Attribute Interferents - False positives in screening tests Description Cyamemazine / Cyamepromazine (Tercian)
Dicyclomine (Bentyl)
Diphenhydramine (Benadryl)
Doxylamine (Dozile, Restavit)
Levomepromazine / Methotrimeprazine (Neurocil, Nozinan)
Olanzapine (Lanzek, Symbyax, Zypadhera, Zyprexa)
Verapamil (Covera, Isoptin, Verelan)
Attribute Interferents - True positives arising from metabolites, medications etc. Description Methadose
Physeptone
Attribute Turn-around Time for reports Description 24 hours after receipt of sample into the Laboratory
xiv Opiates

a. Heroin

Attribute Description
No matching records found
Attribute Class Description Narcotic opioid alkaloids (benzylisoquinoline) produced by opium poppy (Papaver somniferum)
Diacetyl morphine (a.k.a. morphine diacetatr or diamorphine)
Potent opioid analgesic – prodrug of morphine*
Attribute Legitimate / Medical use Description Treatment of severe pain (incl labor pain, AMI, severe injury)
Analgesia for palliative care – more potent analgesic than morphine because greater lipid solubility
Opioid replacement therapy + maintenance therapy for chronic i.v. opiate addicts (in UK, Germany, Switzerland, Denmark)
Attribute Recreational / Illicit use Description Most potent Euphoriant
Transcendent relaxation (“rush” – while diacetylmorphine converted to 6-MAM in brain
Attribute Mode of action Description Greater lipid solubility than morphine – higher, more rapid availability to brain
Potent μ-opioid agonist in CNS (also some δ-opioid rector agonist activity – induces analgesia).
Chronic use raises BDNF (Brain-derived neurotrophic factor) levels in ventral tegmental area
Attribute Effects Description Induces potent euphoria, altered libido, anxiolysis
Attribute Side-effects Description Long-term effects – constipation and dependence
Most side-effects as per morphine : respiratory depressant (severity dose dependent), hypogonadism (suppresses LH) with long-term increased frequency osteoporosis, weak immune system suppressant, increased distractability, minimal/transient antero – and retro – grade amnesia
heroin smokers infrequently & very rarely i.v. users may develop toxic leukoencephalitis – presents predominantly as slurred speed, impaired gait (?cause – possibly contaminants)

Illicit drug commonly 40 – 60% pure in Australia – risks due contaminants include : pathogens (incl needle sharing practice)
poisoning
decreased renal function
Attribute Overdose Description As per morphine : sedation/unconsciousness/coma, asphyxia leading to death due to respiratory depression or aspiration of vomitus (more prominent than with morphine)
Attribute Addiction risk Description High to vary high, with high frequency dependence (esp if psychiatric co-morbidity present)
Tolerance common

Withdrawal Syndrome
Multiphasic : Onset usually within 6 hrs (but may be delayed up to < 14 hours post-dose or very rarely 20 hrs) Craving, anxiety, irritability, perspiration, and mild to moderate dysphoria

14 – 18 hours post-dose Yawning, increased often heavy perspiration, mild depression, occasionally "yen sleep" (waking trance-like state), significant dysphoria, lacrimation, rhinorrhoea,

16 – 24 hours post-dose Beginning of “Cold-Turkey” phase : piloerection, pupillary dilataion, hot & cold flashes, myalgias/arthralgias, onset of abdominal cramps, loss of appetite, some hypoglycaemia

24 – 36 hours post-dose Increased severity of prior symptoms + development of severe abdominal cramping often accompanied by nausea, diarrhoeal motions, restless leg syndrome, worsening agitation, hypertension, moderately raised temperature, tachycardia, hyperpnoea, uncommonly paranoia or panic attacks

> 36 – 72 hours post-dose increased severity of prior symptoms, vomiting, frequent diarrhoea stools with markedly decreased food transit time, leucocytosis on FBC

> 72 hours resolution of symptoms
Attribute Route of administration Description oral ingestion
injected
i.v.
i.m.
s.c.
smoking insufflation (high bioavailability but shorter duration of action)
suppository
Attribute Street name Description H, smack, horse, brown, black tar
In combination with cocaine – injectable form ‘speedball’; smoked ‘moonrocks’
Attribute Legal status Description Schedule 8 restricted drug (diacetylmorphine for restricted medical use); other contexts Schedule 9
Attribute Interactions with medication Description Major synergy with other CNS depressants (esp alcohol & benzodiazepines); essentially as per morphine substantially lowers threshold for AZT toxicity
Attribute Metabolism Description Oral use extensive first-pass hepatic metabolism via deacetylaton – converted to 6-monoacetylmorphine (6-MAM; metabolite unique to heroin) and morphine glucuronide conjugates

Injected diacetylmorphine bypasses first-pass metabolism + rapidly crosses blood-brain barrier; once in the CNS it is deacetylated to inactive 3-monoacetylmorphine + potently active 6-monoacetylmorphine, then converted to morphine (which binds μ-opioid receptors along with 6-MAM)

Excreted principally in urine – primary metabolites are 6-MAM (unique heroin signature if detected), + morphine + its conjugates (morphine – 3 – glucuronide & morphine – 6 – glucuronide) hepatic metabolism by CYP3A4, 3A5 & 2D6
Attribute Testing - Detection widow Description Oral Fluid - 24 to 36 hours

Urine - 6-monoacetylmorphine Detection is definitive proof of heroin (diacetylmorphine) use – detectable up to 24 hrs

Morphine conjugates etc. 24 – 48 hours (mean detection around 18 – 20 hours)

To exclude innocuous sources of opiates (i.e. poppy-seed containing foods : poppy-seed strudel, hamantaschen, purim cake) Requires application of el-Sohly exclusion criteria; innocuous opiate source unlikely if urine specimen contains : [morphine] > 5000 ng/ml [codeine] > 300 ng/ml [morphine] : [codeine] < 2 6 – acetylmorphine
Attribute Interferents - False positives in screening tests Description As per morphine :
Amisulpride (Solian, Sulprix)
Amitriptyline (Elavil)
Chlorpheniramine maleate (Sinarest, Triaminicin)
Ciprofloxacin (Cipro)
Diphenhydramine hydrochloride (Unisom Nighttime Sleeping Aid)
Enoxacin (Enoxen, Penetrex)
Fluoroquinolone (Avelox)
Gemifloxacin (Factive)
Levofloxacin (Levquin)
Loratidine (Ephedrol) Lycopene + Vitamins E+ D3,
Selenium (Silexin, Provantex)
Moxifloxacin (Avelox)
Norfloxacin (Noroxin)
Orphenadrine citrate (Norflex)
Orfloxacin (Floxin)
Papaverine (Cerebid, Pavadil)
Procaine (Gerovital,GH3, KH3, Novocaine, Procaine powder)
Perfloxacin (N/A in Aus)
Quinine in tonic water
Rifampicin (Rifampin)
Theophylline + calcium glycinate (Acet AM)
Attribute Interferents - True positives arising from metabolites, medications etc. Description As for morphine :
Methorphan hydrobromide + chlorpheniramine maleate (Alka Seltzer Plus)
Buprenorphine (Buprenex, Suboxone)
Codeine (DC Cough mixture, Dimetane, Galcodine Linctus, Nucofed expectorant)
Dextromethorphan (Cold remedies, Dimetapp, DM, Mucinex, Quelidrine, Robitussin, St. Joseph’s Cough Syrup, Vicks)
Dextropopoxyphene (Davron)*
Dihydrocodeine (DH-codeine, Dicogesic, Hydrocodin, Paracodin, Remedeine forte)
Ethylmorphine Hydromorphone (Dilaudid)
Morphine sulphate (Contin, Cyclimorph, Duramorph, MS-Contin, Sevredol)
Morphine sulphate + Belladonna (Opazine)
Oxycodone = Hydrocodone (Loratab, Oxycontin, Percodan, Roxicet, Vicodin)
Oxymorphone (Numorphan
Attribute Turn-around Time for reports Description 24 hours after receipt of sample into the Laboratory

b. Morphine & its metabolites

Attribute Description
No matching records found
Attribute Class Description Narcotic opioid alkaloids (benzylisoquinoline) produced by opium poppy (Papaver somniferum)
Most abundant opiate in opium
Attribute Legitimate / Medical use Description Treatment of acute / chronic severe pain (including labor pain, AMI – note possible increased mortality risk when used for non-ST – elevation MI)
Pulmonary oedema*
Attribute Recreational / Illicit use Description Most potent Euphoriant
Anxiolytic
Antidepressive
Antipsychotic
Attribute Mode of action Description Potent μ-opioid agonist in CNS (also some δ-opioid rector agonist activity – induces analgesia).
Chronic use raises BDNF (Brain-derived neurotrophic factor) levels in ventral tegmental area
Attribute Effects Description induces potent euphoria, altered libido, anxiolysis
Attribute Side-effects Description Respiratory depressant (severity dose dependent), hypogonadism (suppresses LH) with long-term increased frequency osteoporosis, weak immune system suppressant, increased distractability, minimal/transient antero – and retro – grade amnesia
Attribute Overdose Description Sedation/unconsciousness/coma, asphyxia leading to death due to respiratory depression
Attribute Addiction risk Description High, with high frequency dependence (esp if psychiatric co-morbidity present)
Note: tolerance develops rapidly (due to opioid receptor phosphorylation) – tolerance much more rapid onset for respiratory depression than for analgesia)

Withdrawal Syndrome
< 14 hours post-dose Craving, irritability, dysphoria

16 – 24 hours post-dose Beginning of “Cold-Turkey” phase : piloerection, hot & cold flashes, myalgias/arthralgias, cramps, some hypoglycaemia

24 – 36 hours post-dose Increased severity of previous symptoms + development of worsening agitation, distractedness, depression, insomnia, dizziness, restless leg syndrome, diarrhoea, hypertension, tachycardia, uncommonly paranoia or panic attacks

> 36 – 48 hours post-dose Worsening of prior symptoms; often significantly decreased food transit time and frequent liquid diarrhoea

> 48 – 72 hours Resolution of symptoms
Attribute Route of administration Description Oral ingestion
sublingual
buccal
Injected
i.v.
intrathecal
epidural
Rectal
Attribute Street name Description M, sister morphine, Vitamin M, morpho
Speedball (morphine + cocaine or amphetamine or methylphenidate)
Attribute Legal status Description Schedule 8 restricted drug (Prescription only)
Attribute Interactions with medication Description Augments / frequently synergizes depressive effects of other CNS antidepressants decreases Didanosine and Stavudine levels in plasma
Concomitant use of either Efavirenz or Rifampicin may induce opiate withdrawal substantially lowers threshold for AZT toxicity
Attribute Metabolism Description Plasma peak develops by 20 mins post-injection & 30 mins post oral dose substantial hepatic metabolism by CYP3A4, 3A5 & 2D6; ~ 60% morphine metabolized to morphine – 3 – glucuronide (pharmacologically active, half as potent as morphine by mass), ~ 6 - 10% converted to pharmacologically active morphine – 6 – glucuronide, variable amount of codeine, normorphine & hydromorphone
half-life of elimination ~ 120 mins; ~87% of dose excreted within 72 hour (note : slow release oral formulations do exist)
Attribute Testing - Detection widow Description Oral Fluid - 24 to 36 hours

Urine - up to 2 days

To exclude innocuous sources of opiates (i.e. poppy-seed containing foods : poppy-seed strudel, hamantaschen, purim cake) Requires application of el-Sohly exclusion criteria; innocuous opiate source unlikely if urine specimen contains : [morphine] > 5000 ng/ml [codeine] > 300 ng/ml [morphine] : [codeine] < 2 6 – acetylmorphine
Attribute Interferents - False positives in screening tests Description Amisulpride (Solian, Sulprix)
Amitriptyline (Elavil)
Chlorpheniramine maleate (Sinarest, Triaminicin)
Ciprofloxacin (Cipro) Diphenhydramine hydrochloride (Unisom Nighttime Sleeping Aid)
Enoxacin (Enoxen, Penetrex)
Fluoroquinolone (Avelox)
Gemifloxacin (Factive)
Levofloxacin (Levquin)
Loratidine (Ephedrol)
Lycopene + Vitamins E+ D3, Selenium (Silexin, Provantex)
Moxifloxacin (Avelox)
Norfloxacin (Noroxin)
Orphenadrine citrate (Norflex)
Orfloxacin (Floxin)
Papaverine (Cerebid, Pavadil)
Procaine (Gerovital,GH3, KH3, Novocaine, Procaine powder)
Perfloxacin (N/A in Aus)
Quinine in tonic water Rifampicin (Rifampin)
Theophylline + calcium glycinate (Acet AM)
Attribute Interferents - True positives arising from metabolites, medications etc. Description Methorphan hydrobromide + chlorpheniramine maleate (Alka Seltzer Plus)
Buprenorphine (Buprenex, Suboxone)
Codeine (DC Cough mixture, Dimetane, Galcodine Linctus, Nucofed expectorant)
Dextromethorphan (Cold remedies, Dimetapp, DM, Mucinex, Quelidrine, Robitussin, St. Joseph’s Cough Syrup, Vicks)
Dextropopoxyphene (Davron)*
Dihydrocodeine (DH-codeine, Dicogesic, Hydrocodin, Paracodin, Remedeine forte)
Ethylmorphine Hydromorphone (Dilaudid)
Morphine sulphate (Contin, Cyclimorph, Duramorph, MS-Contin, Sevredol)
Morphine sulphate + Belladonna (Opazine)
Oxycodone = Hydrocodone (Loratab, Oxycontin, Percodan, Roxicet, Vicodin)
Oxymorphone (Numorphan)
Attribute Turn-around Time for reports Description 24 hours from receipt of sample into the Laboratory

c. Oxycodone

Attribute Description
No matching records found
Attribute Class Description Narcotic analgesic semisynthetic opioid derived from thebaine
Attribute Legitimate / Medical use Description Management of moderate-to-severe chronic pain
Palliative care (2nd line alternative to morphine)
Attribute Recreational / Illicit use Description Euphoriant
Relaxant
Attribute Mode of action Description Controversial – κ2b-opioid receptor agonist + partial (?) agonist μ1-opioid receptor
Attribute Effects Description Potent analgesia, induces potent euphoria, altered libido, anxiolysis
Attribute Side-effects Description Constipation, fatigue, dizziness, nausea/vomiting, dry mouth, anxiety, itching, diaphoresis
Infrequently (< 5% cases) : appetite suppression, abdominal cramping, diarrhoea, urinary retention, hypogonadism (LH suppression), dyspnoea, hiccoughs
Attribute Overdose Description Shallow bradypnoea; bradycardia, peripheral shutdown, hypotension; miosis
Eventual full respiratory depression culminating in apnoea, circulatory arrest, collapse, death
Attribute Addiction risk Description Moderately High

Withdrawal Syndrome
Marked by anxiety, panic attacks, nausea, insomnia, fevers, myalgia, muscle-weakness, flu-like symptoms
Attribute Route of administration Description Oral ingestion
Parenteral
Attribute Street name Description Oxycontin, oxy, OC, O.
Attribute Legal status Description Schedule 8 Restricted drug under Australian Standard for the Uniform Scheduling of Drugs & Poisons Schedule 1 drug under Commonwealth Narcotic Drugs Act 1968
Attribute Interactions with medication Description Exacerbates sedative and CNS depressant effects of sedatives, hypnotics & depressants (esp benzodiazepines and alcohol)
Attribute Metabolism Description Peak plasma concentration ~ 1 hr post-dose (note : delayed release in Oxycontin – peak plasma concentration occurs within 3 hours post-dose) metabolized to α + β oxymorphone thence eventually to 14-hydroxydihydroxycodeine which is converted to 14-hydroxydihydroxymorphine principally eliminated in urine and sweat
Attribute Testing - Detection widow Description Oral Fluid 24 hours
Urine 2 to 3 days
Attribute Interferents - False positives in screening tests Description As per morphine : Amisulpride (Solian, Sulprix)
Amitriptyline (Elavil)
Chlorpheniramine maleate (Sinarest, Triaminicin)
Ciprofloxacin (Cipro)
Diphenhydramine hydrochloride (Unisom Nighttime Sleeping Aid)
Enoxacin (Enoxen, Penetrex)
Fluoroquinolone (Avelox) Gemifloxacin (Factive)
Levofloxacin (Levquin)
Loratidine (Ephedrol)
Lycopene + Vitamins E+ D3,
Selenium (Silexin, Provantex)
Moxifloxacin (Avelox) Norfloxacin (Noroxin)
Orphenadrine citrate (Norflex)
Orfloxacin (Floxin)
Papaverine (Cerebid, Pavadil)
Procaine (Gerovital,GH3, KH3, Novocaine, Procaine powder)
Perfloxacin (N/A in Aus) Quinine in tonic water Rifampicin (Rifampin)
Theophylline + calcium glycinate (Acet AM)
Attribute Interferents - True positives arising from metabolites, medications etc. Description As per Morphine
Attribute Turn-around Time for reports Description 24 hours from receipt of sample into the Laboratory
xv PCP

a. PCP

Attribute Description
No matching records found
Attribute Class Description Dissociative, hallucinogenic anaesthetic arylcyclohexylamine; a.k.a. 1 – (1 – phenylcyclohexyl)piperidine
Attribute Legitimate / Medical use Description None; prior use as anaesthetic withdrawn in 1965
Attribute Recreational / Illicit use Description Dissociative hallucinogen
RARELY used in Australia
Attribute Mode of action Description Centrally acting NMDA receptor antagonist; nicotinic acetylcholine (nACh) receptor inhibitor, partial D2 receptor agonist – possibly dopamine reuptake inhibitor
Attribute Effects Description Somatic numbing (esp of extremities), dissociation, intoxication, unsteady gait/staggering/slurred speech, hallucinations
Attribute Side-effects Description Rage, erythema, dilated pupils, delusions, amnesia, nystagmus, excitation, skin dryness, loss of ego boundaries, paranoia, depersonalization, suicidal impulses, possible cerebral lesions with chronic, heavy use (Oxley’s lesions in rats)
Attribute Overdose Description Severe delusional behaviour, possibly aggressive, mania, eventual convulsions, collapse, death
Attribute Addiction risk Description Moderately High

Withdrawal Syndrome
Difficult to dissociate from psychogenic damage often associated with heavy use
Attribute Route of administration Description Smoked
Inhaled / insufflated
Injected
Attribute Street name Description Angel dust, Ashy, Boat, embalming fluid, Love boat, ozone, purple rain, sherm, rocket fuel, wet stick, zombie
Attribute Legal status Description Banned substance (including all chemical analogues) / Schedule 1 drug
Attribute Interactions with medication Description Synergistic reaction with other NMDA receptor antagonists including NOx and drugs like Dextromethorphan, Ketamine & Tiletamine,
Attribute Metabolism Description High volume of distribution – levels in circulation reflect poorly on CNS levels
Metabolized by hepatic CYP2B1, 2B4 and 2B6 enzyme systems
Excreted in urine as parent compound and metabolites including : PCHP 1-(1-Phenylcyclohexyl)-4-hydroxypiperidine, PCAA 5-[N-(1-phenylcyclohexyl)]-aminopentanoic acid and 2,3-dihydropyridinium When smoked thermal conversion of some PCP to 1-phenyl-1-cyclohexene (PC) and piperidine occurs
Attribute Testing - Detection widow Description Oral Fluid 12 to 24 hours; may be detectable for days with heavy chronic use

Urine commonly over more than 36 – 48 hours; detectable over 7 – 9 days with heavy chronic use
Attribute Interferents - False positives in screening tests Description Ketamine
Doxylamine (depending on type of immunoassay)
Lamotrigine (depending on type of immunoassay)
Meperidine
Venlafaxine (depending on type of immunoassay)
Attribute Interferents - True positives arising from metabolites, medications etc. Description Potentially : PCE a.k.a. eticyclidine (N-ethyl-1-phenylcyclohexylamine)
PCPy a.k.a. rolicyclidine (1-(1-phenylcyclohexyl) pyrrolidine)
TCP a.k.a. tenocyclidine (1-(1-(2-thienyl)cyclohexyl) piperidine
Attribute Turn-around Time for reports Description 24 hours from receipt of sample into the Laboratory