ARTICLE INFO

Article Type

Original Research

Authors

Saberian   M. (*)
Kashani   GH. (1)






(*) Applied Research Center, Behdad Deputy, Tehran, Iran
(1) Police Central Laboratory of Drugs Abuse Investigation, Behdad Deputy, Tehran, Iran

Correspondence

Address: Behdad-e NAJA, Edward Brown Street, Kargar Avenue, Enghelab Square, Tehran, Iran
Phone: +98 (21) 63982235
Fax: +98 (21) 63982161
msbpharmd@yahoo.com

Article History

Received:  March  12, 2018
Accepted:  August 27, 2018
ePublished:  September 29, 2018

BRIEF TEXT


According to the current Iranian laws, identification of drug users is one of the priorities in drug issues, due to the social drugs-related implications.

Drug testing usually is done prior marriage, to obtain or renew a driving license, and prior being employed at private and public organizations. In addition, the prevalence of using effective medications on the nervous system, which usually are first prescribed by therapists and can be self-medication over time, is a new concern beside the existing concerns. According to unofficial observation, some drug users use these drugs prior drug testing at laboratories. They restart using their chosen drugs following the tests. This can be very risky in critical professions, such as driving public transport vehicles, industrial machine users, and other critical occupations that need delicacy [1-3]. Unfortunately, the current drug testing method, which is based on rapid detection of drugs through immunochromatography method, has many defects and disadvantages. For example, a wide range of interactions have been reported using these tests, as some patients attempt to manipulate the results of the morphine detection test by eating different medications such as contraceptives [4-7]. Such interactions also can be occurred while testing amphetamine and methamphetamine, especially by taking conventional medications containing ephedrine or pseudoephedrine [8, 9]. In Iran, Morphine, amphetamine and methamphetamine are currently evaluated via drug testing as legal requirements and it seems that this method is not sufficient for two reasons. First, the type of drugs discovered in Iran has changed dramatically, and new opiates and psychotropic drugs are available to consumers that are not tested in the current drug testing. Secondly, due to the increased awareness and information of the drug users, they try to manipulate the results by taking various medications [8].

The aim of this study was to identify the drugs that are not commonly used in conventional monitoring.

This study was conducted to investigate the medications and drugs that are likely to be used; however there is generally no legal requirement to measure them in the current drug testing.

In this study, the urine samples of the drug users who referred to a drug testing lab were used. The samples were collected through two consecutive days in summer 2017, and were maintained at 2-8°C in the refrigerator until the experiment day.

A total of 153 urine samples that had been identified as negative by test-strip for rapid detection of amphetamines, methamphetamine and morphine through the current drug testing of the one of the diagnostic laboratories of Tehran were tested. The only inclusion criterion was the urine samples that had been identified as negative by test-strip for rapid detection of amphetamines, methamphetamine and morphine at the testing day. In this research, no extra urine samples were taken from the subjects and at the end of the study no statistical analysis was performed on the obtained results, and the values were completely reported.

Evidence Investigator (Randox, England) apparatus was used for simultaneous identification of the drugs and medications in the urine samples, in which the specific kits are used for evaluation of the samples. In this research, the Drug of Abuse 1 (DOA1) was used to assess amphetamines, barbiturates, benzodiazepines, buprenorphine, cannabinoids, cocaine metabolites, methamphetamine, methadone, ecstasy (MDMA), opioids and triple antidepressants. The apparatus and kits were used according to the manufacturers’ brochure as well as the algorithm presented in the kit brochure.

Two urine samples reported with 488.69 ng/ml and 271.19 ng/ml of methamphetamine. One of the urine samples had one types of the Barbiturates (187.89 ng/ml). Eleven urine samples out of 153 samples were contaminated with type 1 Benzodiazepines (206.48, 385.00, 385.00, 176.47, 159.50, 196.55, 189.11, 175.09, 198.29, 150.37, and 385.00 ng/ml) and one sample had 136.92 ng/ml Benzodiazepine type 2. Opioids were also detected in 2 samples with concentrations of 159.74 and 192.46 ng/ml. Methadone was detected in 8 urine samples with concentrations of 459.44, 288.15, 736.00, 286.49, 736.00, 736.00, 736.00, and 736.00 ng/ml, and 9 samples had Cannabis 126.48, 116.38, 133.55, 145.79, 128.52, 141.46, 54.74, 559.00, 82.84 ng/ml. MDMA was found in 3 urine samples (706.26, 329.05, and 329.05 ng/ml), and 3 samples were found to have buprenorphine with the concentrations of 15.54, 20.38, and 7.58 ng/ml. In addition, tricyclic antidepressants detected in 7 urine samples (207.58, 184.58, 196.07, 224.36, 194.01, 211.59, and 108.64 ng/ml). No urine sample was contaminated with cocaine and amphetamine.

... .[6, 7, 10, 11]. Although all urine samples contained urinary morphine below the standard threshold level (300 ng/ml), 3 urine samples contained more than 50% of the threshold level. Similar to methamphetamine, despite the accuracy of the screening method, it is likely that morphine has been misused in the past few days and the drug users have been tried to cheat drug testing before testing day [10, 12-14]. Urine samples contained urinary barbiturates below the standard threshold level (200 ng/ml), accordingly if the concentration of barbiturates fluctuates within this range through all time conditions, the subject will not expect any risk [10, 12 , 15-17]. Since some drug users use benzodiazepines to hide symptoms through withdrawal, it is likely that some contaminated urine samples are related to those who attempted to cheat drug testing by temporary replacement of benzodiazepines with their narcotics [10, 12, 18, 19]. [10, 18, 20-23]. It is not possible to detect buprenorphine with morphine-specific diagnostic kits, since they are specific to detect the presence of morphine and it is possible that an opioid dependent attempts to replace buprenorphine with his narcotics [10, 18, 24-26]. It is likely that people who are addicted to amphetamines and methamphetamine in the days leading up to the testing day replace MDMA with amphetamines and methamphetamine to hide the symptoms through withdrawal, and start re-using their chosen psychedelic drug after testing [10, 18, 27-29]. It is also likely that some drug users stop using narcotics few days prior testing day, and use methadone to hide withdrawal symptoms [10, 15, 18, 30-32]. Cannabisis a narcotic which has been used Iran for a long time [10, 18, 31, 33-37], which can not be detected through the current drug testing and the general program for drug testing in Iran, that can be considered as another limitation of this program. Cocaine is a major central nervous system stimulant which is more produced in South America. Although recreational cocaine use has reported all over in the world, it seems that in Iran there are not more concerns on cocaine compared with other narcotics such as amphetamines [10, 18, 38, 39], which is consistent with the results of this study and none of the tested urine samples were contaminated with cocaine.

Although the current drug testing method significantly can detect those who use amphetamines, methamphetamine and morphine, it is not effective in cases who replace medications such as methadone, benzodiazepines, MDMA or buprenorphine to cheat the testing. Therefore, it seems that the current drug testing method needs to be redefined and an appropriate quantitative method should be replaced with the current screening method.

Some drug users are informed that they can use some medications in a short period prior testing to cheat drug testing in order to hide withdrawal syndrome through the withdrawal period and they probably start reusing their narcotics after testing.

The current drug testing is not an effective and comprehensive method for all types of commonly used drugs.

This study is extracted from a research entitled "Identification of medications and drugs in the negative urine drug test results of patients referred to one of the drug laboratories in Tehran" and supported by the Applicable Research Center, NAJA Deputy of Health & Care.

None declared.

None declared.

This study is supported by the Applicable Research Center, NAJA Deputy of Health & Care.


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