ABSTRACT

A consensus de’nition of the term drugs of abuse is practically impossible to obtain because it is one of those terms that almost everyone de’nes differently. Any de’nition requires agreement on the meaning of the words, drug and abuse-a dif’culty in itself as re™ected by the ’nding that an Internet search of the term yields more than 2 million results. Furthermore, the context of use (medical, criminal justice, workplace, public health, public perception, etc.) contributes heavily to the de’nition. And ’nally, the term denotes a negative connotation (i.e., the misuse of a substance) to most people. For these reasons, any listing and classi’cation of drugs of abuse depend on both the de’nition and context. Nevertheless, there are several drugs and classes of drugs that are usually included when compiling such a list (Table 4.1). Frequently such drugs are considered in groups such as illegal substances, prescription medications, over-the-counter medications, performance-enhancing substances, and so forth. The National Institute on Drug Abuse (NIDA) publishes several relevant lists including a chart of commonly abused drugs (1) and another of prescription drugs that are abused (2). The following substances are included in the NIDA commonly abused drugs list: nicotine, ethyl alcohol, cannabinoids, heroin, opium, cocaine, amphetamine, methamphetamine, methylenedioxymethamphetamine (MDMA),

4.1 Introduction ....................................................................................................93 4.2 Testing for Drugs of Abuse .............................................................................97 4.3 Sympathomimetic Amines Including Amphetamines and Ecstasy ............. 100 4.4 Barbiturates ................................................................................................... 106 4.5 Benzodiazepines ........................................................................................... 107 4.6 Opiates and Opioids ...................................................................................... 109 4.7 Cocaine ......................................................................................................... 113 4.8 Cannabinoids ................................................................................................ 114 4.9 Phencyclidine ................................................................................................ 115 4.10 Club Drugs .................................................................................................... 115 4.11 Inhalants ....................................................................................................... 117 4.12 Specimen Validity Testing ............................................................................ 118 References .............................................................................................................. 120

TABLE 4.1 Drugs That May Be Considered Drugs of Abuse

TABLE 4.1 (continued) Drugs That May Be Considered Drugs of Abuse

™unitrazepam, gamma-hydroxybutyrate (GHB), ketamine, phencyclidine (PCP), salvia divinorum, dextromethorphan, lysergic acid diethylamide (LSD), mescaline, psilocybin, anabolic steroids, and inhalants. Several of these substances are also included on the list of prescription drugs that are often abused. Other medications or classes of drugs on the prescription drug abuse chart include barbiturates, benzodiazepines, codeine, fentanyl, morphine, other opioids (such as oxycodone, meperidine, hydromorphone, hydrocodone, and propoxyphene), and methylphenidate. This

TABLE 4.1 (continued) Drugs That May Be Considered Drugs of Abuse

table is not meant to be all inclusive but is given to illustrate that the range of drugs of abuse is extensive. This chapter will focus on the laboratory detection of many, but not all, of these substances. The genetic aspects of the metabolism and abuse of several of these substances are discussed in more detail in other chapters.