Laboratory Testing Reference Guide

an Alere company.

REFERENCE GUIDE // Result reporting

REFERENCE GUIDE // Table of contents

TABLE OF contents

LABORATORY TESTING SERVICES 5

Drugs of Abuse Testing – Urine ...................................6-8

Drugs of Abuse Testing – Oral Fluid...............................9-10

Esoteric/Specialty Testing ........................................11

SPECIMEN COLLECTION 13

Collection: Site Preparation .......................................14

Collection: Urine/Oral Fluid Collection Protocol .....................15-16

Collection: Specimen Validity................................... 17-18

Collection: Problematic Situations ...............................19-20

SPECIMEN LABELING & SHIPPING 23

Option 1: ToxAccess

™

Labeling Guide ............................24-25

Option 2: Urine Test Request Labeling Guide ......................26-27

Option 3: Oral Fluid Test Request Labeling Guide ...................28-29

Packaging Protocol: Shipping to Lab.............................30-31

RESULT REPORTING & COLLECTION MANAGEMENT 33

ToxAccess

™

: Web Result Reporting & Collection Management ........... 34

Standard Result Reporting ...................................... 35

DRUG INFORMATION 37

Alcohol ..................................................... 38

Amphetamines ............................................... 39

Barbiturates.................................................. 40

Benzodiazepines ...............................................41

Buprenorphine ............................................... 42

Cocaine..................................................... 43

Designer Stimulants ........................................... 44

Diuretics .................................................... 45

Fentanyl..................................................... 46

Gamma-Hydroxybutyric Acid (GHB) ............................... 47

Marijuana (cannabinoids)........................................ 48

Methadone .................................................. 49

Opiates ..................................................... 50

Oxycodone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .51

Phencyclidine (PCP) ........................................... 52

Steroids..................................................... 53

Stimulants ................................................... 54

Synthetic Cannabinoids......................................... 55

Urine Creatinine............................................... 56

CONTACT INFORMATION 58

Laboratory services

Redwood Toxicology Laboratory (RTL) performs drug and alcohol testing in accordance

with strict forensic standards and scientically accepted methods. Testing is performed by

a highly educated, experienced staff using state-of-the-art equipment under the scrutiny of

state and federal agencies. We’ll nd out.

Drugs of Abuse Urine Testing — RTL processes over 85,000 urine specimens each

week for thousands of clients.

Drugs of Abuse Oral Fluid Testing — Oral uid testing is gaining popularity with

many programs that require easy, gender-neutral specimen collection combined with

the accuracy of lab testing.

Esoteric/Specialty Testing — RTL also offers a wide range of specialized tests includ-

ing: EtG/EtS Alcohol testing, Synthetic Cannabinoid testing, Designer Stimulants testing,

Comprehensive drug testing, GHB testing, Fentanyl testing and hCG (pregnancy) testing

and more.

REFERENCE GUIDE // Laboratory services

laboratory services

OVERVIEW

The following is an explanation of Redwood Toxicology

Laboratory’s (RTL) urine screening and conrmation

procedures/cutoff levels. The routine cutoff levels listed

may periodically change. Note: some cutoff levels may

differ for your agency. The analytical methods used by

RTL are scientically accepted and approved by the

U.S. Department of Health and Human Services.

URINE SCREENING METHODOLOGY

In order to determine if a urine specimen is negative or positive

for drugs of abuse, all specimens are initially screened by an

enzyme immunoassay (EIA) procedure. Specimens that yield

an EIA response below the specied cutoff are reported as not

detected. Specimens that show an EIA response at or above

the specied cutoff are considered “presumptive positive” for a

particular drug or drug class. Based on your agency’s account,

presumptive positive specimens may be conrmed by a second

method prior to reporting positive results. (See “urine conrma-

tion methodology”).

Screening Cutoff Levels by Method

DRUG METHOD CUTOFF

Amphetamines

(Amphetamine/Methamphetamine)

EIA 500/1000 ng/mL

Barbiturates EIA 200 ng/mL

Benzodiazepines EIA 200 ng/mL

Buprenorphine EIA 5 ng/mL

Cocaine Metabolite (Benzoylecgonine) EIA 150/300 ng/mL

Cotinine EIA 250 ng/mL

Dextromethorphan (DXM) ELISA 125 ng/mL

Ecstasy (MDMA) EIA 500 ng/mL

Ethanol EA 0.04 gm/dL

EtG EIA 100/500 ng/mL

LSD (Lysergic Acid Diethylamide) ELISA 100 pg/mL

6-MAM (Heroin Metabolite) EIA 10 ng/mL

Methadone EIA 150 ng/mL

Methadone Metabolite EIA 150 ng/mL

Methaqualone EIA 300 ng/mL

Meprobamate EIA 100 ng/mL

Opiates (Morphine and Codeine) EIA 300 ng/mL

Oxycodone EIA 300 ng/mL

Phencyclidine EIA 25 ng/mL

Propoxyphene EIA 300 ng/mL

Tramadol EIA 200 ng/mL

THC (Cannabinoids) EIA 20/50 ng/mL

Drugs of Abuse Testing — Urine

Routine laboratory urine testing services

Cutoff levels u pdated p eriodical ly

Cutoff levels updated periodically

URINE CONFIRMATION METHODOLOGY

Analytical methods of conrmation include, gas chromatography (GC), gas chromatog-

raphy/mass spectrometry (GC/MS) or liquid chromatography/mass spectrometry/mass

spectrometry (LC/MS/MS). The subsequent conrmatory procedures are performed on

a second independent portion of the original urine specimen.

Confirmation Cutoff Levels by Method

DRUG GC/MS LC/MS/MS

Alcohol (ethanol) .02 gm/dL

(GC-FID)

Amphetamines

- Amphetamine / Methamphetamine /

MDA / MDEA / MDMA

250 ng/mL

Barbiturates 200 ng/mL

Benzodiazepines 50 ng/mL

Buprenorphine/Norbuprenorphine 0.5 ng/mL

Cocaine

50 ng/mL

Dextromethorphan (DXM) 50 ng/mL

EtG 100 ng/mL

EtS 25 ng/mL

Fentanyl 5 ng/mL

GHB 10 mcg/mL

Marijuana Metabolite (THC-COOH) 5 ng/mL

Methadone / Methadone Metabolite (EDDP) 100 ng/mL

Opiates

- Total Morphine / Codeine 100 ng/mL

- 6-Monoacetylmorphine 5 ng/mL

- Hydrocodone / Hydromorphone 100 ng/mL

- Oxycodone / Oxymorphone / Noroxycodone 50 ng/mL

Phencyclidine (PCP) 10 ng/mL

Propoxyphene 200 ng/mL

Tricyclic Antidepressants 25 ng/mL

Seditive / Hypnotic Agents

- Carisoprodol 100 ng/mL

- Meprobamate 200 ng/mL

- Zolpidem 1 ng/mL

- Carboxyzolpidem 10 ng/mL

1. Agency has the ability to choose cutoff levels indicated.

2. Test performed by Gas Chromatography Flame Ionization Detection (GC/FID)

REFERENCE GUIDE // Laboratory services

Drug Class Trade Name Street Names Detection Time

DEA†

ANALGESICS (Synthetic)

Meperidine Demerol

Demmies, pain killer 1-3 days II

Methadone Methodose

, Dolophine

Dollies, meth 1-7 days II

Pentazocine Talwin

T’s 1-3 days III

Propoxypene Darvocet

, Darvon

Pain killer 1-7 days IV

CANNABINOIDS

Cannabinoids Marinol

, marijuana, pot, reefer Mary Jane, Grass, Pot, Smoke, Weed See below

HALLUCINOGENS

Lysergic acid diethylamide None LSD, Acid 1.5-5 Days I

Methylenedioxyamphetamine None MDA, Love Drug 1-3 days I

Methylenedioxymethamphetamine (MDMA) Ecstasy MDMA, Adam, Ecstasy, X 1-3 days I

Phencyclidine PCP PCP, Angel Dust 2-30 days II

DEPRESSANTS/SEDATIVES/HYPNOTICS

Barbiturates

Amobarbital Amytal

Yellow jackets, angels, downers 3-10 days III

Butabarbital Butisol

, Butibel

Yellow jackets, angels, downers 1 day–3 weeks III

Butalbital Fiorinal

, Fioricet

Yellow jackets, angels, schoolboys 3-10 Days III

Pentobarbital Nembutal

Yellow jackets, angels, phennies 3-10 Days III

Phenobarbital Belladonna

, Luminal

Yellow jackets, phennies, goofballs 1 day–4 weeks IV

Secobarbital Seconal

Yellow jackets, Barbs, Reds 3-10 days III

Benzodiazepines

Alprazolam Xanax

, Niravam

, Xanor

Downs, Nerve Pills, Tranks 2-8 days IV

Chlordiazepoxide Librium

, Angirex

, Elenium

“ 1-7 Days IV

Clonazepam Klonopin

“ 3-14 days IV

Clorazepate Tranxene

, Novo-Clopate

“ 1-7 Days IV

Diazepam Valium

“ 3-14 days IV

Flurazepam Dalmane

, Dalmadorm

“ 1-3 days IV

Lorazepam Ativan

Lorax

, Emotavil

“ 2-5 days IV

Midazolam Versed, Dormicum, Hypnovel

“ 1-3 days IV

Oxazepam Murelax

, Serax

, Serepax

“ 1-3 days, 4-6 weeks Chronic use

Methaqualone Quaalude Ludes IV

Tricyclic Antidepressants

Amitriptyline Elavil

, Endep

None 2-14 days

Desipramine Norpramin

“

3-15 days

Doxepin Sinaquan

, Adapin

“ 2-8 days

Imipramine Tofranil

, Tofranil-PM “ 1-6 days

Maprotiline Ludiomil

, Deprilept

, Psymion

“ 7-10 days

Nortriptyline Pamelor

, Aventyl

“ 4-21+ days

Alcohol

Ethanol N/A Booze

Alcohol: 1-2 days

blood alcohol decreases ~.02 gm% per hour

OPIATES/ANALGESICS (Semi-Synthetic)

Codeine Tylenol

#3 Schoolboy 1-3 days II and III

Diacetylmorphine Heroin Horse, Smack, “H”, Speedball (w/ Cocaine) 6-MAM 6-8 hours 1-3 days II and III

Hydrocodone Hycodan

, Vicodin

, Lortab

Hydros, dones, vics, itchies 1-3 days II

Hydromorphone Dilaudid

, Hymorphan

Juice, dillies, M2s, hospital heroin 1-3 days II

Morphine Roxanol

, Avinza

, Kadian

“M”, morph 1-3 days II

Oxycodone Oxycontin

, Percodan

, Percocet

Oxy-cofns, killers, percs 1-3 days II

Oxymorphone Opana ER

, Opana IR

, Numorphan

Blues, nu-blues, biscuits, blue heaven 1-3 days II

STIMULANTS

Amphetamine Adderall

, Benzedrine

, Dexedrine

Aimies, back dex, bennies 2-4+ days II

Cocaine None Coke, rock, crack, snow, blow, toot 1-7 days II

Methamphetamine Desoxyn

, Methadrine

Crystal meth, crystal, meth 1-4+ days II

1) Average detection times

2) Cannabinoids Detection Time

Single use: 3 days 1-3 Days

Moderate use: 5-7 days 5-7 Days

Daily use: 10-15 days 10-15+ Days

Long term: >30 days 30+ Days

Oral Ingestion 1-5 Days

3) Chronic use over period of months or years; 4-6 weeks

I Illicit drugs with no medical use; high potential for abuse

II Prescription drugs with high potential for abuse and physical dependency

III Drugs with less abuse potential than schedule II; have moderate to low physical dependency,

but may have high psychological dependence

IV Prolonged use of these drugs may lead to limited physical or psychological dependency; lower

abuse potential than schedule III

† Explanation of Drug Enforcement Agency (DEA) Classification

Urine Drug Testing: Classification Table & Detection Time

Cutoff levels updated periodically

laboratory services

FREQUENTLY ASKED QUESTIONS

Who should consider urine drug testing?

Redwood Toxicology Laboratory’s (RTL) Urine Drug Testing is

recommended for a large variety of arenas, including the following:

Federal & State Corrections, Clinics & Hospitals, Methadone Clinics,

Federal, State & County Probation, Counseling Centers, Physician

Ofces, Federal Halfway Houses, Drug Courts, Pre-employment,

Behavioral Health, Jails & Detention Centers, Rehabilitation &

Treatment, Child & Family Services, Mental Health and Schools

& Universities.

How do I collect the urine and send in a specimen?

Refer to page 13-20 for specimen collection protocols. Instructions

for use are also included with your rst order of lab supplies. Please

read these instructions carefully. RTL offers telephonic training and

instructional materials.

How long can the urine specimen be stored before testing?

Specimens can be stored at room temperature up to 7 days. Urine

specimens should be refrigerated if testing is delayed. However, it is

strongly recommend that the sample be tested as soon as possible

after collection.

What testing methodology does RTL use

to perform initial drug screening?

RTL screens urine specimens by enzyme immunoassay (EIA). An

immunoassay is a test that uses antibodies to detect the presence

of drugs and other substances in urine. The initial screening process

does not measure the specic amount of drug present in urine

samples. It provides either a positive or negative result, indicating

the presence or absence of detectable drug metabolites above a

specic cutoff level.

What testing methodology does RTL use

for conrmations?

Conrmations are available by gas chromatography (GC), gas

chromatography/mass spectrometry (GC/MS) and liquid chromatog-

raphy/mass spectrometry/mass spectrometry (LC/MS/MS). Based

on your agency’s account settings, specimens may be conrmed by

one or more of the aforementioned methods. GC/MS and LC/MS/

MS provides identication of the molecule(s) based on characteristic

fragmentation patterns at specic retention times.

Why are screening and conrmation cutoff

levels different?

Screening and conrmation testing are performed using different

methodologies that necessitate different cutoff levels. The cutoff

levels of an immunoassay screen are typically higher than those of

a more sensitive GC/MS or LC/MS/MS conrm test, because they

screen for a larger group of parent compounds, metabolites and

other structurally similar compounds.

If an immunoassay test detects a drug (above the screening cutoff

level) the presumptive positive specimen may be sent to GC/MS

or LC/MS/MS conrmation testing. Many times, these individual

compounds are present in concentrations much lower than the total

immunoassay response, thus resulting in the cutoff levels being

lower for the GC/MS or LC/MS/MS test.

What is the importance of checking the urine

temperature strip on the collection cup?

Under normal situations fresh urine will display a temperature

between 90 and 100 degrees Fahrenheit on the temperature strip,

if read within 4 minutes of the collection. Should the temperature

strip not register, the specimen should be immediately re-checked

using a new cup (or strip) and the results recorded on the requisi-

tion. Specimens with a temperature out of range may indicate a

substituted or adulterated sample.

How long does it take for results?

Urine screening results are typically available within 24 hours of

receipt of the specimen, while oral uid screen results take 24-48

hours. Presumptive positive specimens are usually conrmed

(unless they are “Screen Only”) within 24-72 hours depending on

the method. Conrmation of specimens that are presumptive posi-

tive by instant/on-site devices take a minimum of 48 hours.

What does ng/mL mean?

Drug testing cutoff levels are usually expressed in the units of mea-

sure ng/mL (nanograms per milliliter). A quantitative positive GC/MS

or LC/MS/MS result is commonly expressed in ng/mL.

Urine drug testing continued

REFERENCE GUIDE // Laboratory services

OVERVIEW

Oral uid testing is gaining popularity with many programs

that require convenient, gender-neutral specimen collec-

tion combined with the accuracy of lab testing. Redwood

Toxicology Laboratory (RTL) provides an easy and afford-

able lab-based testing solution for the detection of drugs

of abuse in oral uid. RTL’s oral uid testing utilizes a

collection device that has a volume adequacy indica-

tor. This indicator ensures that sufcient saliva (1 mL) is

collected to prevent possible false negative results due

to insufcient sample size, and to provide a meaningful

quantitative result.

The collection device also allows drug concentrations

to be reported per mL of oral uid (GC/MS and LC/MS/

MS conrmations only). One (1) mL of oral uid combined

with three (3) mL of buffering agent provides four (4) mL

of specimen, allowing a sufcient amount of sample for

screening and conrmation procedures.

The following is an explanation of RTL’s saliva screening

and conrmation procedures/cutoff levels. The routine

cutoff levels listed below may periodically change. Note:

some cutoff levels may differ for your agency.

SALIVA SCREENING METHODOLOGY

Specimens collected with the oral uid collection device are sent to

Redwood Toxicology Laboratory for screening by Enzyme Immuno-

Assay (EIA) or Enzyme-Linked Immunosorbent Assay (ELISA).

Screening Cutoff Levels by EIA

DRUG EIA

Alcohol .025 g/dL

Amphetamine 50 ng/mL

Barbiturates

50 ng/mL

Benzodiazepines 20 ng/mL

Cocaine

20 ng/mL

Methadone 50 ng/mL

Methamphetamine 50 ng/mL

Opiates (codeine, hydrocodone, hydromorphone,

morphine, 6-monoacetylmorphine)

40 ng/mL

Oxycodone 40 ng/mL

Phencyclidine 10 ng/mL

THC (r-9-THC) 4 ng/mL

SALIVA CONFIRMATION METHODOLOGY

Positive screens are conrmed by gas chromatography/mass

spectrometry (GC/MS) or liquid chromatography-tandem mass

spectrometry (LC/MS/MS).

Confirmation Cutoff Levels by Method

DRUG METHODOLOGY CUTOFF

Alcohol GC-FID .025 g/dL

Amphetamine GC/MS 15 ng/mL

Barbiturates GC/MS 20 ng/mL

Benzodiazepines

LC/MS/MS 0.5 ng/mL

Buprenorphine LC/MS/MS 1 ng/mL

Norbuprenorphine LC/MS/MS 5 ng/mL

Cocaine

GC/MS 8 ng/mL

Methadone GC/MS 10 ng/mL

Methamphetamine GC/MS 15 ng/mL

Opiates

- Codeine, Hydrocodone,

Hydromorphone, Morphine

GC/MS

20 ng/mL

- 6-monoacetylmorphine

GC/MS

4 ng/mL

Oxycodone GC/MS 20 ng/mL

Phencyclidine GC/MS 5 ng/mL

THC (r-9-THC) GC/MS 1 ng/mL

Oral Fluid Detection Times

DRUG Detection Time

Alcohol

After absorption (~1 hour) blood

alcohol decreases ~.02 gm%/hour

Amphetamine From minutes up to 48 hours

Barbiturates From minutes up to 48 hours

Benzodiazepines From minutes up to 48 hours

Cocaine From minutes up to 48 hours

Methadone From minutes up to 48 hours

Methamphetamine From minutes up to 48 hours

Opiates From minutes up to 48 hours

Oxycodone From minutes up to 48 hours

Phencyclidine From minutes up to 48 hours

THC (r-9-THC) From minutes up to 48 hours

Drugs of Abuse Testing — Oral Fluid

Routine laboratory oral fluid testing services

Levels updated periodically

1. Detected by Enzyme-Linked Immunosorbent Assay (ELISA)

2. Cocaine Metabolite: Benzoylecgonine

3. Average detection times

These oral uid cutoffs are based upon preliminary guidelines established by the

Substance Abuse Mental Health Services Administration (SAMHSA) Drug Advisory

Board for drug testing of alternative matrices.

METHODOLOGY

laboratory services

FREQUENTLY ASKED QUESTIONS

How do I know oral uid testing is right for my agency?

Oral uid testing is easily used in a variety of testing arenas: Federal

& State Corrections, Clinics & Hospitals, Methadone Clinics, Federal,

State & County Probation, Counseling Centers, Physician Ofces,

Federal Halfway Houses, Drug Courts, Pre-employment, Behavioral

Health, Jails & Detention Centers, Rehabilitation & Treatment, Child &

Family Services, Mental Health and Schools & Universities.

Why should I implement oral uid testing at my facility?

Not only does oral uid testing save your agency time and money

in collection fees, it offers the convenience of testing for drugs of

abuse anywhere, at any time.

What are the testing and conrmation methodologies?

Specimens collected with the oral uid collection device are sent

to Redwood Toxicology Laboratory (RTL) for screening by Enzyme

Immunoassay (EIA) or Enzyme-Linked Immunosorbent Assay

(ELISA). Depending on account setup, positive screens, other than

methadone, are conrmed by gas chromatography/mass spectrom-

etry (GC/MS) or liquid chromatography-tandem mass spectrometry

(LC/MS/MS).

The analytical methods used by RTL for the detection of drugs of

abuse are scientically accepted and approved by the U.S. Depart-

ment of Health and Human Services.

What are the oral uid drug detection times?

The drug detection times in oral uid closely parallel those in blood.

In general, Amphetamines, Barbiturates, Benzodiazepines, Opiates,

Cocaine/Benzoylecgonine, Methadone, and PCP can be detected

for up to 48 hours

following use. Parent THC (marijuana) can be

detected in oral uid for up to 24 hours

I suspect that my donor just used a substance of abuse,

how long should I wait before collecting the specimen?

Depending on the drug and dosage, drugs may be detected in oral

uid in as little as a few minutes or up to approximately 2 hours

from the time of use.

Why are the drug levels in oral uids

lower than those in urine?

Oral uid drug levels largely correlate with the amount of drug in the

blood (dependent on the saliva/plasma ratio for each drug). Higher

drug and drug metabolite levels are found in urine because they are

concentrated by the kidneys during the excretion process.

How do I collect the oral uid specimen?

Refer to page 13-20 for specimen collection protocols. Instructions

for use are also included with your rst order of oral uid collec-

tion devices. Please read these instructions carefully. RTL offers

telephonic training. If you have questions, please call

800.255.2159, press option 1.

Can I ship my oral uid specimens

with my urine specimens?

RTL will accept both oral uid and urine specimens in the same

lab pack when sending ve or more specimens (e.g. three oral uid

specimens and two urine specimens). The specimens cannot, how-

ever, be mixed in the postage-paid mailer boxes due to U.S. Postal

Service regulations.

NOTE: It is important that the test request form is included with the

oral uid specimen. The specimen cannot be processed without the

information supplied on the test request form.

How long does RTL store the oral uid specimen?

RTL stores positive oral uid specimens for three (3) months in

frozen storage. Negative specimens are kept for 48 hours.

How will RTL report the oral uid results?

RTL offers reporting for the oral uid specimens via internet, U.S.

mail or facsimile. Please indicate your preferred method at the time

of account set-up.

What is the shelf life for the oral uid collection device?

The oral uid collection device has a minimum shelf life of 12 months.

Does OSHA classify oral uid as hazardous?

OSHA considers oral uid collections non-hazardous as long as the

specimen is not tinged with blood.

Who do I call to re-order the oral uid collection devices?

To request labels, collection bottles, and shipping materials, contact

our Supplies Department. Lab supply re-ordering is available to

existing clients with an account number.

Phone: 800.255.2159, press option 4.

E-mail: supplies@redwoodtoxicology.com

Web: https://www.redwoodtoxicology.com/resources/supply_form

Oral fluid drug testing continued

1. Average detection times

REFERENCE GUIDE // Laboratory services

OVERVIEW

Redwood Toxicology Laboratory (RTL) also offers a wide

range of specialized tests including: EtG/EtS Alcohol test-

ing, Synthetic Cannabinoid testing, Designer Stimulants

testing, Comprehensive drug testing, GHB testing, Fen-

tanyl testing and hCG (pregnancy) testing and more.

ETG/ETS ALCOHOL TESTING

EtG is a direct metabolite of alcohol (ethanol). Its presence in urine

may be used to detect recent ethanol ingestion, even after ethanol

is no longer measurable. The presence of EtG in urine is an indicator

that ethanol was ingested and can be detected in urine for up to 80

hours after ingestion.

In addition to EtG, recent scientic studies have identied ethyl

sulfate (EtS) as a second specic metabolite or biomarker of ethanol.

For this reason, RTL tests and reports EtS, in conjunction with EtG,

to conrm recent ethanol ingestion or exposure. The detection of EtG

and EtS offers greater sensitivity and accuracy for determination of

recent ethanol ingestion, than by detection of either biomarker alone.

SYNTHETIC CANNABINOID TESTING

Up to four times stronger than marijuana, synthetic cannabinoids

are deceptively marketed as herbal smoke or incense products.

With high positivity rates, synthetic cannabinoid tests have proven

to be an essential tool for a variety of treatment and criminal

justice situations.

In July 2012, the DEA banned synthetic cannabinoids based on

their structural classication, explicitly naming 15 chemicals, citing

numerous calls to poison control centers around the nation. In May

2013, the DEA placed a temporary ban on three additional synthetic

cannabinoid substances. However, newer generation compounds

continually emerge—making it more vital than ever to target syn-

thetic marijuana.

DESIGNER STIMULANT TESTING

Designer stimulants are sold online or available at smoke shops;

promoted as “bath salts,” “research chemicals,” or “plant food,”

product labeling attempts to circumvent regulation by suggesting

they are not for human consumption. Additionally, some forms of

designer stimulants may be sold as “legal” MDMA (Legal X), or sold

and veiled as MDMA tablets.

A new federal ban targets three designer stimulant compounds for

so-called bath salt drugs. This ban will help deter abuse and suf-

fering from these dangerous designer drugs. However, drug makers

will continue to develop new compounds to circumvent existing

drug laws. We are committed to providing timely and relevant tests

that enable you to make informed decisions. Now you’ll know.

COMPREHENSIVE DRUG TESTING

Conventional drug test panels will not detect the broad variety of

addictive prescription drugs. They pass undetected in standard test-

ing for such drugs as cocaine, marijuana, heroin and amphetamines.

RTL’s Comprehensive Drug Test solves this problem.

RTL’s Comprehensive Drug Test detects prescription drugs within a

variety of categories, including:

• Anticonvulsants

• Antidepressants/Analgesics

• Barbiturates

• Benzodiazepines

• Propoxyphene

• Sedatives/Hypnotic Agents

• Stimulants

RTL’s Comprehensive Drug Test also tests for alcohol, illicit drugs

and specimen validity.

• Alcohol

• Amphetamine

• Cocaine

• Marijuana

• Methadone

• Methamphetamine

• PCP

• Specimen validity (Creatinine)

GHB TESTING

There are increasing reports of Gamma-Hydroxybutyric acid (GHB)

being used recreationally as a euphoriant at “rave” type parties.

GHB is typically associated with sexual assault or as a “date rape”

drug due to its severe hypnotic and sedative effect at higher dos-

ages. Typical illicit use of GHB involves dissolving 2 - 3 grams of

powder in beverages.

STEROIDS/SPORTS DRUG TESTING

Due to popular demand, Redwood Toxicology Laboratory, Inc. (RTL)

developed a comprehensive and affordable steroid panel that is

comparable to WADA

testing. In addition, RTL also offers a diuretics

panel and stimulants panel.

Our tests are ideal for sports organizations, colleges and high

schools, certied athletic trainers, coaches, corrections and law

enforcement, and occupational health agencies

1. World Anti-Doping Agency

2. Compliance with RTL non-pretesting policy is required

Esoteric/Specialty Testing

Laboratory service

Specimen collection

Redwood Toxicology Laboratory provides suggested specimen collection guidelines only. It

is the responsibility of individual collection agencies to adopt their own policies and proce-

dures according to their needs in compliance with individual state and federal regulations.

Laboratory drug and alcohol test results are often used in legal proceedings. The manner

in which specimens are collected and handled is very important. Specimens must be

handled and controlled by collection site personnel throughout the collection process.

Directly observed urine collection is the best means to ensure specimen integrity. However,

outside of probation and parole and some drug rehab environments, the question of civil

rights arises. A uniform urine and oral uid collection process, regardless of the testing

environment, should be followed.

REFERENCE GUIDE // Specimen collection

specimen collection

PRINCIPLE

Requirements for specimen collection vary according to the purpose

for which the results will be used. However, to meet evidentiary

requirements the specimen collection site must be secure in order

to eliminate the possibility of specimen tampering or adulteration

and to ensure the security of the collected specimens.

COLLECTION AREA GUIDELINES

1. Storage area for collection supplies and related

materials is secure.

2. Collection site facility is secure, well lit, and free of

any areas where adulterants or substitute specimens

can be hidden.

3. A suitable clean surface for the collector to use as

a work area.

4. Eliminate or secure all sources of water in the area where

urination occurs. Bluing agent should be placed in the

toilet tanks and bowls to prevent sample dilution.

5. Eliminate or secure all soap or detergent dispensers or

any other potential adulterants.

6. A secured storage area should be available to ensure

specimen security prior to transport to the laboratory.

7. A general log book should be maintained to record

collected specimens.

Collection: Site Preparation

Suggested collection guidelines

Collection Area Example

REFERENCE GUIDE // Specimen collection

PRINCIPLE

The validity of urine drug screen results is dependent on specimen

integrity. While direct-observation collections provide specimens of

the greatest credibility, non-witnessed collections can be effective

if safeguards are in place to ensure the donor does not have access

to substances which may affect test results (water, chemicals,

substitute urine, etc.).

SUGGESTED PROCEDURE

PRIOR TO COLLECTION

Prior to any specimen collection procedure, secure the collection

facility (see Collection Site Preparation page 14) and if necessary,

perform a thorough search for hidden adulterants or substitute urine

specimens. Place bluing agent in the toilet bowl or tank, remove or

secure all chemicals (soaps, cleaning supplies, etc.) and secure or

eliminate all water sources.

1. Check the identity of donor

(e.g. social security number

or driver’s license number

and photo I.D.). If using a drug

screen test request form, note

the identity on the form.

2. Ask the donor to remove any

unnecessary outer clothing. All

personal belongings (the subject may retain a wallet) should be

placed in a secure location outside the stall or partitioned area.

3. Do not ask the donor to empty his/her pockets or to remove

articles of clothing such as shirts, pants, dresses, etc. If a

collector notices any unusual behavior that indicates a donor

may attempt to tamper with or adulterate a specimen (e.g.,

bulging pockets), the collector may request that the donor

empty his/her pockets and explain the need for such items

during collection.

4. Prior to collection, ask the

donor to wash his/her hands

to eliminate any possible

adulterating or contaminating

substances from under the

donor’s ngernails.

URINE COLLECTION PROCEDURE

1. Place the following information on the bottle label:

• Date of collection

• Donor’s name and/or identication numbers

• Collector’s initials

2. Provide the donor with a clean, unused urine specimen

collection container and instruct the donor to ll the

container at least half full (a minimum of 30 mL’s).

3. Unobserved Collection: Allow the donor to enter and maintain

privacy within the stall or partitioned area. The collector will

wait outside the collection area until the donor is nished

urinating. Complete the remainder of the test request form

while the donor is collecting the specimen. (See page 23-31

for detailed labeling instructions).

4. Observed Collection: Inform the donor that collection will

occur under direct observation. Accompany the donor into

the collection facility (the collector must be the same gender).

Instruct the donor to urinate into the sample container with the

witness observing urination. Complete the remainder of the

test request form after the donor has completed collecting the

specimen. (See page 23-31 for detailed labeling instructions).

5. Accept the specimen from the donor. The use of disposable

gloves is recommended when handling specimens, so prior

to accepting the specimen

from the donor, be sure to

wear gloves.

6. Upon receipt of the specimen

from the donor, immediately

apply the temperature strip (if

applicable) to the outside of the

bottle. If using a drug screen

test request form, record the urine

temperature on the form.

NOTE: Urine temperature should be measured within (4) four

minutes of collection and should read between 90-100ºF.

Collection: Urine/Oral Fluid Collection Protocol

Urine and oral fluid collection protocol

EXPIRES 00-00-00

CLASS: C

DRIVERS LICENSE

00000000

John Doe

123 Anywhere Ln.

Santa Rosa CA 95403

SEX:M HAIR:BLN EYES:BLU

HT:6-0 WT:190 DOB:01-01-65

Verify the donors identity

with a photo I.D.

Donors should wash hands before

donating specimens.

Apply temperature strip

to sample bottle.

specimen collection

ORAL FLUID COLLECTION PROCEDURE

1. Remove the kit contents from the packaging. Save the

outer packaging because the specimen must be placed

in the re-closable outer packaging for shipment to

the laboratory.

2. Peel open the collector pad pack-

age and remove the collection

device. Do not touch the pad.

3. Place the collector pad under the

donor’s tongue and instruct the

donor to close his/her mouth.

The donor must not chew or suck

on the pad. When the indicator

window turns blue, remove the

collection device from the donor’s

mouth. DO NOT remove the col-

lection device until the indicator

turns blue. If the indicator does

not turn blue within 15 minutes,

remove the collection device and

discard. Re-collection with a new

device may begin immediately

after saliva has accumulated in

the donor’s mouth.

4. Holding the transport tube in an upright

position, remove the cap, and insert

the collector device, pad rst, into the

tube. DO NOT set the transport tube on a

table. If any of the buffer uid is spilled,

a new transport tube must be used. The

amount of liquid in the transport tube is

critical to the testing process.

5. Push the cap rmly onto the transport tube

until you hear the SNAP. Gently shake the

tube to mix the saturated collector pad with

the buffer.

6. Complete the labeling procedure by following the instructions

on page 28 and 29.

Collection protocol continued

Peel open package and

remove collector.

Place collector pad under

the donors tongue.

Open transport tube and insert the

collector.

REFERENCE GUIDE // Specimen collection

PRINCIPLE

Methods to adulterate urine samples for substance abuse testing

generally fall into three categories; 1) urine substitution; 2) inges-

tion of uids or compounds for ushing out the system, diluting

the sample, or interfering with the

testing process; or 3) direct addition

of adulterants to the urine speci-

men itself. The substitution of one’s

own urine sample with one which

is clean is a common practice. The

best means to combat this practice

is to measure urine temperature,

as urine specimens even held close

to the body for extended periods of

time will not produce a physiologically

temperature-correct specimen. However, practices of reverse cath-

eterization with clean urine and placement of urine lled balloons in

the vaginal cavity can produce urines of correct temperature.

Drinking large volumes of liquid, especially cranberry juice or

vinegar is common practice. However, studies demonstrate these

practices have no effect on testing methodologies and may present

unexpected results.

Many of the drugs being tested are pH dependent. When large

volumes of cranberry juice or vinegar are consumed, the urine pH

is lowered, and the excretion rate of these drugs may increase. If

timed correctly, large amounts of a drug may appear sooner in

the sample.

Be aware, drinking large volumes of vinegar can be toxic.

One potentially effective method

which may negatively impact the

testing process is to consume large

volumes of water, as short term

water loading can increase urine

volume up to eight fold. Therefore,

if the individual‘s drug concentra-

tion is near the cutoff of an assay,

the urine may be diluted enough

so that the sample will test below the

cutoff level. Other attempted methods of

adulteration include ingesting large amounts of vitamin C, vitamin B,

niacin, Golden Seal, etc. All of these practices are ineffective.

Adulteration of a urine sample with various chemicals is shown (in

the literature) to inactivate some of the laboratory testing meth-

odologies, most notably, the enzyme immunoassay‘s. Addition of

compounds such as sodium chloride, sodium bicarbonate, hydrogen

peroxide, bleach, alcohols, blood, various soaps, etc. are shown to

produce both false negatives and false positives.

The current list of urine adulterants is ever changing as the Internet

provides an informational source, as well as a retail outlet for com-

mercial products capable of affecting the outcome of some urine drug

testing methodologies. Currently, nitrites (Klear and Whizzies) and

chromates (Urine Luck) are two adulterating agents commonly found

in the industry. RTL is capable of providing testing for some of

these agents.

Collection: Specimen Validity

Specimen tampering/adulteration

Human urine specimens should

range between 90º and 100º F.

Consuming too much uid prior

to collection can result in an

invalid specimen.

specimen collection

ADULTERATION & DILUTION DETECTION

Means to detect adulteration by the collector and/or the laboratory

include the following:

1. Specimen Temperature: If specimen collection is not

witnessed, the most effective means to detect specimen dilu-

tion, adulteration, or substitution is to measure the sample’s

temperature. The collector should measure the temperature

utilizing the temperature strip afxed to the specimen con-

tainer within four minutes of collection; it should read between

90 and 100 degrees Fahrenheit. The urine temperature should

be noted on Urine Test Request form.

2. Urine Appearance and Odor: Adulterants such as isopro-

pyl alcohol, soaps, bleach and perfumes are readily identied

by their odor. Soaps are also identied by excessive bubbling.

Use of solid adulterants is detected by the presence of residues

in the container.

3. Creatinine: In general, creatinine is a metabolic byproduct

of muscle metabolism which normally appears in urine in rela-

tively constant quantities over each 24 hour period. Therefore,

urine creatinine can be used both as a marker to specically

identify a specimen as urine, and as an indicator of urine water

content (dilution). “Normal” random urine specimens will

generally have urine creatinine levels of greater than 20 mg/dL,

while specimens with creatinine levels between 10 and 20 mg/

dL may be due to increased liquid consumption, dietary habits,

or liquid ingestion preferences. Urine specimens with creatinine

levels between 2 and 10 mg/dL are usually a result of ingestion

of large volumes of water (or other liquid), termed short term

water loading. This is a very common practice when attempting

to dilute a urine so that any drugs in the urine will be diluted

below analytical testing cutoff levels. Urine creatinine levels

below 2.0 mg/dL are usually a result of “dipping”, the direct

addition of a liquid to the urine specimen. Creatinine levels of

0.0 mg/dL indicate the specimen is not consistent with

human urine.

Urine specimens become dilute as a result of the short term

consumption of large amounts of a liquid due to an unknown

stimulus such as a response to heat or exercise, herbal ushes,

prescription diuretics, intentional dilution, or pathological

situations such as diabetes insipidus. The dilution effect from

consuming increased volumes of liquid can last from 2 – 5

hours. Therefore, the increased consumption of liquid would

have to take place between 2 – 5 hours prior to the collection

of the urine specimens.

An important factor to consider when interpreting dilute urine

samples is that drug use can never be assumed unless speci-

cally detected, and conrmed in a urine sample. Certainly, a

dilute sample can produce false negative results, as drugs in

the urine at concentrations near the testing cutoff may be

diluted below the testing cutoff level, however, due to the

reasons stated above it can be difcult to establish the reason

or intent for the sample(s) being dilute. For these reasons, urine

creatinine is reported in conjunction with testing for drugs of

abuse, as an indicator of specimen validity only, as urine

specimens with a creatinine level below 20 mg/dL may have

an increased likelihood of producing a false negative drug

testing result.

For more information about creatinine, refer to page 46.

4. Specic Gravity: Normally, a random urine specimen will

have a specic gravity of greater than 1.003

. An extremely

low specic gravity (<1.003) indicates a dilute specimen,

while abnormally high specic gravity (>1.045) may indicate

the presence of dissolved solids such as sodium chloride and

sodium bicarbonate.

5. pH: Normal random urine pH is 4.8-7.8*. Low pH’s indicate pos-

sible ingestion of acidic substances such as cranberry juice or

vinegar; starvation; diarrhea; or direct adulteration of the speci-

men itself with acidic compounds. Elevated pH’s may indicate

the presence of basic compounds such as sodium bicarbonate,

bleach, or Drano; vegetarian diet; or prolonged vomiting. pH

levels of <3 or ≥11 are consistent with adulteration.

6. Visible Blood: Indicates the presence of blood in the urine

specimen. The presence of blood in the urine sample may

adversely impact the testing process and, in addition,

constitutes a biohazard for laboratory employees. Collection

of clean catch urine specimens during menstruation should

be attempted.

Urine adulteration is a double edged sword as both false negative

and false positive results can occur. However, most adulteration

attempts can be detected by either trained collection site person-

nel or by collection procedures as outlined above. Coordination and

cooperation between the collection site and the testing laboratory

provides effective and reliable drugs of abuse testing.

1. Normal ranges are indicated for freshly voided urines only.

Specimen tampering/adulteration continued

REFERENCE GUIDE // Specimen collection

PRINCIPLE

While most donors will cooperate fully if treated with dignity and

courtesy, there may be instances when unusual events may occur.

For this reason, it is imperative for the collector to have a thorough

understanding of the collection process and to have the ability to

explain the process clearly to the donor so they will fully understand

the directions. During collection of the specimen and completing

the forms, it is vital that the collector devote his/her full attention

to the procedure without interruptions. Any unusual appearance or

behavior is to be noted on the urine chain of custody form.

PROCEDURE

While it is not possible to anticipate every type of unusual event,

some of the more frequent are:

1. Specimen Temperature Outside Limits: If the specimen tem-

perature is outside normal parameters, i.e., less than 90ºF or

greater than 100ºF then:

A. Inform the donor that the temperature of the specimen

is outside normal limits (too low or too high) and that the

specimen needs to be recollected. If the specimen cannot

be recollected or the donor refuses, inform the donor that

specimen temperature will be noted on the nal report.

NOTE: This is important because if the donor has drug

in his/her system at the time of collection, collection at a

later time may allow the drug to clear. Therefore, if at all

possible, make every effort to resolve the situation at the

time of the incident.

2. Specimen Contains Visible Blood: Urine specimens may not

contain visible blood for drug testing because:

• Blood may interfere with the testing process (which could

result in false negative tests).

• Urines containing visible blood are considered biohazard-

ous and require special packing procedures in order to be

shipped (Federal Bloodborne Pathogens standard).

Instructions to client to obtain a clean catch

urine specimen:

A. Wipe area until free of blood.

B. Start urinating into the toilet. After a few seconds, place

the urine container under the stream of urine until the cup

is at least half-full.

3. Uncooperative or Belligerent Donor: Presumably, the donor

has agreed to the drug test prior to appearing at the collection

site. However, attitudes may change just before, or during the

collection process. Remain courteous and do not argue with

a donor. It remains the right of the donor to refuse collection

at any time, of course at his/her own risk. Remind the donor

that you will call the requesting agency with a recount of the

pertinent facts.

If physical violence seems imminent, call for assistance and

ask the donor to leave the premises. Use the same procedure

you would use for any other circumstance in which you fear

bodily harm or property damage, including calling 911.

4. Suspicion Donor is Adulterating Sample (Adding water

or other substance): Remain courteous and do not

argue with the donor. The following statement may

be appropriate:

“We are instructed to tell everyone that the lab tests

for water and other materials that may have been added.

It will show up on the test report.”

Collection: Problematic Situations

Donor situations

specimen collection

Grounds for these type of suspicions may include out of range

specimen temperature, abnormal urine smell or

appearance, or unusual sediments.

5. Donor Cannot Urinate or Produces Insufcient Volume: Upon

receipt of the specimen, the collector must rst determine if

there is sufcient urine for testing. Minimum sample volume

is twenty (20) mL and is sufcient for retest and conrmatory

procedures if required. If there is not sufcient urine volume,

then follow the procedures below:

A. Ask a supervisor to determine if there is adequate urine

volume to perform the requested testing.

B. If there is not a sufcient urine volume, the collector shall

take possession of the partial specimen and instruct the

donor to drink uids (no more than 8 oz.) and try again in

a reasonable amount of time. If possible, the donor should

remain on the premises and preferably within visual

contact of the collection site person until a complete

specimen is provided.

C. In the event a donor cannot provide a specimen of ade-

quate volume, the requesting agency should be notied for

further instruction. In some cases, it may be acceptable to

reschedule the collection. However, it may be necessary to

determine whether a valid medical reason exists for the

donor’s scarce urine output or if the donor is refusing to

provide a specimen.

6. Donor Accuses Collector of Carelessness, Personal Miscon-

duct, or Deliberate Mishandling of Specimen: This is unlikely;

however it does occur.

Remain calm and professional. Listen carefully. If there is

another person at the site, ask that individual to join you and

the participant. If you are alone, call your supervisor while in

the presence of the participant. It is important to document

what took place and what was said. The matter should be

treated with the utmost seriousness. It could result in the loss

of a client, a civil lawsuit, or even a criminal suit. State fully

to the participant and, if possible, to a witness what you did

or did not do. Make every reasonable effort to persuade the

participant of your good intentions and lack of negligence;

however, do not attempt to deny actual error on your part. If it

is obvious that a participant is attacking you to perhaps cover

the presence of drug use, treat it as a legal matter with docu-

mentation and immediate notication to your supervisor.

Donor situations continued

REFERENCE GUIDE // Specimen collection

Specimen labeling & shipping

Redwood Toxicology Laboratory (RTL) provides specimen collection guides on how to prop-

erly label and package specimens being sent to RTL for screening & conrmation testing.

Each test requisition form requires unique labeling and it is important that these guidelines

are followed to ensure proper specimen processing at RTL. Mislabeled specimens can delay

processing and reporting timelines.

REFERENCE GUIDE // Specimen labeling & shipping

specimen collection

Option 1: ToxAccess

™

Form

ToxAccess

™

test requisition form overview

TOXACCESS

™

TEST REQUISITION FORMS

1) Agency Information—Contains the agency’s account

information including: account number, name, address,

phone and fax numbers.

2) Donor Information & Test(s) Requested—Donor informa-

tion will be located in this section. You will also see the tests

requested to the right of the donor’s information.

3) Specimen Verication—Signature area for Donor and Collec-

tor, verifying specimen collected and labeled correctly.

4) Security Seal—Peel off label secures specimen container.

5) Specimen Label—This label will contain all required informa-

tion for the laboratory to process your specimen. Ensure the

label is placed horizontally across the specimen bottle.

6) Receiving (lab only)—To be lled out by RTL personnel only.

7) Donor Receipt—The tear off section of the chain of custody

form is to be provided to the donor for their records.

For training or questions, please contact:

Toxicology Support Services

Phone: 800.255.2159, press option 5.

Fax: 707.577.0365

Email: clientservices@redwoodtoxicology.com

Web: https://www.redwoodtoxicology.com/services/online_reporting

The ToxAccess

™

Collection Management system accelerates donor

scheduling, data entry, and the test ordering process.

The online data you input is automatically transferred into RTL’s

laboratory information system, eliminating both the errors caused

by hand-written labels, and laboratory data entry errors.

Following the data input process; administrators print ToxAccess chain

of custody forms using special paper supplied by RTL. Each printed

form features a unique test request label and specimen security seal.

The printed form will be signed with a water-resistant marker, such as

a blue or black ball-point pen (red color is not recommended since it

tends to rub off).

Print your own test request forms

with paper provided by RTL.

Only available with ToxAccess.

ToxAccess

™

Test Request Form

Laboratory Drug Test

Test Requisition Form

Tear off and provide to donor

11 000 3313 REV3

an Alere company.

AGENCY INFO:

Web Demo Agency

3650 Westwind Blvd

Santa Rosa, CA 95403

Phone: (800)255-2159

Fax:

COLLECTION INFORMATION:

Donor Name: John J. Doe

Requisition #: 000000000

Test Reason: RANDOM

Collection Date: 6/29/2011

Collection Time: 10:00 AM

LABORATORY STAFF ONLY

RECEIVED

AT LAB:

Seal Intact?

Received By (initial) Date

Labels Match?

Agency Name: Web Demo Agency

Address: 3650 Westwind Blvd.

City, State and Zip: Santa Rosa, CA 95403

Agency Phone: (800)255-2159

Agency Fax:

Agency Number: 600000

000000000

DONOR INFORMATION

Donor Name: John J. Doe

Donor Unique ID: 54321

Specimen Type: URINE

Specimen Temperature: 97F

Test Reason: RANDOM - 3

Tests Requested:

647 - Ethylglucuronide (EtG)

P08 - Screen 7 with Creatinine

I certify that this specimen was collected from the above person following established protocols, and the specimen has been properly sealed and labeled.

COLLECTOR VERIFICATION

Collector’s Signature Collector’s Name Collection TimeDate

Jim J. Smith 6/29/2011 10:00 AM

Donor’s Name Date

I certify that I provided my specimen to the collector and that I have not adulterated it in any manner. The specimen was sealed in my presence with a tamper-evident

seal. The information provided on this form and on the label affixed to the specimen container is correct. I authorize Redwood Toxicology Laboratory to perform the tests

listed and to release the results of this test to WEB DEMO AGENCY

DONOR CERTIFICATION

Donor’s Signature

John J. Doe 6/29/2011

 Yes  No  Yes  No

1. Tighten cap.

2. Place security seal across

the lid as shown.

3. Place patient I.D. label around

bottle as shown.

Label usage example

Security

Seal

Security Seal

0000 000 0

Req #: 000000000

Agency: 600000—Web Demo Agency

ID: 54321 John J. Doe

Collector: Jim J. Smith

Collected: 6/29/2010 10:00 AM

Tests: 647, P08

Donor’s Initials

Date:

Redwood Toxicology Laboratory // 3650 Westwind Blvd. Santa Rosa, CA 95403 | (800) 255-2159

6/29/2011

REFERENCE GUIDE // Specimen collection

ToxAccess

™

: Labeling Protocol

How to label specimens using the ToxAccess

™

forms

LABELING OVERVIEW

For customers taking advantage of the web-based ToxAccess

™

Collection Management solution. Please follow these labeling

instructions. Correctly labeled specimens will allow the laboratory

to process your specimens accurately and quickly.

LABELING PROCEDURE

1) Seal container—After the collection process is complete,

ensure the specimen container is tightly sealed.

2) Sign and date the form—The donor will certify that the speci-

men was collected following the appropriate procedures by

signing under the “Donor’s Signature” area. The collector will

also sign the form verifying that the specimen was collected

appropriately in the “Collector Verication” area.

3) Place security seal on the specimen bottle—Once the speci-

men has been veried by the donor and collector, the collector

will remove the security seal from the form and place it across

the top of the bottle. The donor will then initial security seal.

4) Place specimen label on the specimen bottle—Place

the specimen label around the body of the specimen bottle.

The label should lay over the ends of the security seal as

represented in the images to the right. Do not hand write any

tests on the label. Tests may only be ordered through the

ToxAccess program.

5) Package for shipping—After labeling and sealing the speci-

men tightly, place it into a RTL branded plastic baggie with

absorbent material. Ensure baggie is sealed. Store in a

secure area until the specimen is ready to be shipped to

the laboratory.

Laboratory Drug Test

Test Requisition Form

Tear off and provide to donor

11 000 3313 REV3

an Alere company.

AGENCY INFO:

Web Demo Agency

3650 Westwind Blvd

Santa Rosa, CA 95403

Phone: (800)255-2159

Fax:

COLLECTION INFORMATION:

Donor Name: John J. Doe

Requisition #: 000000000

Test Reason: RANDOM

Collection Date: 6/29/2011

Collection Time: 10:00 AM

LABORATORY STAFF ONLY

RECEIVED

AT LAB:

Seal Intact?

Received By (initial) Date

Labels Match?

Agency Name: Web Demo Agency

Address: 3650 Westwind Blvd.

City, State and Zip: Santa Rosa, CA 95403

Agency Phone: (800)255-2159

Agency Fax:

Agency Number: 600000

000000000

DONOR INFORMATION

Donor Name: John J. Doe

Donor Unique ID: 54321

Specimen Type: URINE

Specimen Temperature: 97F

Test Reason: RANDOM - 3

Tests Requested:

647 - Ethylglucuronide (EtG)

P08 - Screen 7 with Creatinine

I certify that this specimen was collected from the above person following established protocols, and the specimen has been properly sealed and labeled.

COLLECTOR VERIFICATION

Collector’s Signature Collector’s Name

Collection Time

Date

Jim J. Smith 6/29/2011

10:00 AM

Donor’s Name Date

I certify that I provided my specimen to the collector and that I have not adulterated it in any manner. The specimen was sealed in my presence with a tamper-evident

seal. The information provided on this form and on the label affixed to the specimen container is correct. I authorize Redwood

Toxicology Laboratory to perform the tests

listed and to release the results of this test to WEB DEMO AGENCY

DONOR CERTIFICATION

Donor’s Signature

John J. Doe 6/29/2011

 Yes  No  Yes  No

1. Tighten cap.

2. Place security seal across

the lid as shown.

3. Place patient I.D. label around

bottle as shown.

Label usage example

Security

Seal

Security Seal

000 000 00

Req #: 000000000

Agency: 600000—Web Demo Agency

ID: 54321 John J. Doe

Collector: Jim J. Smith

Collected: 6/29/2010 10:00 AM

Tests: 647, P08

Donor’s Initials

Date:

Redwood Toxicology Laboratory // 3650 Westwind Blvd. Santa Rosa, CA 95403 | (800) 255-2159

6/29/2011

Donor signature and collector signature lines.

Security seal placed

across the specimen cap.

Place specimen label

over the security seal.

Place urine specimen into the plastic baggie.

specimen collection

Option 2: Urine Test Request Form

Multi-part urine test requisition form overview

[X] P08/1108 Screen 8

[ ] 098 Oxycontin ($5.00)

[ ] Other: Collector: _________

–––––––––––––––––––––––––––––––––––––––––––––––––––––––––

GC/MS Confirm ______________________

(Specify Drug(s))

Patient ID: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Collection Date _ ________

Req#

777777

P.O. Box 5680 Santa Rosa, CA 95403 // Laboratory phone: 800-255-2159

Marijuana

John Smith

10/20/07

A completed chain of custody labelAn initialed security seal

REDWOOD TOXICOLOGY LABORATORY

Security Seal

(Donor’s Initials)

URINE TEST REQUISITIONS

FORMS (RF2/RF3)

1) Agency Information—Contains the agency’s account

information including: account number, name, address,

phone and fax numbers.

2) Urine Drug Screen Type—Indicates multiple boxes with

corresponding reasons for testing the donor

. Specimen

temperature is also noted in this area.

3) Security Seal—Peel off label secures specimen container.

4) Specimen Label—The collector will select the a laboratory

test from the available options or specify the desired test in the

“other” eld. Collector will then enter the donor’s ID, collector

initials and collection date onto the label. Ensure the label is

placed horizontally across the specimen bottle.

5) Donor Information & Collector Verication—Donor informa-

tion will be located in this section. Signature area for Donor and

Collector, verifying specimen collected and labeled correctly.

6) Receiving (lab only)—This section is to be lled out by

Redwood Toxicology Laboratory personnel only.

* Donor identication (Name, ID Number, Etc.) will appear on the nal report.

Donor ID must be written on the Patient ID line of the label. It is recommended

that the donor’s Social Security Number not be writen on the Patient ID line.

9999

Demo Agency

3650 Westwind Blvd.

Santa Rosa, CA 95403

Phone: 707-577-7959

[ ] P08/1108 Screen 8

[ ] 098 Oxycontin ($5.00)

[ ] Other: Collector: _________

–––––––––––––––––––––––––––––––––––––––––––––––––––––––––

GC/MS Confirm ______________________

(Specify Drug(s))

Patient ID: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Collection Date _ ________

Req#

777777

Urine Test Request Form

Urine Test Requisition forms will be provided when ordering urine tests

through the lab. The Urine Test Requisition Forms (RF2 and RF3) are

chain of custody labels with either 2 or 3 part carbon copies.

The forms should be completed with a water-resistant marker, such

as a blue or black ball point pen (red color is not recommended since it

tends to rub off).

For training or questions, please contact:

Toxicology Support Services

Phone: 800.255.2159, press option 5.

Fax: 707.577.0365

Email: clientservices@redwoodtoxicology.com

Web: https://www.redwoodtoxicology.com/services/online_reporting

REFERENCE GUIDE // Specimen collection

Urine Test Request Form (RF2/RF3): Labeling Guide

How to label specimens using the RF2/RF3 multi-part forms

LABELING OVERVIEW

The following procedure gives you an easy to follow guide to ensure

your specimens are labeled correctly using the RF2/RF3 test request

forms. Correctly labeled specimens will allow the laboratory to pro-

cess your specimens accurately and quickly.

LABELING PROCEDURE

1) Seal container—After the collection process is complete,

ensure the specimen container is tightly sealed.

2) Sign and date the form—The donor will certify that the speci-

men was collected following the appropriate procedures by

signing under the “Donor’s Signature” area. The collector will

also sign the form verifying that the specimen was collected

appropriately in the “Collector Verication” area.

3) Place security seal on the specimen bottle—Once the speci-

men has been veried by the donor and collector, the collector

will remove the security seal from the form and place it across

the top of the bottle. The donor will then initial security seal.

4) Indicate the test(s) to be performed—Indicate the following

information in the appropriate area of the specimen label:

• Please indicate which test(s) or panel is to be ordered by

placing a check mark in the appropriate box or by writing the

test on the “other” line. Tests to be run by GC/MS or LC/MS/

MS must be written on the GC/MS request line.

• Donor identication, collection date, and collector.

5) Place specimen label on the specimen bottle—Place the

specimen label around the body of the specimen bottle. The

label should lay over the ends of the security seal as represent-

able in the images to the right.

6) Package for shipping—After labeling and sealing the

specimen tightly, place it into a RTL branded plastic baggie

with absorbent material. Ensure baggie is sealed. Store in a

secure area until the specimen is ready to be shipped to

the laboratory. The test request form (chain of custody form)

must be placed in the same shipping bag as the specimen.

If the form is sent in a separate bag, it will not be matched to

the specimen.

Chain of Custody:

Yes No

URINE DRUG SCREEN TYPE

Pre-Employment

Post-Accident

Periodic Medical

Reasonable Cause

Random

Baseline

Other

Specimen temperature within range:

° ° ° °Yes, 90 -100 F (32 -38 C) No, record specimen temperature here

DONOR CERTIFICATION (To be completed by donor)

I certify, that I provided my urine specimen to the collector and that I have not adulterated it in any manner. The specimen was sealed in my presence with a tamper-

evident seal and the information provided on this form and on the label affixed to the specimen tube is correct. I authorize Redwood Toxicology Laboratory to perform

the tests listed and to release the results of this test to:

Donor’s name as listed above (please print): Donor’s ID (SSN OR DL #):

Donor’s signature:

Collector’s name as listed above (please print): Collection site phone:

COLLECTOR VERIFICATION (To be completed by collection station personnel)

I certify, that this specimen was collected from the above person following established protocols, and the specimen has been properly sealed and labeled.

Collector’s signature:

Date and time of collection:

/ /

RECEIVING (To be completed by laboratory):

Seal intact?

Yes No

Labels match?

Yes No

Specimen received by: Date received:

LABELING AND TESTS ORDERED

Label usage example

1. Tighten cap.

2. Place security seal across

lid as shown.

3. Place patient I.D. label around

bottle as shown.



PEEL OFF



PEEL OFF

REDWOOD TOXICOLOGY LABORATORY

Security Seal

(Donor’s Initials)

Redwood Toxicology Laboratory // P.O. Box 5680 Santa Rosa, CA 95402 // Laboratory phone: 800-255-2159

Security

Seal

3650 Westwind Blvd. Santa Rosa, CA 95403 // Laboratory: 800-255-2159 // Screening Devices: 877-444-0049

Local: 707-577-7959 // Fax: 707-577-0365 // www.redwoodtoxicology.com

11 000 3206 REV1

URINE TEST REQUISITION

Urine Drug Test

laboratory test requisition

Donor signature and Collector Signature lines.

Security seal placed

across the specimen cap.

Place specimen label

over the security seal.

Place urine specimen into the plastic baggie.

specimen collection

Option 3: Oral Fluid Specimens

Multi-part oral fluid test requisition form overview

Oral Fluid Test Request Form

Chain of Custody:

Yes No

ORAL FLUID DRUG SCREEN TYPE

Pre-Employment

Post-Accident

Periodic Medical

Reasonable Cause

Random

Baseline

Other

Collector’s name as listed above (please print): Collection site phone:

COLLECTOR VERIFICATION

(To be completed by collection station personnel)

I certify that this specimen was collected from the above person following collection site protocols, and the specimen has been properly sealed and labeled.

Collector’s signature:

Date and time of collection:

/ /

RECEIVING

(To be completed by laboratory):

Seal intact?

Yes No

Labels match?

Yes No

Specimen received by: Date received:

3650 Westwind Blvd. Santa Rosa, CA 95403 // Laboratory: 800-255-2159 // Screening Devices: 877-444-0049

Local: 707-577-7959 // Fax: 707-577-0365 // www.redwoodtoxicology.com

11 000 3164 REV4

2-PART FORM 1 of 2 LABORATORY COPY

DONOR CERTIFICATION

(To be completed by donor)

I certify that I provided my oral fluid specimen to the collector and that I have not adulterated it in any manner. The specimen was sealed in my presence with a tamper-

evident seal and the information provided on this form and on the label affixed to the specimen tube is correct. I authorize Redwood Toxicology Laboratory to perform

the tests listed and to release the results of this test to:

Donor’s name as listed above (please print): Donor’s ID (SSN OR DL #):

Donor’s signature:

99999 - ANY AGENCY

ORAL FLUID SPECIMEN LABELING

10000 00001

ORAL FLUID TEST REQUISITION

Oral Fluid Drug Test

laboratory test requisition

99999

ANY AGENCY

1111 Anywhere Ln.

Suite 100

Anywhere, CA 95403

Test Panel: 9003 (AMP, COC, m-AMP, OPI, PCP, THC)

GC/MS Confirm:_____________________________________

Donor Initials

Date Collected

Security Seal

REDWOOD TOXICOLOGY LABORATORY

NOTE: Place the center of this

label over the cap of the screening

device or collection device.

10000 00001

LAB BASED COLLECTOR INSTRUCTIONS:

Ensure red cap is tightly fastened. Place the center

of the security seal over the top of the red cap. Be

sure that the barcode runs lengthwise/vertically on

the collection tube.

RTL-Oral Labeling Example

0000000

Security seal

with barcode

APPLY AS SHOWN

Donor initials

Date collected

ON-SITE SCREENING DEVICE EXAMPLE:

Ensure the screw cap is tightly fastened. Write the drug(s) to be

confirmed on the GC/MS confirm line above. Place the center

of the security seal over the top of the cap. Be sure that the

barcode runs lengthwise/vertically on the collection tube.

On-site Screening Device

Security Seal

0000000

Security seal

with barcode

APPLY AS SHOWN

Donor Initials

Date Collected

Security Seal

REDWOOD TOXICOLOGY LABORATORY

10000

00001

10/20/09

Security Seal & Barcode—

A completed oral uid label

1A: Lab Tests—Agency specic drug test panel listed

1B: On-site Devices—List drug(s)

to be conrmed for your

on-site screening device

ORAL FLUID SPECIMEN

TEST REQUISITIONS

1) Lab Test Request Information—Lists agency specic test

panel information. Test(s) to be performed will be printed on the

top of the form. Indicate the panel and/or additional test to be

run by placing a check mark next to the panel or test descrip-

tion. (Diagram 1A)

On-site Device Test Request Information—Use the “GC/MS

Conrm” line to list the presumptive positive drug(s) you want

to conrm through the lab. Please note: panel cannot be run on

on-site devices. (Diagram 1B)

Check one of the boxes for why the donor is being tested in

the green box below the test request information.

2) Security Seal with barcode—Peel off label secures

specimen container.

3) Donor Information & Collector Verication—Donor informa-

tion will be located in this section. Signature area for Donor and

Collector, verifying specimen collected and labeled correctly.

4) Receiving (lab only)—This section is to be lled out by

Redwood Toxicology Laboratory personnel only.

Oral Fluid Test Requisition forms will be provided when ordering oral

uid tests through the lab. These forms are different from the Urine

Test Requisition forms and are therefore not interchangeable. Please

send the appropriate form with the specimen. If the laboratory copy

of this form is not sent with the specimen, the lab will be unable to

process the specimen. This form is a two-part carbon copy.

Ensure that the security seal, dates and appropriate signatures are

completed by the donor and the collector.

The forms should be completed with a water-resistant marker, such

as a blue or black ball point pen (red color is not recommended since it

tends to rub off).

For training or questions, please contact:

Toxicology Support Services

Phone: 800.255.2159, press option 5.

Fax: 707.577.0365

Email: clientservices@redwoodtoxicology.com

Web: https://www.redwoodtoxicology.com/services/online_reporting

REFERENCE GUIDE // Specimen collection

Chain of Custody:

Yes No

ORAL FLUID DRUG SCREEN TYPE

Pre-Employment

Post-Accident

Periodic Medical

Reasonable Cause

Random

Baseline

Other

Collector’s name as listed above (please print): Collection site phone:

COLLECTOR VERIFICATION (To be completed by collection station personnel)

I certify that this specimen was collected from the above person following collection site protocols, and the specimen has been properly sealed and labeled.

Collector’s signature:

Date and time of collection:

/ /

RECEIVING (To be completed by laboratory):

Seal intact?

Yes No

Labels match?

Yes No

Specimen received by: Date received:

3650 Westwind Blvd. Santa Rosa, CA 95403 // Laboratory: 800-255-2159 // Screening Devices: 877-444-0049

Local: 707-577-7959 // Fax: 707-577-0365 // www.redwoodtoxicology.com

11 000 3164 REV4

2-PART FORM 1 of 2 LABORATORY COPY

DONOR CERTIFICATION (To be completed by donor)

I certify that I provided my oral fluid specimen to the collector and that I have not adulterated it in any manner. The specimen was sealed in my presence with a tamper-

evident seal and the information provided on this form and on the label affixed to the specimen tube is correct. I authorize Redwood Toxicology Laboratory to perform

the tests listed and to release the results of this test to:

Donor’s name as listed above (please print): Donor’s ID (SSN OR DL #):

Donor’s signature:

99999 - ANY AGENCY

ORAL FLUID SPECIMEN LABELING

10000 00001

ORAL FLUID TEST REQUISITION

Oral Fluid Drug Test

laboratory test requisition

99999

ANY AGENCY

1111 Anywhere Ln.

Suite 100

Anywhere, CA 95403

Test Panel: 9003 (AMP, COC, m-AMP, OPI, PCP, THC)

GC/MS Confirm:_____________________________________

Donor Initials

Date Collected

Security Seal

REDWOOD TOXICOLOGY LABORATORY

NOTE: Place the center of this

label over the cap of the screening

device or collection device.

10000 00001

LAB BASED COLLECTOR INSTRUCTIONS:

Ensure red cap is tightly fastened. Place the center

of the security seal over the top of the red cap. Be

sure that the barcode runs lengthwise/vertically on

the collection tube.

RTL-Oral Labeling Example

0000000

Security seal

with barcode

APPLY AS SHOWN

Donor initials

Date collected

ON-SITE SCREENING DEVICE EXAMPLE:

Ensure the screw cap is tightly fastened. Write the drug(s) to be

confirmed on the GC/MS confirm line above. Place the center

of the security seal over the top of the cap. Be sure that the

barcode runs lengthwise/vertically on the collection tube.

On-site Screening Device

Security Seal

0000000

Security seal

with barcode

APPLY AS SHOWN

Oral Fluid Test Request Form: Labeling Protocol

How to label your specimens using the oral fluid multi-part forms

LABELING OVERVIEW

The following procedure gives you an easy to follow guide to ensure

your specimens are labeled correctly using the oral uid test request

forms. Correctly labeled specimens will allow the laboratory to pro-

cess your specimens accurately and quickly.

LABELING PROCEDURE

1) Seal container—After the collection process is complete,

ensure the specimen container is tightly sealed.

2) Indicate the test to be performed— Indicate the test to be

performed at the top of the form. For on-site devices, indicate

the drug to be conrmed on the “GC/MS Conrm” line.

3) Sign and date the form— The donor will enter his/her signa-

ture, printed name, date collected and donor ID (SSN or DL#

if required by agency). The collector will verify the information

provided by the donor and validate that the specimen was col-

lected correctly.

4) Place security seal on the collection tube—Once the speci-

men has been veried by the donor and collector, the collector

will remove the security seal from the form and place it across

the top of the collection tube. NOTE: The barcode and number

are required for processing the oral uid specimen. Ensure that

the barcode and number are unobscured and clearly visible on

the side of the collection tube.

5) Package for shipping—After labeling and sealing the speci-

men tightly, place it into a RTL branded plastic baggie with

absorbent material. Ensure baggie is sealed. Store in a

secure area until the specimen is ready to be shipped to

the laboratory.

00000 00000

Donor signature and collector signature lines.

Security seal placed across the collection

tubes cap. Ensure barcode is clearly visible

from side of tube.

00000 00000

Place oral uid specimen into the plastic baggie.

IMPORTANT LABELING INFORMATION

The oral uid sample cannot be processed without the

information supplied on the test request form. If the test

request form does not accompany the specimen, testing

will be delayed.

specimen collection

Packaging Protocol: Shipping to Lab

Urine & oral fluid specimen shipping instructions

URINE & SALIVA SHIPPING PRINCIPLES

The following is a brief description of how to label and send your

urine specimen in to the laboratory for testing:

All on-site device samples & lab

urine samples: After labeling and

sealing the specimen tightly, place it

into a RTL branded plastic baggie with

absorbent material. Ensure baggie is

sealed. Store in a secure area until the

specimen is ready to be shipped to

the laboratory.

Lab oral uid samples: After labeling

and sealing the specimen tightly, place

the transport tube into the original outer

packaging provided with the collector

device. Ensure baggie is sealed. Store

in a secure area until the specimen is

ready to be shipped to the laboratory.

Oral uid samples must be received by

the lab within 7 days of collection. Speci-

mens should be refrigerated until shipped.

The test request form (chain of custody form) must be placed in

the same shipping bag as the specimen. If the form is sent in a

separate bag, it will not be matched to the specimen.

SPECIMEN SHIPPING

Your account has been set up with one of the following specimen

shipping methods:

EXPRESS DELIVERY SERVICE—5 OR MORE SPECIMENS

Please use the packaging materials and labels that are included with

your lab supplies. Instructions for packing and shipping specimens

will be enclosed with your supply shipment.

U.S. POSTAL SERVICE—LESS THAN 5 SPECIMENS

Security

Seal

Place urine specimen into

the plastic baggie.

Place saliva specimen into

the plastic baggie.

5 or more specimens: Use express delivery package

Security

Seal

Security

Seal

Security

Seal

Security

Seal

Security

Seal

LABORATORY SHIPPING PACK

Supplied by RTL

Fewer than 5 specimens: Use USPS Pre-paid Mailer Box

White Oral Fluid Box

Security

Seal

Security

Seal

Brown Urine Box

Please use the pre-paid U.S. mailer boxes. Do not mix oral uid

and urine specimens in the same postage-paid mailer box! Per U.S.

Postal Service regulations, use the box provided specically for

each type of test as indicated on the pre-paid label.

SHIPPING/PICKUP

If you need help with scheduling an express delivery pick-up,

please call Toxicology Support Services at 800.255.2159.

(See page 57 for additional information.)

Supplies Re-ordering: Lab supply re-ordering is available to existing

clients with an account number. RTL offers two convenient methods for

re-ordering drug testing supplies:

Email: supplies@redwoodtoxicology.com

Web: https://www.redwoodtoxicology.com/resources/supply_form

Please order supplies through RTL ONLY. Do not ask drivers for labels or bags since

RTL provides its clients with custom supplies. The supplies have specialized routing

information that drivers do not have access to. This information is also important for

billing purposes.

REFERENCE GUIDE // Specimen collection

IMPORTANT PACKAGING NOTICE

FEDERAL LAW REQUIRES THAT SPECIMENS BE PACKAGED

IN BAGS WITH ABSORBENT MATERIAL.

PLEASE BE SURE TO FASTEN THE LID OF THE BOTTLE

TIGHTLY. LEAVE THE ABSORBENT MATERIAL IN THE BAG

WITH THE SPECIMEN BOTTLE.

LEAKY SPECIMENS MAY BE RETURNED TO YOUR AGENCY

BY YOUR SHIPPING PROVIDER.

IF YOU REQUIRE TRAINING ON SPECIMEN COLLECTION

PROCEDURES, PLEASE CONTACT RTL’S CLIENT SERVICES

DEPARTMENT:

Phone: 800.255.2159

Fax: 707.577.0365

Email: clientservices@redwoodtoxicology.com

THANK YOU.

Result reporting &

collection management

Redwood Toxicology Laboratory’s objective is to provide its clients with all the tools possible

to help deter and prevent drug abuse. Reliable and useful toxicology reports are essential to

this objective. Toxicology results are delivered in the following formats:

Web-Result Reporting & Collection Management—RTL’s ToxAccess

™

site

provides a secure and complete solution for tracking, managing and printing your drug test

reports and chain of custody forms.

• Fast collections—print chain of custody forms using a simple, step by step process

on a single screen

• Accurate data—no more hand-written labels and laboratory data entry errors

• Real-time tracking—track specimens from collection to reporting; includes COC

scans with donor, collector and lab receiving signatures

• Program management—schedule tests, generate collection rosters and

view no-shows

• Powerful reporting—pending specimens, drug statistics, donor summaries

and more

Mail/Fax Reports—RTL offers reporting solutions via U.S. mail or facsimile. Please

indicate your preferred method at the time of account set-up.

REFERENCE GUIDE // Result reporting

result reporting

RTL’s reporting website provides a secure and convenient solution

for viewing, managing and printing your toxicology results. We have

expanded the collection features of ToxAccess

™

to create a more

comprehensive drug test management solution for our clients.

These productivity enhancements offer the following features,

advantages and benets:

FEATURES

FAST COLLECTIONS. Now your drug test collections can be

performed quicker, easier and more efciently because collections

are performed on a single screen in just a few simple steps. All

donor information is saved and stored in the website so you only

have to enter it once. (With traditional chain of custody forms you

have to ll out the donor information time and time again.)

CLEAR, ACCURATE DATA . The information you input is

automatically transferred into RTL’s laboratory information system,

eliminating both the errors caused by hand-written labels and

laboratory data entry errors.

COMPLETE, REAL-TIME TRACKING. Track specimens

every step of the way—from collection to reporting—in real time,

24/7. These steps include:

• Scheduled for testing—schedule donor groups for testing on

a particular date (Optional)

• Collected—the specimen has been collected

• Shipped—the specimen has been shipped to the lab; you

can even enter your FedEx tracking number to track the

shipment (Optional)

• Received by lab—the specimen has been received by the lab

and is being tested

• COC scans—view, print and manage signed COC’s

• Reported—the specimen has been reported

CONVENIENT, IN-CONTROL PROGRAM MANAGEMENT.

Get the big picture by organizing donors into specic groups and then

schedule them for testing utilizing a monthly calendar. View groups

scheduled for each day, the collection roster for the current date,

and no-show lists.

POWERFUL, USABLE REPORTING. Generate, and within

seconds, put at your ngertips a complete listing of a donor’s test

results, pending specimens, drug statistics, no shows and more.

TOTAL, DIGITAL DATA COLLECTION. ToxAccess

™

is a complete

donor data management solution that captures all the following infor-

mation on each donor and stores it electronically:

• Name (First, M.I., Last) • Birth Date

• Sex • Intake Date

• Counselor/Probation Ofcer • Location/Agency

• Default Test/Panel • Donor Group

• Status (Active/Inactive) • Special Instructions

• Unique Identier (e.g. SSN, Employee ID)

ToxAccess

™

Result Reporting & Collection Management

Figure 1: Result Summary &

Specimen Search

View more information at: www.redwoodtoxioclogy.com.

To request access, training or support please contact:

Information Technology Department (IT)

Phone: 800.255.2159, ext. 34311

Email: helpdesk@redwoodtoxicology.com

REFERENCE GUIDE // Result reporting

Sample Final Toxicology Report

Standard Result Reporting

Toxicology results





























































 















  

  

  

  

  



  

 

LC/MS/MS



 

LC/MS/MS





  

 

LC/MS/MS



 

LC/MS/MS



  





  

















GC-FID - Gas Chromatography - Flame Ionization Detector

GC/MS - Gas Chromatography / Mass Spectrometry

















FINAL REPORT

Standard reporting from Redwood Toxicology Laboratory includes

toxicology reports which are delivered via fax, mail or the internet

(ToxAccess

™

). The combination of RTL’s leading testing methods and

chain of custody documentation guarantees legal defensibility.

For more information on specic drugs, including; classications,

metabolism, general abuse information and methods of analysis,

please refer to the Drug Information section, beginning on page 37.

For more information on how to read creatinine levels, please see

page 56 within the Drug Information section.

FINAL REPORT OVERVIEW

1) Donor and agency information—Contains client, donor/

patient and collection information.

2) Final result summary—Features immediate result status,

including a list of any detected analytes or if “None detected.”

3) Test ordered—Lists the tests that were ordered by the client,

and features test panel code information.

4) Drug test overview—Shows test results for each drug, test

methodology and cutoff.

5) Specimen comments—Comments may accompany labora-

tory results and ndings.

Drug information

Included herein is specic drug information including classications, metabolism,

general abuse information and methods of analysis.

This section will assist you in understanding specic drugs of abuse and how

Redwood Toxicology Laboratory’s wide range of urine and oral uid screening

programs test for each drug.

REFERENCE GUIDE // Drug information

drug information

CLASSIFICATION

Common alcohols are a group of compounds whose structures

include a hydroxyl group attached to a carbon chain of varying

length. The number of carbons determine both the name and indi-

vidual properties. The common alcohols are designated as primary,

secondary, or tertiary depending on the number of carbons that are

attached to the carbon bearing the hydroxyl group. Examples of

primary alcohols include methanol and ethanol, which contain one

and two carbons respectively. Secondary alcohols include isopropa-

nol, a three carbon alcohol. Tertiary or four carbon alcohols include

N-butanol. The information contained herein will deal primarily with

ethanol, or beverage alcohol.

METABOLISM

Ethanol is a small molecule which is readily soluble in water and

penetrates membranes throughout the GI tract, including the mouth,

stomach and small intestine. Rate of absorption varies greatly due

to factors such as type of beverage ingested, quantity of food in the

stomach, frequency of gastric emptying, drinking pattern, etc. The

average time to peak absorption is usually 30 to 60 minutes, but

may range from 15 minutes to 3 hours. Approximately 95% of an

ingested dose of ethanol

is metabolized by liver

enzymes, principally alco-

hol dehydrogenase, with

the remainder eliminated

unchanged in the urine,

breath, sweat, and feces.

Ethanol is metabolized to

acetaldehyde and then to a nal end product of acetic acid. Distribu-

tion of alcohol throughout the body occurs via the blood supply and

since ethanol is hydrophilic (strong afnity for water), it will diffuse

into body tissue or uid compartments such as urine, saliva, plasma,

etc. Since plasma or serum have a higher percentage of water by

unit volume, it will have a higher ethanol concentration than whole

blood. A wide range of elimination rates exists, however, ethanol is

typically metabolized at approximately .015-.018 gm/dL per hour in

healthy individuals. Therefore, the detection time of ethanol in body

uids is dose dependent.

ABUSE

Ethanol is the most widely consumed drug in society and is

generally consumed socially. Ethanol is predominantly consumed

as fermented or distilled beverages and is also a component of

mouthwashes, medicinal, and industrial products. Fermented

beverages such as beers and ales contain 3-6% ethanol by volume,

wines contain 10-12%, and distilled spirits contain 20-60% ethanol.

Acute ingestion of ethanol typically leads to progressive stages of

effects depending upon the amount consumed. With low to moder-

ate consumption, a person may initially experience mild euphoria,

sociability, decreased inhibitions and the beginning of sensory-motor

impairment. With increased consumption the effects can progress

to emotional instability, loss of perception, memory and comprehen-

sion in addition to decreased response time and slurred speech,

staggered gait and loss of muscular coordination. Finally, excessive

acute ethanol consumption can lead to impaired consciousness,

respiratory depression, coma and death. Chronic ethanol abuse can

result in multi-organ pathological effects. These can include cirrho-

sis of the liver, acute and chronic gastritis, pancreatitis, cardiomy-

opathy and various neurological and metabolic disorders.

METHODS OF ANALYSIS

One of the most widely used techniques for detecting alcohols

in urine include enzyme assay utilizing alcohol dehydrogenase.

The method is very sensitive and specic in that methanol and

acetone are not detected. However, longer chain alcohols such as

isopropanol may be detected. This is appropriate for clinical set-

tings, however, for forensic purposes, a secondary more denitive

conrmation method is required. Gas chromatographic methods,

either direct injection or headspace sampling, with the incorporation

of an internal standard offer very accurate and precise quantitation

of ethyl alcohol, in addition to identifying other volatile compounds

such as methanol, acetone, isopropanol. Denitive identication of

ethanol and accurate quantitation are required when relating a blood

alcohol concentration to a particular level of impairment. This is

especially critical when the blood alcohol concentration is to be used

as evidence to determine whether grounds exist for presumption

of impairment.

Alcohol

Drug information

REFERENCE GUIDE // Drug information

CLASSIFICATION

Amphetamine and methamphetamine are Schedule II drugs included

in a group of chemicals called sympathomimetic amines, which

contain a phenethylamine chemical nucleus. Sympathomimetic

amines mimic the effects of the endogenous neurotransmitters such

as epinephrine (adrenaline), norepinephrine (noradrenaline) and

dopamine. Also included in this group are various over-the-counter

drugs such as phenylpropanolamine, pseudoephedrine, ephedrine

as well as the Schedule I drug methylenedioxymethamphetamine

(MDMA or Ecstasy). The amphetamines are powerful central

nervous system stimulants and can be taken orally, intravenously,

snorted or smoked. Methamphetamine is one of the most commonly

abused drugs in the Western United States. It is readily synthesized,

with ephedrine being used as the primary precursor.

METABOLISM

Amphetamines are rapidly absorbed from the gastrointestinal

tract and are either deactivated by the liver or excreted unchanged

into the urine. Methamphetamine is excreted primarily unchanged

(44%) and some of the drug (6%) is metabolized and excreted as

amphetamine. Amphetamine is also excreted largely unchanged

(30%) with 20-25% being metabolized to deaminated (hippuric and

benzoic acids) and hydroxylated metabolites. The elimination rate of

amphetamines varies with the pH of the urine, as at low pH the

excretion of unchanged drug increases, while at high pH the excre-

tion of unchanged drug decreases. Within a few hours after any

type of administration, amphetamines appear in the urine and can

typically be detected for up to 72-96 hours.

ABUSE

Amphetamines, particularly methamphetamine, are among the

most popular drugs of abuse. Common street names include speed,

crank, crystal, meth, and ice. Ice and crystal meth are crystals

of methamphetamine HCL. Snot and glue are oils formed from

methamphetamine free base and baking soda. Methamphetamine is

frequently smoked in a glass pipe as it is easily volatilized into a gas

that is inhaled. Although the ice form is primarily found in Hawaii and

the western United States, it has gained the most notoriety mainly

due to the fact that it is >90% pure methamphetamine HCL and its

effects are rapid, intense, and of longer duration than other forms of

methamphetamine.

The signs and symptoms

associated with the abuse

of methamphetamine

depend upon the amount

used and the duration of

use. With infrequent or

low dose use, a person

may experience euphoria,

lowered anxiety, talkativeness, decreased appetite, increased sexual

arousal, increased alertness, and decreased fatigue. Physiologically

there can be increased heart rate and blood pressure. With increased

dose or prolonged abuse (either binge or chronic), an individual may

experience a set of secondary effects that can include increased

anxiety, irritability, aggressiveness, paranoia and hypersexuality.

Physiological effects can include dilated pupils, dry mouth, hippus,

increased body temperature and tachycardia. In overdose situa-

tions, a person may experience hallucinations, coma or death. Crash

symptoms typically follow binge abuse of methamphetamine. This

phase is marked by extreme fatigue, depression, mental exhaustion

and prolonged periods of sleep.

METHODS OF ANALYSIS

Immunoassays are common methods for detecting amphetamines

in urine. Enzyme immunoassay (EIA) is the most commonly used

immunoassay that detects both methamphetamine and amphet-

amine to varying degrees of sensitivity and specicity. However,

it will cross-react with several over-the-counter cold and diet

preparations which indicates the importance of conrmatory test-

ing for samples screened presumptively positive by immunoassay

tests. Gas chromatography/mass spectrometry (GC/MS) and liquid

chromatography/tandem mass spectrometry (LC/MS/MS) provides

reliably sensitive and specic solutions as conrmatory methods.

Amphetamines

Drug information

drug information

CLASSIFICATION

Barbiturates are a class of drugs capable of producing CNS

depression, and depending upon the drug and dosage, may produce

varying states of sedation or hypnosis and are thus classied as

sedative/hypnotics. They are further categorized according to the

duration of their effects, ranging from ultra-short acting, short act-

ing, intermediate acting, and long acting. Duration of effects lasts

anywhere from 15 minutes for the ultra-short acting barbiturates to

a day or more for the long acting drugs. Short and intermediate act-

ing barbiturates include amobarbital, butalbital, pentobarbital, and

secobarbital, while the long acting barbiturates include phenobarbi-

tal. Other common therapeutic indications for use are as anticonvul-

sants and for migraine headaches.

METABOLISM

Barbiturates are distributed throughout the body with highest

concentrations occurring in the brain, liver and kidneys. In general,

duration of action is dependent upon lipid solubility and extent of

protein binding with the short acting barbiturates showing the most

lipid solubility and percentage of protein binding. The short and

intermediate acting

barbiturates are nearly

entirely metabolized by

the liver and excreted

in the urine, while 25-

50% of a dose of a long

acting barbiturate is

excreted as unchanged

drug. The half-life is variable with short acting barbiturates being

detectable in urine for 24 hours and the long acting drugs detectable

for 2-3 weeks following ingestion.

ABUSE

The most common detected barbiturates are butalbital and pheno-

barbital. Butalbital is routinely prescribed for migraine and muscle

relaxation while phenobarbital is primarily prescribed for seizure

disorders. Trade and street names of some common barbiturates

are as indicated below.

Chemical Name Trade Name Street Name

Amobarbital Amytal Yellow Jackets

Butalbital Fiorinal Blue Devils

Secobarbital Seconal Reds

Phenobarbital Luminal Downers, Goofballs

Chronic abuse leads to tolerance, and abrupt discontinuance of use

can induce a life-threatening withdrawal syndrome that can result

in seizures.

METHODS OF ANALYSIS

Immunoassays readily detect barbiturates as a class of drugs.

Specic barbiturate identication can be accomplished by

utilizing conrmatory methods such as gas chromatography/

mass spectrometry (GC/MS) and liquid chromatography/tandem

mass spectrometry (LC/MS/MS).

Barbiturates

Drug information

REFERENCE GUIDE // Drug information

CLASSIFICATION

The benzodiazepines are a class of drugs primarily classied as anti-

anxiety, sedatives, or hypnotics. All contain a benzene ring fused to a

7-membered diazepine ring, hence the term benzodiazepine. Various

modications and substitutions of the ring structure yield compounds

of similar activities. The clinical effects of these drugs result from

actions on the central nervous system and these effects include

sedation, hypnosis, muscle relaxation, and anticonvulsant activity.

METABOLISM

The benzodiazepines are well absorbed after oral administration and

are rapidly distributed throughout the body. They are extensively

metabolized by the liver, and in general, slowly excreted in the urine

as pharmacologically inactive conjugated metabolites. Some metabo-

lites may possess some pharmacological activity of their own, thus

displaying the “next day” effects of some benzodiazepines. Oxazepam

is a common urinary metabolite of several benzodiazepines such as

diazepam and temazepam. Duration of detectability in urine is varied.

Ingestion of therapeutic dosages may be detectable for 1-3 days

while extended usage over a period of months or years can extend

excretion times up to 4-6 weeks after cessation of use (depends on

dosage & benzodiazepine).

ABUSE

The benzodiazepines are considered one of the most widely pre-

scribed drugs in the United States, thus leading to its widespread

abuse. Diazepam (Valium

) and alprazolam (Xanax

) are two of the

most widely abused of the benzodiazepines. Many abusers will

attempt to accentuate the effects of benzodiazepines by the

concomitant use of alcohol or other CNS depressant drugs. As a

result, benzodiazepines are involved in approximately one third of all

drug self induced poisonings. Other commonly abused benzodiaz-

epines are chlordiazepoxide, urazepam, clonazepam, and lorazepam.

Prolonged high doses of benzodiazepines can cause dependency and

a withdrawal syndrome may occur following abrupt cessation of use.

METHODS OF ANALYSIS

There are many problems associated with a comprehensive approach

to the analysis of the benzodiazepines. The benzodiazepines are a

very diverse and complex group of compounds which are extensively

metabolized in urine. For this reason, it is not always possible to

determine the parent drug with urine testing. In addition, dosage

levels and half-life varies substantially between the benzodiazepines

affecting the ability to detect therapeutic use of some benzodi-

azepines. Therefore, the

analytical detection limits

may preclude the detection

of therapeutic use.

The most common analytical

methods to screen for the

presence of benzodiazepines

in urine are the immunoas-

say methods such as enzyme immunoassay (EIA). The immunoassay

methods are class specic in that they detect oxazepam, a common

metabolite of many benzodiazepines. However, many other structur-

ally similar benzodiazepines may also be detected.

While immunoassay cross-reactivity to non-benzodiazepine

compounds is extremely rare, most immunoassay manufacturers

recommend that positive results be conrmed by alternate specic

analytical method such as gas chromatography/mass spectrometry

(GC/MS) or liquid chromatography/tandem mass spectrometry

(LC/MS/MS). Most routine conrmation methods are targeted to

detect the group of benzodiazepines which share a common meta-

bolic pathway and metabolize to nordiazepam and oxazepam thus

making these methods class specic. However, common benzodi-

azepines such as alprazolam (Xanax

), lorazepam (Ativan

), and

clonazepam (Klonopin

) do not share this metabolic pathway and

must be conrmed by specic techniques, such as GC/MS or LC/MS/

MS. It is essential to understand the advantages and limitations of

the various laboratory analytical methods to ensure proper detection

of benzodiazepines. If a case history indicates the use of a particular

benzodiazepine, then a method must be chosen which will have the

necessary sensitivity and specicity to identify the drug of interest.

Benzodiazepines

Drug information

Chemical and trade names are as follows:

Chemical Name Trade Name

Alprazolam Xanax

Chlordiazepoxide Librium

Clonazepam Klonopin

Clorazepate Tranxene

Diazepam Valium

Flunitrazepam Rohypnol

Flurazepam Dalmane

Lorazepam Ativan

Midazolam Versed

Oxazepam Serax

Prazepam Centrax

Temazepam Restoril

Triazolam Halcion

drug information

CLASSIFICATION

Buprenorphine (Suboxone, Subutex) is a semi-synthetic thebaine

derivative that has both analgesic and opioid antagonist proper-

ties. As an analgesic, buprenorphine is approximately 25 to 40

times more potent than morphine and as an opioid antagonist it is

roughly equivalent to naltrexone. Buprenorphine is prescribed in the

hydrochloride form and therapeutic dosages range from 0.3 - 0.6

mg when given parenterally, or 0.2 - 0.4 mg sublingually, every

6 - 8 hours. The use of larger daily doses (2 - 16 mg daily) have

been used successfully for the treatment of opiate withdrawal or

maintenance. Overdose symptoms include confusion, dizziness,

pinpoint pupils, hallucinations, hypotension, respiratory difculty,

seizures and coma. Fatalities due to buprenorphine overdosage

alone and by poly-drug use have been reported.

METABOLISM

Buprenorphine is rapidly metabolized in the liver by the cytochrome

P450 system to form a pharmacologically active N-dealkylated

metabolite, norbuprenorphine and glucuronide conjugates.

Buprenorphine and norbuprenorphine are excreted in urine almost

exclusively as glucuronides with very little free drug being detected.

Studies indicate that concentration of free buprenorphine and norbu-

prenorphine in urine can be less than 1 ng/mL following therapeutic

administration, but can range up to 20 ng/mL in abuse situations.

Total buprenorphine and norbuprenorphine concentrations in urine,

ranging from 0.5 - 2936 ng/mL and 4.0 - 4462 ng/mL respectively,

have been reported following daily doses between 0.2 - 24 mg. The

corresponding median norbuprenorphine to buprenorphine ratio was

0.23. However, there is signicant inter- and intra-individual vari-

ability in the ratio because the elimination kinetics of norbuprenor-

phine are slower; therefore, the ratio is greatly inuenced by dosage

and sample time. Approximately 95% of a labeled dose is excreted

within 144 hours, 68% in the feces and 27% in the urine.

ABUSE

Like methadone when buprenorphine is taken by an individual

who is addicted to heroin or other opioid, buprenorphine reduces

craving and helps the person remain drug-free. Because of its opioid

effects, buprenorphine can also be abused, particularly by individu-

als who are not physically dependent on opioids.

Compared with methadone, buprenorphine has a relatively lower

risk of abuse, dependence, and side effects, and it has a longer

duration of action. Because buprenorphine is a partial opioid ago-

nist, its opioid effects, such as euphoria and respiratory depression,

as well as its side effects, reach a ceiling of maximum effect, unlike

with methadone or heroin. For this reason, buprenorphine may be

safer than methadone, as long as it is not combined with sedatives

such as tranquilizers or alcohol. The side effects of buprenorphine

are similar to those of other opioids and may include nausea, vomit-

ing, and constipation. Both buprenorphine and buprenorphine with

naloxone can result in the opioid withdrawal syndrome if used by

people on high doses of other opioids. Symptoms of opioid with-

drawal can include: dysphoria, nausea and vomiting, muscle aches

and cramps, sweating, tearing, diarrhea, mild fever, running nose,

insomnia, and irritability.

METHODS OF ANALYSIS

Enzyme immunoassay (EIA) is used as a screening method for the

detection of buprenorphine. The assay has equal cross reactivity to

norbuprenorphine, the primary urinary metabolite of buprenorphine.

Conrmation of screened positive urines should be performed by a

specic method such as

gas chromatography-

mass spectrometry (GC/

MS) or liquid chromatog-

raphy-tandem mass spec-

trometry (LC/MS/MS).

Buprenorphine

Drug information

OCH

REFERENCE GUIDE // Drug information

Cocaine

Drug information

CLASSIFICATION

Cocaine (benzoylmethylecgonine) is a central nervous system

stimulant derived from the leaves of the coca plant. Cocaine has

two major pharmacological actions; one is a local anesthetic, and

the other is an indirect acting sympathomimetic having many of the

properties of an amphetamine. The drug is either in the salt/powder

form (cocaine HCL) which can be administered by snorting or intra-

venous injection or in the free base “crack” form which is smoked.

METABOLISM

After smoking, cocaine is rapidly absorbed with peak plasma

concentrations occurring at about 5 minutes, versus 30-40 minutes

following intranasal ingestion. Cocaine is extensively metabolized

by the liver and blood

enzymes with approxi-

mately one percent of the

dose excreted in the urine

unchanged. The major

metabolite found in the

urine is benzoylecgonine

(25-40% of the dose),

followed by ecgonine methyl ester (18-22%). Depending upon the

dosage ingested, frequency of use, and metabolic variation, benzoy-

lecgonine can remain detectable in the urine for as long as 48-96

hours post ingestion.

ABUSE

Cocaine produces a short-lived, intense high which is extremely

addictive. The signs and symptoms associated with the abuse of

cocaine depend upon the amount used and the duration of use.

With infrequent or low dose use a person may experience euphoria,

lowered anxiety, talkativeness, decreased appetite, increased sexual

arousal, increased alertness, and decreased fatigue. Physiologically

there can be increased heart rate and blood pressure.

With increased dose or prolonged abuse (either binge or chronic)

an individual may experience a set of secondary effects that can

include increased anxiety, irritability, aggressiveness, paranoia and

hypersexuality. Physiological effects can include dilated pupils, dry

mouth, hippus, increased body temperature and tachycardia. In

overdose situations, a person my experience hallucinations, coma or

death. Crash symptoms typically follow binge abuse of cocaine. This

phase is marked by extreme fatigue, depression, mental exhaustion

and prolonged periods of sleep.

METHODS OF ANALYSIS

Enzyme immunoassay (EIA) is a widely used screening method

designed to specically detect benzoylecgonine and to a lesser

extent, cocaine and ecgonine methyl ester (secondary cocaine

metabolite). Redwood Toxicology Laboratory utilizes liquid chroma-

tography/tandem mass spectrometry (LC/MS/MS) for conrmation.

This method offers excellent sensitivity and specicity and is the

method of choice for the conrmation of the immunoassay

positive screens.

drug information

CLASSIFICATION

Recreational drugs produced in the laboratory have been around

since at least the middle of the 20th century, when LSD was rst

studied. But over the past few years, a new wave of synthesized

chemicals, so-called “designer drugs” and “designer stimulants”

have had a signicant impact on the drug culture.

The term “designer stimulants” is used for chemicals that produce

similar subjective effects to illegal recreational drugs. Development

of synthesized drugs may involve altering the molecular structure

of existing drugs, or identifying different chemical structures that

generate the same effects that illegal drugs produce.

A group of synthetic compounds consisting of β-keto- and methy-

lendioxy- derivatives of amphetamines and derivatives of piperazine

have been recently developed as recreational (“party”) drugs with

psychoactive properties. They gained popularity as legal alternative

to amphetamines and cocaine and have been abused worldwide,

prompting investigation into their safety. These drugs were proven

to possess central stimulation effects similar to those of other

illicit drugs.

Due to their high potential for abuse and addiction, most designer

stimulants have been recently banned in many European countries,

Australia and New Zealand. A federal ban enacted in July 2012 tar-

gets MDPV and Mephedrone, two designer drug compounds found

in so-called bath salts. This important measure will prove critical in

deterring abuse from these dangerous designer drugs. Nevertheless,

they are still readily available via the Internet and in many “head-

shops” around the country.

METABOLISM

Designer stimulants are excreted in urine unchanged and as

conjugated hydroxy-metabolites. Cathinone is known to metabolize

extensively by reduction of β-keto group into free norephedrine

and nor-ψ-ephedrine. Similar metabolic path is expected for other

synthetic stimulants possessing β-keto structure.

ABUSE

Synthetic designer stimulants are produced in clandestine labora-

tories and are commonly sold as “bath salts” at smoke shops or

available online. They are sold under a variety of names that include

Ivory Wave, Cloud Nine, Bliss, Red Dove, Vanilla Sky and

Hurricane Charlie.

These “bath salts” are in reality potent crystallized chemicals that

may be snorted, swallowed or smoked. They contain powerful

stimulants such as methylone, methylenedioxypyrovalerone (MDPV)

and mephedrone, which mimic the stimulating effects of cocaine,

methamphetamine or MDMA. Additionally, some forms of designer

stimulants may be sold and veiled as MDMA (ecstasy) tablets.

Effects sought by users include feelings of physical and mental well-

being, exhilaration, euphoria, increased alertness, elevated motor

activity, and postponement of hunger or fatigue. Young adults in the

United States and other countries have reportedly died from using

these products. While synthetic stimulants appear to affect users

in ways similar to amphetamines and cocaine, reports concerning

aggression, tachycardia, paranoia and suicide suggest that they

may be more acutely toxic. There are no known medical uses for

synthetic stimulants, and long-term effects are unknown, although

experts have stated that cardiovascular effects can last for days

after ingestion.

Several agencies have issued alerts about synthetic stimulants,

noting ease-of-access concerns and the number of nationwide

emergency-room visits related to these drugs.

In 2011, poison centers nationwide responded to over 6,000 calls

related to bath salts. In 2012, that number dropped to over 2,500

and in 2013 the number of calls was over 900 showing that the true

extent of the public health threat is still prevalent.

METHODS OF ANALYSIS

RTL’s test utilizes gas chromatography/mass spectrometry (GC/

MS) or liquid chromatography/tandem mass spectrometry (LC/MS/

MS) for screening and conrmation of designer amphetamines,

cathinones and designer piperazines. All presumptive positive

specimens are conrmed using a second aliquot prior to reporting

positive results. The analytical methods used by RTL are scienti-

cally accepted.

Two test panel variations are available: an expanded designer

stimulant panel covering 21 drugs or the limited panel covering

MDPV, Methylone and Mephedrone.

Designer Stimulants

Drug information

REFERENCE GUIDE // Drug information

CLASSIFICATION

Diuretics elevate the rate of bodily urine excretion (diuresis). All

diuretics increase the excretion of water from the body, although

each class of diuretics does so in a distinct way employing different

mechanisms of action. In medicine, diuretics are used to treat heart

failure, liver cirrhosis, hypertension and certain kidney diseases.

Side effects include dehydration, hypotension, disturbed electrolyte

balance, muscle cramps and weakness.

Diuretics are prescription drugs with relatively low potential for

abuse among the general population. They are not classied as

Controlled Substances in the United States. There are several

categories of diuretics:

• High ceiling loop diuretics such as furosemide, bumethanide

and ethacrynic acid may cause substantial diuresis. They

inhibit the body’s ability to reabsorb sodium in the kidney

which leads to retention of water in the urine as water nor-

mally follows sodium back into the extracellular uid.

• Thiazides such as hydrochlorothiazide, cause moderate

diuresis. They act as carbonic anhydrase inhibitors with the

major site of action in the renal distal tube. They enhance

excretion of sodium, potassium, calcium and chlorine ions.

• Potassium sparing diuretics such as amiloride, triamterene

and spironolactone do not promote the secretion of potas-

sium into the urine; thus potassium is spared and not lost as

much as in other diuretics.

• Osmotic diuretics like mannitol, glucose and other sugars are

ltered in the kidneys, but cannot be reabsorbed leading to

elevated water elimination with urine.

• Low ceiling diuretics—the term is used to indicate a

pharmacological prole with rapidly attening dose

effect curve (in contrast to “high ceiling”, where the

relationship is close to linear). The thiazides usually

fall into this category.

METABOLISM

Most diuretics are excreted in urine with minimal metabolites. A

few exceptions include spironolactone metabolizing into canrenone

and canrenoic acid; and triamterene, which in the body undergoes

conversion to hydroxytriamterene sulfate.

ABUSE

Diuretics are sometimes abused by people with eating disorders for

weight loss. Use of diuretics in sports is prohibited. Increased urine

ow would reduce concentrations of banned performance enhanc-

ing substances in urine such as anabolic steroids, thus complicating

their detection in doping control (masking). In sports where weight

categories are involved diuretics are abused as weight reducing

agents. Diuretic abuse in sports is unethical and dangerous for ath-

lete health (dehydration). Diuretic testing is a part of routine doping

control in sports.

METHODS OF ANALYSIS

RTL utilizes Methylation and gas chromatography/mass spectrome-

try (GC/MS), which has been traditionally used for diuretic screening

and conrmation in athletic doping control.

Diuretics

Drug information

drug information

Fentanyl

Drug information

CLASSIFICATION

Fentanyl (Duragesic, Sublimaze, “China White”) is an extremely fast-

acting synthetic narcotic analgesic, of high potency (approximately

100 – 200 times that of morphine) and short duration of action.

There are several analogues and derivatives of fentanyl which are

also abused, and may have higher potencies. Pharmaceutical fen-

tanyl has been available since 1963 as an anaesthetic supplement,

and is available as a citrate salt for I.V or I.M injection. Transder-

mal patches are also available for management of chronic pain or

for breakthrough cancer pain. Fentanyl abuse among healthcare

workers has become popular due to the drugs euphoric effects and

easy availability. Due to the lipophilicity of the drug, fentanyl rapidly

crosses the blood-brain barrier, producing fast and pronounced CNS

effect, such as a heightened euphoria and respiratory depression,

and possible toxic effects which include muscle rigidity, seizures,

coma, and hypotension. Fentanyl also has similar tolerance and

physical dependence properties to those of morphine.

METABOLISM

Fentanyl is rapidly metabolized by the liver to the inactive

metabolites, norfentanyl, hydroxyfentanyl, and hydroxynorfentanyl.

Approximately 85% of an intravenous dose is excreted in urine over

a 3 – 4 day period, with 0.4 – 6% of the drug excreted unchanged,

26 – 55% excreted as norfentanyl, and unknown amounts of

hydroxyfentanyl, and hydroxynorfentanyl excreted.

Fentanyl is administered I.V. or I.M. at single dosage levels of 25 –

100 µg as needed, transdermally at dosages of 25 – 100 µg/hr for

72 hours for chronic pain management, or by oral transmucosal

dosages of 200 – 1600 µg for breakthrough cancer pain. Following

a single 50 – 100 µg fentanyl dose, fentanyl was detected in the

urine of 3 of 7 patients for 24 hours. Urine fentanyl concentrations

ranged from 89 – 449 ng/mL in 4 adults who died following the

excessive use of transdermal fentanyl. In another series of 7 adult

deaths, fentanyl concentrations ranging from 5.0 – 93 ng/mL were

found following self-administered intravenous injections.

ABUSE

Illicit fentanyl which appears on the street in the U.S., is principally

in the form of the transdermal patches, which can be cut up and

eaten, or the gel can be extracted from the patches and smoked

or injected by addicts. Illicitly synthesized fentanyl powder manu-

factured in Mexico has

appeared in the U.S.

recently, and may be

abused by itself or mixed

with heroin or cocaine,

which have resulted in

several deaths.

METHOD OF ANALYSIS

Immunoassay screens are commercially available for detecting

fentanyl in urine specimens. Conrmation of the presumptive posi-

tives is generally performed using a specic technique such as gas

chromatography/mass spectrometry (GC/MS) or liquid chromatogra-

phy/tandem mass spectrometry (LC/MS/MS). Redwood Toxicology

Laboratory utilizes a direct method for the detection of fentanyl in

urine using liquid-liquid extraction, deuterated internal standards,

and GC/MS detection.

REFERENCE GUIDE // Drug information

CLASSIFICATION

GHB was rst developed as an anesthetic, but was discontinued for

this use due to its adverse and unpredictable effects. However, GHB

is readily available and used in Europe as a sedative. The salt form

of GHB has been marketed in gymnasiums and health food stores

for the past few years as a steroid alternative for body-building and

as a tryptophan replacement for sedation. There have also been

increasing reports of GHB being used recreationally as a euphoriant

at “rave” type parties. As typically follows, there have also been

reports of GHB being associated with sexual assault or as a “date

rape” drug due to its severe hypnotic and sedative effect at

higher dosages.

METABOLISM

GHB is thought to be extensively metabolized by alcohol dehy-

drogenase and/or succinic semialdehyde dehydrogenase. Meta-

bolic precursors to GHB,

gamma-butyrolactone

(GBL) and 1,4 butanediol

are also readily available

as substances of abuse.

Endogenous GHB is also a

product of GABA metabo-

lism, and concentrations

of 0 – 6.6 mg/L have been reported. Oral doses of approximately

2.5 g (I teaspoon of GHB powder) dissolved in water, produced

urine GHB concentrations of 29 mg/L in a 100 kg man. Studies also

indicate peak urine GHB concentrations of 100 mg/L following a 100

mg/kg oral dose, and no detectable drug in the urine by 12 hours.

Less than 5% of an oral dose is eliminated unchanged in urine. To

distinguish between endogenous and exogenous GHB, a reporting

cutoff of 10 µg/mL is suggested.

ABUSE

Typical illicit use of GHB involves dissolving 2 – 3 grams of powder

in water or other beverages. Onset of effects occur within 10 – 30

minutes of ingestion and include euphoria, increased libido, drowsi-

ness, reduced inhibitions, dizziness, nausea and may persist for 2

- 5 hours. Toxic effects include hypotension, respiratory depression,

seizure, unconsciousness, and coma. Deaths have been reported

when GHB is used alone or in conjunction with ethanol, heroin, or

ketamine. The California Department of Health Services and the

Food and Drug Administration (FDA) banned over-the-counter sales

of GHB in 1990 and GHB is currently classied as Schedule I by the

federal Controlled Substances Act.

METHOD OF ANALYSIS

Determination of gamma-hydroxybutyric acid (GHB), also known

as liquid Ecstasy, in human samples is challenging. Due to the

small size of GHB, immunological testing is very difcult and limited

immunoassays are available for screening. GHB detection in urine

relies on specic chromatographic methods such as gas chromatog-

raphy/mass spectrometry (GC/MS) or liquid chromatography/tandem

mass spectrometry (LC/MS/MS). RTL’s test utilizes GC/MS for the

direct analysis of GHB from urine after liquid-liquid extraction and

silyl-derivatization. Compared to existing methods, this method

is superior because it is specic to GHB without conversion

to gamma-butyrolactone (GBL).

Gamma-hydroxybutyric Acid (GHB)

Drug information

drug information

CLASSIFICATION

Marijuana is a preparation derived from the leaves and owering

tops of cannabis plants (Cannabis sativa) that is capable of produc-

ing psychoactive effects when ingested. One of the primary classes

of compounds found in marijuana is called cannabinoids. There are

up to 60 cannabinoids in marijuana with delta-9-tetrahydrocannabi-

nol (THC) being the primary psychoactive constituent.

METABOLISM

When marijuana is smoked, THC is rapidly absorbed through the

lungs and enters the bloodstream in minutes. Following oral inges-

tion, THC does not reach the bloodstream for approximately 1.5-3

hours. Once in the blood, THC is bound to blood proteins and carried

throughout the body where it is either absorbed into body tissues

(including the brain, heart, and fat) or transformed by the liver into

the water soluble metabolites 11-hydroxy-THC and carboxy-THC.

These water soluble metabolites, are readily excreted into the urine,

with the inactive metabolite carboxy-THC being the predominant

metabolite detected. Initially, THC is quickly absorbed into the body

tissues and then is slowly released back into the blood stream where

it is carried to the liver and metabolized. Because THC tends to be

stored in fatty tissues, it accumulates faster than it can be eliminated

in chronic repetitive smokers. This leads to extended retention of

THC which is then eliminated from the body at a relatively constant

rate with an average elimination half-life being estimated at 2-4

days. Urinary concentrations of THC are very difcult to interpret due

to variables such as dosage of THC ingested, frequency of use, tim-

ing of urine collection relative to last exposure to marijuana, rate of

release of stored cannabinoids in adipose tissue, and an individual’s

hydration state. Therefore, the detection of THC metabolites in the

urine is only an indication of past marijuana use and is not related to

the degree of intoxication or impairment.

ABUSE

The psychological effects of THC include an increased sense of well

being or euphoria, relaxation, slowed psycho-motor response, an

altered sense of time, short term memory impairment and impair-

ment of multi-tasking performance.

THC Retention Time

• Infrequent (less than twice/week) Smoking: When screening

assays of 50 ng/mL or greater are used, urine samples will

generally be positive for 1-3 days.

• Regular (several times per week) Smoking: May result in

urine specimens testing positive for 7-21 days.

• Chronic (daily) Smoking: An individual who smokes mari-

juana daily for prolonged periods of time can test positive for

30 days or longer.

• Oral Ingestion: Metabolic proles in urine samples cannot

generally differentiate between marijuana ingested orally ver-

sus marijuana ingested by smoking. However, oral ingestion

requires approximately three times more THC than smok-

ing to produce similar effects or “highs”; therefore, visual

detection of the marijuana in the ingested item would seem

reasonable, thus ruling out unknown consumption. Retention

time of orally ingested marijuana ranges from 1-5 days.

• Passive Inhalation: In general, routine passive exposure to

marijuana smoke will not result in a positive result for can-

nabinoids in excess of a 50 ng/mL screening cutoff.

METHODS OF ANALYSIS

The most common screening methods used to detect cannabinoids

in urine include enzyme immunoassay (EIA). Urine cannabinoid

immunoassays are usually optimized for the detection of carboxy-

THC, but also react with other cannabinoids present in the urine.

Because of this cross-reactivity, immunoassay results are expressed

in terms of “total cannabinoids” and not specically in terms of

carboxy-THC concentration as is detected by specic conrmation

methods such as gas chromatography/mass spectrometry (GC/MS)

or liquid chromatography/tandem mass spectrometry (LC/MS/MS).

Therefore, when interpreting THC concentrations, it is important to

realize that GC/MS or LC/MS/MS, which measures only carboxy-

THC, generally yields quantitative results which may represent only

10-50% of the “total cannabinoid” value as detected by immuno-

assays. While immunoassay cross-reactivity to non-cannabinoid

compounds is extremely rare, most immunoassay manufacturers

recommend that positive

results be conrmed

by alternate specic

analytical methods.

The chromatographic

methods; GC/MS and

LC/MS/MS meet this

requirement while

providing most reliable

test results.

Marijuana (THC)

Drug information

REFERENCE GUIDE // Drug information

CLASSIFICATION

Methadone is a narcotic analgesic which is approximately

equipotent to that of morphine. Methadone has been utilized

to treat opioid dependency and prescribed as a heroin substitute in

methadone maintenance programs since the 1960’s. Typically, daily

oral dosing with doses up to 180 mg/day, is prescribed with efcacy

measured by the absence of withdrawl symptoms. Dosing is then

gradually decreased until opiate dependency is eliminated.

METHODS OF ANALYSIS

Immunoassays, such as enzyme immunoassay (EIA) are common

methods for detecting methadone and methadone metabolite

(EDDP) in urine. Independent EIA methods are used to specically

detect methadone or methadone metabolite. Conrmation of pre-

sumptive positive urines should be performed by specic methods

such as gas chromatography/mass spectrometry (GC/MS) or liquid

chromatography/tandem mass spectrometry (LC/MS/MS).

METABOLISM

Methadone is metabolized

primarily to two pharmaco-

logically inactive metabolites,

EDDP and EMDP. Monitoring

for the presence of EDDP (methadone metabolite) is a means to

determine compliance to methadone treatment. The elimination half-

life of methadone is approximately 15-55 hours with about 5-50%

of a dose eliminated as methadone and 3-25% as EDDP. Large

individual variations in elimination do occur due to urine pH, urine

volume, dose, rate of metabolism, drug interation, etc.

Methadone

Drug information

CH3CH2C—C—CH2—CH—N

CH3

drug information

Opiates

Drug information

CLASSIFICATION

The term “opioid” refers to all drugs, natural or synthetic, with

morphine-like properties. Both morphine and codeine are naturally

occurring alkaloids derived from the seed pod of the opium poppy.

Semi-synthetic opiates include heroin, a diacetyl derivative of

morphine; hydromorphone, hydrocodone, and oxycodone derived by

a simple modication of the morphine molecule. Synthetic opiates

such as methadone and meperidine, mimic opiate effects but are

not prepared from the poppy. The drugs may be administered by

snorting, subcutaneous or intravenous injection, or smoking. Opioid

compounds have analgesic and antitussive properties.

METABOLISM

Morphine is rapidly

absorbed. Plasma peak

levels following an oral

dose occur after 15-60

minutes, and following IV

injection occur after 15

minutes. Extensively

metabolized by the liver,

only 2-12% is excreted as unchanged drug, while 60-80% is excret-

ed as morphine-3-glucuronide. The half-life of morphine is 1.7-4.5

hours. Heroin is rapidly metabolized (plasma half-life is 3 minutes),

rst to 6-monoacetylmorphine (6-MAM) and further to morphine.

The urinary excretion prole is similar to morphine, in that 7% is

excreted as unchanged morphine and 50-60% as glucuronides.

Trace amounts of 6-MAM, a specic metabolite of heroin, are also

excreted for approximately 6-8 hours following heroin use. Follow-

ing an oral dose, codeine is also rapidly absorbed and metabolized,

principally to codeine-6-glucuronide, with 10-15% metabolized to

morphine and norcodeine. Opiates may be detected in urine for 2-4

days following ingestion.

The interpretation of results for urines positive for opiates merit spe-

cial consideration. Since codeine is metabolized to morphine, both

substances may appear in the urine following codeine ingestion.

However, the codeine concentration is generally greater than that of

morphine. Street heroin also contains acetylcodeine, which metabo-

lizes to codeine, therefore, both codeine and morphine may be pres-

ent in the urine of some heroin users, although morphine generally

predominates. In cases of low morphine and codeine concentrations

in urine, it is not possible to determine whether codeine, morphine,

or heroin were ingested. The presence of morphine alone would

generally indicate either clinical morphine use or illicit morphine or

heroin use. A specic metabolite of heroin, 6-monoacetylmorphine,

is also at times detected and would denitely conrm illicit drug

(heroin) use. Poppy seeds, which have not been effectively washed,

contain trace amounts of codeine and morphine. When consumed

in sufcient amounts, poppy seeds may produce urines which test

positive for opiates.

ABUSE

Opioid compounds have effects on the CNS and usually on the

bowel. They produce analgesia, respiratory depression, euphoria,

mood changes, confusion, and constipation. Tolerance and depen-

dence develop with repeated use, with overdose being characterized

by coma, respiratory depression, and pinpoint pupils. Discontinuing

the drug in a dependent individual will precipitate a withdrawal syn-

drome. Heroin and morphine are the most commonly abused opioid

compounds; however codeine, propoxyphene, oxycodone, hydro-

codone, etc. are also extensively abused, as they are more readily

available. Most heroin and morphine abusers inject or “mainline”

the drugs intravenously, as this produces the most immediate and

intense effects. The heroin or morphine “rush” is the most desired

sensation which is characterized by an intense orgasmic sensation

centered in the abdomen.

METHODS OF ANALYSIS

The immunoassay methods such as enzyme immunoassay (EIA)

detect codeine and morphine in free and conjugated forms at cutoff

levels of approximately 300/2000ng/mL or less. Other opioids

detected by immunoassay at higher cutoff levels are hydrocodone,

hydromorphone, while the routine detection of oxycodone requires

a more sensitive and specic immunoassay screen. Since the

immunoassays do not distinguish between the various narcotics, a

conrmation method is required that can specically identify these

compounds. Methods commonly used include gas chromatography/

mass spectrometry (GC/MS) or liquid chromatography/tandem mass

spectrometry (LC/MS/MS). These methods determine the total

morphine and codeine content in the urine specimens. Since 90% of

these compounds are conjugated in the urine, acid or enzyme hydro-

lysis is required to convert the conjugated form into the free form.

REFERENCE GUIDE // Drug information

CLASSIFICATION

Oxycontin

is the trade name of one of numerous Schedule II

prescription drugs that contain the opioid oxycodone as the active

ingredient. Opioids refer to a class of drugs, natural and synthetic,

with morphine-like actions. Oxycodone is reported to have equiva-

lent potency to that of morphine. Other prescription drugs that

contain oxycodone include Percodan

and Percocet

. Schedule II

drugs are those which are approved for medical use and have a high

potential for abuse and may lead to severe physical and psychologi-

cal dependence. Oxycontin

was rst introduced by Purdue Pharma

in 1996 as a controlled sustained release formulation for pain relief.

It was estimated that almost 6 million prescriptions for Oxycontin

were lled in the year 2000 and sales reached 1 billion dollars. It is

legitimately prescribed for moderate to severe chronic or long-

lasting pain. Oxycontin

is available in tablet forms containing 10,

20, 40, and 80 mg. A 160 mg oxycodone tablet was available which

was discontinued in May 2001. By comparison, Percocet

typically

contains 5 mg of oxycodone. Thus, one 160 mg tablet of Oxycontin

contained the equivalent amount of oxycodone as 32 Percocet

(5 mg) tablets.

One of the primary benets of Oxycontin

is that because it is

controlled release, it only needs to be taken orally every 12 hours. In

contrast, short acting oxycodone tablets like Percocet

require the

dosage be taken every 4-6 hours to maintain pain relief. Thus, the

controlled release formulation allows for continuous pain relief for a

substantial period of time when compared to traditional Percodan

or Percocet

tablets.

METABOLISM

A large portion of oxycodone is N-dealkylated to noroxycodone

during rst-pass metabolism. Oxymorphone, is formed by the

O-demethylation of oxycodone. The metabolism of oxycodone to

oxymorphone is catalyzed

by CYP2D6. Free and

conjugated noroxycodone,

free and conjugated oxy-

codone, and oxymorphone

are excreted in human

urine following a single

oral dose of oxycodone.

Approximately 8% to 14% of the dose is excreted as free oxycodone

over 24 hours after administration. Following a single, oral dose of

oxycodone, the mean ± SD elimination half-life is 3.51 ± 1.43 hours.

ABUSE

The attraction of Oxycontin

as a preferred drug of abuse over

other oxycodone containing products has several reasons. The large

amounts of oxycodone per tablet versus Percodan

or Percocet

are

one of the primary reasons, while a second factor is that Percodan

and Percocet

additionally contain 325 mg of aspirin or up to 650

mg of acetaminophen, respectively while Oxycontin

has neither.

Thus, the oxycodone high will not be associated with any toxic side

effects that may result from either excessive aspirin or acetamino-

phen. Oxycontin

tablets are to be taken whole to allow for the

controlled release of oxycodone. Abusers will destroy the controlled

release capabilities of Oxycontin

by either chewing the tablets prior

to swallowing, crushing the tablets and snorting the powder or they

may be crushed, dissolved in water and injected. This allows for a

rapid and large absorption of oxycodone into the blood stream pro-

ducing a powerful euphoric high. This rapid, bolus absorption is also

thought to be responsible for an apparent increase in oxycodone

related overdoses in the east. Several Oxycontin

street slang’s

include “OC”, “OXY”, “Oxy-Cofns”, Hillbilly Heroin, Poor-Mans

Heroin and Killers. Diversion of the prescription has also been a

problem associated with Oxycontin

. It has been reported that

while a single 160 mg tablet may retail for up to $14, it can fetch

up to $1 per mg on the street. Thus, a 160 mg tablet, known as a

“blue bomber”, may sell for up to $160 with its illicit sale. Interest-

ingly, Oxycontin

is sometimes referred to as poorman’s heroin.

We recently encountered a case in California in which a parolee

who was being prescribed Oxycontin

was suspected of diverting

his prescription to purchase heroin. Specic analysis of his urine

determined no detectable level of oxycodone but the primary heroin

metabolite, morphine, was present in his urine in excess of 2,000

ng/mL, thus offering scientic support to the diversion suspicion.

METHODS OF ANALYSIS

Typically oxycodone does not produce a positive response to routine

immunoassay screens for opiates, which generally target morphine

and/or codeine; therefore, Redwood Toxicology Laboratory utilizes

an enzyme immunoassay (EIA) screening method which specically

targets oxycodone at a cutoff of 300 ng/mL. Conrmation of pre-

sumptive positive urines should be performed by specic methods

such as gas chromatography/mass spectrometry (GC/MS) or liquid

chromatography/tandem mass spectrometry (LC/MS/MS).

Oxycodone

Drug information

NCH

drug information

Phencyclidine (PCP)

Drug information

CLASSIFICATION

Phencyclidine (l-phencyclohexylpiperidine, PCP) is prepared from

l-piperidinocyclohexane-carbonitrile in a Grignard reaction, as rst

performed in 1956 for use as an intravenous anesthetic. Pharma-

cologically PCP is classied as a dissociative anesthetic. PCP is

currently a popular drug of abuse and was once used as a veterinary

tranquilizer. A structural analog, ketamine, is currently used as a

veterinary tranquilizer. PCP is self-administered either by smoking

(drug-laced tobacco, marijuana, or parsley), by nasal insufation

and intravenous injection, or by oral ingestion.

METABOLISM

PCP is a lipophilic drug

with a large volume of

distribution. It under-

goes extensive hepatic

oxidative metabolism with

about 10-15% of a dose

excreted unchanged in

urine, and about 65% excreted as hydroxylated metabolites

and other polar metabolites. Renal excretion of PCP (pKa 8.5) is

enhanced when urine is acidic, and it is reduced when urine is

alkaline. Frequent or chronic PCP users may excrete PCP for 2-10+

days following last use. Urine concentrations may range from <0.1

mcg/mL to 340 mcg/mL.

ABUSE

Phencyclidine’s pharmacological actions are complex, since it

interacts with several neurotransmitter systems (i.e., GABAergic,

dopaminergic, cholinergic, and adrenergic). As a result, PCP has

stimulant, depressant, hallucinogenic, and analgesic properties.

Adverse effects are unpredictable and include agitation, delusions of

grandeur, anxiety, hostility, stupor, paranoia, and coma. Death has

been known to result following the ingestion of 120 mg of PCP (toxic

dose 10-20 mg).

METHODS OF ANALYSIS

The immunoassay methods (EIA) are widely used screening meth-

ods designed to specically detect phencyclidine and its inactive

metabolites. Commonly used conrmation methods include gas

chromatography/mass spectrometry (GC/MS) and liquid chromatog-

raphy/tandem mass spectrometry (LC/MS/MS). These methods offer

excellent sensitivity and specicity and are the methods of choice for

most forensic applications. False positive immunoassays have been

reported following the use of thioridazine (Mellaril), chlorpromazine

(Thorazine), dextromethorphan, or diphenhydramine (Benadryl),

therefore indicating the necessity for specic secondary

conrmation testing.

REFERENCE GUIDE // Drug information

Steroids

Drug information

CLASSIFICATION

A steroid is a terpenoid lipid characterized by a carbon skeleton with

four fused rings, generally arranged in a 6-6-6-5 fashion.

Steroids vary by the functional groups attached to these rings and

the oxidation state of the rings. Hundreds of distinct steroids are

found in plants, animals, and fungi. Many more have been produced

as synthetic drugs.

Three steroid classes found in human body belong to a subset of the

sex hormones that produce sex differences and control reproduc-

tion. They include androgens, estrogens, and progestagens.

• Androgens (androgenic-anabolic steroids) are a class of

steroids responsible for the development and maintenance

of male sexual characteristics. Androgens interact with

androgen receptors to increase muscle and bone synthesis

exhibiting their anabolic performance enhancing effect.

There are natural and synthetic anabolic steroids available.

Testosterone is a principal androgenic-anabolic steroid in the

body. In popular language the word “steroids” usually refers

to anabolic steroids.

• Estrogens are involved in female reproductive function.

• Progestagens serve as protectors of pregnancy.

• Corticosteroids include glucocorticoids and mineralocorti-

coids. Glucocorticoids regulate many aspects of metabolism

and immune function, whereas mineralocorticoids help

maintain blood volume and control renal excretion

of electrolytes.

• Cholesterol is a major source for the synthesis all other

steroid hormones in the body.

METABOLISM

In the body testosterone and its synthetic analogs are bio-trans-

formed into more polar compounds, metabolites. Enzymatically

catalyzed reduction, oxidation, hydroxylation and isomerization

are the major metabolic reactions. Consequent conjugation with

glucuronic acid or sulfate facilitates ultimate elimination of steroid

metabolites from the body with urine.

ABUSE

Androgenic-anabolic steroids (AAS) have limited medical use, but are

abused as performance enhancing drugs in sports and more recently

in some professional areas, where strong muscular appearance is

important. In the general population, especially among adolescents

and young adults, AAS are abused as a cosmetic tool helping to

improve physique.

AAS have been classied as Schedule III Controlled Substances in

the United States since 1991. Side effects include suppression of

endogenous hormone production, gynecomastia (female type breast

growth in males), acne, liver toxicity, mood swings, aggression,

infertility and masculinization in females: deepening of the voice

and male type hair growth.

T/E RATIO

Testosterone and its precursors may be endogenous (produced

in the body naturally) or exogenous (ingested as drugs or supple-

ments). The T/E ratio is used to distinguish between the two. This

ratio is a urine concentration ratio of two steroids, testosterone (T)

and its natural isomer, epitestosterone (E). The normal average ratio

is approximately 1, with individual variation on both sides, either

higher or lower.

Ingestion of exogenous testosterone or its precursors suppresses

internal steroid production in the body. Both endogenous T and E

would be suppressed. However, total testosterone concentration

in urine will rise above normal due to ingested drug. Low E and

high T cause the T/E ratio to rise above 6 (cutoff), indicating

testosterone abuse.

METHODS OF ANALYSIS

RTL utilizes the most sophisticated, sensitive, and specic equip-

ment and technology available. RTL performs a fast, efcient and

sensitive GC/MS steroid screen, capable of detecting 85 endog-

enous and exogenous compounds providing information about

naturally occurring and synthetic steroids and metabolites. The RTL

Steroid Test includes specic GC/MS conrmation methods for each

individual drug.

Accurate quantication is performed for nandrolone and testos-

terone with cut-off levels of 2 ng/mL (nandrolone metabolite) and

testosterone to epitestosteroine ratio above 6 (T/E > 6).

drug information

Stimulants

Drug information

CLASSIFICATION

Stimulants are psychoactive drugs that induce temporary improve-

ments in mental and/or physical function. The effects of stimulants

include enhanced alertness, wakefulness, endurance, productivity

and motivation; increased arousal, locomotion, heart rate/blood

pressure; and a perception of a diminished requirement for sleep.

Symptoms of excessive stimulation of the central nervous system

(CNS) include restlessness, difculty sleeping, tremor, headaches

and even psychotic episodes. Loss of appetite (anorexia) and weight

loss also occur with CNS.

Most stimulants are classied as Controlled Substances (CS) in the

United States. Designer drugs like MDMA (ecstasy), which have

no medical use, are classied as Schedule I CS; the others belong

to Schedule II – IV substances. There are several categories of

stimulants possessing different chemical structures and employing

different pharmacological mechanisms:

• Amphetamine, Methamphetamine, their precursors and

structurally related designer drugs represent a broad range

of classic stimulant agents.

• Cocaine is the most potent of naturally-occurring stimulants.

It is commonly abused and a highly

addictive drug.

• Piperazines, such as benzylpiperazine and triuoromethylpi-

perazine, possess stimulant and hallucinogenic activity. They

became especially popular worldwide as party drugs in the

recent years.

• Eugeroics, like adrtanil and modanil, are prescribed for

the treatment of narcolepsy (excessive daytime sleepiness).

They were abused as “wakefulness promoting agents” and

as CNS stimulants in sports.

• Methylxanthines, such as caffeine, are found in tea, coffee

and “energy” drinks. They are also potent stimulants. How-

ever, their use is widely accepted in the society.

• Nicotine in tobacco products is also a stimulant, which is not

currently banned.

• Other Stimulants—this is a broad group of Controlled Sub-

stances with different chemical structures and common CNS

pharmacological effects. Many of them, like fenuramine

and phentermine, were originally designed as weight loss

drugs. They are no longer used due to severe side effects.

METABOLISM

Most stimulants are excreted in urine unchanged with only minor

metabolites. Numerous precursor drugs metabolize extensively

into active amphetamine and methamphetamine. Cocaine is rapidly

inactivated in the body and excreted with urine fully metabolized.

ABUSE

Stimulants may cause extreme psychological dependence. As drugs

of abuse, stimulants are frequently taken to produce a sense of

exhilaration, enhance self esteem, improve mental performance,

increase activity, produce prolonged wakefulness, and to “get high”.

Stimulants are also popular as appetite suppressants. Ability to

improve short-term physical performance made stimulants one of

the most abused drug classes in sports.

METHODS OF ANALYSIS

Immunoassay screens with gas chromatography/mass spectrometry

(GC/MS) or liquid chromatography/tandem mass spectrometry

(LC/MS/MS) for conrmation is a classic approach for amphet-

amines and cocaine analysis in urine. RTL’s comprehensive stimu-

lant test for athletic doping control employs gas chromatography/

mass spectrometry (GC/MS).

REFERENCE GUIDE // Drug information

Synthetic Cannabinoids

Drug information

CLASSIFICATION

Synthetic Cannabinoids are chemicals that act as cannabinoid

receptor agonists. Chemically they are not similar to cannabinoids

but the term “Synthetic Cannabinoids” or “Cannabinomimetics”

is widely used to refer to them as they’re cannabinoid-like in

their activity.

The synthetic cannabinoid receptor agonists fall into seven major

structural groups:

• Naphthoylindoles (e.g. JWH-018, JWH-073)

• Naphthylmethylindoles* (JWH-185, JWH-199)

• Naphthoylpyrroles* (JWH-369, JWH-370)

• Naphthylmethylindenes* (JWH-176)

• Phenylacetylindoles (JWH-250)

• Cyclohexylphenols (e.g. CP 47,497 and

homologues of CP 47,497)

• Classical cannabinoids (e.g. HU-210)

*Compounds in these groups have not been detected in herbal blends so far.

METABOLISM

Little is known about the detailed pharmacology and toxicology of

the synthetic cannabinoids and few formal human studies have

been published.

Synthetic Cannabinoids metabolize extensively in humans via oxida-

tion and glucuronide conjugation. Following a single low dose, the

hydroxylated synthetic cannabinoids and the carboxylated synthetic

cannabinoids metabolites can be detected up to 72 hours in urine.

Very little parent drug excreted in human urine has been reported.

In case of chronic use the detection window could be longer.

Presence of parent drug in saliva conrms ingestion; average

detection window up to 24-48 hours.

It is possible that, apart from high potency, some other synthetic

cannabinoids could have particularly long half-lives, potentially

leading to a prolonged psychoactive effect. In addition, there is

considerable inter-and intra-batch variability in smoking mixtures,

both in terms of substances present and their quantity. Thus, there

is a higher potential for overdose than with cannabis.

ABUSE

Initially, JWH-018 and JWH-073 were the two most common

synthetic cannabinoid chemicals found in a variety of herbal smok-

ing blends. Others like AM-1248, AKB-48, UR-144, and XLR-11

have started appearing in newer synthetic cannabinoid products

and preparations. Reportedly offering a high 4 times stronger than

marijuana, these compounds are commonly associated with herbal

smoke and incense products sold under names such as K2, K3

Legal, Spice, Syn, Haze, Cloud Nine, Serenity and many others.

Synthetic cannabinoid chemicals are often laced in the herbal smok-

ing products that are readily available via the Internet and in many

“head-shops” around the country.

Users looking for a “high” often turn to these herbal smoking or

incense products because they do not show up on a standard urine

drug test. Users smoke the product by wrapping joints, smoking it in

pipes, or inhaling fumes via vaporizers. Users also report that herbal

blends or pure chemical concoctions can be ingested with an infu-

sion or solvent process; purportedly allowing them to manage the

potency and dose of the active ingredient(s).

Users indicate the high comes on slow at rst, then with surprising

potency. There have been many reports about the adverse effects

including agitation, rapid heart rate, confusion, dizziness and nausea.

According to the American Association of Poison Control Centers,

the number of human exposure calls relating to synthetic canna-

binoids was 6,968 and decreased over the following years. As of

August 2014, the total volume of calls regarding synthetic cannabi-

noid exposures is still over 2,000 showing that the true extent of the

public health threat is still prevalent.

Long-term effects from these research chemicals are unknown.

In July 2012, the DEA banned synthetic cannabinoids based on

their structural classication, explicitly naming 15 chemicals, citing

numerous calls to poison control centers around the nation. In May

2013, the DEA placed a temporary ban on three additional synthetic

cannabinoid substances. However, newer generation compounds

continually emerge—making it more vital than ever to target syn-

thetic marijuana.

METHODS OF ANALYSIS

Immunoassay screens are now available for synthetic cannabinoid

testing. RTL’s test utilizes the most sophisticated, sensitive and

specic equipment and technology available, liquid chromatography/

tandem mass spectrometry (LC/MS/MS) to conrm presumptive

positive specimens for synthetic cannabinoid metabolites in urine.

The method relies on monitoring multiple metabolites for each drug.

RTL’s test methodology provides the most denitive synthetic can-

nabinoid biomarker test results.

For oral uid testing, LC/MS/MS is utilized to conrm parent syn-

thetic cannabinoid drugs.

drug information

Urine Creatinine

Drug information

CLASSIFICATION

Creatinine is a metabolic by-product of muscle metabolism, and

normally appears in urine in relatively constant quantities over a 24

hour period with “normal” liquid intake. Therefore, urine creatinine

can be used as an indicator of urine water content (dilution) or as a

marker identifying a specimen as urine. Greater than normal intake

of water will increase the urine water content (lowering the creati-

nine level) consequently diluting any drug which may be present in

urine. Conversely, a limited intake of water can lead to an abnor-

mally concentrated urine specimen (as occurs with dehydration)

resulting in elevated creatinine levels.

INTERPRETATION OF RESULTS

Creatinine Conc.: Interpretation:

<20 mg/dL Dilute urine specimen: Most likely due to

increased water or liquid intake. Can be a result

of short-term water loading (ushing) in an

attempt to dilute any drug below testing cutoff

concentrations.

<2.0 mg/dL Abnormally dilute: Specimen showing an

excessively low creatinine value. May be an

indication that the specimen is not consistent

with normal human urine.

NOTE: The above values are based on the critical points

that the Federal Department of Health and Human Services,

Substance Abuse Mental Health Services Administration (SAMHSA)

has set as decision points for interpreting dilute or substituted

urine specimens.

The above interpretations are general guidelines only. Redwood

Toxicology Laboratory recommends consulting with a certied

toxicologist regarding proper interpretation prior to taking adminis-

trative action based solely on the creatinine concentrations. Other

physiological conditions may account for low creatinine concentra-

tions such as diabetes or use of prescription diuretics.

REFERENCE GUIDE // Drug information

contact information

Get in touch with us.

SALES AND

GENERAL INQUIRIES

RTL offers toll-free sales and customer support services during regular business hours.

RTL hours are 7:30 AM to 4:00 PM PST.

Phone: Laboratory Services – 800.255.2159, press option 1 or 707.577.7959

Screening Devices – 877.444.0049 or 707.571.1157

Fax: 707-577-8102

E-mail: sales@redwoodtoxicology.com

Address: P.O. Box 5680, Santa Rosa, CA 95402 or

3650 Westwind Blvd., Santa Rosa, CA 95403

TOXICOLOGY

SUPPORT SERVICES

Trained customer support representatives are available to assist you in a prompt and

courteous manner. We’ll get you up and running on specimen collection, results

interpretation and technical inquiries.

Phone: 800.255.2159, press option 5 or 707.577.7959

Fax: 707.577.0365

E-mail: clientservices@redwoodtoxicology.com

INFORMATION

TECHNOLOGY

IT is available during regular business hours to answer client inquiries about internet

(www.RedwoodToxicology.com) and statistical reporting. Contact IT to request your

ToxAccess

™

username and password for convenient results retrieval.

Phone: 800.255.2159, ext. 34311 or 707.577.7959

Fax: 707.577.0 471

E-mail: helpdesk@redwoodtoxicology.com

TESTING SUPPLIES

To request labels, bottles and shipping materials, contact our Supplies Department.

Lab supply re-ordering is available to existing clients with an account number.

Phone: 800.255.2159, press option 4 or 707.577.7959

E-mail: supplies@redwoodtoxicology.com

Web: https://www.redwoodtoxicology.com/resources/supply_form

SCHEDULING A

SPECIMEN PICKUP

MORE THAN 3 PICKUPS A WEEK—RTL will arrange for daily FedEx pickups.

A FedEx courier will stop at your location daily (M-F) and pick up your specimen boxes.

Please do not arrange pickups directly as this may result in your agency being billed for

these services.

LESS THAN 3 PICKUPS A WEEK—To schedule a pickup, change a previously

scheduled pickup or cancel/suspend a pickup, please call FedEx directly at 1-800-GoFedEx

(1-800-463-3339). For assistance nding a drop-off location visit fedex.com.

To contact Redwood Toxicology Laboratory (RTL), please select from the

departments listed below. All requests made during non-business hours

will be responded to as early as possible the next business day.

CONFIDENCE IN TESTING

Redwood Toxicology Laboratory, Inc. (RTL) is the preferred choice

in drug testing providers. RTL provides accurate laboratory testing

services for drugs of abuse in urine and oral uid, synthetic can-

nabinoids, designer stimulants, EtG/EtS, steroids, GHB, fentanyl

and more. We also sell instant, on-site drug and alcohol screening

devices. Our reputation for experience, accuracy and excellence in

customer service speaks for itself.

Address: 3650 Westwind Blvd.,

Santa Rosa, CA 95403

Laboratory Services: (800) 255-2159

Screening Devices: (877) 444-0049

Fax: (707) 577-0365

Email: sales@redwoodtoxicology.com

Website: www.redwoodtoxicology.com

11 000 3034 REV10

Toxicology Laboratory logo are trademarks of the Alere group of companies.