TOXICOLOGY Urine Drug Testing - Production · TOXICOLOGY Urine Drug Testing LEGAL AID INFORMATION...
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TOXICOLOGY Urine Drug Testing LEGAL AID INFORMATION SESSION Neville Bailey Forensic & Scientific Services Coopers Plains
Transcript of TOXICOLOGY Urine Drug Testing - Production · TOXICOLOGY Urine Drug Testing LEGAL AID INFORMATION...
TOXICOLOGY Urine Drug Testing
LEGAL AID INFORMATION SESSIONNeville Bailey
Forensic & Scientific ServicesCoopers Plains
TOXICOLOGY• Detection of drugs in biological fluids
Qualifications science degree majoring in chemistry
this provides a fundamental expertise in analytical techniques and instrumental chemistry
• a knowledge of Pharmaco-kinetics [ie how the drugs distribute throughout the body and eliminate from the body (drug metabolism the action of the body on drugs)]Knowledge largely derived from additional university study and extensive reading of specific scientific literature
Pharmacology is the study of the action of drugs on the body (Forensic Medical Officers best qualified to comment on effects of drugs eg impairment)
Presenter
Presentation Notes
Comment on impairment
GASTRO-INTESTINAL MEMBRANE
OTHER TISSUES
HEART
LUNGS / NASALA
RT
ER
IAL
BL
OO
D
VE
NO
US
BL
OO
D
SCHEMATIC OF SYSTEMIC BLOOD CIRCULATION
KIDNEY
RENAL EXCRETION
BILE
LIVER
METABOLITES
INHALATION
ORAL
INJECTION
Presenter
Presentation Notes
Oral ingestion, injection and inhalation Metabolism largely occurs within the liver. Drug circulated through the body and is in equilibrium with a number of organs.
SPECIMEN TYPES FOR DRUG ANALYSIS
• BLOOD: Primary specimen of choice
• URINE : Most common specimen collected in workplace environment
• BREATH: Primarily used for alcohol testing
• ORAL FLUID: Emerging technology within the workplace environment as alternative to urine
• HAIR: Provide a history of drug use / Time line
• SWEAT:
Presenter
Presentation Notes
Blood (serum or plasma) is the primary specimen as the drug is in equilibrium with the sites where drug action occurs and therefore a better correlation between observed drug effect and blood drug concentration. Pharmacokinetic parameters have been established in drug trials and allow for a number for backcalculation of a possible drug level at a previous nominated time / estimate of dose possible and time of dose. Through these trials information is generated as to dose and clinical response. Urine is generally and indicator of drug use, there are no direct pharmacokinetic parameters to predict drug dose / time of dose / etc Breath; Because of the volatile nature of alcohol an equilibrium is established between alcohol concentration in the blood and the alcohol concentration in the alveolar air of the lung. Oral Fluid; Once again an equilibrium is established between the drug concentration in the blood and the fluid in the oral cavities and is a better indicator of recent usage. There are limitations the benzodiazepine class does not transfer readily, neither dose THC.
MANIPULATION OF THE URINE SPECIMEN• Individuals who use drugs can be interested in
concealing their drug use through manipulation of the urine test.
• Involve substitution / water dilution of urine specimen
• Certain adulterants can affect testing of specific drugs in immunoassay testing (both onsite or laboratory based)
• The use of a substance (adulterant) that will eliminate traces of drug from the urine or otherwise modify the urine so that certain substances are not detected.
• Generally manipulation of a urine specimen can be detected
Bleach Ammonia Water Vinegar Klear Urine Luck Stealth
Creatinine N N N N N N NNitrite N N N N A N NGlutaraldehyde N N N N N N NPh N A N A N N NS.G. N N N N N N NBleach A N N N A A APCC A N N N A A A
INTECT 7 (STRIP PANEL FOR ADULTERANT DETECTION)
Pearce; J.Anal Tox, Vol 26, 2002A = Abnormal response
TEMPERATURE [33 TO 38 DEG CELCIUS]
CREATININE AND SPECIFIC GRAVITY
INTEGRITY OF URINE SPECIMEN
Presenter
Presentation Notes
Tests that can be readily used to detect possible adulterants. Temperature relates to body temperature. Creatine is an amino acid that is important in cellular energy production. In this process creatine is metabolised to creatinine which is eliminated in the urine as a waste product. Creatine is also a popular dietary supplement. The use of this supplement has been observed to increase urine creatinine levels. Creatinine is produced relatively consistently in the body and occurs in the urine at a reasonably consistent concentration and can therefore act as an indicator of urine dilution.
IMPACT OF EXCESS FLUID INGESTION (WATER DILUTION & CREATININE LEVELS)
0
50
100
150
200
250
300
0 20 40 60 80TIME (HOURS)
CR
EA
TIN
INE
M
G /
DL
APPROX 1 LITRE WATER
CONSUMMED AT HOURLY
INTERVALS
350 PERSONS
AVERAGE URINE CREATININE
171.6 MG/DL
[340 (97 %) GREATER THAN
30 MG / DL]
Cone; J. Anal Tox, Vol 22, 1998
The effects of water dilution on drug testing results were clearly evident in the current study. Subjects consistently produced dilute specimens upon drinking large volumes and drug metabolite concentrations declined below cutoff concentrations
Presenter
Presentation Notes
Laboratory reports creatinine as mg / L.
0
500
1000
1500
2000
2500
3000
3500
4000
4500
Cre
atin
ine
mg/
l
6.9 % of urine creatinine levels less than 200 mg/l [or 20 mg/dl]
CREATININE LEVELS
Source: Laboratory Data
CURRENT STANDARD 50 - 200 MG/L
MAY INDICATE DILUTION IN SOME INDIVIDUALS. DOES NOT NECESSARILY REPRESENT A
DELIBERATE ATTEMPT AT DILUTION
LESS THAN 50 MG/L
FURTHER TESTING FOR DILUTION REQUIRED REGARDED AS NOT
CONSISTENT WITH HUMAN
*A URINARY CREATININE CONCENTRATION SHALL BE MEASURED
AUSTRALIAN STANDARD AS/NZS 4308:2008
DRUG TEST PROCEDURES: IMMUNOASSAY
• Immunoassay has wide application within urine drug testing and more recent applications within oral fluid testing
• Initially laboratory based however now commonly in wide-spread use for on-site testing.
• Rapid and convenient method to screen large numbers of specimens in a variety of matricies.
• The differentiation of negative specimens
• Limited generally to detection of drug classes
DRUG TEST PROCEDURES: IMMUNOASSAY
Immunoassays are based on the interaction of a target molecule (antigen) with the corresponding antibody
Drug analysis uses antibody specific for the drug class analysed together with a labelled form of the same drug.
Competitive reaction is established whereby the drug in the specimen competes with the added labelled drug for the antibody
The labelled form of the drug is responsible for generating a measurable signal. where the drug is labelled with an enzyme or a fluorescent substance the measurement is observed by spectrophotometry
The proportion of labelled drug bound is inversely proportional to the amount of drug present in the specimen
DRUG CLASS WITH SIMILAR STRUCTURE CROSS – REACTIVITY (BENZODIAZEPINES)
Presenter
Presentation Notes
With most immunoassays positive response due to a member of the drug class / With amphetamines cross reaction with other amines (that may be naturally occuring) has resulted in false positives
DRUG CLASS WITH SIMILAR STRUCTURE SENSITIVITY (BENZODIAZEPINES)
DRUGS WITHIN A CLASS WILL HAVE A DIFFERENT RESPONSE
50 NG/ML200 NG/ML
500 NG/ML
Presenter
Presentation Notes
Diazepam in the urine at a concentration of 50 ng/ml will produce the same response as oxazepam at a concentration of 200 ng/ml. Clonazepam has to be at a concentration of 500 ng/ ml to produce the same response as Oxazepam. Simply means that immunoassay is limited in ability to forecast concentrations. Some laboratories report +++ or whatever to denote a concentration. When asked what this means I respond that I have no idea. The reality is that the test has produced a response greater than the response assigned to the cut-off concentration.
cannabinoid conc (immunoassay)
020406080
100120140
0 10 20 30 40 50 60 70
cannabinoid conc (immunoassay)
25 NG / ML
50 NG / ML
100 NG / ML
EFFECT OF CUTOFF VALUE ON DETECTION WINDOW
WHEN IS A DRUG DETECTED ?
Presenter
Presentation Notes
Cut-off values are assigned based on decisions by various groups. In Australia the group has produced an Australian Standard which requires all screening tests to comply with the levels. Manufacturers therefore produce kits to these values. A response at the cut-off value is regarded as the baseline or zero point and any response therefore greater than this is regarded as a positive response. The important message is that whilst a negative response is regarded as not detected by this standard, the drug may still be present in the specimen.
SIMILARITY OF CHEMICAL STRUCTURE
MORPHINE AND CODEINE CROSS REACT WITH REAGENTS IN AN OPIATE IMMUNOASSAY KIT TO PRODUCE A POSITIVE
RESULT
Presenter
Presentation Notes
Oxycodone is also within the opiate class with similar chemical structure and properties however it requires a concentration of 16,000 ng/ml to produce the same response as 300 ng/ml of morphine. Normal urine levels expected from normal dosing are below this level.
3 MONOACETYL MORPHINE
ACETYL CODEINE
SYNTHESIS OF HEROIN FROM OPIUM POPPY EXTRACT (ACETYLATION)
THEBAINE
6ACETYL CODEINE
METABOLISM OF HEROIN
Presenter
Presentation Notes
The point to observe here is the intermediate metabolite can be detected in urine. The detection of this compound in the urine is generally regarded as an indicator of heroin use. This metabolite may also be available.
TIME POST ADMINISTRATION
CO
NC
EN
TR
AT
ION
PHARMACOKINETIC PROFILE OF HEROIN METABOLISM IN BLOOD FOLLOWING A HEROIN INTRAVENOUS ADMINISTRATION
GLUC
GLUC
6-GLUCURONIDE
3-GLUCURONIDE
METABOLISM OF MORPHINE
IDENTIFY MORPHINE USE WHEN MORPHINE &
GLUCURONIDE METABOLITES DETECTED IN
URINE
METABOLISM OF CODEINE
CONCENTRATION OF CODEINE V’S RATIO OF THE CONCENTRATION OF MORPHINE TO CODEINE IN
URINE SPECIMENS FOLLOWING CODEINE ADMINISTRATION
HOWEVER FROM THE DATA IT IS
ALSO OBSERVED THAT
MORPHINE CAN BE DETECTED AT
CONCENTRATIONS> CODEINE
IN MOST CASES CODEINE IS THE
MAJOR DRUG DETECTED
Presenter
Presentation Notes
Note: Another unit (micromoles / litre) that represents concentration. Interchange of units is common across the scientific literature.
ELIMINATION OF MORPHINE AND CODEINE IN URINE FOLLOWING A CODEINE
ADMINISTRATION
MORPHINE HAS A LONGER HALF-LIFE
THAN CODEINE
POTENTIAL SOURCE OF AN OPIATE FOLLOWING THE DETECTION OF A CONCENTRATION OF
MORPHINE THAT IS LESS THAN 1500 NG/ML YET GREATER THAN CODEINE IN URINE
Residual levels detected following codeine administration (24 to 48 hours)
Levels consistent with consumption of poppy seed on bakery products (buns, rolls, bread)
Residual levels detected following heroin administration
Use of morphine in conjunction with any of the above
NOTE: Codeine present in combination with other drugs in medications that require prescription
Morphine requires a prescription
2,000 2,000 NG / MLNG / ML
INTERPRETATION OF MORPHINE / CODEINE CONCENTRATION
MORPHINE > CODEINE
[RATIO > 1]
MORPHINE CONCENTRATION
LESS THAN 2000 NG/ML
UNABLE TO IDENTIFY THE SOURCE
OF THE OPIATE
THE DETECTION OF MORPHINE AND CODEINE IN THE URINE AT LEVELS LESS THAN 2000 NG / ML COULD REFLECT THE USE
OF MORPHINE, HEROIN, CODEINE OR INGESTION OF POPPY SEEDS; THE IDENTITY OF THE ORIGINAL DRUG CONSUMMED
CANNOT BE DETERMINED
Morphine 800 Morphine 800 ngng/ml/ml
Codeine 900 Codeine 900 ngng/ml/ml
Presenter
Presentation Notes
The act of interpretation is not as black and white in many cases as you may desire. The laboratory comment is based on guidelines established from laboratory information or scientific literature. In many cases caution is necessary as we may not have all the information.
MORPHINE (NG/ML)
CODEINE (NG/ML)
CREATININE (MG/L)
DAY 1 <110,000 3200 1430
DAY 7 30,000 20,000 1410
DAY 15 28,000 22,000 1370
DATA FOR INTERPRETATIVE CONSIDERATION
DIAZEPAMDIAZEPAM TEMAZEPAMTEMAZEPAM
OXAZEPAMOXAZEPAMNORDIAZEPAMNORDIAZEPAM
METABOLISM OF DIAZEPAM (VALIUM)
NORDIAZEPAM 400 NORDIAZEPAM 400 ngng/ml/ml
TEMAZEPAM 300 TEMAZEPAM 300 ngng/ml/ml
OXAZEPAM 300 OXAZEPAM 300 ngng/ml/ml
THE BENZODIAZEPINE RESULT IS CONSISTENT THE BENZODIAZEPINE RESULT IS CONSISTENT WITH THE USE OF VALIUMWITH THE USE OF VALIUM
Presenter
Presentation Notes
Decision is based on our knowledge of metabolism, the combination of drugs and the concentration.
The assay provides only a preliminary analytical test result. A more specific alternative chemical method must be used in order to obtain a confirmed analytical result.
Gas chromatography/mass spectrometry (GC/MS) is the preferred confirmatory method.1,2
Clinical consideration and professional judgment should be applied to any drug of abuse test result, particularlywhen preliminary positive results are used.
Immunoassay Kit Insert
Intended Use
The DRI® Opiate Assay is intended for the qualitative and semiquantitative determination of opiates in human urine.
Presenter
Presentation Notes
Another important message is that the manufacturer’s themselves recognise the limitations of these assays and support confirmation of the result.
DIAZEPAM
NORDIAZEPAM
OXAZEPAM
TEMAZEPAM
CLONAZEPAM
NITRAZEPAM
FLUNITRAZEPAM
ALPRAZOLAM
TRIAZOLAM
MIDAZOLAM
BROMAZEPAM
LORAZEPAM
CLOBAZAM
FLURAZEPAM
BENZODIAZEPINE CLASS OF DRUGSBENZODIAZEPINE CLASS OF DRUGS
Presenter
Presentation Notes
Range of drugs within a class and the value of mass spectrometry techniques to determine the nature of the drugs.
AMPHETAMINE
METHYLAMPHETAMINE
PHENTERMINE
FENFLURAMINE
EPHEDRINE
PSEUDOEPHEDRINE
MDMA (METHYLENE DIOXYMETHYL AMPHETAMINE)
MDA
MDEA
BDMA
PMA
DMA
BDMPEA
AMPHETAMINE TYPE SUBSTANCESAMPHETAMINE TYPE SUBSTANCES
Presenter
Presentation Notes
Ephedrine and pseudoephedrine are isomers (they have the same structure) and therefore fragment the same in mass spectrometry. The chromatography does not separate these drugs and therefore the drugs when detected are identified as either / or. If it was considered necessary a different approach would separate the drugs and clearly identify one from the other.
PRINCIPLES OF GAS CHROMATOGRAPHY MASS SPECTROMETRY (GCMS)
As compounds (drugs) elute from the column into the collision chamber of the mass spectrometer they are bombarded with a high energy electron beam
The electron beam imparts energy to the compounds which then fragment into smaller ion charged particles that are separated within an oscillating magnetic field based on their
mass to charge ratio
The particles are collected by the detector as they pass through the field and provide a characteristic pattern for a
particular compound (drug fingerprint)
IDENTIFICATION OF A COMPOUND IS ACHIEVED WHEN THE FRAGMENTATION PATTERN IS COMPARED AGAINST A LIBRARY
OF KNOWN DRUG FRAGMENTATION PATTERNS
CH
RO
MA
TOG
RA P
HY
MASS SPECTROMETRY
LIQUID CHROMATOGRAPH
ELECTROSPRAY INTERFACE
IN-LINE MASS SPECTROMETER
0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0
Jan-08
Feb-08
Mar-08
Apr-08
May-08
0.0 5.0 10.0 15.0 20.0 25.0
Jan-08
Feb-08
Mar-08
Apr-08
May-08
0.0 5.0 10.0 15.0 20.0
Jan-08
Feb-08
Mar-08
Apr-08
May-08
0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0
Jan-08
Feb-08
Mar-08
Apr-08
May-08
CANNABIS METABOLITES
AMPHETAMINES
BENZODIAZEPINES
OPIATES
ANALYSIS TIME IN DAYS (WEEKENDS INCLUDED) FOR ALL CORRECTIVE SERVICE SPECIMENS FROM RECEIPT OF SPECIMEN TO REPORT (NOTE: PRIORITY GIVEN TOWARDS DRUG COURT SPECIMENS)
TOXICOLOGY_QUEENSLAND HEALTH FORENSIC AND SCIENTIFIC SERVICES
-100
0
100
200
300
400
500
600
700
800
900
0 20 40 60 80 100 120 140
THCCOOH CONC
CREATININE
NUMBER OF DAYS
URINE COLLECTED OVER A NUMBER OF DAYS
VARIATION OF DRUG CONCENTRATION (CANNABIS METABOLITE) AND CREATININE
IN URINE
Presenter
Presentation Notes
Set of data from one person The observation here is that as the creatinine concentration increases then so does the cannabinoid concentration. Does this signal reuse of the drug?
0.00
2.00
4.00
6.00
8.00
10.00
12.00
14.00
0 20 40 60 80 100 120 140
0
100
200
300
400
500
600
700
800
900
0 20 40 60 80 100 120 140
THCCOOH NORMALISED AGAINST CREATININE
Presenter
Presentation Notes
Take the previous information and normalise it against creatinine the spikes are removed and the curve becomes more consistent with normal drug elimination rather than a suggestion of re-use.
0.00
1.00
2.00
3.00
4.00
5.00
6.00
0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0
RATIO OF NORMALISED THCCOOH / CREATININE DAY X+ NORMALISED THCCOOH / CREATININE DAY X
RATIO 2.09
RATIO 1.5RATIO 0.76
RATIO 1.83(< 20 CREATININE)
NEW USE DIFFERENTIATED FROM RESIDUAL USE IN OCCASSIONAL CANNABIS SMOKERS
REDUCED CHANCE OF DETECTION OF OCCASSIONAL CANNABIS USAGE IF INTERVAL BETWEEN COLLECTION EXCEED 3 DAYS
-200
0
200
400
600
800
1000
1200
1400
1600
1800
2000
DAYS BETWEEN TESTS
THC-COOH (NG/ML)
THC-COOH NORMALISED AGAINST CREATININE
RATIO NORMALISED CURRENT TO PREVIOUS
CREATININE (MG/L)
22 23.9 92043 16 15.5 0.6 103035 130 481.5 31 27034 450 750 1.6 60014 190 575.8 0.8 33015 1525 837.9 1.5 18206 970 461.9 0.6 21008 115 396.6 0.9 290
13 160 592.6 1.5 27023 1800 775.9 1.3 2320
Lab # Collected Date
Received Date
Creatinine concmg/litre
Carboxy THC Concentrationng/ml
08TC5A 22 /4/ 08 1/5/08 2720 290
08TC5B 28 /4 /08 1/5/08 1640 510
If the carboxy THC concentration in the urine sample collected on the 22/4/08 is normalised to a creatinine concentration of 1640 the corresponding carboxy THC concentration would be of the order of 175. By way of either creatinine normalisation or viewing the reported result, the concentration of carboxy THC has increased in the urine specimen from that collected on the 22/4/08 to the one collected on the 28/4/08 some 6 days later. My opinion is that this increase in concentration is not consistent with normal elimination patterns in urine following cannabis use and is consistent with use of the drug within the interval between the two tests.
The level of cannabinoids detected through passive exposure experiments is dependent on the concentration of smoke in the air, this is a function of room size and number of cigarettes smoked
PASSIVE SMOKING
The concept of a non-smoker passively inhaling nicotine from normal cigarette smoke also applies to side-stream smoke from cannabis cigarettes.
.
It is possible for urine levels to exceed 20 ng/ml as a result of passive inhalation. the question is to whether these experimental conditions are achieved in real life
Closed medium sized station wagon with four subjects each smoking two cigarettes. two non smokers exposed to smoke for one hour. 1 urine specimen out of 23 collected over a twenty-four hour period was positive at just above the immunoassay cutoff
Experimental conditions designed to maximise the exposure and increase the likelihood of passive inhalation
Note from author:
‘IT SEEMS IMPROBABLE THAT SUBJECTS WOULD UNKNOWINGLY TOLERATE THE NOXIOUS SMOKE CONDITIONS PRODUCED BY THIS EXPOSURE ‘
Subject Four SixteenA nil 19B nil 15C 8 35D nil 20E 12 25F n/a 87G n/a 10
Maximum Urine Concentration of THCCOOH (ng/ml) after Passive
Exposure for one hour each session to a number of cigarettes over six days
Number of cigarettes
SMALL UNVENTILATED ROOM (2.1 X 2.5 X 2.4) RESEMBLED THAT OF A BATHROOM
delta-9-tetrahydrocannabinol (THC) is regarded as the psychoactive principle in cannabis
11-nor-delta-9- tetrahydrocannabinol-9- carboxylic acid (THC-COOH) is the inactive metabolite
TETRAHYDROCANNABINOL (THC) LEVELS IN BLOOD
ORAL FLUID CAVITY IS CONTAMINATED WITH THC IN CIGARETTE SMOKECOLLECTION TIME(HOURS)
THC ORAL FLUID GC-MS (NG/ML)
THC PLASMA GC-MS (NG/ML)
0.2 5800 1930.33 81 145
0.5 49 51
1 29 17
2 3.5 3
4 3.6 2
Neidbaler; J. Anal Tox, Vol 28,2004
0
50
100
150
200
250
300
350
400
450
0 50 100 150 200 250
Average data from four passive smokers
THC LEVELS IN ORAL FLUID AFTER SMOKING CANNABIS
Time (minutes)
THC
con
cent
ratio
n ng
/ ml
EQUILIBRIA IS ALSO ESTABLISHED BETWEEN THE DRUG CONCENTRATION IN BLOOD AND ORAL FLUID
ORAL FLUID DRUG DETECTION WINDOW SIMILAR TO DETECTION WINDOW IN BLOOD AS CONCENTRATION DEPENDENT ON BLOOD DRUG CONCENTRATION (EXCEPTION TETRAHYDROCANNABINOL)
2COCAINE
2.8AMPHETAMINE
0.03
1
0.2
0.1
ORAL FLUID TO PLASMA RATIO
DIAZEPAM
CODEINE
MORPHINE
THC
DRUG
TABLE OF ORAL FLUID TO BLOOD RATIOS FOR NOMINATED DRUGS
THC IS DEPOSITED IN ORAL CAVITY DURING CANNABIS SMOKING
RADIOLABELLED THC THROUGH INTRAVENOUS INJECTION SHOWS LITTLE OF THE ISOTOPE IS DETECTED IN THE ORAL FLUID
POOR RESPONSE TO BENZODIAZEPINES
LIMITATIONS TO SUITABILITY OF ORAL FLUID FOR DETECTION OF ALL DRUGS BY ON-SITE TEST DEVICES
ORAL FLUID
CLASS OF DRUG CUT-OFF LEVEL (UG /L)
OPIATES 300
AMPHETAMINE TYPE SUBSTANCE
300
CANNABIS METABOLITES 50
COCAINE METABOLITES 300
BENZODIAZEPINES 200
IMMUNOASSAY SCREENING TEST CUT-OFF LEVELS
AS/NZ 4308 CUTOFF LEVELS FOR IMMUNOASSAY SCREEN TESTS
A RESULT WITH AN OPIATE VALUE (500) OBTAINED ABOVE THE CUTOFF VALUE (300) WILL BE REPORTED AS DETECTED (POSITIVE) AND A CONFIRMATORY TEST IS REQUIRED
SIMILARLY AN OPIATE VALUE (250) OBTAINED BELOW THE CUTOFF VALUE (300) WILL BE REPORTED AS NOT DETECTED (NEGATIVE)
COMPOUNDCUT-OFF LEVEL
(UG/L)
MORPHINE 300CODEINE 300
6-ACETYLMORPHINE 10AMPHETAMINE 150
METHYLAMPHETAMINE 150METHYLENEDIOXYMETHYLAMPHETAMINE 150
PHENTERMINE 500PSEUDOEPHEDRINE 500BENZYLPIPERAZINE 500
11-NOR-DELTA-9-TETRAHYDROCANNABINOL-9-CARBOXYLIC
ACID15
BENZOYLECGONINE 150ECGONINE METHYL ESTER 150
OXAZEPAM 200TEMAZEPAM 200
DIAZEPAM 200NORDIAZEPAM 200
ALPHA-HYDROXY-ALPRAZOLAM 1007-AMINO-CLONAZEPAM 100
7-AMINO-FLUNITRAZEPAM 1007-AMINO-NITRAZEPAM 100
CONFIRMATORY TEST CUT-OFF CONCENTRATION (AS TOTAL DRUG)CUT-OFF LEVELS
AS/NZ4308:2008
CONFIRMATION ANALYSIS REPORTING OF RESULTS
INDIVIDUAL DRUGS OR METABOLITES CONFIRMED BY THE LABORATORY AT A CONCENTRATION GREATER THAN THE CUTOFF VALUE NOMINATED IN THE STANDARD SHALL BE REPORTED AS DETECTED
CENTRALCOMPARTMENT(CIRCULATORY
SYSTEM)
PERIPHERALCOMPARTMENT
(TISSUE & ORGANS)INTRAVENOUS
DOSE
EXCRETION METABOLISM
ORAL DOSE
ABSORPTION
TWO COMPARTMENT PHARMACOKINETIC MODEL
POTENTIAL RESERVOIR
