FROM THE EDITOR By Lisa Moynihan, Edi tor Designer drugs S

ubstance abuse is one of the United States’ largest health problems, yet an all-inclusive reference chart for Cutoff and Toxicity Levels for Dugs-of-Abuse Testing is partial,

at best. The reason? The ever-changing horizon of chemical compounds.

While limits for opiates, hallucinogens, and stimulants are

readily available, two trending “designer drugs,” specifically, bath salts and synthetic cannabinoids, are not. In fact, MLO was advised it wouldn’t be useful to include either of these drugs because as soon as the chart is published, it’s likely those spe- cific compounds would no longer be relevant. Due to these constantly changing compounds, no accurate studies exist to determine urine detection windows, therapeutic doses, etc.

Bath salts are synthetic stimulants, or cathinones; a family of drugs containing one

or more synthetic chemicals related to cathinone, a stimulant found naturally in the khat shrub in East Africa and southern Arabia. Synthetic cathinones can be purchased online and in drug paraphernalia stores under a variety of brand names, including Bliss, Cloud Nine, Lunar Wave, Vanilla Sky, and White Lightning.1

In many cases,

synthetic cathinones are specifically created to evade detection, being introduced and reintroduced into the market in quick succession to dodge law enforcement efforts to address their manufacture and sale. Public health officials refer to synthetic cathinones as “new psychoactive substances” (NPS).2

NPS are unregulated psychoactive mind-altering substances with

no legitimate medical use and are made to copy the effects of controlled substances. Of- ten undetectable by typical urinalysis, NPS can be detected in urine and hair using gas chromatography-mass spectrometry or liquid chromatography-mass spectrometry. Similarly, synthetic cannabinoids are not one drug and are not detectable on most

standard in-house hospital drug screens, including assays for tetrahydrocannabinol (THC)..3

A number of commercial labs offer testing for synthetic cannabinoids, how-

ever, the panels are often limited. These chemicals are called cannabinoids because they are similar to chemicals found in cannabis. Because of this similarity, synthetic canna- binoids are sometimes misleadingly called “synthetic marijuana” (also known as K2, Spice, AK-47, Mr. Happy, Scooby Snax, and Black Mamba5

), and are often marketed as

safe, legal alternatives. In fact, they are not safe and may affect the brain much more powerfully than marijuana; their actual effects unpredictable and, in some cases, more dangerous or even life-threatening.4 Redwood Toxicology Laboratory (RTL), the government services division of Alere

Toxicology, and one of the nation’s largest drug and alcohol testing laboratories, claims to be the first lab in the world to develop a urine-based metabolite test and oral fluid parent drug test for “synthetic marijuana,” targeting 19 of the most common chemical compounds found in synthetic cannabinoids.5 ARUP laboratories offers a Bath Salts Panel for urine which, “may be useful in the assessment of exposure to bath salts up to several days post-exposure. For the assess- ment of acute exposure, Bath Salts Panel, Serum or Plasma (2011411) may be useful.” The methodology? Quantitative high performance liquid chromatography/tandem mass spectrometry.

Quest Diagnostics states they are, “Working collaboratively with the oil and gas industry and other laboratories to refine our synthetic drug testing panel based on information from the National Forensic Laboratory Information System (NFLIS), the Drug Enforcement Administration (DEA), peer-reviewed scientific literature, and industry-observed trends and usage.”6

Their intention? Providing a standardized

panel that can detect the most relevant drugs from an ever-changing list of substances. Although substance abuse and designer drugs will continue to come and go, as laboratorians, the goal remains steadfast: Being privy to accurate drug detection tools with the ultimate goal of discouraging addiction.

Please visit for references. MLO - MEDICAL LABORATORY OBSERVER

(ISSN: 0580-7247). Published monthly, with an additional issue in August, by Endeavor Business Media, LLC., 2477 Stickney Point Rd, Suite 221B, Sarasota, FL 34231 (941) 388-7050. Subscription rates: $127.60/ year in the U.S.; $154.88 Canada/Mexico; Intl. subscriptions are $221.43/year. All issues of MLO are available on microfilm from University Microfilms International, Box 78, 300 N. Zeeb Rd., Ann Arbor, MI 48106. Current single copies (if available) $15.40 each (U.S); and $19.80 each (Intl.). Back issues (if available) $17.60 each (U.S.); $22.00 each (Intl.). Payment must be made in U.S. funds on a U.S. bank/ branch within the continental U.S. and accompany request. Subscription inquiries: MLO is indexed in the Cumulative Index for Nursing and Allied Health Literature and Lexis-Nexis. MLO Cover/CE, Clinical Issues, and Lab Management features are peer reviewed. Title®

registered U.S. Patent Office. Copyright© 2019 by Endeavor

Business Media, LLC. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage-and- retrieval system, without written permission from the publisher. Office of publication: Periodicals Postage Paid at Nashville, TN 37209 and at additional mailing offices. Postmaster: Send address changes to Omeda (MLO Medical Laboratoy Observer), PO Box 3257, Northbrook, IL 60065-3257.

4 $-3 t .-0 t XXX DMS POMJOF DPN Printed in U.S.A.


Publisher/Executive Editor Kristine Russell

Editor Lisa Moynihan

Editor Janette Wider

Graphic Artist Patti Connors

Audience Development/List Rentals Laura Moulton

Ad Traffic Manager Norma Machado

eProduct Coordinator Mary Haberstroh


East Coast/Midwest Sales (except IL) Classified/Recruitment Advertising Carol Vovcsko (941) 321-2873

South/West Coast/Illinois Sales Lora Harrell (941) 328-3707


John Brunstein, PhD, Biochemistry (Molecular Virology) President & CSO PathoID, Inc., British Columbia, Canada

John A. Gerlach, PhD, D(ABHI) Laboratory Director Michigan State University, East Lansing, MI

Barbara Strain, MA, SM(ASCP) Principal, Barbara Strain Consulting LLC, Charlottesville, VA

Jeffrey D. Klausner, MD, MPH Professor of Medicine and Public Health Division of Infectious Diseases: Global Health, Dept. of Epidemiology, David Geffen School of Medicine, Karen and Jonathon Fielding School of Public Health, University of California Los Angeles, CA

Susan McQuiston, JD, MT(ASCP), SCy(ASCP) Instructor, Biomedical Laboratory Diagnostics Program Michigan State University, East Lansing, MI

Donna Beasley, DLM(ASCP) Director Huron Healthcare, Chicago, IL

Anthony Kurec, MS, H(ASCP)DLM Clinical Associate Professor, Emeritus SUNY Upstate Medical University, Syracuse, NY

Suzanne Butch, MLS(ASCP)CM Freelance Consultant, Ann Arbor, MI


Paul R. Eden, Jr., MT(ASCP), PhD Lt. Col., USAF (ret.) (formerly) Chief, Laboratory Services 88th Diagnostics/Therapeutics Squadron Wright-Patterson AFB, OH



Chris Ferrell, CEO Scott Bieda, EVP, CRO | June Griffin, CMO

Tracy Kane, VP, General Counsel, HR | Patrick Rains, COO Angela Rex, VP Accounting | Kristine Russell, EVP

2477 Stickney Point Rd., Suite 221B Sarasota, FL 34231 Phone: (941) 388-7050 Fax: (941) 388-7490

Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36