Most papers that describe relatively simple quantification methods are carried out in pharmaceutical research with controlled standards, methodologies, and standards. While quantification of unknown substances is technically possible, it really comes down to a case-by-case basis and is generally a laborious process undertaken by advanced to expert level technicians and chemists in forensic laboratories. It is highly unlikely that quantification would be viable using this technology in this kind of setting. Recent advances in IR technology have allowed for the development of portable IR devices. Cocaine remains to this day a matter of concern for public health, as it holds strong as the second most used illicit substance in most countries. Whether it is in the form of cocaine powder or ‘crack’ cocaine, its prevalence and use by individuals from all walks of life should be taken seriously as it will not spare users from the inherent toxicity of the drug’s use.
ELISA can, however, be used to perform other types of biochemical assays in the detection of an analyte in a liquid sample. Very little scholarly information is easily accessible about which specific drugs ELISA can detect outside of biological samples (post ingestion/metabolization). Several commonly abused substances can be identified, including cocaine, heroin, methadone, GHB (gamma hydroxybutyrate), ketamine, phencyclidine, amphetamines, and methamphetamine 34. With test reagents chosen to induce development of specific microcrystals with the analyte and a reference/control standard available, these tests can be highly specific as the crystals formed are a direct consequence of choice of reagent and analyte and are unique under these circumstances. This is provided that other substances do not react in a similar way, if at all, with the reagent, and provided that impurities, dilutents, and adulterants do not prevent or mask the formation of characteristic microcrystals for the drug tested.
For this reason, it is likely that illicit substance use related ICD codes capture more problematic and health-impacting patterns of illicit substance use, which is supported by our finding that sensitivity was enhanced among patients who reported more frequent illicit substance use. Regarding variable sensitivities of ICD-10-CM codes by substance, perhaps methamphetamine and cocaine use are more likely to result in related healthcare encounters compared to opioids, and thus methamphetamine- and cocaine-related diagnostic codes appear more sensitive for detecting use. In addition, lower sensitivity of emergency department ICD codes might be expected given that visits for acute illness or injury may be less likely to involve toxicology testing or other assessments of drug use. The present analysis used data from a retrospective cohort study of 602 publicly insured or uninsured patients in San Francisco who had been prescribed opioid pain relievers for chronic non-cancer pain for ≥3 months from 2013− 2015. Potential participants were identified through patient registries maintained by each clinic in the San Francisco Health Network, the city’s public healthcare system.
Amphetamines
Firm conclusions or recommendations, however, are almost impossible as the majority of trials included people with diverse SUD without differentiating results according to the substance of abuse. There is only one RCT conducted in methamphetamine-only users, two in cocaine-only users and none in cannabis-only users. Substance use disorders (SUD) are highly prevalent in bipolar disorder (BD) and significantly affect clinical outcomes.
- Neurons from these pathways are located in the ventral tegmental area and project to other brain locations, including the nucleus accumbens 78.
- Two groups of synthetic drugs — synthetic cannabinoids and substituted or synthetic cathinones — are illegal in most states.
- Testing performed at the request of other parties (including law enforcement), or to benefit other parties (including other patients) is not permissible without the patient’s consent.
- This alarming surge highlights the urgent need to address the nation’s ongoing battle against cocaine addiction.
- Most of the studies included in this review were carried out in Iran, therefore, this may affect its broader application.
2. Longitudinal Trends in Comorbid Illicit Substance Use Disorder and Bipolar Disorder
Moderate doses of cocaine induce euphoria, improve alertness and concentration, increase libido, promote a general sensation of well-being, and reduce fatigue and appetite. This is, however, accompanied by insomnia, anxiety, irritability, dysphoria, and impulsive behaviour—the less desirable effects may not be noticed immediately and might increase in frequency with continued drug use. Hallmark physiological effects of cocaine include those of the cardiovascular nature, such as vasoconstriction, tachycardia, and hypertension.
The choice of the drug to combine with cocaine is often based on the desire to counteract the stimulant (‘upper’) effects of cocaine, so another drug to ‘mellow down’ (a ‘downer’) is frequently selected. Examples of these drugs are alcohol, benzodiazepines (e.g., lorazepam and diazepam), cannabis and opioids (e.g., heroin) 149. Two of the most common combinations are cocaine in conjunction with alcohol and opioids/heroin (also known as ‘speedball’) 1,24, and therefore will be given special standout. The 2012 Canadian Network for Mood and Anxiety Treatments (CANMAT) recommends adding valproate to lithium in BD cocaine illicit use: addiction, overdosage, and drug testing patients with cannabis or cocaine use disorder 35, based on open and retrospective studies 36,37,38,39. In 2019, Coles and coworkers published a systematic review including open and controlled studies in BD comorbid with SUD, ranging from tobacco to opioids, with the majority looking into AUD 40. However, there are also a few randomized, controlled studies that included comorbid BD subjects with cannabis, cocaine, amphetamine or opioids use, summarized in Table 2.
How accurate are drug tests? Can a drug test result in a false positive or false negative?
Many programs usetemperature strips to make certain that urine specimens are produced on site and arebody temperature. Tests of creatinine or specific gravity can determine whether asample has been diluted with water or the client is consuming excessive fluids tolower the concentration of drugs below detectable levels (Preston et al. 1999). Given the widespread prevalence of drug use and abuse,20 there is a great need for laboratories to provide identification of prescribed, non-prescribed, and illicit drug use. Fifty milliliter aliquots of each authentic wastewater samples were spiked with 25 µL of 0.1 µg/mL IS mixture, containing the deuterated analogues of all the target analytes except MDA.
Epidemiology of Illicit Substance Use in Bipolar Disorder
It also tells how long the person may continue to test positive after the last time he or she took the drug. These are only guidelines, however, and the times can vary significantly from these estimates based on how long the person has been taking the drug, the amount of drug they use, or the person’s metabolism. By combining these evidence-based treatments, Care Plus aims to empower individuals to overcome cocaine addiction and achieve lasting recovery.
These requirements are essentially an attempt to ensure the sample is from the individual providing it and without added diluents or substances that might interfere with testing. In vivo and in vitro studies have also shown that cocaine has a neurotoxic potential. Cunha-Oliveira et al. saw that 1 mM of cocaine led to an increase in calcium concentrations and caspase-3 activity, as well as a decrease in mitochondrial membrane potential and ATP in rat cortical neurons exposed for 24 h 112. Furthermore, cocaine exposure in models of rat primary hippocampal neurons (1 mM) and mouse primary cortical neurons (1, 10, 100 and 200 μM) increased the expression of autophagy markers LC-3 I and II 113,114. Nifedipine, a selective blocker of L-type calcium channels, reverted the reduction of cerebral blood flow and tissue oxygenation induced by increases in neuronal calcium currents, in the prefrontal cortex of rats exposed to 1 mg/Kg cocaine 115. Overall, motives for consuming illicit drugs in individuals with BD do not differ from people with BD and primary SUD (SUD before the onset of BD).
- It has also been reported that morphine could exert a hypoglycaemic effect at low dose infusion when the endocrine pancreatic function is fixed at basal level 12.
- Synthetic cannabinoids, also called K2 or Spice, are sprayed on dried herbs and then smoked, but can be prepared as an herbal tea.
- ICD-10-CM codes to detect substance use, particularly those from emergency department visits, should be used with caution, but may be useful as a lower- bound population measure of substance use or for capturing frequent use among certain patient populations.
- Of note, when the subject rejects benzodiazepines’ oral administration, the intramuscular or intravenous routes are recommended 89,160.
- There are several kinds of drug tests based on the biological sample they use and the types of drugs they detect.
The full extent of the effects of cocaine use on the unborn or newborn child are difficult to predict. Multiple factors can play into this outcome, such as use of other illegal drugs, maternal sexually-transmitted diseases, extent of prenatal care, and socioeconomic factors, among others. Of note, and contrasting its observed detrimental effects in BD subjects 55,56, some investigators also suggest a potential therapeutic role for cannabis derivative in BD 57. The endocannabinoid system is known to exert neuro-modulatory effects on other neurotransmitter systems critical in controlling emotions 58. Selective activation of the cannabinoid receptor 2 (CB2) and antagonism of cannabinoid receptor 1 (CB1) may alleviate the symptoms of BD and, according to Arjmand and colleagues 59, should be rigorously explored. This is in line with genetic findings suggesting that carriers of a specific variant of CB1 are also at higher risk of developing BD 60.
The number of reported overdose cases is steadily increasing, which is of grave concern for healthcare providers and policymakers. According to the 2016 National Survey on Drug Use and Health (NSDUH), it was estimated that 28.6 million individuals aged 12 and older were illicit drug users in the month before the survey was conducted 1. The number of marijuana users was at its highest in comparison to the data from 2002 to 2015; 24.0 million individuals aged 12 and over reported that they were current users.
