DOCSLIB.ORG

RPAG-Substance-Use-I

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
RPAG-Substance-Use-I Substance Use in Pregnancy A Clinician’s Toolkit for Screening, Counseling, Referral and Care Presented by: The Regional Perinatal Advisory Group (RPAG) June 2014 The toolkit online: www.baltimorecountymd.gov/go/perinatal RPAG Substance Use in Pregnancy A Clinicianʼs Toolkit for Screening, Counseling, Referral and Care For Maryland Prenatal Care Providers and Substance Use Disorder Treatment Providers Section.Page 1. Overview • Letter of Support .……………………………………… 1.1 • Introduction .…………………………………………… 1.2 • Scope of the Problem ………………………………….. 1.3 2. Screening, Counseling and Billing • Screening ………………………………………………. 2.1 • Screening Tools ..………………………………………. 2.3 • Negative Screening …………………………………….. 2 .13 • Positive Screening - Brief Intervention ………………... 2 .14 • Documentation ………………………………………… 2 .16 • Billing ………………………………………………….. 2.17 • Chart – Drink Equivalent ………………………………. 2.18 • Patient Drinking and Smoking Teaching Sheets ………. 2.19 3. Referral and Treatment • Referral for Substance Use Treatment …………………. 3.1 • Patient Self Referral Handout ………………………….. 3.2 • Substance Use Disorder Treatment in Pregnancy ……... 3.3 • Communication Between Providers …………………… 3.10 • Consent for Communication …………………………… 3.12 4. Effects of Substance Use on Mother, Fetus, Infant and Child • Overview …………………………………………….… 4.1 • Table of Substances and Their Effects ………………… 4.3 • Fetal Alcohol Spectrum Disorder ……………………… 4.28 • Neonatal Abstinence Syndrome ……………………….. 4.30 • Chart of Critical Periods in Gestational Development … 4.34 Regional Perinatal Advisory Group Substance Use in Pregnancy Toolkit 2014 Table of Contents Section.Page 5. Care of the Substance Using Pregnant Woman • Overview ………………………………………………. 5.1 • Special Considerations in Prenatal Care ……………….. 5.2 • Special Considerations in Postpartum Care …………… 5.6 • Special Considerations in Substance Treatment ……….. 5.7 6. Care of the Substance Exposed Infant • Breastfeeding …………………………………………... 6.1 • Therapeutic Handling ………………………………….. 6.5 7. Laws and Mandates • Resources Available for Substance Use Treatment ……. 7.1 • Substance Exposed Newborn ………………………….. 7.2 • Postpartum Resources …………………………………. 7.4 • Maternal/Child Health Funding Resources ……………. 7.4 • Health Services Required to be Paid by Insurances …… 7.6 • Affordable Care Act and Maternal/Child Health ……… 7.6 • Newborn Screening ……………………………………. 7.7 • Guide to Accessing Maryland Statutes ………………… 7.7 • Report of Substance-Exposed Newborn DHR/SSA……. 7.8 Form 2079 • Jurisdiction Departments of Social Services …………... 7.9 8. Perinatal Substance Treatment Programs in Maryland - Examples • Example One - CAP at Johns Hopkins Bayview ……… 8.1 • Example Two - SART in Carroll County ……………… 8.4 9. Resources • ACOG Committee Opinion: At-Risk Drinking and……. 9.1 Alcohol Dependence: Obstetric and Gynecological Implications August 2011 reaffirmed 2013 • ACOG Committee Opinion: Nonmedical Use of ……… 9.7 Prescription Drug October 2102 • ACOG Committee Opinion: Opioid Abuse, …...………. 9.13 Dependence, and Addiction in Pregnancy May 2012 Regional Perinatal Advisory Group Substance Use in Pregnancy Toolkit 2014 Table of Contents Section.Page 9. Resources (continued) • ACOG Committee Opinion: Smoking Cessation ……… 9.20 During Pregnancy Reaffirmed 2013 • ACOG Committee Opinion: Substance Abuse ………… 9.24 Reporting and Pregnancy: The Role of the Obstetrician-Gynecologist Reaffirmed 2012 • Pediatrics: Prenatal Substance Abuse: Short and ……... 9.26 Long Term Effects on the Exposed Fetus February 2013 • Pediatrics: The Transfer of Drugs and Therapeutics ….. 9.44 into Human Breast Milk August 2013 • Patient Materials ……………………………………….. 9.60 • Local Resources by Jurisdiction ………………………. 9.61 • Frequently Asked Questions - Laminated Sheet ………. Front flap • CD with Information and Patient Handouts …………… Front flap • HRSA Screening for Substance Abuse During ………... Back flap Pregnancy: Improving Care, Improving Health 1997 10. Addenda • Depression Screening and Mental Health Referral ……. 10.1 • Depression Screening Tool …………………………….. 10.2 • Mental Health Core Service Agencies ………………… 10.4 • HIV in Pregnancy ……………………………………… 10.5 • Intimate Partner Violence ……………………………… 10.10 • DHMH IPV Screening Tool ………………………….. 10.12 • IPV Resources …………………………………………. 10.13 Regional Perinatal Advisory Group Substance Use in Pregnancy Toolkit 2014 Table of Contents 1.1 ACOG – Maryland Section Chair Jessica L. Bienstock, MD MPH 410.955.8487 [email protected] Dear Colleague: As the epidemic of drug and alcohol abuse continues unabated in the United States, the magnitude of impact on the health of the women we serve, as well as their infants, has also grown. This increase has largely been due to the explosion in misuse of legal opioid drugs as well as illicit opioids. Opioid overdose is now the leading cause of accidental death among adults, surpassing motor vehicle accidents, and approaching the number of HIV/AIDS-related deaths that occurred at the height of the HIV/AIDS epidemic. In addition, a 2012 JAMA study estimated that every hour, a baby is born in the United States with evidence of withdrawal from opiates (~13,500 infants per year). Unfortunately, Maryland statistics reflect these national trends. More than ever, women rely on us for generalized medical care beyond their gynecological and obstetric needs. Adequate screening for threats to the well-being of these women and their offspring has become an integral part of good care. Over the past several years, there have been significant changes in our recommendations for patient screening for depression, HIV, intimate partner violence, and substance misuse. In an effort to increase knowledge and improve practices among those providing obstetric care, as well as those providing substance abuse treatment to pregnant women, the Regional Perinatal Advisory Group (RPAG) has created Substance Use in Pregnancy: A Clinician’s Toolkit for Screening, Counseling, Referral, and Care. This toolkit will be distributed statewide to all sites/providers providing prenatal care and/or substance use disorder treatment, health departments, and hospitals providing obstetrical care. To provide comprehensive obstetric care, it is up to us to screen all of our patients for substance use and take appropriate actions, based on the results, in an unbiased manner. Indeed, we can make a difference in preventing or mitigating the harmful effects of substance use on our patients and their infants. I trust you will find this toolkit helpful and that it will encourage you to expand your screening for substance use to all your patients, as there is evidence that substance use disorder crosses all socio-economic borders. The Maryland Chapter of the American Congress of Obstetricians and Gynecologists Is committed to increasing the available information and tools regarding the problem of substance use in pregnancy in order for our members to continue to provide excellent care for their patients and families. Sincerely, Jessica L. Bienstock, MD MPH Chair – Maryland Section ACOG 1.2 Introduction This toolkit was created for obstetric care providers and substance use disorder treatment providers in order to: • Provide key information about the impact of legal and illegal substances on a woman’s pregnancy and on the unborn child. • Help professionals take better care of the pregnant woman who has been using or abusing substances. • Improve the collaboration between obstetric and substance use disorder treatment providers in the care of pregnant women who are misusing drugs or other substances. Use of legal and illegal substances occurs in all racial, ethnic and socio-economic groups. The use of tobacco and alcohol, misuse of prescription medications, as well as the use of illegal drugs contribute substantially to maternal, fetal, and neonatal morbidity and mortality. In addition, there is increasing evidence that use of some of these substances during pregnancy can have long-term impact on the child’s development and behavior. Pregnant women misusing substances are at greater risk for HIV infection and domestic violence than the general population. Misuse of legal and illegal drugs, alcohol, and tobacco often is not disclosed without specific questioning. Skillful screening for use, counseling about the risks associated with use, referral for treatment, and continuing collaboration between those offering treatment and those caring for the woman’s pregnancy are critical to providing optimum care. In order to give their infants the best chance in life, pregnant women are often more open to behavior change. They may be motivated to address substance use issues in an effort to protect their unborn infant. We hope this toolkit will help address the important problem of substance misuse and give you direction as you care for the pregnant woman and her unborn child. R egional Perinatal Advisory Group Substance Use in Pregnancy Toolkit 2014 Introduction 1.3 Scope of the Problem Tobacco Use Nationally • Cigarette smoking rates are lower in pregnant women aged 18 to 44 than their non- pregnant counterparts, but 22.7% of pregnant women aged 18 to 25 and 11.8% of 1 pregnant women aged 26 to 44 continue to smoke throughout pregnancy. • Tobacco use during pregnancy is associated with preterm labor, lower birth weights, fetal 2 deaths, and a variety of other pregnancy complications. • Tobacco use rates are especially high in adults who also abuse other drugs. Among adults in treatment for substance abuse, studies report as many as 80-98% also use 3 tobacco. • Maternal smoking during
Load more

Recommended publications
  • Guidelines for the Forensic Analysis of Drugs Facilitating Sexual Assault and Other Criminal Acts
    Vienna International Centre, PO Box 500, 1400 Vienna, Austria Tel.: (+43-1) 26060-0, Fax: (+43-1) 26060-5866, www.unodc.org Guidelines for the Forensic analysis of drugs facilitating sexual assault and other criminal acts United Nations publication Printed in Austria ST/NAR/45 *1186331*V.11-86331—December 2011 —300 Photo credits: UNODC Photo Library, iStock.com/Abel Mitja Varela Laboratory and Scientific Section UNITED NATIONS OFFICE ON DRUGS AND CRIME Vienna Guidelines for the forensic analysis of drugs facilitating sexual assault and other criminal acts UNITED NATIONS New York, 2011 ST/NAR/45 © United Nations, December 2011. All rights reserved. The designations employed and the presentation of material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the United Nations concerning the legal status of any country, territory, city or area, or of its authorities, or concerning the delimitation of its frontiers or boundaries. This publication has not been formally edited. Publishing production: English, Publishing and Library Section, United Nations Office at Vienna. List of abbreviations . v Acknowledgements .......................................... vii 1. Introduction............................................. 1 1.1. Background ........................................ 1 1.2. Purpose and scope of the manual ...................... 2 2. Investigative and analytical challenges ....................... 5 3 Evidence collection ...................................... 9 3.1. Evidence collection kits .............................. 9 3.2. Sample transfer and storage........................... 10 3.3. Biological samples and sampling ...................... 11 3.4. Other samples ...................................... 12 4. Analytical considerations .................................. 13 4.1. Substances encountered in DFSA and other DFC cases .... 13 4.2. Procedures and analytical strategy...................... 14 4.3. Analytical methodology .............................. 15 4.4.
    [Show full text]
  • Development of Pain-Free Methods for Analyzing 231 Multiclass Drugs and Metabolites by LC-MS/MS
    Clinical, Forensic & Toxicology Article “The Big Pain”: Development of Pain-Free Methods for Analyzing 231 Multiclass Drugs and Metabolites by LC-MS/MS By Sharon Lupo As the use of prescription and nonprescription drugs grows, the need for fast, accurate, and comprehensive methods is also rapidly increasing. Historically, drug testing has focused on forensic applications such as cause of death determinations or the detection of drug use in specific populations (military, workplace, probation/parole, sports doping). However, modern drug testing has expanded well into the clinical arena with a growing list of target analytes and testing purposes. Clinicians often request the analysis of large panels of drugs and metabolites that can be used to ensure compliance with prescribed pain medication regimens and to detect abuse or diversion of medications. With prescription drug abuse reaching epidemic levels [1], demand is growing for analytical methods that can ensure accurate results for comprehensive drug lists with reasonable analysis times. LC-MS/MS is an excellent technique for this work because it offers greater sensitivity and specificity than immunoassay and—with a highly selective and retentive Raptor™ Biphenyl column—can provide definitive results for a wide range of compounds. Typically, forensic and pain management drug testing consists of an initial screening analysis, which is qualitative, quick, and requires only minimal sample preparation. Samples that test positive during screening are then subjected to a quantitative confirmatory analysis. Whereas screening assays may cover a broad list of compounds and are generally less sensitive and specific, confirmation testing provides fast, targeted analysis using chromatographic conditions that are optimized for specific panels.
    [Show full text]
  • Big Pain Assays Aren't a Big Pain with the Raptor Biphenyl LC Column
    Featured Application: 231 Pain Management and Drugs of Abuse Compounds in under 10 Minutes by LC-MS/MS Big Pain Assays Aren’t a Big Pain with the Raptor Biphenyl LC Column • 231 compounds, 40+ isobars, 10 drug classes, 22 ESI- compounds in 10 minutes with 1 column. • A Raptor SPP LC column with time-tested Restek Biphenyl selectivity is the most versatile, multiclass-capable LC column available. • Achieve excellent separation of critical isobars with no tailing peaks. • Run fast and reliable high-throughput LC-MS/MS analyses with increased sensitivity using simple mobile phases. The use of pain management drugs is steadily increasing. As a result, hospital and reference labs are seeing an increase in patient samples that must be screened for a wide variety of pain management drugs to prevent drug abuse and to ensure patient safety and adherence to their medication regimen. Thera- peutic drug monitoring can be challenging due to the low cutoff levels, potential matrix interferences, and isobaric drug compounds. To address these chal- lenges, many drug testing facilities are turning to liquid chromatography coupled with mass spectrometry (LC-MS/MS) for its increased speed, sensitivity, and specificity. As shown in the analysis below, Restek’s Raptor Biphenyl column is ideal for developing successful LC-MS/MS pain medication screening methodologies. With its exceptionally high retention and unique selectivity, 231 multiclass drug compounds and metabolites—including over 40 isobars—can be analyzed in just 10 minutes. In addition, separate panels have been optimized on the Raptor Biphenyl column specifically for opioids, antianxiety drugs, barbiturates, NSAIDs and analgesics, antidepressants, antiepileptics, antipsychotics, hallucinogens, and stimulants for use during confirmation and quantitative analyses.
    [Show full text]
  • LZI Buprenorphine Enzyme Immunoassay for in Vitro Diagnostic Use Only 8ºC 0270 (100/37.5 Ml R1/R2 Kit) 0271 (1000/375 Ml R1/R2 Kit) 2ºC
    LZI Buprenorphine Enzyme Immunoassay For In Vitro Diagnostic Use Only 8ºC 0270 (100/37.5 mL R1/R2 Kit) 0271 (1000/375 mL R1/R2 Kit) 2ºC Lin-Zhi International, Inc. Intended Use Calibrators and Controls* The Lin-Zhi International (LZI) Buprenorphine Enzyme Immunoassay is *Calibrators and controls are sold separately and contain negative human intended for the qualitative and semi-quantitative determination of urine with sodium azide as a preservative. norbuprenorphine (a buprenorphine metabolite) in human urine at a cutoff value NORBUPRENORPHINE Calibrators/Controls REF of 5 ng/mL and 10 ng/mL. The assay is designed for prescription use with a Negative Calibrator 0001 number of automated clinical chemistry analyzers. Control: Contains 3 ng/mL norbuprenorphine 0272 The assay provides only a preliminary analytical result. A more specific Cutoff/Calibrator: Contains 5 ng/mL norbuprenorphine 0273 alternative analytical chemistry method must be used in order to obtain a Control: Contains 7 ng/mL norbuprenorphine 0274 confirmed analytical result. Gas or Liquid Chromatography/Mass Cutoff/Calibrator: Contains 10 ng/mL norbuprenorphine 0275 Control: Contains 13 ng/mL norbuprenorphine 0276 Spectrometry (GC/MS or LC/MS) are the preferred confirmatory methods Calibrator: Contains 20 ng/mL norbuprenorphine 0277 (1, 2). Clinical consideration and professional judgment should be exercised Calibrator: Contains 40 ng/mL norbuprenorphine 0278 with any drug of abuse test result, particularly when the preliminary test Calibrator: Contains 75 ng/mL norbuprenorphine 0279 result is positive. Precautions and Warning Summary and Explanation of Test • This test is for in vitro diagnostic use only. Harmful if swallowed. Buprenorphine is a semi-synthetic opioid derived from thebaine, an alkaloid of • Reagents used in the assay contain sodium azide as a preservative, which the poppy plant, Papaver somniferum.
    [Show full text]
  • A Generic LC-MS Method for the Analysis of Multiple of Drug of Abuse Classes with the Thermo Scientific Exactive TM System
    A Generic LC-MS Method for the Analysis of Multiple of Drug of Abuse Classes with the Thermo Scientific Exactive TM System Kent Johnson Fortes lab, Wilsonville Oregon Forensic Toxicology Use Only List of drug of abuse candidates for LC-MS analysis Sample matrix: urine and blood Benzodiazepines Opiates Other drugs group 1 Other drugs group 2 7-Aminonitrazepam Morphine Ketamine Methylphenidate 7-Aminoclonazepam Hydromorphone Norketamine Ritalinic Acid 7-Aminoflunitrazepam Oxymorphone Butorphanol Dextromethorphan 2-Hydroxy-ethyl-flurazepam Codeine Fentanyl Dextrophan Desalkylflurazepam Dihydrocodeine Norfentanyl Propoxyphene Diazepam Hydrocodone Nalbuphine Norpropoxyphene Hydroxy-alprazolam Oxycodone Alfentanil 6-MAM Hydroxy-triazolam Meperidine Sulfentanil Nordiazepam Normeperidine Zolpidem Lorazepam Trazodone Oxazepam Venlafaxine Temazepam Zopiclone Forensic Toxicology Use Only 2 Methods Employed Prior to LC-MS • Benzodiazepines GC-MS • Opiates GC-MS • Other drugs of abuse group 1 ELISA • Other drugs of abuse group 2 not analyzed before Forensic Toxicology Use Only 3 Why switch to LC-MS method? Benefits of replacing GC-MS • Faster less need for chromatographic separation • Less sample prep no derivatization • No thermal instability benzodiazepines analysis • No volatility limitations Benefits of replacing immunoassay • Lower consumables cost • More specific More cost efficient and analytically more universal Forensic Toxicology Use Only 4 Goal • Develop fast, easy to use, generic LC-MS method to analyze multiple classes of drugs
    [Show full text]
  • Fatal Toxicity of Antidepressant Drugs in Overdose
    BRITISH MEDICAL JOURNAL VOLUME 295 24 OCTOBER 1987 1021 Br Med J (Clin Res Ed): first published as 10.1136/bmj.295.6605.1021 on 24 October 1987. Downloaded from PAPERS AND SHORT REPORTS Fatal toxicity of antidepressant drugs in overdose SIMON CASSIDY, JOHN HENRY Abstract dangerous in overdose, thus meriting investigation of their toxic properties and closer consideration of the circumstances in which A fatal toxicity index (deaths per million National Health Service they are prescribed. Recommendations may thus be made that prescriptions) was calculated for antidepressant drugs on sale might reduce the number offatalities. during the years 1975-84 in England, Wales, and Scotland. The We used national mortality statistics and prescription data tricyclic drugs introduced before 1970 had a higher index than the to compile fatal toxicity indices for the currently available anti- mean for all the drugs studied (p<0-001). In this group the depressant drugs to assess the comparative safety of the different toxicity ofamitriptyline, dibenzepin, desipramine, and dothiepin antidepressant drugs from an epidemiological standpoint. Owing to was significantly higher, while that ofclomipramine, imipramine, the nature of the disease these drugs are particularly likely to be iprindole, protriptyline, and trimipramine was lower. The mono- taken in overdose and often cause death. amine oxidase inhibitors had intermediate toxicity, and the antidepressants introduced since 1973, considered as a group, had significantly lower toxicity than the mean (p<0-001). Ofthese newer drugs, maprotiline had a fatal toxicity index similar to that Sources ofinformation and methods of the older tricyclic antidepressants, while the other newly The statistical sources used list drugs under their generic and proprietary http://www.bmj.com/ introduced drugs had lower toxicity indices, with those for names.
    [Show full text]
  • CEDIA® Buprenorphine II Assay
    CEDIA® Buprenorphine II Assay For In Vitro Diagnostic Use Only Rx Only 10020849 (3 x 17 mL Kit) 10020850 (65 mL Kit) Intended Use Warnings and Precautions The CEDIA® Buprenorphine II Assay is a homogeneous enzyme immunoassay for the DANGER: Powder reagents contain ≤55% w/w Bovine Serum Albumin (BSA) fragments and qualitative and/or semi-quantitative determination for the presence of buprenorphine and its ≤1% w/w Sodium Azide. Liquid reagents contain ≤0.5% Bovine Serum, ≤0.2% Sodium Azide, metabolites in human urine at a cut-off concentration of 10 ng/mL. The assay is intended to and ≤0.1% Drug-Specific Antibody (Mouse). be used in laboratories and provides a simple and rapid analytical screening procedure to detect buprenorphine and its metabolites in human urine. The assay is designed for use with a The reagents are harmful if swallowed. number of clinical chemistry analyzers. H317 - May cause allergic skin reaction. The semi-quantitative mode is for the purpose of enabling laboratories to determine an H334 - May cause allergy or asthma symptoms or breathing difficulties if inhaled. appropriate dilution of the specimen for confirmation by a confirmatory method such as EUH032 - Contact with acids liberates very toxic gas. Liquid chromatography/tandem mass spectrometry (LC-MS/MS) or permitting laboratories to establish quality control procedures. Avoid breathing mist or vapor. Contaminated work clothing should not be allowed out of the workplace. Wear protective gloves/eye protection/face protection. In case of inadequate The assay provides only a preliminary analytical test result. A more specific alternative ventilation wear respiratory protection.
    [Show full text]
  • Drug-Facilitated Sexual Assault Panel, Blood
    DRUG-FACILITATED SEXUAL ASSAULT PANEL, BLOOD Blood Specimens (Order Code 70500) Alcohols Analgesics, cont. Anticonvulsants, cont. Antihistamines, cont. Ethanol Phenylbutazone Phenytoin Cyclizine Amphetamines Piroxicam Pregabalin Diphenhydramine Amphetamine Salicylic Acid* Primidone Doxylamine BDB Sulindac* Topiramate Fexofenadine Benzphetamine Tapentadol Zonisamide Guaifenesin Ephedrine Tizanidine Antidepressants Hydroxyzine MDA Tolmetin Amitriptyline Loratadine MDMA Tramadol Amoxapine Oxymetazoline* Mescaline* Anesthetics Bupropion Pyrilamine Methcathinone Benzocaine Citalopram Tetrahydrozoline Methamphetamine Bupivacaine Clomipramine Triprolidine Phentermine Etomidate Desipramine Antipsychotics PMA Ketamine Desmethylclomipramine 9-hydroxyrisperidone Phenylpropanolamine Lidocaine Dosulepin Aripiprazole Pseudoephedrine Mepivacaine Doxepin Buspirone Analgesics Methoxetamine Duloxetine Chlorpromazine Acetaminophen Midazolam Fluoxetine Clozapine Baclofen Norketamine Fluvoxamine Fluphenazine Buprenorphine Pramoxine* Imipramine Haloperidol Carisoprodol Procaine 1,3-chlorophenylpiperazine (mCPP) Mesoridazine Cyclobenzaprine Rocuronium Mianserin* Norclozapine Diclofenac Ropivacaine Mirtazapine Olanzapine Etodolac Antibiotics Nefazodone Perphenazine Fenoprofen Azithromycin* Nordoxepin Pimozide Hydroxychloroquine Chloramphenicol* Norfluoxetine Prochlorperazine Ibuprofen Ciprofloxacin* Norsertraline Quetiapine Ketoprofen Clindamycin* Nortriptyline Risperidone Ketorolac Erythromycin* Norvenlafaxine Thioridazine Meclofenamic Acid* Levofloxacin* Paroxetine
    [Show full text]
  • Drug Plasma Half-Life and Urine Detection Window | January 2019
    500 Chipeta Way | Salt Lake City, UT 84108-1221 Phone: (800) 522-2787 | Fax: (801) 583-2712 www.aruplab.com | www.arupconsult.com DRUG PLASMA HALF-LIFE AND URINE DETECTION WINDOW | JANUARY 2019 URINE- PLASMA DRUG, DRUG METABOLITE(S)* COMMON TRADE AND STREET NAMES, NOTES DETECTION HALF-LIFEt WINDOWt STIMULANTS Benzedrine, dexedrine, Adderall, Vyvanse, speed; could be methamphetamine Amphetamine 7–34 hours 1–5 days metabolite; if so, typically < 30 percent of parent Cocaine Coke, crack; parent drug rarely observed due to short half-life 0.7–1.5 hours < 1 day Benzoylecgonine Cocaine metabolite 5.5–7.5 hours 1–2 days Desoxyn, methedrine, Vicks inhaler (D- and L-isomers not resolved; low concentrations Methamphetamine expected if the source is Vicks); selegeline (Atapryl, Carbex, Eldepryl, Zelapar) 6–17 hours 1–5 days metabolite Methylenedioxyamphetamine (MDA) MDA 11–17 hours 1–3 days Methylenedioxyethylamphetamine (MDEA) MDEA, MDE, Eve 6–11 hours 1–3 days Methylenedioxymethamphetamine (MDMA) MDMA, XTC, ecstasy, Molly 6–10 hours 1–3 days Methylphenidate Ritalin, Concerta, Focalin, Metadate, Methylin 1.4–4.2 hours < 1 day Ritalinic acid Methylphenidate metabolite 1.8–2.5 hours < 1 day Phentermine Adipex-P, Lomaira, Qsymia 19–24 hours 1–5 days OPIOIDS Buprenorphine Belbuca, Buprenex, Butrans, Suboxone, Subutex, Sublocade, Zubsolv 26–42 hours 1–7 days Norbuprenorphine, Glucuronides Buprenorphine metabolites 15–150 hours 1–14 days Included in many preparations; morphine metabolite; may be a contaminant if < 2 Codeine 1.9–3.9 hours 1–3 days percent of morphine Fentanyl Actiq, Duragesic, Fentora, Lazanda, Sublimaze, Subsys, Ionsys 3–12 hours 1–3 days Norfentanyl Fentanyl metabolite 9–10 hours 1–3 days Heroin Diacetylmorphine, dope, smack, dust; parent drug not detected.
    [Show full text]
  • Brain Pulsatility and Pulsatile Tinnitus: Clinical Types
    EDITORIAL International Tinnitus Journal. 2012;17(1):2-3. Brain pulsatility and pulsatile tinnitus: clinical types The purpose of this commentary is to share our supported in the literature by animal and human studies evolving clinical experience with the tympanic membrane ongoing since 1980. The raw data analysis of the IPPA displacement (TMD) analyzer which has focused on wave in patients with nonpulsatile, predominantly central- brain pulsatility in nonpulsatile, predominantly central- type severe disabling SIT resistant to attempts for tinnitus type severe disabling subjective idiopathic tinnitus relief with instrumentation or medication are published (SIT) patients resistant to attempts for tinnitus relief with in this issue of the International Tinnitus Journal (see the instrumentation or medication. article “The Tympanic Membrane Displacement Test and One outcome of this evolving TMD experience Tinnitus”). has been the establishment of a classification system for In our experience, the extensive otologic, pulsatile tinnitus and its clinical translation for diagnosis neurotologic, and neuroradiolgical workup for pulsatile and treatment. tinnitus is frequently negative, and the etiology of the A new discipline, brain pulsatility, has been pulsation is a vascular hypothesis based predominantly emerging in the last 50-60 years, the principles of which on the clinical history and or physical examination. The are based on physical principles of matter, volume, and establishment of an accurate diagnosis and treatment pressure relationships in a confined area (i.e., brain) of pulsatile tinnitus has a satisfactory outcome to the and find clinical translation to the ear and the discipline patient and physician when a pathological process is of tinnitology - in particular, pulsatile tinnitus.
    [Show full text]
  • ARK™ Ketamine Assay Package Insert
    The ARK Ketamine Assay provides only a preliminary analytical test result. A more specific alternative chemical method must be used in order to obtain a confirmed positive analytical result. Gas Chromatography/Mass Spectrometry (GC/MS) or Liquid Chromatography/tandem Mass Spectrometry (LC-MS/MS) is the preferred confirmatory method. Clinical consideration and professional judgment should be exercised with any drug test result, particularly when the For Criminal Justice and Forensic Use Only preliminary test result is positive. 3 SUMMARY AND EXPLANATION OF THE TEST Ketamine ((+/-)-2-(2-chlorophenyl)-2-(methylamino)cyclohexanone) is a synthetic, non- RK™ Ketamine Assay barbiturate and rapid-acting general anesthetic that is indicated for use in both human and A veterinary surgical procedures.1,2 This ARK Diagnostics, Inc. package insert for the ARK Ketamine Assay must be read prior to use. Package insert instructions must be followed accordingly. The assay provides a simple Ketamine is a Schedule III substance under the United States Controlled Substances Act for and rapid analytical screening procedure for detecting ketamine in urine. Reliability of the its potential for abuse and risk of dependence. Ketamine is structurally and pharmacologically assay results cannot be guaranteed if there are any deviations from the instructions in this similar to phencyclidine (PCP), but is less potent, has a faster onset and shorter duration of package insert. action relative to PCP. Ketamine produces a variety of symptoms including, but not limited to anxiety, dysphoria, disorientation, insomnia, flashbacks, hallucinations, and psychotic episodes.1,3 CUSTOMER SERVICE Following administration in humans, ketamine is N-demethylated by liver microsomal ARK Diagnostics, Inc.
    [Show full text]
  • NORTH – NANSON CLINICAL MANUAL “The Red Book”
    NORTH – NANSON CLINICAL MANUAL “The Red Book” 2017 8th Edition, updated (8.1) Medical Programme Directorate University of Auckland North – Nanson Clinical Manual 8th Edition (8.1), updated 2017 This edition first published 2014 Copyright © 2017 Medical Programme Directorate, University of Auckland ISBN 978-0-473-39194-2 PDF ISBN 978-0-473-39196-6 E Book ISBN 978-0-473-39195-9 PREFACE to the 8th Edition The North-Nanson clinical manual is an institution in the Auckland medical programme. The first edition was produced in 1968 by the then Professors of Medicine and Surgery, JDK North and EM Nanson. Since then students have diligently carried the pocket-sized ‘red book’ to help guide them through the uncertainty of the transition from classroom to clinical environment. Previous editions had input from many clinical academic staff; hence it came to signify the ‘Auckland’ way, with students well-advised to follow the approach described in clinical examinations. Some senior medical staff still hold onto their ‘red book’; worn down and dog-eared, but as a reminder that all clinicians need to master the basics of clinical medicine. The last substantive revision was in 2001 under the editorship of Professor David Richmond. The current medical curriculum is increasingly integrated, with basic clinical skills learned early, then applied in medical and surgical attachments throughout Years 3 and 4. Based on student and staff feedback, we appreciated the need for a pocket sized clinical manual that did not replace other clinical skills text books available. Attention focussed on making the information accessible to medical students during their first few years of clinical experience.
    [Show full text]