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In new era, cannabis testing a mixed bag

From CAP Today:

The legal use of marijuana has evolved over the last several years.  Ten years ago, California passed the nation’s first law that permitted patients to use marijuana for medical purposes.  Today, 25 states have legalized medical marijuana.  In addition, 4 states as well as Washington D.C. have legalized recreational marijuana use.

Currently, marijuana is the most popular recreational drug in the United States.  Dr. Marilyn Huestis, Ph.D., serves as a Senior Scientific Advisor to NMS Labs and is working to research the long-term impact of the wider access to marijuana.  Essentially, the legal climate surrounding marijuana is changing the methods and usage patterns of marijuana (cannabis) testing in the laboratory.  As a market leader, NMS continues to expand its offerings to meet the demand for cannabis testing. 

Because cannabis contains over 100 cannabinoids, it is a very complex drug to test.  In addition, the emerging regulations for judging impairment are currently evolving.  According to Dr. Huestis, impairment should be measured and linked to the actual time of cannabis usage.  For instance, occasional smokers may ingest very low doses of the marijuana psychoactive ingredient THC, which can have little effect.  However, a chronic smoker can potentially have traces of THC in their system 30 days after they’ve used cannabis.  Therefore, identifying a marker that measures the recent cannabis usage is more effective at measuring impairment as opposed to overall usage.  In her research, Dr. Huestis has sited cannabigerol and cannabinol has the markers to measure whether someone has recently used marijuana.  NMS Labs is currently developing a method including these 2 cannabinoids.

Dr. Huestis also states that there are serval advantages to use oral fluid testing to test for recent cannabis usage.  When someone smokes or eats editable cannabis it gets into the oral mucosa and saliva, which indicates that the person actually took the drug as oppose to be exposed to it.  Oral fluid testing offers a reduction in specimen collection errors, and it’s easier to reduce the adulteration that is high in urine testing because it’s an observed sample.  In addition, oral fluid testing is easier to navigate in an emergency situation because you don’t have to catheterize them after suffering from trauma.  

Training for oral fluid testing is also significant to the process.  While it is much easier to train someone to take oral specimens as opposed to blood, they still have to know what they’re doing.  Dr. Huestis predicts that oral fluid will become very prominent and will be a major focus for laboratories when conducting cannabis testing.  It is predicted that hospitals and clinical laboratories will enter the oral fluid market in the near future.  Oral fluid testing is also predicted to become a prominent in postmortem autopsy cases. 

In terms of laboratory offerings, Dr. Huestis advocates testing for markers of recent cannabis use to help interpret results as opposed to simply testing for blood cannabinoids and THC.  As the market for medical marijuana grows, she also predicts that labs will start doing therapeutic drug monitoring to test the concentrations of THC to interpret marijuana’s therapeutic range. 

NMS Labs continues to be at the forefront of the cannabis testing. 

For more information cannabis testing as well as any additional NMS Labs products and services, please call 1-866-522-2216 to chat directly with our experts.

Posted: 2/23/2017 10:40:00 AM

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Local, national labs offer PFC blood tests

From the Bucks County Courier Times:

Undergoing a routine medical test and then waiting by the phone for the results can be a nerve-wracking experience. Now, imagine asking your doctors to test your blood for mysterious chemicals they’ve never heard of, finding a lab to draw the blood, another lab to test it and waiting more than a month to get the results -- and still not knowing quite what to make of them.


That’s been the reality for several residents of Bucks and Montgomery counties (in Pennsylvania) who have had their blood tested for the unregulated chemicals PFOA and PFOS.


The chemicals, linked by many studies to health effects ranging from cancer to low birth weight, have been found in the drinking water of at least 70,000 area residents. Tests of public water supplies have detected the chemicals in amounts that greatly exceed recommended safety limits and rank among the highest found anywhere in the country.


While there have been some conversations among government agencies about offering wide-scale blood testing programs for exposed residents, there has been no official action to date.


There are only a handful of laboratories in North America that can test blood for PFOA and PFOS. One of those is NMS Labs in Upper Moreland's Willow Grove section, which offers a test for PFOA, but is developing a full panel that will include PFOS and other related perfluorinated compounds.

"It is a very challenging test," said Robert Middleberg, vice president of quality assurance for NMS. "These are complex compounds that are chemically — for us as chemists or toxicologists — very challenging to analyze for. "

PFOS is typically found in much higher levels than PFOA locally, prompting NMS to recommend residents wait for the full panel, which Middleberg said could be ready sometime in the next six months to a year.

"They can go to their doctor and get the PFOA done and we'd be happy to do it here," Middleberg said. "(But) if it comes back 'none detected' and they were not looking for these other (related chemicals) ... they may have a false sense of security that, 'Oh, I'm clean, I don't have any PFOA in me.' But they may be loaded with PFOS."

If residents don't want to wait until the full panel is ready, Middleberg said NMS recommends residents get the "low-level" serum or plasma test for PFOA, which costs $298. That test can detect PFOA down to 2 ppb, lower than the lab's other PFOA test, which is designed for workers who are exposed to the chemical on the job and only detects down to 10 ppb.

There is one caveat: the human body naturally eliminates perfluorinated compounds at a rate of about 50 percent every two to nine years, depending on the chemical and the individual. That means the longer people wait for testing, the less they are to likely to receive a result that accurately shows how much of the chemicals had accumulated in their blood.

Posted: 2/3/2017 8:29:00 AM

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This Is U-47700, Once a Lab Experiment, Now a Killer Opioid

From the Wall Street Journal:

In a high-stakes game of cat-and-mouse, overseas labs are churning out new synthetic drugs at a furious pace, often staying a step ahead of authorities and helping to fuel America’s rampant opioid crisis.

The United Nations Commission on Narcotic Drugs estimates that “new psychoactive substances”—a broad list that includes synthetic opioids—are emerging globally at an average rate of one a week. As with U-47700, rogue chemists sometimes piggyback on research by legitimate scientists that was abandoned before making it to the legal market.

Synthetic opioids are often more deadly than other kinds of common designer drugs, such as artificial cannabinoids or stimulants known as bath salts. Some opioids have flared up before—fentanyl variants caused problems on the West Coast in the late 1970s and 1980s—and they are roaring back at a perilous time.

The designer opioids mainly come from Chinese labs, the DEA says, and many labs sell them openly in online drug bazaars. On online forums, people compare notes on their experiences using the synthetics.

The U.S. surveillance system for these chemicals is a largely informal network of crime labs, medical examiners and law-enforcement authorities who share clues and alert each other when they find something new. It can be a laborious task, slowed in part by the challenge of finding something they didn’t know they were looking for.

At least six states specifically banned U-47700 before the DEA announced plans in September to make the drug illegal. DEA spokesman Rusty Payne said the agency’s scheduling actions are subject to “exhaustive reviews,” which take time.

So far this year through September, NMS Labs, a major private lab outside Philadelphia that works with states around the U.S., has tallied 105 overdose deaths related to U-47700 and 265 fatalities related to furanyl fentanyl—an analog, or chemical compound that is closely related to fentanyl. Axis Forensic Toxicology, a private lab firm in Indianapolis, has seen another 20 deaths linked to U-47700.

The U-47700-related fatalities span at least 31 states from Alaska to Utah to Florida.

The origins of U-47700 date to 1973, when Upjohn Co. asked its scientist Jacob Szmuszkovicz to create a drug with the pain-relieving power of morphine, but without the risk, according to a chapter he wrote for a 1999 book on drug research. Researchers wanted to find the Holy Grail that is elusive to this day: potent pain relievers that don’t have dangerous side effects, such as addiction and a potentially fatal slowdown in breathing.

By about 1974, Dr. Szmuszkovicz created a chemical Upjohn dubbed U-47700 at a company lab in Kalamazoo, Mich. Researchers knew it was a morphine-like drug when it triggered erect tails in mice, a reaction known as a Straub tail, says Phil von Voigtlander, a retired Upjohn research director who worked on the project.

Another test, which involved shining a hot light on mice’s tails to judge how long it took them to move, helped measure U-47700’s potency, says Dr. von Voigtlander. He learned the compound worked on the same receptor as morphine with roughly 7.5 times the strength.

Further rodent testing also revealed a downside. “Once we saw that it just caused tolerance and dependence like opioids and had opioid side effects, we thought, well, that’s just another morphine and that’s not what we’re looking for,” Dr. von Voigtlander says.

He calls U-47700 an important research steppingstone, and Upjohn patented the chemical. The company never tested U-47700 on people.

These kinds of pharmaceutical research efforts leave behind copious patents and scientific papers, which can serve as recipes for today’s enterprising chemists. Some researchers believe Chinese labs are scouring patent literature for new synthetic compounds to produce, before selling them.

Foreign labs began making U-47700 and offering it for sale online by late 2014, according to a forum on the social-media website Reddit devoted to discussion of chemical vendors and frequented by drug users. Buyers can choose from an array of online vendors selling synthetic drugs, including opioids, dubbed “research chemicals.”

The websites typically carry warnings that the chemicals they sell are “not for human consumption”—an attempt to gain legal cover, authorities say—and that buyers are responsible for complying with their home countries’ laws.

U-47700 began claiming lives in the U.S. by May 2015, when a 28-year-old man overdosed in Knox County, Tenn. The medical examiner there initially pegged his death to oxycodone, which was in his system. It took many more months to discover U-47700 was also there.

First, labs had to figure out what the drug was. NMS Labs detected U-47700 in November 2015 while testing blood samples from four different states at its facility outside Philadelphia.

“We actually found it by accident,” says Barry Logan, chief scientist there. U-47700 closely resembles a synthetic opioid called AH-7921—another research relic—which NMS had started watching for last year.

NMS, which is now rushing to create new tests to screen for 21 different designer opioids, eventually linked U-47700 to the Knox County case.

NFL adds synthetic marijuana to its list of banned substances

From ESPN:

The NFL and NFL Players Association has added synthetic marijuana to the list of banned substances within its 2016 drug policy, according to a joint announcement by the league and union Wednesday.

Players and teams were informed in August of the change. The NFLPA made public the information Wednesday.

Per the policy, any player whose drug test reveals more than 2.5 ng/ML of synthetic cannabinoids will be in violation and subject to the normal course of intervention and potential discipline. It is one of nine drugs, including cocaine, PCP and traditional marijuana, that are part of the NFL's standard drug testing panel. The policy is developed jointly by the league and the NFL Players Association.

First responders react to overdose increases

From The Journal Times:

There are myriad dangers present when first responders, whether police or EMS, arrive at any emergency scene. Typically they are walking into unfamiliar territory.

With a recent influx of designer drugs, namely synthetic opioids, responders are now dealing with additional stress from more calls and a range of potencies in drugs.

Overdoses are becoming commonplace in Racine County and around the nation, according to Chris Eberlein, medical adviser for the southwest region of the Department of Health Services. And he sees increased wear on EMS personnel.

With so little information, it is difficult to determine the correct treatment to combat the effects of the illegal drugs. With drugs like Narcan, which is used to reverse the effects of opiate substances, the drug is usually harmless even if administered to a patient that had not taken an opiate substance.

A problem arises when responders have to administer drugs that may not react well with whatever the patient used. This has become more of an issue with the national influx of designer drugs. The chemical compounds are similar, but when mixed to create a drug cocktail, the effects increase.

Even with Narcan sometimes, there isn’t a guarantee drugs like it will have the same reactions.

“It’s important for responders to know that designer-drug users may not respond to naloxone in the same way a heroin user would respond,” said Barry Logan, chief of forensic toxicology at NMS Labs in Pennsylvania.

Kratom to join heroin, LSD on Schedule I drug list

From CNN Health:

Beginning September 30, kratom will be considered a Schedule I drug, a substance that has "no currently accepted medical use and a high potential for abuse," the Drug Enforcement Administration announced today.

Other Schedule I drugs include heroin, LSD, marijuana and ecstasy.

In this week's Federal Register, the DEA proposes designating the drug as Schedule I for up to three years. After that time, the status could be extended permanently. Up until this point, it has been considered a supplement, loosely regulated by the Food and Drug Administration.
 
Posted: 9/1/2016 3:57:00 PM

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Addicts Who Can’t Find Painkillers Turn to Anti-Diarrhea Drugs

From The New York Times:

They call it the poor man’s methadone.

The epidemic of opioid addiction sweeping the country has led to another form of drug abuse that few experts saw coming: Addicts who cannot lay hands on painkillers are instead turning to Imodium and other anti-diarrhea medications.

The active ingredient, loperamide, offers a cheap high if it is consumed in extraordinary amounts. But in addition to being uncomfortably constipating, it can be toxic, even deadly, to the heart.

A report published online in Annals of Emergency Medicine recently described two deaths in New York after loperamide abuse. And overdoses have been linked to deaths or life-threatening irregular heartbeats in at least a dozen other cases in five states in the last 18 months.

Most physicians just recently realized loperamide could be abused, and few look for it. There is little if any national data on the problem, but many toxicologists and emergency department doctors suspect that it is more widespread than scattered reports suggest.

Some toxicologists argue that the sales of loperamide should be limited, much as the nonprescription drug pseudoephedrine was restricted a decade ago to help prevent the manufacturing of crystal meth.

Posted: 8/29/2016 11:17:00 AM

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Party drug ketamine closer to approval for depression

From CNN:

The Food and Drug Administration put the experimental drug esketamine (also known as ketamine) on the fast track to official approval for use in treating major depression, Janssen Pharmaceutical announced Tuesday. This designated "breakthrough therapy" would offer psychiatrists a new method for treating patients with suicidal tendencies and would qualify as the first new treatment for major depressive disorder in about half a century.

In some quarters, though, this potentially effective medicine can't escape its reputation as "Special K," a street drug known for producing a high similar to an out-of-body experience -- and sometimes used as a date rape drug.

Ketamine was first synthesized in 1962 by Calvin Stevens at Parke Davis Laboratories, according to Encyclopedia Britannica. It received FDA approval for use in humans in 1970, and shortly after, Army doctors used the drug on American soldiers fighting in Vietnam as an analgesic and sedative. Yet its minor hallucinogenic side effects soon warned doctors off treating people. Today, ketamine's most common use is as a veterinary anesthetic.

A concern with using ketamine to treat depression is that it can reverse tolerance to opioids, Coffman said. Essentially, patients will get a higher dose of pain medicines, she explained, so any psychiatric uses would require "close oversight" by a multidisciplinary team of doctors.
Iosifescu said the short-term effects are known, but the long-term effects remain mysterious.
 
Another concern is the similarity between prescription ketamine and the street drug, a substance of abuse.

These are all reasons why Janssen's formulation will be provided and administered in doctors' offices or clinics, not distributed by pharmacies.
Posted: 8/22/2016 10:21:00 AM

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People Are Overdosing on ‘Game of Thrones’ Heroin

From TIME:

A dangerous strain of heroin with a “Game of Thrones” label has been circulating in Vermont and New Hampshire, where officials have counted nearly a dozen recent overdoses.

Vermont’s Department of Health said the strain of heroin is possibly laced with fentanyl, which makes the drug 50 times stronger. Fentanyl is a powerful opioid that is similar to morphine but is 50 to 100 times more potent, according to the National Institute on Drug Abuse. It’s usually used to treat severe pain.

The heroin bags being passed around bear the logo of the hit HBO show, which may be bolstering its popularity on the streets.

It was also involved in a 32-year-old man’s overdose in New Hampshire.

Posted: 8/16/2016 2:18:00 PM

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Another Powerful Painkiller Found in Prince's System: U-47700

From Eyewitness News 5 (Minneapolis/St. Paul):

Although it was a fentanyl overdose that killed Prince April 21, the medical examiner said it was part of a deadly chemical cocktail.

A source close to the investigation says U47700 was part of the mixture.  The potent painkiller is a synthetic opioid, eight times stronger than morphine.

Investigative sources told reporter Beth McDonough that Prince may have thought he was taking a legitimate painkiller, like hydrocodone or fentanyl, that unknowingly also had U-47700 in it.

The pills often look just like other medications.  Plus, U47700 can be resistent to the life-saving antidote Narcan. 

Because U-47700 is not considered a controlled substance by state or federal agents, it's not regulated.  The Drug Enforcement Administrations says it tends to be produced overseas in China or Eastern Europe.  It's widely available, easily accessible and affordable, about $40 online.