Posts Tagged ‘methamphetamine’

Meth continues to grow with “shake-n-bake”

Wednesday, September 2nd, 2009

Addiction podcast examines the new “shake-n-bake” method of making methamphetamine. Dr Darryl Inaba expands and includes a look at the chemistry involved, with left- and right- handed molelcules.

Transcript of podcast (click to listen):

Welcome to the CNS pod cast featuring Dr Darryl Inaba, Research Director for CNS Productions.

CNS: Hi and welcome once again to the addiction pod cast from CNS. I’m Howard LaMere here with Darryl Inaba. Darryl, what’s in the news?

Darryl: It’s very fascinating in the news this week, out of Oklahoma, Tennessee, Arkansas, Kansas, the central belt of our country is having a just a birth in, or a burst rather of methamphetamine addiction and I thought historically when we have these upper -  downer trends, they usually last only about ten to thirty years. And we’ve been on an upper trend ever since cocaine just took hold in 1980. So we should we should be on, waning down, it appeared earlier in Oregon and all over the country that methamphetamine was starting to wane but all of a sudden it’s starting to grow again and, and the stories coming out of the mid-west and that part of our country is beginning to explain why there’s, there’s been a new process or a new way of making methamphetamine which they hadn’t seen before that is exploded and made it really practical for people to have methamphetamine again, and it’s called the shake and bake method. Just a…

CNS: Not chicken.

Darryl: Not chicken, but it’s still amazing that, the street chemist can come up with such ingenious ways to get access and medication, not to the medication but to the drugs they want. It’s sort of like when there’s a will there’s a way and when most of the states like Oregon, restricted, and nationally there’s a law that restricted access to pseudoephedrine, the main ingredient in Sudafed for colds, congestion. That was the main ingredient for making the new methamphetamine base chemical we thought that it would disappear or at least take another ten or thirty years before they’d figure out another way to make methamphetamine. But what has come about is a process actually more; it seems like a more efficient process where they can take the Sudafed that is available. Many states restrict it to maybe a package of 24 or 30 tablets that you can buy, and you can only buy two packages of that and they make you buy it straight from the pharmacist behind the counter and that would eliminate, we thought, the massive amounts of Sudafed that could be used in of course manufacture of methamphetamine. But the shake and bake method, just takes a two liter soda bottle, plastic soda bottle. I think one of the secrets were they found out that a instead of anhydrous ammonia, they can actually take ammonium that’s available in some of those cold packs, the instant cold packs and use that plus a whole host of just household chemicals. Throw it all, crush up the Sudafed, throw it in this bottle, put all their additives, it looks god-awful when it’s done, there’s actually some videos on, on U-tube and stuff showing people making it up and it looks just like a murky darkish bunch of chemicals that are thrown into this bottle. You shake it up and you have to keep the bottle sealed because there’s a chemical reaction, you can actually see lightning, or actually sparks that are occurring within the liquid themselves with the gas that the concoction produces if it, if it gets enough oxygen, it’s been known to explode. So again it’s a dangerous thing, a toxic chemical thing, but I think what’s important to me or astounding rather to me, is that it seems to be more efficient than the old ways of making methamphetamine. They’re able to take the limited amounts of Sudafed, say thirty tablets, or thirty milligrams, and if you convert all of that effectively in 100% to methamphetamine you’re, you’re probably going to end up with about close to gram of methamphetamine, so they’re cooking up in these bottles, hits or grams at a time that are sufficient to maintain their habits and to, and to perpetuate their habits and we’re seeing an outbreak again or an increase again, of methamphetamine across the United States.

CNS: So is this a do it yourself?

Darryl: Yeah, it’s, it’s I like that part of it, it sort of cuts out the middle man, I mean the trafficker because its… kids have even learned how to do it and there’s been news stories where part of the process is you have to shake it up good and then they put it, they get on their bicycles and ride. I guess they’re all jazzed up anyway and it provides enough shaking so that it bakes in the bottle but yeah it cuts out the cartel, it cuts out the trafficking, and its do it yourself until the government even further restricts Sudafed from getting out to the street.

CNS: Which this is too bad, because it’s a really good cold medicine.

Darryl: Absolutely you know the, the pharmacies and the pharmaceutical firms and the government says they should, we should be instead using a similar type of chemical called phenylephrine. But the thing is right now is phenylephrine a decongestant is impossible to convert into methamphetamine, so there’s been some advocacy of switching everything on the counters, the Sudafed’s and all that decongestant cold pills to phenylephrine. But people that have taken that have pretty much testified it’s not as good as Sudafed. Sudafed is much more effective so they rather would have the Sudafed and the Sudafed story is interesting…

CNS: Well, you can’t even buy that anymore, can you? I mean do you have to have a prescription?

Darryl: Well, almost like that, you can get it from, in Oregon it’s very much restricted, across the country it was restricted but it’s, it’s available behind the counter, some states make you sign for it and it’s available only in limited amounts. They, they thought if you could keep somebody from getting thousands of pills then you can control methamphetamine. But people, as you mentioned enjoy it and effects tremendously effective for colds and congestion so the government allows you to buy packages of 24 tablets or two packages of 24 tablets which they thought would be impractical to convert to methamphetamine. But it just amazing how the street can come up with ways of more efficiently converting it to methamphetamine and therefore makes methamphetamine available for street abuse.

CNS: Is it any less you know toxic than the bath tub method, the traditional?

Darryl: In some ways it, it’s well I don’t know because I haven’t analyzed you know the end product that after they dry it all out and get the powder and its methamphetamine. But the processes that I’ve seen used to cook it, just throw it all in these, you know, the under the kitchen counter chemicals into it…

CNS: Right

Darryl: And shaking and baking it, it looks god-awful and then what and then what they do with this residual chemicals afterwards is they just throw it out in the gutter and stuff like that. I’m sure it’s causing some toxic residue any place it’s being used. But the story of Sudafed itself is amazing and it, and it brings to light an interesting thing about organic chemistry and about psychoactive chemicals. Basically organic chemicals or chemicals that contain carbon, if there’s a carbon in the series or the compound that is bonded with covalent bonding to four other atoms, so you have to have four very unique atoms attached to a carbon, you can have oxygen, nitrogen, hydrogen, or other carbon. Those carbons are asymmetric which means that when mother nature puts those together in a synthesis she actually makes a right and left handed molecule with it. A right handed compound verses a left handed compound and all that means is if you can stop this chemical bonding as it occurs and then show how oxygen, nitrogen, hydrogen carbon are stuck to a central carbon, you can show that to a mirror and what the mirror does it transposes the bonding, you get all the same atoms but you’re getting a right hand and a left hand and it turns out that our body only uses and our receptor sights are configured specifically for a right hand or a left hand compound. In the case of methamphetamine or the what we call the phenyl-isopromines or phenyleph amines, we, our body responds to the stimulatory phase in our brain pretty much to the right handed side of the compound. Whereas if you give the brain a left sided compound it doesn’t stimulate the brain too much at all but it stimulates the heart, it stimulates the blood vessels, stimulates the lungs and, and the bronchial tubes and things like that. So that’s what Sudafed was. Sudafederon was left handed. Sudafredrine which is in the same chemical family it looks like amphetamine, but is in fact a left handed pure left handed compound. So it basically stimulates your heart, stimulates your sinuses, stimulates your bronchial tubes and things like that but does not stimulate your brain that’s why it’s allowed to be sold over the counter, people don’t abuse you know if they do they’re going to end up with a heart attack or something like that.

CNS: Right

Darryl: So, who would think that they would take a left handed Sudafed to make methamphetamine because you know projection would be you take left handed Sudadederin you’re going to make left handed methamphetamine. Left handed methamphetamine is still sold in a number of decongestion products like Lytosine. And things like decongestants are sold over the counter, if you look closely some of them are methamphetamine but they’re left handed legal form of methamphetamine what’s not going to stimulate your brain. So, I would, I would think, why do that, why even use Sudafed? But amazingly what occurred was that street chemists discovered that if you take pure left handed Sudafed and you convert it to a methamphetamine compound by adding a few carbons on to it and taking off the oxygen, pure left handed Sudafed makes pure right handed methamphetamine. So again the street just figured this out on their own and came out with that great stimulus of methamphetamine and the epidemic we had we thought was going to go away, now the street comes up with another method of, of just taking this Sudafed and basic chemicals that are out there and, and in a very easy synthesis way allowing people to shake and bake it up so that they have their own supply of meth.

CNS: Let’s talk a little bit about the sociology of it. Do you think that the stimulant phase is continued because of the, the ever increasing pace of our life?

Darryl: You know there’s, there’s been a lot of speculation through out the years Dr. Musto wrote a book Addiction, The American Disease, in which he also documents, there’s these eras in which there are ten to thirty years where people seek out as a group of people, say our society as the United States, the over all picture of drug abuse is people are interested in and seeking out downers or depressants. And in another ten to thirty years following that where people seek out uppers or stimulants and that these oscillate these cycles oscillate back and forth ever since the eighteen hundreds. Well why does that occur as we talk about what goes up must come down. Is that you know you can only, even speed freaks can only stay loaded on uppers for so long before they crash and they’re so paranoid delusional and so tweaked out and agitated and panicky that they need downers just to come down from it. So there’s a pharmacological view that there was a Canadian view that these cycles pretty much match economic cycles. That when we have a depressant or depressed economy people naturally need to feel more energized some how, and so we get more abuse of uppers and then when we have an up economy people tend to just mellow themselves out with alcohol and downers and maybe that has to do with it. There has been speculation about just what’s available in the social trends. Well they say people how people interact with each other and, and what they’re interested in as terms of as a group culture or a collective unconscious as Freud once said, how they want to feel. What ever the case may be and, and I don’t think I’ve found viability for any these theories. It just so happens if you look there does seem to be this upper downer cycle and that’s something that’s always interested us.

CNS: Well we’ll have to keep a close eye on that one and see where it goes. That’s interesting to put the economic spin on it. Well this has been the CNS pod cast on addiction for this week. I would encourage you if you have any questions or comments for Darryl please send them along we will try to respond to them if we can in the future pod cast. Go to our website you can send an email from there and that’s at cnsproductions.com. Thanks Darryl.

Darryl: Thanks Howard

CNS: That wraps our pod for today. Thanks for visiting the CNS pod cast. Please check back soon for the next in the series and visit our website www.cnsproductions.com.

 
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Food-Source Opiates: Therapeutic Positive UA

Friday, March 13th, 2009

Recently I reviewed two urine tests from two residential clients that were positive for opiates. The drug testing provider confirmed these opiate positive results with follow-up tests utilizing Gas Chromatography/Mass Spectrometry (GC/MS). The quantitative GC/MS test was also positive for opiates but found both urine samples to contain fairly low levels of morphine and other opiate alkaloids. One of the urine specimens contained 0.15 micrograms/milliliter (µg/ml) of morphine and the other 0.3 µg/ml. Urine toxicology is routinely ordered for residential clients when they return from off site dental appointments or lab tests. Both clients were in treatment for alcohol and marijuana dependence with no history of opiate abuse and were doing well in our residential program. Neither exhibited clinical signs of being under the influence of any drugs, and denied any use while off site.

I contacted our testing provider’s toxicologist for more information and was told that the lab attributed morphine urine levels of under 5.0 µg/ml to be food-source contamination. Studies have confirmed that foods containing poppy seeds can result in a positive urine test for opiates.1, 2 Some cakes, cupcakes and bagels can contain enough poppy seeds to produce a positive urine tests when no opiates were abused. This is known as a false-positive opiate urine test.

Prior to 1998, the US threshold level for a positive opiate urine test was a morphine concentration greater than 300 nanograms/ml (ng/ml) or 0.3µg/ml. Those levels were changed to concentrations greater than 4000 ng/ml for morphine and 2000 ng/ml for codeine in response to the recognition that poppy seed contamination could indeed result in false-positive opiate test at that level. 1 This is 13 times greater than the amount that would have resulted in a positive urine test for opiates prior to 1998! The International Olympic Committee (IOC) set their threshold for morphine at 1000 ng/ml and will re-examine any disputed positive opiate test upon request.2 A nanogram is equal to 1000 micrograms so these levels are equivalent to 4.0 µg/ml and 2.0 µg/ml in the US and 1 µg/ml for the IOC.

Our clients’ urine tested positive for morphine with concentrations of only 0.15 and 0.3 µg/ml. These levels are well below the current threshold concentrations established for identifying use of opiates and clearly seemed to have resulted from food-source contamination. On the other hand, if one of these clients did use opiates and then remained abstinent several days previous to being tested, the low levels of opiates in the urine could actually be a positive indication of that use since body metabolism of the abused opiate would result in low residue urine concentrations several days after use. In this latter scenario, attributing low concentrations of opiates in the urine tests to food-source contamination would be a false-negative test for opiates in the urine and could contribute to continued abuse resulting in an eventual relapse to addiction. Unfortunate and unwarranted consequences result from misinterpreting low opiate concentrations of a false-positive urine test as a positive indication of drug abuse when it actually resulted from food-source contamination. But, equally unfortunate consequences can result from misinterpreting low opiate urine concentrations as a negative test if a urine specimen is collected after a sufficient length of time had lapsed since abuse of an opiate drug – a false-negative test.

We rely on a process known as a Therapeutic Positive to address this and other urine drug testing dilemmas. The Therapeutic Positive process brings the primary counselor and/or our program’s medical review officer and the client together to review the results of a positive drug test without providing the detail of the low concentration of the drug. The client is asked to explain why their urine contained the substance. This process provides an opening for the client to admit to a recent slip or drug exposure. If an admission is made, it is only used therapeutically to intensify the treatment process and develop strategies to avoid future interruptions to their recovery efforts. It is never used punitively to catch a client in a lie that could result in discipline or banishment from treatment. If the client adamantly denies use, and their treatment participation/performance validates this claim, program staff then works with the testing lab’s toxicologist to explore potential causes of a potential false-positive test.

Foods ingested prescription and non-prescription medications, illnesses, cosmetics and even personal hygiene products should be considered as possible sources for a false-positive test. In the two cases presented here, both clients ate a poppy seed muffin while waiting to be seen for their medical tests which were off-site.

Several years ago, I worked with a client who had tested cocaine positive due ingestion of Mate De Coca, a tea that contains coca leaves.3,4 Hemp oil is sometimes added to foods and it will result in a false-positive THC or marijuana test.5

In addition to food-source contamination, biologic processes and medications can result in questionable urine testing results. Sequestration and subsequent release of drugs from body fat can result in a marijuana or PCP urine “spike” which is another form of a false-positive test. The urine of diabetics have fermented into ethanol resulting in false-positive tests of alcohol consumption.6-9 A person’s hydration status and some disease states can impact urine creatinine which may be misinterpreted as a purposeful attempt to dilute urine and evade detection of drug abuse. The problem of false-positive ethanol test due to urine fermentation may have been partially addressed by the recent development of ethyl glucuronide (EtG) testing. EtG is only produced by the liver when alcohol is ingested. However, ethanol can also enter the body via other products such as food cooked with wine, mouthwash, or hand sanitizers and could result in false-positive tests. EtG testing better addresses false-negative tests because ethanol remains in urine for up to 80 hours after drinking whereas an ethanol level of 0.08 (legal limit for DUI violation) will result in no measurable levels of alcohol 5.33 hours after the last drink.10

Many prescription and non-prescription medications can complicate urine drug testing. Ibuprofen (Advil®, Motrin®, et. al.) is reported to cause both false-positive and false-negative (at high doses) THC or marijuana urine tests.11 Vicks® inhaler and nasal spray have resulted in false-positive urine tests for methamphetamine and Ecstasy. Dextromethorphan, found in cough and cold medications has been misidentified as morphine or other opiates. Antibiotic medications like amoxicillin or ampicillin have been misidentified as cocaine in some tests. An ongoing, growing and referenced list of many other medications and even illnesses that have been reported to result in false-positive urine tests for abused substances can be accessed on line at:

http://www.askdocweb.com/falsepositives.html

Darryl S. Inaba, PharmD., CADC III

References

  1. Meadway C, George S and Braithwaite R (1998). Opiate concentrations following the ingestion of poppy seed products – evidence for ‘the poppy seed defense’. Forensic Science International, 96:29-38.
  2. Kaczorowski M (2008). The poppy seed defense: scientifically sound? McGill Sci Undergrad Res J, 3(1):40-41.

  3. Jenkins AJ, Llosa T, Montoya I, Cone EJ (1996). Identification and quantitation of alkaloids in coca tea. Forensic Sci Int., 77(3):179-89.

  4. elSohly MA, Stanford DF, elSohly HN (1986). Coca tea and urinalysis for cocaine metabolites, J Anal Toxicol, 10(6):256.

  5. Kwong TC (2008). Handbook of drug monitoring methods: therapeutics and drugs of abuse. Humana Press, New York, NY.

  6. Sulkowski HA, Wu AH, McCarter YS (1995). In-Vitro production of ethanol in urine by fermentation, J Forensic Sci. 40(6):990-3.

  7. Saady JJ, Poklis A, Dalton HP. Production of urinary ethanol after sample collection, J Forensic Sci, 38(6):1467-71.

  8. Logan BK, Jones AW (2000). Endogenous ethanol ‘auto-brewery syndrome’ as a drunk-driving defence challenge, Med Sci Law, 40(3):206-15

  9. Gruszecki AC, Robinson CA, Kloda S, Brissle RM (2005). High urine ethanol and negative blood and vitreous ethanol in a diabetic woman: a case report, retrospective case survey, and review of the literature, Am J Forensic Med Pathol, 26(1):96-8.

  10. Skipper GE, Weinmann W, Thierauf A, Schaefer P, Wiesbeck G, Allen JP, Miller M, Wurst FM (2004). Ethyl glucuronide: a biomarker to identify alcohol use by health professionals recovering from substance use disorders, Alcohol Alcohol, 39(5):445-9.

  11. Brunk SD (1988). False negative GC/MS assay for carboxy THC due to ibuprofen interference. J Anal Toxicol, 12(5):290-1.