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When mixed with alcohol, the effects of these drugs may be enhanced.


prescriptions or “doctor shopping.” The younger sibling can be readily synthe- sized using non-prescription medicines as the base materials. This illicit syn- thesis has become widespread, leading to a dramatic increase in abuse over the last two decades. Recently, the govern- ment’s efforts to restrict the availability of the OTC precursors have significantly decreased domestic production of the illicit sibling. Following the therapeutic use of the


non-prescription drug, the concentration of the l-form in urine generally does not reach levels that can render a positive im- munoassay screen. The d- and l-isomers of these drugs can be separated and quantitated by Gas Chromatography/ Mass Spectrometry (GC/MS). Due to the sibling’s structural similarity to OTC and other prescription medications, there is the potential for cross-reactivity with the immunoassay screening test. However, chromatographic/mass spectrometric (e.g. GC/MS) confirma- tion can easily differentiate between the siblings of interest and other structurally related compounds. There are a number of other medica-


tions, especially those not available in the U.S., that are metabolized into at least one of these siblings. Some examples include fenethylline, fenproporex, furf- enorex, mefenorex. Other better known “pro-drugs” in the U.S. include benz- phetamine and selegiline. The younger sibling can also be changed into the older sibling and both may be found after the use of the former. The drugs may be used intravenously,


intranasally, orally or by smoking. When injected, the onset of action is immedi-


ate. When snorted, effects occur within 3 to 5 minutes, and when ingested, within 15 to 20 minutes. The half-life of the drug is 7 to 34 hours and the plasma life for the l-isomer has been found to be up to 39 percent longer, indicating that it is metabolized at a slower rate. When mixed with alcohol, the effects of these drugs may be enhanced. Te drug is excreted primarily as the


unchanged drug. Under normal condi- tions, approximately 30 percent of the dose is excreted unchanged over 24 hours in urine. Tis may increase to 74 percent in acid urine and may decrease to 1 percent in alkaline urine. The older sibling goes by several


names including bennies, black beau- ties, co-pilots, eye-openers, lid poppers, speed, uppers and white-crosses. While the younger sibling goes by chalk, crank, crystal, ice, glass, go, meth, speed and zip. Prescription forms of these drugs include: Adderall®, Dexedrine®, Vyvanse® and Desoxyn®. What are they? Te older sibling


is amphetamine, the younger, methamphetamine. ❚


Dr. Rody Predescu, MD is an Operations Director at Quest Diagnostics. She serves as the Scientific Director and Respon- sible Person for the Forensic Toxicology Laboratory in West


Hills, California. Dr. Predescu has worked in the field of toxicology since 1987. She earned her medical degree from the Carol Davila University of Medicine and Pharmacy in Bucharest, Ro- mania. She also serves as a National Laboratory Certification Program (NLCP) and College of American Pathologists (CAP) Inspector.


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datia focus


summer 2013


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