Techniques For Cleansing the Body and Detoxifying
The current interest in drug courts developed in response to the overlap between substance abuse and crime in order to provide treatment for defendants. The interest in drug courts increased recently with the expanded number of courts that grew to 275 jurisdictions in 1998 from the first drug court in Dade County, Florida, in 1989 (Belenko, 1998). The benefits of drug courts have been documented reduced recidivism, decreased drug use, increased birth rates of drug-free babies, high program retention, increased relapse prevention, and cost efficient treatment. The drug court is a court-managed drug intervention and treatment program designed to provide a cost-effective alternative to traditional criminal case processing. Drug courts are treatment-oriented and target clients whose major problems stem from substance abuse. However, although there are standards that are required for each drug court program, each drug court program is different.
The method of switching ''clean'' urine for ''dirty'' urine resubmitting one's own or urine that is provided by someone else are the most common ways to fool the drug screening system. A number of entrepreneurs have attempted to bypass urine- Water-loading (drinking large amounts of water prior to voiding) poses an interesting challenge to testing laboratories. Specific gravity has been used to detect dilution however, the measurement range is limited so it is not yet useful. Creatinine levels on random urine samples appear to be a promising method for detection of water-loading. A number of adulteration methods are being advertised on the Internet. Invariably, one of the instructions for adulteration is to drink copious amounts of fluids to bring about in-vivo dilution or water loading. Some Internet sites even sell adulterants that can be added to the urine. Typically these products either try to oxidise the drug present or try to change the pH of the urine to interfere with the...
Coerced treatment is that substance abusers have limited internal motivation and consequently need to be externally motivated to enter treatment in order to change their behaviors. Expected change includes reduced arrests, reduced crime, and no drug use. It is important to keep in mind that, from a criminal justice point of view, no drug use is expected, which is different from a public health harm reduction approach. Consequently, substance offenders who have limited internal motivation to change their behaviors are externally motivated to enter treatment using the authority of the criminal justice system. This authority includes probation, parole, diversion, and drug courts, which can include incentives for substance offenders like reduced sentences or decreased time under criminal justice supervision.
Naltrexone is rapidly metabolized in the liver, but one of its metabolites is 6-naltrexol, which has some activity and a longer duration of action. In the 1990s, naltrexone was used to treat opiate addiction and for rapid opioid detoxification. Its greater potency than naloxone, along with its greater and longer activity after oral administration, has made this the antagonist of choice (for clinicians) in the treatment of opioid addiction.
Urine is the most commonly used fluid for drug screening. The methods most commonly used in toxicology laboratories are immunoassay, chromatographic and chromatography coupled with mass spectrometry. These methods vary considerably with respect to their sensitivity and reliability. Thin-layer chromatography is least expensive, gas chromatography coupled with mass spectrometry (GC MS), which is considered as nearly perfect or ''gold standard'', is the most expensive. Table 2 summarizes the various methods. Common Drug-Testing Methods Table 4 gives a summary of the advantages and disadvantages of each method of chromatographic drug testing and Table 5 compares all the methods of testing. The initial minimal immunoassay and GC MS (cut-off) levels for five drugs or classes of drugs as suggested by the U.S. National Institute of Drug Abuse, are listed in Table 6.
As the medical and social costs of prenatal alcohol and drug exposure become more apparent, so does public pressure for action. Many advocate termination of parental rights in cases where a newborn tests positive for drug or alcohol exposure. In some jurisdictions, mothers who used alcohol or drugs during pregnancy have been charged with child abuse or delivering a controlled substance to a minor. Critics of these policies charge that alcohol and drug screening will discourage substance-abusing women from obtaining necessary prenatal care. Legally, it may be difficult to establish criminal intent if substance abuse occurred early in an unintended and unrecognized pregnancy. Further, it is often difficult to causally disentangle alcohol or
Three science-based treatment research protocols will start in 2000, including two behavioral therapies developed to enhance treatment outcomes, and one that will test a new medication for use in opiate detoxification. Several other protocols are currently being developed. All treatment components to be tested have been shown to be effective in controlled research environments.
Drug testing in the workplace typically uses a zero tolerance approach. In the late 1970s, employ ees challenged these policies in the courts. However, the U.S. Supreme Court, in New York City Transit Authority v. Beazer, 440 U.S. 568, 99 S.Ct. 1355, 59 L.Ed.2d 587 (1979), ruled that a city agency's blanket exclusion of persons who regularly use narcotic drugs did not violate the Equal Protection Clause of the Fourteenth Amendment. This zero tolerance decision subsequently has been extended to various employment situations. By 2000, many employers routinely required a drug test as part of the employee hiring process. Applicants who failed the test usually are not hired because employers use a zero tolerance drug policy.
Drug courts and, 432-433 prosecutors and, 445-446 Judicial Assistance Act of 1984, 217 Just Say Know New Directions in Drug drug testing and, 453 -454 peak BAC, 859 of benzodiazepines, 1020 of calcium carbimide, 215 of cannabis, 704 clearance, 853 of CNS depressants, 848 of cocaine, 268-269 distribution, 849, 852 drug interactions and, 434, 437, 438, 439 drug testing and, 450-453, 854 personality Preclinical drug testing. See Abuse liability
Another point of discord is the belief that ''methadone keeps you high,'' a notion that reflects misunderstanding about the effects of a properly adjusted dose. Once stabilized, most patients experience little or no subjective effects heroin addicts will readily state that they seek methadone to avoid becoming sick (prevent withdrawal effects), not to get high. When the patient's dose is being stabilized, he or she may experience some subjective effects, but the wide therapeutic window allows for dose adjustment between the points of craving and somnolence. Dose adjustment may take some weeks and may be disrupted by a variety of medical and lifestyle factors, but once achieved the patient should function normally. There is ample scientific evidence that the long-term administration of methadone results in no physical or psychological impairment of any kind that can be perceived by the patient, observed by a physician, or detected by a scientist. More specifically, there is no...
In this paper, major issues related to drug testing are discussed. For example, drug-testing techniques measure drug presence but are not sophisticated enough to measure impairment from drug use. It is also very difficult to determine the route of drug administration, quantity, frequency, or when the drug was last taken. Selection of the drug to be tested should depend on the local availability of the drug, its abuse potential, and clinical effects, as well as the available analytical technology and expertise in testing and interpretation of the laboratory results. The most sophisticated drug-testing approach, gas chroma-tography in combination with mass spectrometry, is considered as a gold standard and thus utilized in confirmatory testing. Typically GC MS is preceded by a rapid immunoassay method to eliminate the majority of negative samples. Despite the existence of sophisticated drug-testing methods, incorrect test results can still occur. These can be due to the presence of...
Performance of Drug-Involved Offenders. Shaw and MacKenzie (1992) studied the performance of drug-involved offenders during community supervision in Louisiana. In comparison to offenders who were not drug-involved, those who were drug-involved did poorer during community supervision. This was true of those on probation, parolees from traditional prisons, and parolees from the boot camp. The boot-camp parolees did not do better than others. During the first year of supervision, the drug-involved offenders were more likely to have a positive drug screen.
Altered metabolism and drug detoxification. Cancer cells can gain resistance by increasing their ability to detoxify drugs. A common example is increased resistance due to enhanced activity of the glutathione S-transferase drug detoxification system recall that this enzyme catalyzes the formation of drug-glutathione conjugates (see Figure 18.1). Once formed, these water-soluble conjugates can be expelled from the cell.a Increased glutathione concentrations and or glutathione S-transferase activity have been associated with resistance to many drugs. Multiple means are available by which the conjugates can be expelled from the cell the primary mechanism in most appears to be via the glutathione-xenobiotic (GSH-X) pump. Increasing evidence indicates this pump is closely related to, if not identical with, the multidrug resistance protein (MRP) mentioned above. If they are indeed identical, this implies that MRP is able to expel both conjugated and unconjugated compounds. Although each of...
In Vitro Drug Release Testing of a Modified Release Oral Dosage Form Versus Dissolution Testing of an Immediate Release
The major difference between an in vitro dissolution test and an in vitro drug release test is that a dissolution test lasts for less than an hour, whereas an in vitro drug release test can last many hours. Hanson and Banakar list a number of external variables that affect drug dissolution 3, 4 including eccentricity of the stirrer, vibration of the apparatus, alignment and centering of the stirrer, agitation rate, dissolved gasses, media pH, media composition, evaporation, temperature, flow pattern of the media arising, for example, from probes, sampling position, blockage of filters, interference of drug detection methods and sorption of drug onto the equipment. This list applies equally well to in vitro drug release test methodologies.
Participants in the criminal justice system recognized that drug-related crimes should be addressed in different ways. The emergence of drug courts in the 1990s signaled a new way of prosecuting drug offenders. Drug courts seek to reduce drug use and associated criminal behavior by retaining drug-involved offenders in treatment. Drug courts divert drug offenders from jail or prison and refer them to community treatment. Defendants who complete the program either have their charges dismissed or probation sentences reduced. A 1994 federal law authorizes the U.S. Attorney General to make grants to state and local governments to establish drug courts. By 1999, 416 drug courts were operating in the United States, with over 270 more in the planning stages. These courts shift discretion from the prosecutor and place it with the judge, who has broad discretion in a drug court.
The Center for Substance Abuse Prevention (CSAP) is the Nation's focal point for the identification, promotion, and dissemination of effective strategies to prevent drug and alcohol abuse, and the use of tobacco. CSAP programs identify prevention strategies-such as targeted family and community strengthening-that work best for specific populations at risk of substance abuse. Program approaches emphasize both cultural relevance and competence. The Center oversees Federal workplace drug testing programs as well as State implementation of the Synar youth tobacco access reduction law. Finally, CSAP supports the National Clearinghouse for Alcohol and Drug Information (NCADI), the Nation's largest information source on substance abuse research, treatment, and prevention. NCADI's toll-free number is 1-800-7296686 its Internet address is www.health.org.
Historically, many of the medications used to treat heroin withdrawal in the general public have been largely ineffective in some cases, the cure has been worse than the disease. Among the numerous ineffective treatments have been Thorazine, Barbiturates, and electroshock therapy. In one method, belladonna and laxatives were used, because of the incorrect supposition that narcotics needed to be rinsed from the bodily tissues in which they were stored. At one institution that used this treatment, six of 130 addicts died during such opiate detoxification. Commenting on these methods, two of the researchers at Lexington noted The knockout feature of these treatments . . . doubtless had the effect of holding until cured many patients who would have discontinued a withdrawal treatment before being cured, and the psychological effect of doing something for patients practically all the time has a tendency, by allaying apprehension, to hold them even though what is done is harmful'' (Kolb &...
TASC served as the precursor for the system of 'Drug Courts' currently operating in California and in many other states. A Drug Court is a special court given the responsibility of select felony and misdemeanor cases involving nonviolent drug-using offenders. The program includes random drug testing, judicial supervision, counseling, educational and vocational opportunities and the imposition of sanctions for failure. There are 600 Drug Courts in the nation with about 92 in California. Each is set up utilizing the guidelines of the Federal Office of Drug Court Policy. Clients are responsible for their development and participation in the treatment process. Regular status hearings are held with the judge and the drug court team. After the successful completion of the criminal drug court program, a minimum of 12 months, the drug charge is dismissed. California Drug Courts operate on Federal and State grant money and matching funds from the county where the court is located.
DRUG COURTS Drug courts emerged as a method for responding to America's drug problems at a time when health, treatment and justice systems were overwhelmed by the drug epidemics of the 1980s. The dramatic increase in the availability The first drug court in the United States went into operation in Miami under the supervision of Judge Stanley Goldstein, the nation's first drug court judge, in the summer of 1989. Since the breakthrough efforts of the Miami justice leaders, by all measures, the growth of treatment drug courts in the United States has been extraordinary, with upwards of 400 courts reportedly in operation in the year 2000 and others in some stage of planning or preparation. The drug court model has also been adapted in other countries, from Canada and Australia to Great Britain and Ireland. as usual'') toward an approach that seeks to confront and meliorate the problems associated with persons who appear in the criminal caseload. The challenges implicit in this approach...
The costs of incarceration in the United States are high. In 1997, the Federal Bureau of Prisons calculated the average yearly cost to incarcerate an inmate at 23,542. The average yearly cost for a state prisoner was 19,800 and the cost for those housed in local jails was 20,225. In light of these costs, states have begun to establish drug courts that use drug treatment programs rather than incarceration as the preferred remedy. States have also tried boot-camp prisons as a way to reduce the recidivism rates the rate of repeat criminal activity of juvenile and adult offenders, yet by 2000 states began to abandon or scale back such approaches because they proved no more effective than traditional forms of incarceration.
A positive or negative result is highly dependent on the sensitivity of the drug detection method. A false negative occurs when the drug is present but is not found because the detection limit of the method used is too high or the absolute quantity of the drug in the specimen is too low. Large amounts of fluids consumed prior to obtaining a sample for analysis can affect detection of drugs in urine samples. Under conditions of dilution, although the absolute amount of drug or metabolite excreted maybe the same over a period of time, the final concentration per millilitre will be reduced and may give a false negative result. Acidity levels in the urine may also affect the excretion of the drug into the urine. In some cases elimination is enhanced, whereas in other cases, the drug is reabsorbed. At times false positives are attributable to ingested substances such as allergy medications. Some authors have suggested that employees subject to drug screening refrain from...
Reports are beginning to surface on modulating drug detoxification with natural compounds. For example, altered plasma concentrations were observed in two recent studies on Hypericum (St. John's wort). In the first, oral administration of 900 milligrams per day of Hy-pericum extract (standardized for 3 percent hypericin) reduced the plasma concentration of indinavir in healthy volunteers by an average of 57 percent indinavir is a HIV-1 protease inhibitor used in HIV treatment.274 In the second study, the authors described two cases where Hypericum initiated the rejection of heart transplants in patients being treated with cyclosporin, an immune suppressant.275 We can see from these studies that such drug natural compound interactions can be life threatening in some situations.
Services Drug Detox Unit 760 Broadway Brooklyn, NY 11206 Chemical Dependency Services Alcohol and Drug Detox Unit 760 Broadway Brooklyn, NY 11206 Program Inpatient Drug Detox Program Inpatient Primary Alcohol Drug Detoxification Program 1-9 Nathan D Perlman Place New York, NY 10003 Drug Detoxification Program Methadone Treatment Program 1900 2nd Avenue, 2nd Floor New York, NY 10029
Other supposed anabolic agents include dehydroepiandrosterone (DHEA), androstenedione, and Tribulus terrestris (tribestan). All of these are banned by the U.S. Olympic Committee, the National Collegiate Athletic Association (NCAA), the National Football League, and the American Tennis Federation. Studies have demonstrated the ineffectiveness of an-drostenedione as an anabolic substance or strength enhancer, but they have demonstrated potentially worrisome side effects, including a decrease in serum HDL level and an increase in serum estrone and estradiol, which increases the likelihood of gynecomastia (breast enlargement). In addition, several laboratory tests have shown that the amount of actual product in these supplements can vary dramatically, and some are contaminated with nandrolone, an anabolic steroid that can cause a positive result in a drug test.
Challenging headaches include hormone fluctuation pain in females around the menstrual cycle. I normally see elevated estrogen levels in saliva testing suggesting inadequate liver clearing of estrogen, with not enough progesterone to cause equilibrium. This is best treated by consuming whole grain B vitamin food, whole food B vitamin supplementation, and eliminating B vitamin-depleting sugar. Adding beets to the diet along with flax oil (one tablespoon per 100 pounds of body weight) is also recommended.
In the only randomized, double-blind, placebo-controlled study of lithium for the treatment of adolescents with BD, Geller et al 118 evaluated 25 adolescents with BD and secondary substance dependency over the course of six weeks. Mean age was 16.3 years, mean age of illness onset was 9.6 years, and mean age of onset of substance dependency was 15.3 years. Outcome measures included response as defined by a score on the Children's Global Assessment Scale (CGAS) of 65, as well as positive random weekly urine drug testing. At endpoint, adolescents receiving lithium were found to have a significantly greater improvement on the CGAS, as well as having significantly fewer positive urine drug tests. Using categorical outcomes, 6 13 (46 ) of adolescents receiving lithium achieved a positive response on the CGAS, as compared to 1 12 (8 ) of those receiving placebo. Limitations of this study included the small sample size, the fact that all subjects had active substance dependency, as well as...
Is present for a longer time in urine, two to four days, depending on the quantity of cocaine ingested. Assays for this metabolite are frequently employed in treatment programs, to evaluate compliance with the program, and in workplace drug testing to indicate cocaine use. Under these conditions, it is important to keep in mind that ben-zoylecognine in the urine is an indication of prior cocaine use, but reflects neither current use nor impairment. (SEE ALSO Cocaethylene Drug Testing andAnaly-sis)