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Drug screens are used for one of \par three purposes: \par \par }{\rtlch \ab\af2\alang1025 \ltrch \b\cf6\insrsid10766354\charrsid7622695 1) medical purposes}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 (e.g., to monitor a patient's progress in a medical \par treatment program for a drug abuse problem the patient has \par acknowledged), \par \par }{\rtlch \ab\af2\alang1025 \ltrch \b\cf6\insrsid10766354\charrsid7622695 2) legal purposes}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 (e.g., to determine if a suspect had taken controlled \par substances prior to some accident or crime), and \par \par }{\rtlch \ab\af2\alang1025 \ltrch \b\cf6\insrsid10766354\charrsid7622695 3) medicolegal purposes}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 (e.g., in an employer's drug abuse program aimed at \par both preventing drug-related accidents and crimes and identifying and \par treating employees with drug abuse problems). \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid7622695 For medical purposes}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 , laboratories often use simple, less-expensive \par methods aimed at identifying specific drugs with which the patient has had \par problems in the past. It is not expected that the results of such drug \par tests will be used as evidence against the patient in court. If these \par results are used as evidence, it is likely that defense testimony will \par successfully impugn the evidence. \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid7622695 For legal and medicolegal purposes}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 , more stringent testing is necessary \par to obtain information that will successfully withstand technical criticism \par in court. Therefore, drug screens done for these purposes often take a \par two-tiered approach. First, there is a screening test done on the subject's \par urine. This is usually a sensitive test that may have some discrepancies \par in specificity (for instance, some popular over-the-counter cold medicines \par may yield a positive amphetamine screen). Only if this test is positive for \par one or more drugs is the second, more expensive test performed. Generally \par courts will uphold testimony based on a drug test if positive results were \par obtained on two separate tests based on different chemical methods. \par \par }\pard \ltrpar\s15\ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid12922375 {\rtlch \ab\af2\afs24\alang1025 \ltrch \b\f58\fs24\cf17\insrsid10766354\charrsid12922375 AMPHETAMINES \par }\pard \ltrpar\s15\ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid12922375 {\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid12922375 Examples:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 amphetamine sulfate, dextroamphetamine (Dexedrine), \par methamphetamine (Desoxyn, Methedrine). \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid12922375 \par Medical uses:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Attention deficit disorder (hyperactivity) of childhood, \par narcolepsy, obesity (occasionally and for limited period) \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid12922375 Effects attractive to abuser:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Euphoria, increased ability to \par concentrate, increased alertness, heightened ability to perform \par intellectual and physical tasks, appetite suppression (for weight loss). \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid12922375 Adverse effects:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Insomnia, restlessness, irritability, palpitations, \par rapid heartbeat, sweating, dilation of pupils, confusion, psychosis, \par convulsions, death. \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid12922375 How abused:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Pills taken orally; solution injected intravenously; \par occasionally snorted into the nose in granular form. \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid12922375 \par Typical urine detection cutoff level:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 300 ng/mL \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid12922375 Period detectable after last dose:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Up to 30 hours on low dose, 120 hours \par on high dose. \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid12922375 Substances causing false positive results (on initial drug screen only): \par }{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 decongestants (ephedrine [Vatronol, Efedron], phenylpropanolamine \par [Propagest, Sucrets Decongestant Formula, Rhindecon]); "diet pills" \par (phenmetrazine [Preludin], phentermine [Phentrol, Tora, Fastin, Obe-Nix, \par Obephen, Obermine, Obestin, Parmine, Phentamine, Phentrol 2, Unifast, \par Wilpowr, Adipex-P, Dapex-37.5, Ionamin, Phentrol], phenylpropanolamine \par [Diadax, Prolamine, Control, Dex-A-Diet, Dexatrim-15, Unitrol, Maximum \par Strength Acutrim, Appedrine]; blood vessel dilators (isoxuprine \par [Vasodilan], nylidrin [Adrin, Arlidin]). Only confirmatory testing of the \par urine will determine if these interfering drugs are present. It should be \par noted that some of these drugs, such as phenmetrazine and phentermine, \par while not technically amphetamines, have similar abuse potential and \par similar adverse effects. \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid12922375 Phenylethylamine}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 (a product of decomposing, unpreserved urine) may \par produce false-positive screens in unrefrigerated, old specimens which have \par not been treated with fluoride preservative. \par }\pard \ltrpar\s15\ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid12922375 {\rtlch \ab\af2\afs24\alang1025 \ltrch \b\f58\fs24\cf17\insrsid10766354\charrsid12922375 \par BARBITURATES \par }\pard \ltrpar\s15\ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid12922375 {\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid12922375 Examples:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Long acting- phenobarbital; intermediate-acting- amobarbital \par (Amytal), butabarbital, talbutal; short-acting- secobarbital (Seconal), \par pentobarbital (Nembutal). \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid12922375 \par Medical uses:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Treatment of insomnia (short term only, and avoided \par altogether by most physicians), long-term treatment of epilepsy \par (phenobarbital), surgical anesthesia. \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid12922375 Effects attractive to abuser:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Sedation, loss of inhibitions, induction \par of sleep. Generally, the short-acting barbiturates have more abuse \par potential than long-acting types. \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid12922375 \par Adverse effects:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Agitation, confusion, nightmares, hallucinations, \par lethargy, hangover, suppression of breathing reflexes, coma, death. \par Physical dependence is well known, and withdrawal effects can be severe and \par dangerous, even fatal. \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid12922375 How abused:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Pills taken orally; solution injected intravenously. \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Typical urine detection cutoff level:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 300 ng/mL \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Period detectable after last dose:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 long-acting 7 days, intermediate-acting \par 2-3 days; short-acting 1-2 days. \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 \par Substances causing false positive results:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 None reported. \par \par }\pard \ltrpar\s15\ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid12922375 {\rtlch \ab\af2\afs24\alang1025 \ltrch \b\f58\fs24\cf17\insrsid10766354\charrsid12922375 METHADONE \par }\pard \ltrpar\s15\ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid12922375 {\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Examples:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Roxane, Dolophine \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Medical uses:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Treatment of opiate addicts in approved program \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Effects attractive to abuser:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Same as opiates (below) \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Adverse effects:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Same as opiates (below) but with lesser degree of physical \par dependency (addiction) \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 How abused:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Pills taken orally; solution injected intravenously. \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 \par Period detectable after last dose:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 7.5-56 hours \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Substances causing false positive results:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 doxylamine [Unisom Nighttime \par Sleep Aid]. Presence of this substance would be ruled out by confirmatory \par testing. \par }\pard \ltrpar\s15\ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid12922375 {\rtlch \ab\af2\afs24\alang1025 \ltrch \b\f58\fs24\insrsid10766354\charrsid12922375 \par }{\rtlch \ab\af2\afs24\alang1025 \ltrch \b\f58\fs24\cf17\insrsid10766354\charrsid12922375 OPIATES \par }\pard \ltrpar\s15\ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid12922375 {\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Examples:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Morphine, heroin, codeine (as found in many prescription cough \par medicines, such as Robitussin-AC, and pain medications, such as Tylenol \par #3, Phenaphen #3 & #4, Empirin #3 & #4), oxycodone (Percodan), \par hydromorphone (Dilaudid), hydrocodone (as in many prescription cough \par medicines). \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Medical uses:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Relief of moderate to severe pain, treatment of persistent \par cough (codeine), treatment of diarrhea. \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Effects attractive to abuser:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Euphoria, sedation. \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Adverse effects:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Drowsiness, apathy, confusion, nausea, vomiting, \par suppression of breathing reflexes, constricted pupils, physical addiction, \par coma, death. \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 How abused:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Pills taken orally; solution injected intravenously or \par subcutaneously; occasionally snorted into the nose in granular form. \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 \par Typical urine detection cutoff level:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 300 ng/mL \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 \par Period detectable after last dose:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 heroin, 1-4 days; meperidine, 4-24 \par hours; morphine, 84 hour minimum \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Notes:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 This family of drugs undergoes extensive chemical changes due to \par the normal detoxification processes of the body. Therefore, the drug \par detected in the urine screen may not be the same as that originally taken \par by the subject. For instance, both heroin and codeine are converted to \par morphine before excretion in the urine. \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Substances causing false positive results:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 none reported; however, foods \par containing poppy seeds (the natural source of traditional opiate drugs) \par will produce true positive results when screening the urine of an otherwise \par innocent subject. \par \par }\pard \ltrpar\s15\ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid12922375 {\rtlch \ab\af2\afs24\alang1025 \ltrch \b\f58\fs24\cf17\insrsid10766354\charrsid12922375 BENZODIAZEPINES \par }\pard \ltrpar\s15\ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid12922375 {\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Examples:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Diazepam (Valium), chlordiazepoxide (Librium), flurazepam \par (Dalmane), oxazepam (Serax), lorazepam (Ativan), clonazepam (Clonopin). \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Medical uses:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Treatment of anxiety disorders, convulsions, and muscle \par spasms. \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Effects attractive to abuser:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Euphoria, sedation, relief of anxiety, \par induction of sleep. \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 \par Adverse effects:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Drowsiness, apathy, fatigue, decreased activity level, \par dizziness, fainting, impaired ability to concentrate on tasks, \par disturbance of vision and hearing, physical addiction. \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 How abused:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Pills taken orally. \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Typical urine detection cutoff level:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 300 ng/mL \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Period detectable after last dose:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 around 2-4 days, but depending \par greatly on dose. For instance, a single 10 mg PO dose of diazepam may not \par ever be detected, but a 5 times daily dose of 10 mg will be detectable for \par 3-7 days. \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Substances causing false positive results:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 none reported. \par \par }\pard \ltrpar\s15\ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid12922375 {\rtlch \ab\af2\afs24\alang1025 \ltrch \b\f58\fs24\cf17\insrsid10766354\charrsid12922375 CANNABINOIDS \par }\pard \ltrpar\s15\ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid12922375 {\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Examples:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Marijuana, hashish, hash oil \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Medical uses:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Treatment of nausea and vomiting due to cancer chemotherapy. \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 \par Effects attractive to abuser:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Euphoria, intensified sensual and \par aesthetic perceptions. \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 \par Adverse effects:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Paranoia, panic, impairment of memory and ability to \par perform tasks, distorted perception of time, physical and psychological \par dependence. \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 \par How abused:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Smoked in cigarettes or pipe; occasionally eaten as \par ingredient baked into confections. \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 \par Typical urine detection cutoff level:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 100 ng/mL or 20 ng/mL (optional) \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 \par Period detectable after last dose:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 This is highly variable. A one joint \par per week user has detectable levels of cannabinoids form 7 to 34 days, \par while a heavy daily user may be detected from 6 to 81 days after last use. \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 \par Substances causing false positive results:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 none reported. A screen \par detection cutoff level of 20 ng/mL, requested by some laboratory clients, \par may produce false positives due to passive inhalation of marijuana smoke, \par but this is controversial. \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 \par At the cutoff level of}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 100 ng/mL, persons exposed passively to the smoke \par of others by virtue of being in the same room with abusers should be \par negative on urine drug screen, although more sensitive chemical techniques \par (such as gas chromatography/mass spectrometry, which has a sensitivity of \par 10 ng/mL) may demonstrate the drug in such an individual's urine. \par \par }\pard \ltrpar\s15\ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid12922375 {\rtlch \ab\af2\afs24\alang1025 \ltrch \b\f58\fs24\cf17\insrsid10766354\charrsid12922375 COCAINE \par }\pard \ltrpar\s15\ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid12922375 {\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Examples:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Cocaine hydrochloride is the typical form used by abusers who \par ingest the drug by snorting the granular form into the nose; it can also be \par dissolved in water and injected intravenously. Cocaine base is available in \par a waxy cake form ("rock" or "crack") which is vaporized with a torch and \par the vapors inhaled through a tube. \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Medical uses:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Used almost exclusively by ear, nose and throat doctors to \par produce local anesthesia and control blood loss during minor nasal \par surgery. \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Effects attractive to abuser:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Euphoria, increased ability to \par concentrate, increased alertness, heightened ability to perform \par intellectual and physical tasks, sexual stimulation, heightened \par sociability, enhanced self-confidence. \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Adverse effects:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Restlessness, nervousness, tremor, convulsions, \par disturbances in heart rhythm, psychological dependence, myocardial \par infarction, sudden death. \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 How abused:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Snorted, injected, or smoked (see above). \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 \par Typical urine detection cutoff level:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 300 ng/mL \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 \par Period detectable after last dose:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 8-48 hours \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Note:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 The laboratory detection of cocaine is performed by analyzing the \par urine for the presence of benzoylecgonine, a substance produced by the \par body's chemical detoxification of cocaine. Continuous conversion of cocaine \par to the metabolite occurs in voided, standing urine specimens (even with \par fluoridation and refrigeration) unless the specimen is kept at acid pH \par (<5). This may give the appearance of a negative specimen "turning \par positive" during storage, if the initial level of the metabolite was too \par low to trigger the screen in the fresh specimen. In truth, the specimen was \par positive all along, of course. \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Substances causing false positive results:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 none reported; however, some \par legal South American herbal teas may contain small amounts of coca leaf \par extract, which may trigger a positive test in an "innocent" subject. Please \par note that cocoa, cacao, and Coca Cola are all completely unrelated to coca, \par which is the source of cocaine. \par \par }\pard \ltrpar\s15\ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid12922375 {\rtlch \ab\af2\afs24\alang1025 \ltrch \b\f58\fs24\cf17\insrsid10766354\charrsid12922375 METHAQUALONE \par }\pard \ltrpar\s15\ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid12922375 {\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Examples:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Quaalude, Sopor \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 \par Medical uses:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Once used as a sleeping pill/sedative, now methaqualone is \par virtually never used for medical purposes. \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 \par Effects attractive to abuser:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Same as that for barbiturates (see above) \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Adverse effects:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Same as that for barbiturates (see above) \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 \par How abused:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Pills taken orally. \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Typical urine detection cutoff level:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 300 ng/mL \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Period detectable after last dose:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 up to 90 hours, depending on dose \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Substances causing false positive results: }{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 none reported. \par \par }\pard \ltrpar\s15\ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid12922375 {\rtlch \ab\af2\afs24\alang1025 \ltrch \b\f58\fs24\cf17\insrsid10766354\charrsid12922375 PHENCYCLIDINE \par }\pard \ltrpar\s15\ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid12922375 {\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Examples:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 PCP, "angel dust" \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Medical uses:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Veterinary tranquilizer; not used in human medicine. \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 \par Effects attractive to abuser:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Hallucinogenic effects \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 \par Adverse effects:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Lethargy, loss of co/rdination; unpredictable \par psychosis, sometimes with criminally violent behavior; death. \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 \par How abused:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Taken orally, smoked in cigarette (often mixed with \par marijuana), injected intravenously as a solution, snorted into the nose in \par granular form. \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Typical urine detection cutoff level:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 75 ng/mL \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Period detectable after last dose:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 5-10 days \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Substances causing false positive results:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Thioridazine (Mellaril), an \par antipsychotic drug, has been reported to cause false positive results, \par as has the insecticide parathion. \par \par }\pard \ltrpar\s15\ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid12922375 {\rtlch \ab\af2\afs24\alang1025 \ltrch \b\f58\fs24\cf17\insrsid10766354\charrsid12922375 PROPOXYPHENE \par }\pard \ltrpar\s15\ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid12922375 {\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Examples:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Darvon, Dolene, Doxaphene, Profene 65 \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 \par Medical uses:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Relief of mild to moderate pain. \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Effects attractive to abuser:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Same as that for opiates (see above) \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 \par Adverse effects:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Same as that for opiates (see above). \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 \par How abused:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Pills taken orally; occasionally injected as solution made \par by dissolving pills in water. \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Period detectable after last dose:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 1-3 days \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Note:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Propoxyphene is technically an opiate and is chemically closely \par related to methadone. As a pain-relieving drug, it is two-thirds as potent \par as codeine. Although considered something of a minor leaguer in the opiate \par world, it is nevertheless a cause of many drug-related deaths (including \par that of former football star John Matuszak) especially if used in \par combination with alcohol and other drugs. \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 \par Substances causing false positive results:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Methadone (see above) at \par high, toxic concentrations may cause false positive results. Confirmation \par testing will eliminate interference by this drug. \par \par }\pard \ltrpar\s15\ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid12922375 {\rtlch \ab\af2\afs24\alang1025 \ltrch \b\f58\fs24\cf17\insrsid10766354\charrsid12922375 ALCOHOL (ETHANOL) \par }\pard \ltrpar\s15\ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid12922375 {\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Examples:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Beer, wine, distilled spirits \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Medical uses:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Rarely, if ever, used for medical purposes. \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Effects attractive to abuser:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Release of social inhibitions, euphoria, \par sedation \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 \par Adverse effects:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 Same as that for barbiturates (see above). Also, use by \par pregnant women, even in small ("social") amounts may have adverse effect \par on the fetus. \par \par How abused: Drunk in beverage \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Period detectable after last dose:}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 8-10 hours \par \par Note: Alcohol is the only drug of abuse (other than tobacco) that is \par legal for all adults to use. Illegal use (as in driving while intoxicated) \par is defined by the presence of a blood alcohol level of greater than 100 \par mg/dL (0.10% by volume) in Texas (lower in some other states). It is \par impossible to determine if a subject is legally intoxicated by measurement \par of the urine alcohol level. \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 A blood specimen must be collected for this determination}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 to be made by \par a clinical laboratory. \par }\pard \ltrpar\s15\ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid12922375 {\rtlch \ab\ai\af2\afs22\alang1025 \ltrch \b\i\f58\fs22\ul\cf18\insrsid10766354\charrsid12922375 \par }{\rtlch \ab\ai\af2\afs22\alang1025 \ltrch \b\i\f58\fs22\ul\cf19\insrsid10766354\charrsid13597050 LIMITATIONS OF DRUG SCREENS \par }\pard \ltrpar\s15\ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid12922375 {\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 \par From a practical viewpoint it is impossible to determine in every case \par that a given individual is impaired in the workplace due to drug abuse. \par Just as in the case of alcohol, the use of drugs spans a wide spectrum of \par behavior, from the occasional recreational user who assiduously avoids \par coming to work under the influence, to the hard-core addict whose only \par motivation is the acquisition of his or her next dose. Generally the \par clinical laboratory is not able to distinguish these two types of \par individuals. Such a distinction comes about only by careful evaluation by \par professionals specially trained in the psychology and physiology of drug \par abuse. The laboratory should be used only as a helpful tool for such \par professionals. \par \par Urine drug screens panels are set up to analyze urine for a variety of \par drugs that are known to have high abuse potential and affect task \par performance. \par To rule out the presence of all drugs that may impair a worker's \par performance is not generally allowable within the bounds of cost \par containment. Certain drugs which are not usually picked up on routine drug \par screens are noted below. If intoxication by any of the drugs listed below \par is suspected, it is recommended that the client contact the B&A \par pathologist, who will be glad to help determine a strategy as to how the \par case should be most efficiently handled. \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Methylphenidate (Ritalin), phentermine (Fastin, Parmine), phenmetrazine \par (Preludin), phendimetrazine (Plegine), diethylpropion (Tenuate), \par mazindol (Mazanor, Sanorex), benzphetamine (Didrex) and fenfluramine \par (Pondimin)}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 all have amphetamine-like effects and abuse potential. Some of \par them, such as phentermine, benzphetamine, fenfluramine and diethylpropion, \par may not be picked up on routine screens. \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Methylenedioxyamphetamine (MDA, "Ecstasy")}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 is has been popular in \par Houston high schools. Although it is technically an amphetamine, it \par requires a special analysis to be identified. \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Lysergic acid diethylamide (LSD)}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 is also chemically related to the \par amphetamines, but it is much better known for its profound \par hallucinogenic effects. Special analysis is available. \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Meperidine (Demerol) and pentazocine (Talwin)}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 have physiological effects \par and abuse potential essentially identical to those of opiates. However, \par since they are chemically dissimilar to morphine, they may not show up as \par "opiates" on a routine screen. Special analysis is available. \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Barbiturates}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 which are not easily detected on drug screens include \par amobarbital (Amytal), pentobarbital (Nembutal), and butethal. The detection \par systems used to pick up barbiturates are optimized for secobarbital \par (Seconal), which is probably the most important barbiturate in abusing \par populations. \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Flurazepam (Dalmane),}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 a benzodiazepine used as a sleeping pill, is not \par ordinarily picked up on benzodiazepine screens. \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Glutethimide (Doriden), ethchlorvynol (Placidyl), meprobamate (Miltown, \par Equanil), methyprylon (Noludar), and ethinamate (Valmid)}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 are sedative \par drugs that can produce dependence and impaired function. Although they may \par have some effects similar to those of the barbiturates, they are chemically \par unrelated and must be detected with special procedures. \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Hydrocarbon solvents.}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 These are inhaled by glue sniffers to produce a \par euphoric effect. Although this seems to be less of a problem socially now \par than in previous years, special analysis of hydrocarbons and chlorinated \par hydrocarbons is available. \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Ketamine (Ketalar), chemically related to phencyclidine (PCP), }{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 is used \par as a general anesthetic but has been abused, often by health care workers. \par It must be injected for effect. Analysis is available only through \par specialized laboratories, and turnaround time is typically long. \par \par }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 Designer opiates}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 . These, like }{\rtlch \af2\alang1025 \ltrch \cf6\insrsid10766354\charrsid13597050 meperidine}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 , are synthetic analogues of \par natural opiates. Accordingly, their chemical structure may be so alien to \par that of natural opiates that they go completely undetected. These are \par medically very significant drugs. For instance, 3-methylfentanyl ("China \par white") is 3000 times as potent as morphine and has been responsible for \par over 100 overdose deaths in California. Another, 1-methyl-4- \par phenylpropionoxypiperidine (MPPP), may be contaminated with an unintended \par byproduct (1-methyl-4-phenyl-1,2,5,6-tetrahydropyridine, or MPTP) which \par destroys the substantia nigra of the brain and produces permanent \par parkinsonism. \par \par }\pard \ltrpar\s15\ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid12922375 {\rtlch \ab\ai\af2\afs24\alang1025 \ltrch \b\i\f58\fs24\ul\cf17\insrsid10766354\charrsid13597050 Adulteration of urine samples with such substances}{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 as lemon juice, \par }\pard \ltrpar\s15\ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid12922375 {\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 vinegar, chlorine bleach, and NaCl has been used to successfully interfere \par with detection of cannabinoids. Also, marked overhydration of the subject \par (by quaffing large volumes of water) may so dilute the urine that the \par concentration of the telltale metabolite falls below the detection \par threshold of the screen. \par }\pard \ltrpar\s15\ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid12922375 {\rtlch \ab\af2\afs24\alang1025 \ltrch \b\f58\fs24\cf18\insrsid10766354\charrsid12922375 \par }{\rtlch \ab\af2\afs24\alang1025 \ltrch \b\f58\fs24\cf17\insrsid10766354\charrsid13597050 A WORD ON TEST RELIABILITY \par }\pard \ltrpar\s15\ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid12922375 {\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 \par Published data indicate that a system of drug screening similar to that \par used by most laboratories has a sensitivity of 76% and a specificity of \par 99%. This excellent specificity parameter means that of 100 persons who do \par not use drugs, 99 would be expected to test negative by confirmation. This \par is certainly an excellent specificity for any medical determination. \par However, one should also be aware of another parameter, the predictive \par value of a positive test. As applied to drug testing, this figure expresses \par the probability that a subject that has tested positively has in fact used \par the drug. Although a high specificity, such as 99%, optimizes the \par predictive value, a more significant factor is the prevalence of drug use \par in the population being tested. The more prevalent the usage of drugs in a \par subject population, the greater the reliability of drug testing procedure. \par Given the sensitivity and specificity values quoted above, the following \par table indicates the predictive value for several levels of drug abuse \par prevalence. \par \par Percentage of tested population | Probability that a given \par \par using drugs (the prevalence of | subject that tests positive \par \par drug abuse) | has really taken the drug \par \par | (the predictive value of a \par \par | positive test) \par ______________________________________________________________________ \par \par 0.1% | 7.1% \par 1.0% | 43.4% \par 10.0% | 89.4% \par 20.0% | 95.0% \par 50.0% | 98.7% \par \par Therefore, in a population with a high incidence of drug use (200 per \par thousand), the false positive rate on drug screens is only 5%, while in \par a low-incidence population (1 per thousand) the false positive rate on \par randomly screened individuals (i.e., those of whom there is no particular \par suspicion of drug use) is expected to be a whopping 93%! For this reason, \par it is my recommendation that drug screens not be applied on a random, \par not-for-cause basis, except in situations where the prevalence of drug use \par is known to be high (such as in substance abuse treatment programs). \par \par }{\rtlch \ab\af2\afs16\alang1025 \ltrch \b\fs16\cf17\insrsid10766354\charrsid7622695 DISTRIBUTION RESTRICTIONS}{\rtlch \ab\af2\afs16\alang1025 \ltrch \b\fs16\cf20\insrsid10766354\charrsid7622695 : This monograph may be freely duplicated and \par reformatted, as long as the informational content is not altered. It may \par be freely distributed, if 1) the author is given credit, and 2) it is not \par used as an aid for marketing or maintaining commercial laboratory accounts \par without prior express written permission of the author \par }{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 \par }{\rtlch \ab\af2\alang1025 \ltrch \b\insrsid10766354\charrsid13597050 Copyright (C) 1989, 1993, Edward O. Uthman \par }{\rtlch \af2\alang1025 \ltrch \insrsid10766354\charrsid10766354 \par }\pard \ltrpar\s15\ql \li0\ri0\widctlpar\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid7622695 {\rtlch \af2\alang1025 \ltrch \insrsid10766354 \par }}