Chapter 15 - Confirmation Methods for SAMHSA Drugs and Other Commonly Abused Drugs

Abstract

The Substance Abuse and Mental Health Services Administration (SAMHSA, an agency under the US Department of Health and Human Services) drug testing program was initiated in 1988 to include the primary drugs of abuse during that time period: amphetamine/methamphetamine, cocaine, marijuana, phencyclidine (PCP), and morphine/codeine. In subsequent revisions, other analytes, including 6-acetylmorphine (6-AM), 3,4-methylenedioxymethamphetamine (MDMA), 3,4-methylenedioxyamphetamine (MDA), and 3,4-methylenedioxyethylamphetamine (MDEA), have been added to the testing panel. Revisions proposed in 2015 add oxycodone, oxymorphone, hydrocodone, and hydromorphone, which will be discussed in further detail under non-SAMHSA drug section. For workplace drug testing, initial step is immunoassay screening using an Food and Drug Administration (FDA) approved immunoassay followed by confirmation using an alternative method preferably gas chromatography/mass spectrometry (GC/MS) or liquid chromatography combined with mass spectrometry (LC-MS) or tandem mass spectrometry (LC-MS/MS). Some drug metabolites are excreted in urine in conjugated form so hydrolysis of urine prior to extraction is useful in liberating free drugs. One major advantage of LC-MS/MS is that unlike GC/MS where derivatization is needed for several drugs, for LC-MS/MS most drugs can be analyzed without derivatization.