Addictive substances panel (Gift card)

Before giving the sample, read the instructions HERE.

The results will be displayed in minu.synlab.ee and terviseportaal.ee. If you ordered the panel anonymously, the results will not go to the terviseportaal.ee portal.

• A positive result means that the concentration of the tested substance exceeds the detection limit of the test. The result is qualitative; the level of addictive substance, its method of administration or its concentration in the urine cannot be detected.
• A negative result means that the concentration of the tested substance is below the detection limit of the test.
• The use of some medicinal products can cause cross-reactivity and produce false-positive test results.
• Manipulation or dilution of the sample material, or adding disinfectants or bleaching agents to it can affect the test result.
• To detect potential wrongful manipulation of urine samples, the laboratory performs creatinine and pH analysis from the sample, the results of which will not be released.

Addictive substances are consumed for narcotic intoxication and psychological stimulation to increase alertness and both mental and physical capacity.

Cocaine and amphetamines are neurostimulants, opiates create feelings of euphoria, and benzodiazepines, barbiturates and cannabinoids are known as depressants. Narcotic substances are also used as drugs for medical purposes (as tranquilisers, sedatives, anticonvulsants, anaesthetics, etc.). When used regularly, addictive substances can cause various problems, from physical ailments to mental health and social issues. The majority of addictive substances are prohibited by law.

According to data from the National Institute for Health Development, the number of drug overdose deaths is increasing in Estonia each year. For instance, the number of overdose deaths rose from 31 in 2020 to 39 in 2021. In 2022, however, there were a total of 79 overdose deaths confirmed by toxicological tests. Overdose deaths can also be caused by the simultaneous use of several narcotic and psychotropic substances.

The addictive substances panel is a primary screening method for detecting a narcotic substance in the urine. Results cannot be used for legal purposes, such as to detect the abuse of narcotic substances. For such purposes, testing is carried out by the Estonian Forensic Science Institute.

The addictive substances panel helps detect the presence of the following 6 narcotic substances in the urine:

Cocaine

Cocaine is a narcotic drug that belongs to the class of stimulants that act on the central nervous system. Users experience a spike of energy and sense of euphoria; however, the drug is highly addictive, leading to both psychological and physical dependence.

Cocaine increases the level of dopamine in the brain and stimulates the sympathetic nervous system, leading to tachycardia, vasoconstriction, hypertension, dilated pupils, increased bowel peristalsis, increased body temperature, shivering and sweating. Cocaine also suppresses appetite. Other possible symptoms include hallucinations and paranoia; a person can become aggressive and exhibit dangerous behaviours towards others. A cocaine overdose is characterised by seizures, delirium, arrhythmia, heart attack and sudden death. Cocaine also passes across the placental barrier and into breast milk.

Narcotic intoxication is produced quickly and it lasts for about an hour; with crack smoking, the effects last for about 20 minutes.

When used once, cocaine is detectable in the urine 1-3 days afterwards, and with regular use, 10-22 days after most recent consumption due to its accumulation in tissues.

In 2022, 15% of all overdose deaths in Estonia were linked to cocaine use (National Institute for Health Development, 2022).

Amphetamine

Amphetamines are chemically synthetic sympathomimetic amines (phenethylamines) that stimulate dopamine and adrenaline in the brain, thus acting as powerful stimulants of the central nervous system.  

As an addictive substance, amphetamine (colloquially known as “speed” or sometimes “crank”) and its following derivatives are used: crystal meth (ice), 3,4-Methylenedioxy-methamphetamine (MDMA, ecstasy), 3,4-Methylenedioxy-N-ethylamphetamine (MDEA, eve), 3,4-Methylenedioxyamphetamine (MDA) and others. MDMA and MDA do not only stimulate the central nervous system but are also known for their strong empathogenic effect – empathogens facilitate communication and increase empathy. 

Amphetamines are used for a boost of energy, mood and wellbeing. They can be orally ingested, snorted, smoked or injected. Depending on the method of ingestion, the effects are felt within about 20 minutes and they can last for several hours.

Amphetamines become detectable in the urine 3 hours after use. Their presence in the urine at concentrations greater than 500 ng/mL indicates that the person has used amphetamines within the past 48 hours, even if it was a single use.

Amphetamines/methamphetamines produce feelings of euphoria, excitement, increased energy and perceived higher capability. However, they also cause the narrowing of peripheral vessels, hypertension, tachycardia, hyperthermia (due to adrenaline), bronchial dilation, restlessness, lack of appetite and insomnia. Symptoms of intoxication include arrhythmia, lactic acidosis, rhabdomyolysis, acute liver and kidney failure, disseminated intravascular coagulation, intracerebral haemorrhage and coma. Loss of consciousness, panic attacks and paranoia are also possible. Repeated ingestion of amphetamine over the course of several days can lead to amphetamine-induced psychosis, the symptoms of which are similar to those of paranoid schizophrenia. Aggressive behaviour towards oneself or others is not uncommon. Ecstasy-exposed infants have a significantly higher prevalence of congenital defects compared to their peers, with cardiovascular and musculoskeletal anomalies being most common.

Immunological method can produce a false-positive result in combination with other sympathomimetic drugs such as ephedrine and pseudoephedrine, and medications like chlorpromazine, promethazine, antimalarial drug chloroquine, etc.

In 2022, 29% of all overdose deaths in Estonia were linked to amphetamine use (National Institute for Health Development, 2022).

Opiates

Opiates include opium derivatives and synthetic compounds naturally found in the opium poppy plant Papaver somniferum. Opium contains up to 40 different narcotic and non-narcotic alkaloids; the most important of these are morphine, codeine and thebaine. Opium contains about 4-21% of morphine and a small amount of codeine.

Opiates are narcotic substances that produce euphoria.

Opioids is a general term that is used for substances with a similar effect that bind to opioid receptors in the central nervous system. These include both natural (morphine), semi-synthetic (produced by altering the molecule of the natural opioid, e.g., heroin), synthetic (their effect is similar to morphine but there are some molecular differences, e.g., methadone, fentanyl, tramadol, oxycodone, etc.) and endogenous opioids (endorphins) that are produced by the human body. They also share some similarities with morphine.

Opiates are powerful analgesics with a sedative effect. They can cause orthostatic hypotension and euphoria. Some opiate-based pharmaceutical preparations can help with a cough and diarrhoea.

Opiates can be injected (intramuscularly, intravenously – heroin), smoked (heroin, opium), taken orally, under the tongue or administered rectally as a suppository. When injected, heroin absorbs immediately, producing fast effects, but it can lead to overdose – especially if it is used in combination with other substances, such as alcohol or benzodiazepines. In the body, heroin is metabolised to morphine.

An opiate overdose manifests as euphoria, sensory disorders, miosis, nausea and vomiting, respiratory depression and suffocation (heroin), cardiopulmonary arrest and coma.

Morphine can be detected in the urine 1-3 days and heroin less than a day after ingestion. Codeine can be detected in the urine for 2 days.

Benzodiazepines

Benzodiazepines are a group of central nervous system depressants. Benzodiazepines are prescribed as anxiolytics (anti-anxiety medications), tranquillisers, sleep aides, anticonvulsants and central muscle relaxants.

Benzodiazepines differ from each other by speed, duration and strength of effect.  

Benzodiazepine use is associated with psychological and physical dependence – the greater the doses and longer the treatment, the greater the possibility of addiction. Over time, the body gets used to the substance, and greater doses are needed for sedative effect.

The risk of dependence is higher in those already dependent on alcohol or other narcotic substances. Mixing alcohol and benzodiazepines increases the risk of overdose death, as both substances act on GABA receptors and can suppress breathing. The concomitant use of benzodiazepines and opiates is the main risk factor for drug-related deaths.

The most common side effects associated with benzodiazepine use are fatigue and drowsiness, subdued reaction, anxiety, restlessness, aggression, and problems with coordination and memory.

A benzodiazepine overdose commonly manifests as somnolence, confusion, ataxia, dysarthria and muscle weakness; very high doses can result in hypotension, respiratory depression and coma.

Typical detection windows for different benzodiazepines in the urine vary; for diazepam, it is 1-7 days.

Barbiturates

Barbiturates are synthetic derivatives of barbituric acid. They are depressants, i.e., they produce the depression of the central nervous system.

The most common barbiturate is phenobarbital – an anticonvulsant that is used in epilepsy treatment. It is also known for its sedative and calming effect.

Barbiturate dependence can develop as early as after a few weeks of use.

Barbiturate use can cause skin lesions or make the skin more sensitive to sunlight. Overdose is often accompanied by coordination and memory issues, irritability and respiratory depression. Intoxication is characterised by hypothermia, hypotension, cardiac arrest, vomiting, delirium, seizures and coma. Depending on their onset of action, different barbiturates have different detection windows in the urine after their administration.

Short- and intermediate-acting barbiturates remain detectable in the urine for about 1-4 days, while long-acting barbiturates (phenobarbital) can be detected several weeks after regular use.

Cannabinoids

Cannabis is the most commonly used narcotic substance both globally and in Estonia. Cannabinoids are narcotic substances produced in the Cannabis sativa L. plant with THC, or delta-9-tetrahydrocannabinol, acting as the main active ingredient. THC acts as both a central nervous system stimulant and depressant. Consuming cannabis can distort a person’s perception and behaviour (the so-called substances with multidrug effect). It causes dependence; an increase in doses leads to mental and physical health issues. THC is consumed in various forms: it can be smoked as a mix of herbs (marijuana), cannabis resin (hashish) or cannabis oil.

THC produces feelings of relaxation, euphoria and wellbeing; it slows down digestion and increases appetite. However, it can also lead to tachycardia, hypothermia, problems with memory, coordination and reaction, and cause hallucinations, among other things. Although both cannabis overdose and cannabis intoxication are possible, it is very unlikely that a person dies from cannabis intoxication alone. Combining cannabis with other drugs can result in both overdose and death.

When inhaled, marijuana usually takes a few minutes to produce an effect, maximum plasma concentration can be observed approximately 15 minutes after the onset of smoking, and the effects can last up to 2-4 hours. 

Cannabinoids can be detected in the urine 5 days after single use; in the case of long-time and regular use, they are detectable for about 46 days due to their accumulation in adipose tissue.

1. Cocaine in urine
2. Amphetamine in urine
3. Opiates in urine
4. Benzodiazepines in urine
5. Barbiturates in urine
6. Cannabinoids in urine