Synthetic Drugs: Dangers, Detection, & Trends
Presented by
Problems & Challenges Posed by
Spice/K2, Bath Salts, Heroin, Painkillers, Oxy, Bup,
etc.
Vinnie Happ
Redwood Toxicology Laboratory
October, 2014
Drug Testing: Synthetic THC / K2
n
n
n
n
n
n
Rapid, onsite instant test
Laboratory-based screening test (becoming more widespread)
Most Laboratories are employing LC/MS/MS technology
Primarily via urine, however some labs can test via oral
fluid and or blood
$$$ varies greatly
Onsite vs Laboratory testing is very different
On-site vs Laboratory testing for K2
On-site K2 test
JWH-018 & JWH-073
primary strucuture
Cut-off at 25 or 50ngs/ml
Higher threshold to trigger +
Greater chance for false +/Screening technology
Laboratory K2 test
JWH-018, 073, plus *28 other synthetic
cannabinoid structures:
JWH-019, 081, 122, 200, 203, 210, 250, 398, AM2201,
MAM2201, RCS4, RCS8, AM-694, AM-1248, AKB48, UR-144, XLR-11, 5-Fluro AB-PINACA,5-Fluoro
ADB-PINACA5-Fluoro ADBICA,5-Fluoro AKB-48,
5-Fluoro PB-22, AB-PINACA, AB-FUBINACA,
ADB-PINACA, ADBICA, PB-22, BB-22
Cut-off 1ng/ml or less
Detecting presence
Confirmatory technology
*Redwood Toxicology Laboratory
FAX
CESAR
September 8, 2014
Vol. 23, Issue 13
A Publication from the Center for Substance Abuse Research
University
of
Maryland,
College
Park
Study of Patients in a Midwestern Residential Treatment Program
Finds 71% of Those Reporting Synthetic Cannabinoid Use Report
Using to Avoid Positive Drug Test
Self-Reported Reasons for Using Synthetic Cannabinoids
(N=150 Adult Residential Substance Use Disorder Treatment Patients Reporting Lifetime Synthetic Cannabinoid Use)
91%
Cur iosity
89%
To Fe e l G ood or G e t High
71%
To Re lax or Re lie ve Te nsion
71%
To G e t High Without Having a Positive Dr ug Te st
63%
Like d the Effe c ts
59%
B or e dom
To Have a G ood Time with Fr ie nds or to Fit In
59%
Ange r or Fr ustr ation; To G e t Away fr om Pr oble ms or Tr ouble s
48%
To He lp De al with Pain
39%
To Inc r e ase or De c r e ase t he Effe c ts of Some Othe r Dr ugs
32%
B e c ause It Is Safe r Than Othe r Dr ugs
30%
0%
20%
40%
60%
80%
100%
SOURCE: Adapted by CESAR from Bonar, E.E., Ashrafioun, L., and Ilgen, M.A, “Synthetic Cannabinoid Use Among Patients in Residential Substance Use Disorder Treatment:
Prevalence, Motives, and Correlates,” Drug and Alcohol Dependence, In Press, 2014. For more information, contact Erin Bonar at erinbona@med.umich.edu.
301-405-9770
(voice) 301-403-8342 (fax) CESAR@umd.edu www.cesar.umd.edu 
The CESAR FAX is independently funded by CESAR and may be copied without permission. Please cite CESAR as the source.
MDPV
(Methylenedioxypyrovalerone)
a psychoactive drug with powerful stimulant properties
which acts as both a norepinephrine & dopamine
reuptake inhibitor (NDRI). “A two for”
usually snorted like cocaine
duration of effect 2-3 hours /adverse effect 6-8 hrs
MDPV - no history of FDA approved medical use
adverse medical or psychiatric ramifications
Mephedrone
(Methylmethcathinone)
amphetamine-like properties, powerful stimulant
“rediscovered” by synthetic chemists in 2003
reformulation of cathinone, a chemical found in the
khat plant of Eastern Africa
khat existence traced to 15th C. Ethiopia
khat is banned in the U.S.
Methylone
(3,4-methylenedioxy-N-methylcathinone)
very similar to MDMA
stimulant
phenethylamine, amphetamine, and cathinone
properties
euphoria and increased sociability
insomnia and restlessness
hallucinations and psychosis
MDMA – Ecstasy / Molly
•
MDMA, was patented by Merck pharmaceuticals in 1912
• Used in the 70/80’s as a psychotheraputic tool
• Became popular “club drug” in 90’s then fell out of favor,
too may additives. Come back in last couple of years
• capsules sell for $8 to $40.
• the most common Molly additives are bath salts,
including methylone and mephedrone.
• DEA's New York division highlighted the results of 143
lab tests over the past four years of substances suspected
of being Molly. Only 13% of the drugs were MDMA,
while 41% were 4-MEC, and 20% were methylone (bath
salt materials).
Pharmacological Effects of
“Bath Salts”
increase heart rate & blood pressure
pupil dilation, rapid speech
hyperactivity, arousal, & over stimulation
increased energy & motivation
euphoria - agitation
dizziness, nausea
hallucinations, seizures, convulsions
breathing difficulties!!!
diminished perception of the requirement for food and sleep
Testing for Bath Salts??
Yes! However:
No on-site, rapid, instant tests
No laboratory-based screening tests
Laboratories employing GC/MS and
LC/MS/MS technologies
Detection times remain unknown
Bath Salts and beyond!!!
Expanded Synthetic Stimulant Panel
α-PVP
BZP
Butylon
Buphedrone
Cathinone
Ethylone
Flephedrone
MBDB
mCPP
MDA
MDEA
MDMA
MDPV
Mephedrone
Methcathinone
4-Methylethcathinone- (4MEC)
Methylone
Pentedrone
Pentylone
Pyrrolidinopentiophenone
TFMPP
FAX
CESAR
August 12, 2013
Vol. 22, Issue 32
A Weekly FAX from the Center for Substance Abuse Research
University
of
Maryland,
College
Park
Number of Calls to U.S. Poison Control Centers About Exposure to
Synthetic Marijuana and Synthetic Cathinones Stable at Lower Levels Than Recent Years
800
700
Synthetic
Marijuana
Number of 600
Exposure 500
Calls
400
300
200
Synthetic
Cathinones
100
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
0
2010
2011
2012
.
2013
Narcotics / Opiate Family
Opiates and Opioids:
Heroin
Morphine
Codeine
Hydrocodone - (Vicodin, Loratab, ZohydroER, TarginiqER)
Hyrdomorphone - (Dilaudid)
Oxycodone – (OxyContin, Percocet, Roxicodone)
Oxymorphone – (Opana, OpanaER)
Fentanyl
Methadone
Buprenorphine – (Suboxone)
Tramadol – (Ultram)
- Philip Seymour Hoffman's heroin overdose
exposes 100 percent RISE in 'epidemic' across US
since 2007
-
More than 660,000 Americans used heroin in 2012
-
Resurgence attributed to crackdown on illegal 'pill mills'
producing prescription drugs like OxyContin, which gives
same high as heroin
-
Pill addicts have turned to heroin because its cheaper and
available
-
Popular in rural and suburban areas, not just inner city
-
Users buying single hits of heroin for as little as $4
-
Drug cartels pushing ever-larger amounts across the
Southwest border
New York hospital pharmacist
charged in theft of 200,000 pills
JULY 9, 2014
Tuesday, June 8, 2014 photo shows Anthony D'Alessandro.
The former pharmacy chief for Mount Sinai
Beth Israel hospital in Manhattan allegedly
stole nearly 200,000 oxycodone pills from the
medical center over more than five years.
Prosecutors are still investigating what became of the drugs
but believe the medications ended up on the thriving black
market for prescription narcotics, where the
more than
193,000 missing pills could fetch a total of
about $5.6 million.
Ex-sheriff's wife released from
prison early
Jul 08, 2014
WAUSAU (WI) – A one-time state probation agent
and wife of a former Marathon County sheriff has
been released from prison about seven months early,
according to the state Department of Corrections.
Last August, Kim Hoenisch, now 42, was sentenced to 18 months
in prison and six years probation after she was convicted of three
felonies -burglary, misconduct in office and possession of narcotic
drugs - and two misdemeanors.
Hoenisch was fired from her job after a state
investigation concluded she had stolen prescription
drugs, including Vicodin and oxycodone, from one
of her clients.
One in Four Americans Admits Abusing
Prescription Drugs, Says FindLaw.com Survey
One in four Americans admits that
they have abused prescription drugs, according to a
new national survey by FindLaw.com, the most
popular legal information website.
EAGAN, Minn., Aug. 5, 2014 -
Prescription drug abuse involves taking a drug for
reasons other than the drug's intended usage or use of
a drug by someone other than the person listed on the
prescription. The drug abuse can either be an attempt
to self-medicate a medical condition, or for purposes
such as getting high.
How bad is the painkiller prescription problem??
CESAR
FAX
June 3, 2013
Vol. 22, Issue 22
A Weekly FAX from the Center for Substance Abuse Research
U n i v e r s i t y
o f
M a r y l a n d ,
C o l l e g e
Pa r k
Lab Test Results Suggest Majority of Patients Do Not Take Prescription Drugs as Prescribed
A large percentage of patients do not take their prescription drugs as prescribed, according to data from
Quest Diagnostics prescription drug monitoring service. Of 151,405 urine test results from patients referred
by their physicians for drug testing in 2012, 40% tested positive only for the drugs that were prescribed for
them. The remaining 60% of specimens had inconsistent results, suggesting that the patient misused their
medication in one of three ways: 1) by not using the prescribed drug (those testing negative for any drug,
25%); 2) by using other drugs instead (those testing negative for prescribed drugs and positive for other
drugs, 15%); or 3) by combining the prescribed drug with other drugs (those testing positive for both
prescribed and other drugs, 20%). According to the authors, “each of the three patterns of misuse has the
potential to put a patient’s health at risk. A patient who does not take a prescribed drug will not receive
potentially efficacious treatment for a medical condition and contributes to healthcare waste. A patient who
uses non-prescribed dugs does so without a clinician’s supervision. And a patient who combines drugs
without a physician's guidance increases the potential for dangerous drug combinations” (p. 4).
Percentage of Patients Referred to Quest Diagnostics Laboratories for Drug Testing by Their
Physicians Testing Positive and Negative for Drugs Prescribed for Them, 2012
Negative for Any Drug
(Including Prescribed Drug)
Positive for Prescribed
Drug and Negative for
Other Drug
25%
40%
Negative for Prescribed
Drug and Positive for
Other Drug
15%
20%
Positive for Prescribed
Drug and Positive for
Other Drug
NOTE: The Quest Diagnostics prescription drug monitoring service tests for up to 26 commonly prescribed and abused drugs,
including pain medications, central nervous system medications and amphetamines, as well as certain illicit drugs, such
as marijuana and cocaine. Data presented here include results of 1) testing services ordered by physicians (such as family
practitioners and internists) serving patients in a primary care setting; 2) testing services ordered by specialists that may
be expected to use Quest’s prescription drug monitoring services (such as psychiatrists and neurologists); and 3) patients
under care at pain management clinics and hospitals. Data do not include results of patients tested by drug rehabilitation
clinics or those receiving treatment from clinicians focused on drug addiction, given the unusually high rates of drug
inconsistency expected within this clinical segment.
SOURCE: Adapted by CESAR from data from Quest Diagnostics, Prescription Drug Misuse in America: A Report on
Marijuana and Prescription Drugs, 2013. Available online at www.questdiagnostics.com/home/physicians/health-
FDA Toughens Warning on Pain Drugs
Agency Cites Serious Risks Associated With Pills Such as OxyContin
USA TODAY - September 10, 2013
The FDA said that long-acting forms of "opioid" painkillers, such as OxyContin, should be
used only when there is no alternative. The new drug label drops the word "moderate" and
says it should be used only to manage "pain severe enough to require daily, around-the clock,
long-term treatment.”
The new warnings only relate to extended-release forms of the drugs, which are often prescribed for months
or years to treat chronic pain. They don't affect immediate-release forms, which include Vicodin or Percocet
and are often used to treat acute pain, such as after surgery.
The FDA is also considering whether to tighten restrictions on
hydrocodone products like Vicodin.
Doctors urge FDA to reverse approval of Zohydro,
controversial new pain drug
The potent drug has drawn widespread concern from addiction experts and state attorneys general, who fear
it will fuel opioid abuse and overdose.
FEBRUARY 28, 2014
REUTERS
ZohydroER contains a higher dosage of pure hydrocodone
than Vicodin. Unlike Vicodin, the drug does not contain
aspirin or acetaminophen. Acetaminophen was removed
because of liver-damage concerns.
Zohydro's labeling will feature warnings about abuse,
addiction and misuse. Zogenix is working on an abuse-deterrent
version of Zohydro that should become available in three years
March/April, 2014
Purdue Pharma announces & then submits NDA to FDA for its abuse-resistant, extended-release hydrocodone product.
July 2, 2014 -- Zogenix, Inc. (ZGNX) today announced an update on its development programs focused on the introduction
of abuse deterrent formulations of Zohydro(R) ER Application for Next Generation of Zohydro(R) ER to be filed by
October 2014
Extended-Release Opioid Receives FDA Approval
July 24, 2014
The Food and Drug Administration (FDA) announced its approval of Targiniq ER,
an extended-release opioid combining the effects of oxycodone and a drug commonly
used to reverse the effects of opioid overdose, known as naloxone.
Purdue Pharma L.P., which originally marketed a harder to crush version of their
opioid OxyContin in 2010, created Targiniq ER. When Targiniq ER is crushed and
snorted, or dissolved and injected, the typical euphoric effects of oxycodone are
blocked by naloxone.
Mexico Trades Marijuana for Heroin
April 2014 -The Washington Post has printed a grim
exposé on the shift from Mexican marijuana to
Mexican heroin.
Mexican marijuana has dropped from $100 per
kilogram to just $25 per kilogram. Said Rodrigo Silla,
50, a lifelong cannabis farmer. “I wish the
Americans would stop with this legalization.”
The DEA paints a picture of shrewd Mexican cartels reacting to their cut in marijuana
business by sowing more heroin addicts. DEA claims cartels send their heroin
pushers to work in the cities with the worst prescription pill epidemics and have
them “set up right outside the methadone clinics.”
Heroin-fentanyl mix plaguing many states
January 31, 2014 Pittsburgh Post-Gazette
Police: 2 dead after chewing
on pain patches to get high
July 2014 - Authorities in Athens, Tenn., say two of three men who died Friday of apparent
drug overdoses had misused the pain medication Fentanyl.
Harold “Marty” Coleman, 48, of 1004 South Jackson Street, Athens, was found lying in the
driveway at his mobile home. He had a pain patch in his mouth. Coleman had a
prescription for the patches and other narcotics found inside the residence.
While emergency medical officials were preparing to transport Coleman's body, authorities
found 46-year-old Donald Sturdivant in the laundry room of the home unconscious but
breathing, the detective said.
Sturdivant died a short time later after he was taken to the hospital.
Screening vs Confirmation testing of Opiates
Typical Screening test
Primarily targets:
Morphine/Codeine
Confirmation Testing (GC/MS)
Morphine
Codeine
Hydrocodone
Hydromorphone
6-MAM (heroin marker)
Oxycodone
Drugs not detected
Buprenorphine
Methadone
Fentanyl
Tramadol - Ultram
Soma
Opiate vs Oxycodone Screen
why you should consider splitting them out when testing
Opiate Screen @ 300ng
Primarily targets morphine
and codeine
Oxycodone – 30,000ng
Needed to trigger a positive
Miss the chippers, O.O.U.
Opana – Oxymorphone
100,000ng needed to trigger
positive on onsite Opiate test
Oxycodone Screen @ 100ng
Oxycodone – 100ng
Needed to trigger a positive
Detect the chippers
Will detect oxymorphone
and hydrocodone if 1562ngs
Oxymorphone – Opana / ER
Oxycodone lab EIA screen has
100% cross reactivity to
Oxymorphone
From: Tracy, Carrie
Sent: Tuesday, August 05, 2014 11:31 AM
To: Happ, Vinnie
Subject: false positive question
Hi VinnieWondering if someone that is prescribed Vicodin and taking it
regularly would all of the sudden test positive for Oxycodone
on 3 occasions and then miraculously test negative for
Oxycodone when confronted about possible use.
ThanksCarrie
Carrie L. Tracy
Senior Probation Officer
Take away comments
If positive on an Opiate screening test – an Opiate family
member most likely detected
Confirmation testing will specifically identify the member
If 6-AM (6-Acetylmorphine) detected at the Lab:
heroin use
If confirmed positive just for Morphine
metabolized heroine to morphine and or
morphine use i.e. from a prescription medication,
poppy seed use
Sharp rise in ER visits tied to abuse of sedative
May 22, 2014 (HealthDay News) -- There's been a
steep increase in the number of Americans being
treated at emergency departments for abuse of the
sedative alprazolam, best known as Xanax.
The number of emergency department visits
related to abuse of climbed from more than 57,000
in 2005 to nearly 124,000 in 2011, according to the
U.S. Substance Abuse and Mental Health Services
Administration (SAMHSA).
Xanax abuse "is especially concerning in light of
the dramatic rise in nonmedical use of opioid
painkillers like oxycodone [OxyContin] and
Vicodin, because these increases in nonmedical
use parallel the rapid rise in accidental overdose
deaths in our country," Collins said.
Suboxone-Buprenorphine
FDA approved in 2002
used to treat opiate addiction
alternative to methadone
partial agonist (ceiling)
in pill, film, patch
2mg & 8mg doses
will not test positive on an opiate test
significant diversion
contains naloxone- guard against misuse
subutex – no naloxone
individuals will get high on this stuff
What’s the attraction to Bup?
user’s experience euphoria effect
if taken in conjunction with other sedative drugs like
alcohol, sleeping pill (ambien) or a benzodiazepine
(klonopin)- extreme sedation, drowsiness, unconscious, or
even death may occur
method of ingestion – typically sublingual (under tongue),
pill format going away, reports of snorting & injecting
self medication and or currency in W/R or C/R setting
only test positive if specifically testing for buprenorphine
incredibly easy to smuggle
Endo and BioDelivery Sciences announce positive
top-line results from the Phase III clinical trial of
BEMA® buprenorphine in opioid-experienced
patients with chronic pain
July 7, 2014 /PRNewswire/ --
Endo Pharmaceuticals Inc. and BioDelivery
Sciences International, Inc. announced today positive top-line results
from its pivotal Phase III efficacy study of BEMA buprenorphine in
opioid-experienced patients.
BEMA buprenorphine is being developed for the management of pain
severe enough to require daily, around-the-clock, long-term opioid
treatment and for which alternative treatment options are inadequate
in both patients who are opioid naive and opioid experienced.
Top 17 Abused Prescription Drugs of 2013
Below is a list of 17 abused prescription drugs as listed by
CDC, FDA, the U.S. Drug Enforcement Agency (DEA), and
non-government nonprofit sources on public websites.
OxyContin- oxycodone
Suboxone - buprenorphine
Ambien - sedative
Ritalin - stimulant
Zoloft – antidepressant
Lunesta -sedative
Adderall -amphetamine
Opana - oxymorphone
Xanax - benzodiazepine
Klonopin – benzodiazepine
Fentora - fentanyl
Percocet - oxycodone
Ativan - benzodiazepine
Soma - sedative
Valium - benzodiazepine
Vicodin -hydrocodone
July 2, 2014
SUMMARY
With the issuance of this final rule, the Deputy Administrator of
the Drug Enforcement Administration places the substance 2[(dimethylamino)methyl]-1-(3-methoxyphenyl)cyclohexanol
(tramadol), including its salts, isomers, and salts of isomers, into
schedule IV of the Controlled Substances Act.
Corrective measures in other States
Emerging Drugs
or
Media Hype??
Smiles, NBOMe, Krokodil, and Kratom
(2C-I) Nicknamed Smiles
popular among teens, responsible for dozens of overdoses and deaths.
white crystalline powder, typically snorted or ingested.
high and effects can last a few hours to a few days
a combination of MDMA and LSD, only more intense.
2C-I is being made by dealers and “hobbyists,”
chemicals can be obtained over the internet
2C-I overdoses can cause seizures, kidney failure, and fatally high
blood pressure.
NBOMe – Synthetic LSD
BRAND NAMES
2C-C-NBOMe = (25C-NBOMe; NBOMe-2C-C);
2C-I-NBOMEe = (25I-NBOMe; NBOMe-2C-I);
EFFECTS CLASSIFICATION
Psychedelic; Stimulant; Euphoriant
DESCRIPTION
The NBOMe series of chemicals are primarily N-o-methoxybenzyl analogs of the 2CX family of phenethylamines, and are (serotonin 2A) receptor agonists. This group
are active at very low sub-milligram doses. These chemicals have nearly no history of
human use prior to 2010 when they first became available online.
DEA declared three N-bomb variants—25I-NBOMe, 25C-NBOMe and 25B-NBOMe
to be illegal Schedule I drugs under the Controlled Substances Act.
Pharmacological Effects
Dilated pupils
Sweating
Dry mouth
Rapid speech
Rapid/frequent mood swings
Hyperactivity/ Elevated BP
Hair standing on end
Nasal passage irritation
Behind the Krokodil Panic
Nov 7, 2013- The Daily Beast
Relax! The home-brewed Russian drug isn’t invading America.
Cases popped up in at least six states and the media went wild.
But here’s the catch: not one of the dozens of suspected cases tested positive for
desomorphine, the drug's official name. In fact, according to public-health experts
and federal officials, the great Krokodil scare of 2013 is really just the latest symptom
of a true epidemic long in the making: American’s growing dependence on heroin
and prescription painkillers.
The drug, a morphine analogue that acts similarly to heroin but with a shorter high, is made by
combining codeine, paint thinner, and lighter fluid (among other things) in small batches. An
April 2013 article from the International Journal of Drug Policy titled “Breaking Worse” explains the dangers
of the homemade drug. “Desomorphine may be the opioid that the cooks intend to produce, but it is not
what they necessarily end up with,” the article reads. The “bootleg chemistry” results in a drug that is
notoriously impure and often contains a lethal mix of toxins. But for American’s who can buy
heroin much more easily than they can codeine, Krokodil use just doesn’t make
sense.
OP/ED 1/10/2014 Forbes
Krokodil Crock: How Rumors Of A 'Flesh-Eating
Zombie Drug' Swept The Nation
“A lot of people want to call it a trend, but we’re not seeing it,” says Joseph Moses, a spokesman for the
Drug Enforcement Administration (DEA). In fact, Moses says, “I’m not aware of any forensic
laboratory that has come up with a desomorphine sample.
A report by two St. Louis doctors who claimed to have treated a man with krokodil-related
symptoms, published online by The American Journal of Medicine in November 2013, was
removed from the journal’s website a week later after the paper received strong scientific
criticism
NMS Labs has had approximately forty toxicology cases of
suspected Krokodil from around the US submitted in the last six
months. All have been negative. “To our knowledge there is not a
single confirmed Krokodil death through either toxicological
testing or through testing of associated paraphernalia, in the US.”
KRATOM
not a synthetic but a plant derived drug
main alkaloids responsible for the effect are
mitragynine and 7-hydroxymitragynine.
at low doses causes a stimulating effect
at high concentrations causes an opiate like sedative
effect
From the website:
buykratom.us
Your Price:
$14.99
This is our newest addition and
we are very excited about
offering another Bali'esque type
strain. This strain is harvested
from the Kalimantan Region,
using only mature leaves and
then finely ground.
You must be 18 years of age to purchase any products on the website. All products on the website
are sold not for human consumption, and are for incense or ethnobotanical research purposes
only.
Kratom Products: The Best Option to Wean Off
Opiate and Heroin Addiction
June 11, 2014 Livermore, CA –
To clarify the majority’s misconceptions on kratom (Mitragyna Speciosa), it is not an
opiate. It is not a drug, and it does not give that high that one is getting from heroin.
Kratom soothes the “needy” receptors, easing through natural stimulation back into a
more balanced state.
The use of kratom for opiate withdrawal began to appear in 1987, when Henry Nicholas
Ridley published the book “Malay Plant Names” and stated that the plant can be used to
wean opium addicts. Nowadays, kratom is often used in methadone detox programs.
Hospitals like the National Institute of Thai Traditional Medicine in Bangkok are
endorsing kratom as a course of action against drug addiction withdrawal. Recent
research points to the plant’s alkaloids, 7-hydroxymitragynine as possibly the major
agonist accountable for soothing withdrawing receptors.
Erowid.org
“Documenting the complex relationships between humans and psychoactives”
Great resource for information
Take with a grain of salt
Your clients are probably aware of this site as
well
Thank you for
your time.
Vinnie Happ vhapp@redwoodtoxicology.com