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Appendix A5 -Training Material slEmployees Oploids: Morphine/Codeine/Heroin/Others <br />Natural and natural derivatives include: opium; morphine; codeine; and heroin (semi -synthetic). Synthetics include: <br />meperidine (Demorol); oxymorphone (Numorphan); oxycontin, and oxycodone (Percodan). Taken in pill form, smoked, or <br />injected, depending on the type of narcotic used. <br />Because of the variety of compounds and forms, Opiolds are more difficult to clearly describe in terms of form, color, <br />odor, and other physical characteristics. Opium and its derivatives can range from dark brown chunks to white crystals or <br />powders. <br />Since the body metabolizes codeine to morphine, both substances may occur in urine following the use of codeine. <br />Poppy seeds contain trace amounts of morphine and codeine, <br />so an employee who consumes poppy seed rolls may produce urine positives for morphine (with <br />or without codeine). <br />Laboratory tests use "cutoff concentrations" which provide the MRO with valuable information regarding the verified <br />test result (e.g., sorting out the need for either clinical evidence of abuse, <br />or a legitimate medical explanation). <br />Clinical evidence of substance abuse includes but is not limited to: needle tracks or signs of intoxication or <br />withdrawal... m oderate, nonlethal, "flu" -like abstinence syndrome with nausea, diarrhea, coryza, occasional vomiting, <br />weakness, malaise, "gooseflesh," and mydriasis. <br />6-Acetylmorphine (6-AM) is a metabolite of heroin, but not of codeine or morphine. Therefore, <br />the MRO is prohibited from accepting an assertion that there is a legitimate medical explanation for the presence of 6-AM <br />in a drug test specimen. <br />Signs and Symptoms: <br />Evidence of Presence: Needles; syringe caps; eyedroppers; bent spoons; bottle caps; and rubber tubing (used in <br />preparation and injection of the drug). Foil, glassine envelopes, or paper "bindles" (packets for holding drugs); balloons or <br />prophylactics used to hold heroin; bloody tissues used to wipe the injection site; and burned matches used to heat the drug <br />prior to injection. <br />Physical Symptoms: constricted pupils; sweating; nausea and vomiting; diarrhea; needle marks or "tracks'; wearing long <br />sleeves to cover "tracks'; loss of appetite; slurred speech; slowed reflexes; depressed breathing and heartbeat; and <br />drowsiness and fatigue. <br />Behavioral Symptoms: mood swings; impaired coordination; depression; apathy; stupor; and euphoria. <br />Personal Health, Safety, and the Work Environment: <br />General Health Effects:. Intravenous (IV) needle users have a high risk for contracting hepatitis and AIDS due to sharing <br />of needles. ■ Because Opioids increase tolerance to pain, individuals may under -estimate the extent of injuries, leading to <br />failure to seek medical attention after an accident. ■ Because the effects of Opioids are multiplied when used in <br />combination with other depressant drugs and alcohol, overdoses are more likely. <br />Safety and the Work Environment: Regular use can cause the following effects: ■ Depression <br />■ Apathy ■ Wide mood swings ■ Slowed movement . Slower reflexes ■ Physical or psychological dependence ■ The <br />apathy caused by Opioids results in an "I don't really care" attitude towards performance. • Physical effects, depression, <br />fatigue, slowed reflexes raise potential for accidents. <br />Overdose Effects: ■ Slowlshallow breathing ■ Clammy skin ■ Convulsions ■ Coma ■ Death <br />Withdrawal Syndrome: ■ Watery eyes ■ Runny nose • Yawning ■ Loss of appetite ■ Irritability <br />■ Tremors ■ Panic ■ Cramps ■ Nausea ■ Chills ■ Sweating <br />2020 Drug Screens Plus. All Rights Reserved. (26) FMCSA 20200101 266 <br />