This study was conducted somewhat differently from prior CDEWS studies because we collected two samples of urine specimens from Maryland probationers/parolees: 1) The Maryland Regional Sample (N=288 specimens) was designed to replicate the findings from a study we had conducted in Maryland in 2008, and 2) The Opiate Positive (Opiate+) Sample (N=202) was designed to address the nature of the opioid epidemic in Maryland. The Opiate+ Sample consisted of specimens that had tested positive for the opiate screen used by the Maryland Division of Parole and Probation’s (DPP) contracted laboratory.
The most dramatic finding was the number of other drugs detected in the Opiate+ Sample. While these specimens had, by definition, tested positive for the general opiate screen (morphine – a metabolite of heroin, codeine, hydromorphone, and/or hydrocodone) used by the DPP laboratory, these specimens contained many other licit and illicit drugs. About one in three also contained cocaine, one-fifth contained marijuana and/or benzodiazepines and about one-quarter contained a prescription opioid, such as oxymorphone.

Figure 1: Drugs Detected in 21 Fentanyl+ Specimens

Similarly, the 21 specimens from both samples that had tested positive for any fentanyl compound also contained many other drugs. Because all but one of these specimens came from the Opiate+ Sample, we expected them to contain morphine, codeine, hydromorphone and/or hydrocodone. However, Figure 1 shows that eight of these specimens also contained cocaine.
Oxymorphone and marijuana were each detected in 5 of the 21 specimens. Multiple drug use appears to be common in the probationers/parolees who used opiates, and especially fentanyl.
While synthetic cannabinoids (SC) were rarely found, the 25 specimens from both samples that tested positive for any SC contained multiple new generation (e.g., AB-
FUBINACA [parent], AB-CHMINACA [metab. 4]) and old generation (e.g., 5F-PB-22, UR-144, XLR-11) metabolites. Given the unpredictable composition of the SC being marketed, it is not possible for users to know what they are consuming and to predict the effects.
The new test results were similar to those from our 2008 study of Maryland probationers/parolees. The exceptions were a decline in cocaine and buprenorphine positives and an increase in codeine. The increase in codeine positives could have stemmed partially from the current laboratory’s use of a more sensitive test for the drug, the use of a mixture of codeine syrup and promethazine (known as “purple drank”), or the use of codeine extracted from pills. Further research is needed to understand these changes.

Source: Community Drug Early Warning System (CDEWS-3): Maryland –Site 4 of 4, (2017) available at: