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Tricyclic antidepressants (TCAs) are a class of medications originally developed in the 1950s to treat major depressive disorder, anxiety disorders, and certain chronic pain conditions. They work by increasing levels of serotonin and norepinephrine in the brain while also affecting several other neurotransmitter systems, which gives them both therapeutic benefits and a higher side-effect profile compared to newer antidepressants. Common TCAs include amitriptyline, nortriptyline, imipramine, desipramine, and clomipramine. These medications are usually dispensed as tablets or capsules, varying in color and dosage depending on formulation.

In healthcare settings, TCAs remain valuable for conditions such as neuropathic pain, migraine prevention, fibromyalgia, obsessive-compulsive disorder (clomipramine), and treatment-resistant depression. Because they affect multiple receptor systems—including cholinergic, adrenergic, and histaminergic pathways—TCAs can produce sedation, anticholinergic effects, and cardiovascular changes. Recreational misuse is rare but possible; when misused, individuals may attempt to achieve sedative or euphoric effects, though doing so poses significant toxicity risk. Overdose is particularly dangerous due to the drug’s effect on cardiac conduction and the central nervous system.

For toxicology screening programs, TCAs are often included in point-of-care testing panels because of their narrow therapeutic window and risk of accidental or intentional overdose. Detection helps medical providers monitor adherence, assess toxicity, and identify potential misuse or dangerous drug interactions.

Effects:

• Reduced symptoms of depression and anxiety

• Pain modulation and relief in neuropathic pain conditions

• Sedation, which can aid sleep in some patients

• Migraine and tension-headache prevention

• Dry mouth, blurred vision, constipation (anticholinergic effects)

• Drowsiness, dizziness, or cognitive slowing

• Increased heart rate and blood-pressure fluctuations

• Risk of cardiac arrhythmias, especially in overdose

• Seizures, confusion, or delirium at toxic levels

• High overdose lethality due to cardiac and CNS toxicity

What is PPX?

Propoxyphene (PPX) is a synthetic opioid analgesic that was once commonly prescribed for mild to moderate pain. Structurally similar to methadone but significantly weaker, it was marketed under brand names like Darvon and Darvocet. In medical form, PPX appeared as tablets or capsules, often pink, orange, or white, depending on formulation. It was taken orally and typically combined with acetaminophen.

Recreationally, propoxyphene was misused for its mild opioid effects, though it was never as powerful or euphoric as stronger opioids. Misuse involved taking higher-than-prescribed doses or crushing and ingesting tablets to intensify sedation. However, PPX also carried significant cardiac risks, including arrhythmias and fatal heart conduction abnormalities, even at therapeutic levels. Because of these dangers, the FDA removed propoxyphene from the U.S. market in 2010, though it may still appear in illicit circulation or older patient supplies.

Despite its discontinuation, PPX remains relevant in toxicology testing because legacy prescriptions, leftover medication, or diversion can still occur. Its presence in a screen may indicate misuse, accidental ingestion, or exposure to outdated pharmaceuticals.

Effects:

• Mild euphoria

• Pain relief and reduced physical discomfort

• Drowsiness and sedation

• Dizziness or lightheadedness

• Nausea or vomiting

• Impaired motor coordination

• Constipation

• Respiratory depression at high doses

• Risk of cardiac conduction abnormalities

• Potential progression to opioid dependence

What is PCP?

Phencyclidine (PCP) is a dissociative anesthetic originally developed in the 1950s for medical use, but it was discontinued in humans due to severe psychological side effects, including hallucinations and violent behavior. Today, PCP has no accepted medical use in people, though it remains an illicit recreational drug known for producing detachment from reality, erratic behavior, and profound changes in perception.

Illicit PCP is sold in various forms: as a crystalline powder, tablets, capsules, or a liquid (PCP dissolved in ether or similar solvents). Powder and crystal forms may appear white, yellow, or tan. It is commonly smoked by applying the liquid or powder to plant material (e.g., marijuana, mint leaves), but it may also be snorted or ingested.

Effects:

• Intense euphoria or dissociation (“out-of-body” sensations)

• Distorted perception of time, sound, and sight

• Feelings of extreme strength or invulnerability

• Agitation, aggression, or violent behavior

• Hallucinations or psychosis

• Numbness, loss of coordination, or blank stare

• Elevated heart rate and blood pressure

• Nausea, dizziness, or drooling

• Risk of seizures or coma at high doses

• Long-term cognitive impairment or mood disturbances

What is methamphetamine?

Methamphetamine is a powerful and highly addictive central nervous system stimulant closely related to amphetamine but significantly more potent and longer lasting. Medically, a pharmaceutical form known as Desoxyn® is occasionally prescribed in tightly controlled cases for ADHD or severe obesity, but this use is rare. Most methamphetamine encountered in testing programs is illicitly produced and used recreationally.

Illicit methamphetamine appears in several forms: crystal meth (clear or bluish shards resembling glass), powder (white or off-white), or paste depending on manufacturing methods. It may be smoked, injected, snorted, or taken orally. Recreational use produces intense euphoria, increased energy, and prolonged wakefulness but is associated with extreme risk—addiction, cardiovascular strain, neurological damage, and severe behavioral changes.

Effects:

• Intense euphoria and increased confidence

• Surge in energy and alertness

• Rapid heart rate and elevated blood pressure

• Hyperthermia (dangerously high body temperature)

• Decreased appetite

• Dilated pupils and rapid breathing

• Agitation, anxiety, and restlessness

• Insomnia or long periods of wakefulness

• Paranoia, aggression, or hallucinations

• High risk of dependence and severe withdrawal symptoms

What is Benzodiazepine? 

Benzodiazepines are a class of central nervous system depressants that act by enhancing the neurotransmitter GABA, producing calming effects such as reduced anxiety, muscle relaxation, and sedation. Medically, they are widely prescribed for anxiety disorders, insomnia, muscle spasms, seizure control, and alcohol-withdrawal management. Common prescription examples include Xanax® (alprazolam), Valium® (diazepam), Klonopin® (clonazepam), Ativan® (lorazepam), and Restoril® (temazepam).

Pharmaceutical benzodiazepines typically come as tablets, capsules, liquid solutions, or occasionally injectable formulations used in clinical settings. Illicitly misused benzodiazepines may appear as diverted prescription pills or counterfeit tablets produced to resemble pharmaceutical products. Recreational use often involves taking higher-than-prescribed doses to achieve sedation, euphoria, or potentiation of other substances, particularly opioids and alcohol, which drastically increases overdose risk. Benzodiazepines are associated with dependence, withdrawal, and impaired cognitive and motor function, especially with long-term misuse.

Effects:

• Sedation and drowsiness

• Reduced anxiety and muscle tension

• Impaired coordination and slowed reaction time

• Memory impairment or “blackouts”

• Slurred speech

• Confusion or cognitive slowing

• Dizziness or loss of balance

• Respiratory depression (especially with opioids or alcohol)

• Risk of dependence and withdrawal symptoms

• Emotional blunting or flattened affect

What is Cocaine?

Cocaine is a powerful central nervous system stimulant derived from the leaves of the coca plant. It rapidly increases dopamine levels in the brain, producing intense euphoria, heightened alertness, and a short-lived but highly reinforcing sense of energy. Pharmaceutical-grade cocaine exists in limited medical contexts (such as topical anesthesia for certain ENT procedures), but nearly all cocaine encountered in the United States is illicit and unregulated.

In its powdered form (cocaine hydrochloride), it typically appears as a fine white crystalline powder that is snorted, rubbed onto gums, or dissolved and injected. Another form, crack cocaine, is produced by processing the powder with baking soda or other agents to create small “rocks” that can be smoked, delivering a faster and more intense high. Because illicit cocaine is frequently adulterated with substances like levamisole, fentanyl, or local anesthetics, users face increased health risks beyond the effects of the drug itself.

Recreational cocaine use is associated with patterns of bingeing, addiction, cardiovascular complications, and significant behavioral changes. Its highly addictive nature, rapid onset, and short duration make it a major substance of concern across emergency departments, workplace testing programs, criminal justice systems, and treatment centers.

Effects:

• Intense euphoria and elevated mood

• Increased energy, alertness, and confidence

• Decreased appetite

• Dilated pupils

• Elevated heart rate, blood pressure, and body temperature

• Restlessness, agitation, or anxiety

• Insomnia and repetitive behaviors

• Increased risk of heart attack, stroke, or cardiac arrhythmias

• Strong cravings and high addiction potential

• Paranoia, aggression, or hallucinations at higher doses or during binges