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Choi H, Baeck S, Jang M, Lee S, Choi H, Chung H. Simultaneous analysis of psychotropic phenylalkylamines in oral fluid by GC–MS with automated SPE and its application to legal cases. Forensic Sci Int 2012; 215:81-7. [DOI: 10.1016/j.forsciint.2011.02.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 12/31/2010] [Accepted: 02/07/2011] [Indexed: 11/29/2022]
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Thomas A, Geyer H, Guddat S, Schänzer W, Thevis M. Dried blood spots (DBS) for doping control analysis. Drug Test Anal 2011. [DOI: 10.1002/dta.342] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Andreas Thomas
- Institute of Biochemistry/Center for Preventive Doping Research; German Sport University Cologne; Germany
| | - Hans Geyer
- Institute of Biochemistry/Center for Preventive Doping Research; German Sport University Cologne; Germany
| | - Sven Guddat
- Institute of Biochemistry/Center for Preventive Doping Research; German Sport University Cologne; Germany
| | - Wilhelm Schänzer
- Institute of Biochemistry/Center for Preventive Doping Research; German Sport University Cologne; Germany
| | - Mario Thevis
- Institute of Biochemistry/Center for Preventive Doping Research; German Sport University Cologne; Germany
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Gjerde H, Normann PT, Christophersen AS, Mørland J. Prevalence of driving with blood drug concentrations above proposed new legal limits in Norway: Estimations based on drug concentrations in oral fluid. Forensic Sci Int 2011; 210:221-7. [DOI: 10.1016/j.forsciint.2011.03.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 03/07/2011] [Accepted: 03/12/2011] [Indexed: 11/16/2022]
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Strano-Rossi S, Anzillotti L, Castrignanò E, Felli M, Serpelloni G, Mollica R, Chiarotti M. UHPLC-ESI-MS/MS method for direct analysis of drugs of abuse in oral fluid for DUID assessment. Anal Bioanal Chem 2011; 401:609-24. [DOI: 10.1007/s00216-011-5108-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Revised: 04/29/2011] [Accepted: 05/13/2011] [Indexed: 11/29/2022]
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Menza TW, Jameson DR, Hughes JP, Colfax GN, Shoptaw S, Golden MR. Contingency management to reduce methamphetamine use and sexual risk among men who have sex with men: a randomized controlled trial. BMC Public Health 2010; 10:774. [PMID: 21172026 PMCID: PMC3016390 DOI: 10.1186/1471-2458-10-774] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2010] [Accepted: 12/20/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Methamphetamine use is associated with HIV acquisition and transmission among men who have sex with men (MSM). Contingency management (CM), providing positive reinforcement for drug abstinence and withholding reinforcement when abstinence is not demonstrated, may facilitate reduced methamphetamine use and sexual risk. We compared CM as a stand-alone intervention to a minimal intervention control to assess the feasibility of conducting a larger, more definitive trial of CM; to define the frequency of behavioral outcomes to power such a trial; and, to compute preliminary estimates of CM's effectiveness. METHODS We randomly assigned 127 MSM from Seattle, WA who use methamphetamine to receive a 12-week CM intervention (n = 70) or referral to community resources (n = 57). RESULTS Retention at 24 weeks was 84%. Comparing consecutive study visits, non-concordant UAI declined significantly in both study arms. During the intervention, CM and control participants were comparably likely to provide urine samples containing methamphetamine (adjusted relative risk [aRR] = 1.09; 95%CI: 0.71, 1.56) and to report non-concordant UAI (aRR = 0.80; 95%CI: 0.47, 1.35). However, during post-intervention follow-up, CM participants were somewhat more likely to provide urine samples containing methamphetamine than control participants (aRR = 1.21; 95%CI: 0.95, 1.54, P = 0.11). Compared to control participants, CM participants were significantly more likely to report weekly or more frequent methamphetamine use and use of more than eight quarters of methamphetamine during the intervention and post-intervention periods. CONCLUSIONS While it is possible to enroll and retain MSM who use methamphetamine in a trial of CM conducted outside drug treatment, our data suggest that CM is not likely to have a large, sustained effect on methamphetamine use.
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Affiliation(s)
- Timothy W Menza
- Center for AIDS and STD, Harborview Medical Center, 325 Ninth Avenue, Seattle, WA, 98104, USA
- Department of Epidemiology, University of Washington School of Public Health, Box 357230, Seattle, WA, 98195, USA
- Public Health--Seattle & King County, 401 5th Ave., Suite 1300, Seattle, WA, 98104, USA
| | - Damon R Jameson
- Center for AIDS and STD, Harborview Medical Center, 325 Ninth Avenue, Seattle, WA, 98104, USA
- Department of Epidemiology, University of Washington School of Public Health, Box 357230, Seattle, WA, 98195, USA
- Public Health--Seattle & King County, 401 5th Ave., Suite 1300, Seattle, WA, 98104, USA
| | - James P Hughes
- Center for AIDS and STD, Harborview Medical Center, 325 Ninth Avenue, Seattle, WA, 98104, USA
- Department of Biostatistics, University of Washington School of Public Health, Box 357230, Seattle, WA, 98195, USA
| | - Grant N Colfax
- San Francisco Department of Public Health, 101 Grove Street, Room 408, San Francisco, CA, 94102, USA
| | - Steven Shoptaw
- Department of Family Medicine, David Geffen School of Medicine at UCLA, 50-078 Center for Health Sciences, Los Angeles, CA, 90095, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA, 90095, USA
| | - Matthew R Golden
- Center for AIDS and STD, Harborview Medical Center, 325 Ninth Avenue, Seattle, WA, 98104, USA
- Department of Epidemiology, University of Washington School of Public Health, Box 357230, Seattle, WA, 98195, USA
- Department of Medicine, University of Washington School of Medicine, Box 356420, Seattle, WA, 98195, USA
- Public Health--Seattle & King County, 401 5th Ave., Suite 1300, Seattle, WA, 98104, USA
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Li L, Everhart T, Jacob Iii P, Jones R, Mendelson J. Stereoselectivity in the human metabolism of methamphetamine. Br J Clin Pharmacol 2010; 69:187-92. [PMID: 20233182 DOI: 10.1111/j.1365-2125.2009.03576.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
AIM To characterize the formation and urinary elimination of metabolites of S-(+) and R-(-) methamphetamine (MA) in humans. METHODS In this 12-subject, six-session, double-blind, placebo-controlled, balanced, crossover design study, the formation of the MA metabolites para hydroxymethamphetamine (pOH-MA) and amphetamine (AMP) were determined in urine after intravenous doses of S-(+)-MA 0.25 and 0.5 mg kg(-1), R-(-)-MA 0.25 and 0.5 mg kg(-1), racemic MA 0.5 mg kg(-1), or placebo. Parent drug and metabolite levels in urine and plasma were measured by gas chromatography-mass spectrometry. Pharmacokinetic parameters were calculated by noncompartmental models using WinNonlin. RESULTS An approximately threefold enantioselectivity difference in elimination was observed for AMP, with 7% of the dose converted to S-(+)-AMP vs. 2% to R-(-)-AMP (P < 0.001). Furthermore, less R-(-)-pOH-MA was excreted in the urine compared with S-(+)-pOH-MA (8% vs. 11%, P= 0.02). Correspondingly, S-(+)-MA excretion was less than R-(-)-MA (42% vs. 52%; P= 0.005). CONCLUSIONS The metabolism of MA is enantioselective, with formation of AMP having the highest isomer selectivity. A greater percentage of MA is converted to pOH-MA (8-11%) than AMP (2-7%). The formation of pOH-MA was less affected by the MA enantiomer administered, suggesting that urine pOH-MA may be a more stable biomarker of MA metabolism.
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Affiliation(s)
- Linghui Li
- Addiction Pharmacology Research Laboratory, California Pacific Medical Center Research Institute, San Francisco, CA 94110, USA.
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Abstract
INTRODUCTION Metamfetamine is a highly addictive amfetamine analog that acts primarily as a central nervous system (CNS) stimulant. The escalating abuse of this drug in recent years has lead to an increasing burden upon health care providers. An understanding of the drug's toxic effects and their medical treatment is therefore essential for the successful management of patients suffering this form of intoxication. AIM The aim of this review is to summarize all main aspects of metamfetamine poisoning including epidemiology, mechanisms of toxicity, toxicokinetics, clinical features, diagnosis, and management. METHODS A summary of the literature on metamfetamine was compiled by systematically searching OVID MEDLINE and ISI Web of Science. Further information was obtained from book chapters, relevant news reports, and web material. Epidemiology. Following its use in the Second World War, metamfetamine gained popularity as an illicit drug in Japan and later the United States. Its manufacture and use has now spread to include East and South-East Asia, North America, Mexico, and Australasia, and its world-wide usage, when combined with amfetamine, exceeds that of all other drugs of abuse except cannabis. Mechanisms of toxicity. Metamfetamine acts principally by stimulating the enhanced release of catecholamines from sympathetic nerve terminals, particularly of dopamine in the mesolimbic, mesocortical, and nigrostriatal pathways. The consequent elevation of intra-synaptic monoamines results in an increased activation of central and peripheral α±- and β-adrenergic postsynaptic receptors. This can cause detrimental neuropsychological, cardiovascular, and other systemic effects, and, following long-term abuse, neuronal apoptosis and nerve terminal degeneration. Toxicokinetics. Metamfetamine is rapidly absorbed and well distributed throughout the body, with extensive distribution across high lipid content tissues such as the blood-brain barrier. In humans the major metabolic pathways are aromatic hydroxylation producing 4-hydroxymetamfetamine and N-demethylation to form amfetamine. Metamfetamine is excreted predominantly in the urine and to a lesser extent by sweating and fecal excretion, with reported terminal half-lives ranging from ∼5 to 30 h. Clinical features. The clinical effects of metamfetamine poisoning can vary widely, depending on dose, route, duration, and frequency of use. They are predominantly characteristic of an acute sympathomimetic toxidrome. Common features reported include tachycardia, hypertension, chest pain, various cardiac dysrhythmias, vasculitis, headache, cerebral hemorrhage, hyperthermia, tachypnea, and violent and aggressive behaviour. Management. Emergency stabilization of vital functions and supportive care is essential. Benzodiazepines alone may adequately relieve agitation, hypertension, tachycardia, psychosis, and seizure, though other specific therapies can also be required for sympathomimetic effects and their associated complications. CONCLUSION Metamfetamine may cause severe sympathomimetic effects in the intoxicated patient. However, with appropriate, symptom-directed supportive care, patients can be expected to make a full recovery.
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Affiliation(s)
- Leo J Schep
- National Poisons Centre, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand.
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Pil K, Raes E, Verstraete AG. The toxicological challenges in the European research project DRUID. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.fsisup.2009.08.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
BACKGROUND Oral fluid (OF) is an exciting alternative matrix for monitoring drugs of abuse in workplace, clinical toxicology, criminal justice, and driving under the influence of drugs (DUID) programs. During the last 5 years, scientific and technological advances in OF collection, point-of-collection testing devices, and screening and confirmation methods were achieved. Guidelines were proposed for workplace OF testing by the Substance Abuse and Mental Health Services Administration, DUID testing by the European Union's Driving under the Influence of Drugs, Alcohol and Medicines (DRUID) program, and standardization of DUID research. Although OF testing is now commonplace in many monitoring programs, the greatest current limitation is the scarcity of controlled drug administration studies available to guide interpretation. CONTENT This review outlines OF testing advantages and limitations, and the progress in OF that has occurred during the last 5 years in collection, screening, confirmation, and interpretation of cannabinoids, opioids, amphetamines, cocaine, and benzodiazepines. We examine controlled drug administration studies, immunoassay and chromatographic methods, collection devices, point-of-collection testing device performance, and recent applications of OF testing. SUMMARY Substance Abuse and Mental Health Services Administration approval of OF testing was delayed because questions about drug OF disposition were not yet resolved, and collection device performance and testing assays required improvement. Here, we document the many advances achieved in the use of OF. Additional research is needed to identify new biomarkers, determine drug detection windows, characterize OF adulteration techniques, and evaluate analyte stability. Nevertheless, there is no doubt that OF offers multiple advantages as an alternative matrix for drug monitoring and has an important role in DUID, treatment, workplace, and criminal justice programs.
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Affiliation(s)
- Wendy M. Bosker
- Maastricht University, Faculty of Psychology and Neuroscience, Neuropsychology & Psychopharmacology, Experimental Psychopharmacology Unit, Maastricht, The Netherlands
- Chemistry and Drug Metabolism, National Institute on Drug Abuse, NIH, Baltimore, MD
| | - Marilyn A. Huestis
- Chemistry and Drug Metabolism, National Institute on Drug Abuse, NIH, Baltimore, MD
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Abstract
Drug oral fluid analysis was first used almost 30 years ago for the purpose of therapeutic drug monitoring. Since then, oral fluid bioanalysis has become more popular, mainly in the fields of pharmacokinetics, workplace drug testing, criminal justice, driving under the influence testing and therapeutic drug monitoring. In fact, oral fluid can provide a readily available and noninvasive medium, without any privacy loss by the examinee, which occurs, for instance, during the collection of urine samples. It is believed that drug concentrations in oral fluid may parallel those measured in blood. This feature makes oral fluid an alternative analytical specimen to blood, which assumes particular importance in roadside testing, the most published application of this sample. Great improvements in the development of accurate and reliable methods for sample collection, in situ detection devices (on-site drug detection kits), and highly sensitive and specific analytical methods for oral fluid testing of drugs have been observed in the last few years. However, without mass spectrometry-based analytical methods, such as liquid chromatography coupled to mass spectrometry (LC–MS) or tandem mass spectrometry (LC–MS/MS), the desired sensitivity would not be met, due to the low amounts of sample usually available for analysis. This review will discuss a series of published papers on the applicability of oral fluid in the field of analytical, clinical and forensic toxicology, with a special focus on its advantages and drawbacks over the normally used biological specimens and the main technological advances over the last decade, which have made oral fluid analysis of drugs possible.
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Gallardo E, Queiroz JA. The role of alternative specimens in toxicological analysis. Biomed Chromatogr 2008; 22:795-821. [DOI: 10.1002/bmc.1009] [Citation(s) in RCA: 135] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
In the last few years, significant developments have occurred on the key issues involved in oral fluid drug testing. New pharmacokinetic studies have been conducted, optimal cutoffs have been proposed, and new studies have examined the correlation between oral fluid drug concentrations and impairment. Recent studies (eg, the discovery of the presence of THC-COOH in oral fluid) can contribute to solve the issue of false-positive results caused by passive exposure to marijuana. Reliable point-of-care drug testing is still problematic, especially for cannabinoids and benzodiazepines. To date, there is no device that allows both reliable and practical point-of-care testing. The importance of liquid chromatography- tandem mass spectrometry in confirmation analysis has increased over the last several years. It can be expected that this trend will continue because the low sample volumes make simultaneous detection of different drug classes with limited sample preparation necessary. Literature on proficiency testing to ensure reliability and comparability of results is limited. Oral fluid has become an important sample type in driving under the influence research, and the first legal random drug testing program in oral fluid since 2004 has been organized in Victoria. It can be expected that the role of oral fluid as an alternative matrix will keep increasing in the future.
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