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Casati S, Binda M, Dongiovanni P, Meroni M, D'Amato A, Roda G, Orioli M, Del Fabbro M, Tartaglia GM. Recent advances of drugs monitoring in oral fluid and comparison with blood. Clin Chem Lab Med 2023; 61:1978-1993. [PMID: 37302088 DOI: 10.1515/cclm-2023-0343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/31/2023] [Indexed: 06/13/2023]
Abstract
The use of alternative matrices in toxicological analyses has been on the rise in clinical and forensic settings. Oral fluid (OF), as non-invasive fluid, has attracted attention in the field of drug screening, both for therapeutic and forensic purposes, as well as for medical diagnosis, clinical management, on-site (real time) doping and for monitoring environmental exposure to toxic substances. A good correlation between OF and blood is now established for drug concentrations. Therefore, OF might be a potential substitute of blood, especially for long-term surveillance (e.g., therapeutic drugs) or to screen a large number of patients, as well as for the development of salivary point-of-care technologies. In this review, we aimed to summarize and critically evaluate the current literature that focused on the comparison of drugs detection in OF and blood specimens.
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Affiliation(s)
- Sara Casati
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Maddalena Binda
- Department of Pharmaceutical Sciences, University of Milan, Milan, Italy
| | - Paola Dongiovanni
- Medicine and Metabolic Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marica Meroni
- Medicine and Metabolic Diseases, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alfonsina D'Amato
- Department of Pharmaceutical Sciences, University of Milan, Milan, Italy
| | - Gabriella Roda
- Department of Pharmaceutical Sciences, University of Milan, Milan, Italy
| | - Marica Orioli
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- UOC Maxillo-Facial Surgery and Dentistry Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Gianluca M Tartaglia
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
- UOC Maxillo-Facial Surgery and Dentistry Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Milan, Italy
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Khazanov GK, Ingram E, Lynch K, Trim R, McKay J, Oslin DW. Validity and reliability of in-person and remote oral fluids drug testing compared to urine drug testing. Drug Alcohol Depend 2023; 250:110876. [PMID: 37429052 DOI: 10.1016/j.drugalcdep.2023.110876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/08/2023] [Accepted: 06/22/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Increased telehealth use has led to greater interest in remote drug testing. The speed, acceptability, and ability to observe oral fluids testing makes it the best candidate for remote drug testing, but its validity and reliability compared to gold-standard urine drug testing have not been established. METHODS Veterans (N = 99) recruited from mental health clinics completed in-person and remote oral fluids testing and in-person urine drug testing. The validity of oral fluids versus urine drug testing and reliability of in-person versus remote oral fluids testing were evaluated. RESULTS Validity of oral fluids testing was similar for samples collected in-person and virtually. Oral fluids testing had good specificity (0.93-1.00) and negative predictive value (0.85-1.00), but lower sensitivity and positive predictive value. Sensitivity (0.21-0.93) was highest for methadone and oxycodone, followed by cocaine and then amphetamine and opiates. Positive predictive value (0.14-1.00) was highest for cocaine, opiates, and methadone, followed by oxycodone and then amphetamine. Validity for cannabis was low, likely because of differences in detection windows for oral fluids versus urine drug screens. Reliability of remote oral fluids testing was adequate for opiates, cocaine, and methadone, but not oxycodone, amphetamine, or cannabis. CONCLUSIONS Oral fluids testing identifies most negative, but not most positive, drug test results. While oral fluids testing is appropriate in some circumstances, its limitations should be acknowledged. Remote drug testing addresses many barriers, but also generates new barriers related to self-administration and remote interpretation. Limitations include a small sample and low base rates for some drugs.
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Affiliation(s)
- Gabriela Kattan Khazanov
- Center of Excellence for Substance Addiction and Treatment (CESATE), Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland AvenuePhiladelphiaPA19104United States; Department of Psychiatry at the University of Pennsylvania Perelman School of Medicine, 3535 Market StreetPhiladelphiaPA19104United States.
| | - Erin Ingram
- Mental Illness Research, Education, and Clinical Center of the Veterans Integrated Service Network 4, Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland AvenuePhiladelphiaPA19104United States
| | - Kevin Lynch
- Department of Psychiatry at the University of Pennsylvania Perelman School of Medicine, 3535 Market StreetPhiladelphiaPA19104United States
| | - Ryan Trim
- Center of Excellence for Substance Addiction and Treatment (CESATE), Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland AvenuePhiladelphiaPA19104United States
| | - James McKay
- Center of Excellence for Substance Addiction and Treatment (CESATE), Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland AvenuePhiladelphiaPA19104United States; Department of Psychiatry at the University of Pennsylvania Perelman School of Medicine, 3535 Market StreetPhiladelphiaPA19104United States
| | - David W Oslin
- Department of Psychiatry at the University of Pennsylvania Perelman School of Medicine, 3535 Market StreetPhiladelphiaPA19104United States; Mental Illness Research, Education, and Clinical Center of the Veterans Integrated Service Network 4, Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland AvenuePhiladelphiaPA19104United States
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Magura S, Lee-Easton MJ, Abu-Obaid R, Reed P, Allgaier B, Amaratunga P, Lorenz-Lemberg B, Levitas M, Achtyes ED. Comparing presumptive with direct-to-definitive drug testing in oral fluid vs. urine for a U.S. national sample of individuals misusing drugs. Drug Alcohol Depend 2023; 250:110894. [PMID: 37481872 PMCID: PMC10530259 DOI: 10.1016/j.drugalcdep.2023.110894] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 07/03/2023] [Accepted: 07/06/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND The aims are to compare the results of presumptive drug testing with confirmation of positives vs. direct-to-definitive drug testing, combined with investigation of urine vs. oral fluid as test matrices. METHODS Paired oral fluid and urine specimens were collected voluntarily and anonymously from 1098 individuals applying for methadone treatment in 11 clinics across 7 U.S. states. All specimens were analyzed by immunoassay (IA) and liquid chromatography-tandem mass spectrometry (LC-MS-MS). RESULTS Confirmed IA prevalences for urine were significantly higher than for oral fluid for 7 out of 10 drug classes - benzodiazepines, cannabis, cocaine, methadone, opiates, oxycodone and tramadol. Drug prevalences by direct-to-definitive LC-MS-MS were either the same or higher than prevalences by confirmed IA. Drug prevalences by LC-MS-MS were higher in urine for two drug classes (cocaine, methadone) and higher in oral fluid for two drug classes (buprenorphine, tramadol), but were equivalent in urine and oral fluid when averaged over all 10 drug classes. Certain drugs of special concern such as heroin and buprenorphine were more frequently detected in oral fluid than urine. CONCLUSIONS Urine analysis showed some technical advantage over oral fluid in sensitivity to several drug classes within a confirmed IA testing protocol, but this may be outweighed if there is reason to believe that tampering with urine specimens is a significant problem. Overall drug detection by direct-to-definitive testing was similar for oral fluid and urine, but one matrix may be preferable if there is a particular drug of clinical or epidemiological interest.
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Affiliation(s)
| | | | | | - Pete Reed
- Forensic Fluids Laboratories, Inc, USA
| | | | | | | | | | - Eric D Achtyes
- Western Michigan University Homer Stryker M.D. School of Medicine, USA
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Cafaro A, Conti M, Pigliasco F, Barco S, Bandettini R, Cangemi G. Biological Fluid Microsampling for Therapeutic Drug Monitoring: A Narrative Review. Biomedicines 2023; 11:1962. [PMID: 37509602 PMCID: PMC10377272 DOI: 10.3390/biomedicines11071962] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/04/2023] [Accepted: 07/10/2023] [Indexed: 07/30/2023] Open
Abstract
Therapeutic drug monitoring (TDM) is a specialized area of laboratory medicine which involves the measurement of drug concentrations in biological fluids with the aim of optimizing efficacy and reducing side effects, possibly modifying the drug dose to keep the plasma concentration within the therapeutic range. Plasma and/or whole blood, usually obtained by venipuncture, are the "gold standard" matrices for TDM. Microsampling, commonly used for newborn screening, could also be a convenient alternative to traditional sampling techniques for pharmacokinetics (PK) studies and TDM, helping to overcome practical problems and offering less invasive options to patients. Although technical limitations have hampered the use of microsampling in these fields, innovative techniques such as 3-D dried blood spheroids, volumetric absorptive microsampling (VAMS), dried plasma spots (DPS), and various microfluidic devices (MDS) can now offer reliable alternatives to traditional samples. The application of microsampling in routine clinical pharmacology is also hampered by the need for instrumentation capable of quantifying analytes in small volumes with sufficient sensitivity. The combination of microsampling with high-sensitivity analytical techniques, such as liquid chromatography coupled with tandem mass spectrometry (LC-MS/MS), is particularly effective in ensuring high accuracy and sensitivity from very small sample volumes. This manuscript provides a critical review of the currently available microsampling devices for both whole blood and other biological fluids, such as plasma, urine, breast milk, and saliva. The purpose is to provide useful information in the scientific community to laboratory personnel, clinicians, and researchers interested in implementing the use of microsampling in their routine clinical practice.
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Affiliation(s)
- Alessia Cafaro
- Chromatography and Mass Spectrometry Section, Central Laboratory of Analysis, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Matteo Conti
- Public Health Department, Imola Local Unit, Regione Emilia-Romagna Healthcare Service, 40026 Imola, Italy
| | - Federica Pigliasco
- Chromatography and Mass Spectrometry Section, Central Laboratory of Analysis, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Sebastiano Barco
- Chromatography and Mass Spectrometry Section, Central Laboratory of Analysis, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Roberto Bandettini
- Chromatography and Mass Spectrometry Section, Central Laboratory of Analysis, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
| | - Giuliana Cangemi
- Chromatography and Mass Spectrometry Section, Central Laboratory of Analysis, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy
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5
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Savage T, Sanders T, Pieters R, Miles A, Barkholtz H. Suitability of SoToxa® Oral Fluid Screening Over Time: Re-examination of Drugged Driving in Wisconsin. J Anal Toxicol 2022; 46:825-834. [PMID: 35767245 DOI: 10.1093/jat/bkac047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/11/2022] [Accepted: 06/28/2022] [Indexed: 11/15/2022] Open
Abstract
Drug impaired driver detection is a critical element of traffic safety. However, shifting drug use patterns over time and geography may limit long-term reliability of assay-based screening tools. In this work, we compare qualitative results from the Abbott SoToxa® oral fluid (OF) screening device to Quantisal™ OF and whole blood. Our objective was to examine these three qualitative toxicological approaches, scope applicability of OF collection at the roadside, and compare to a previous analysis of SoToxa® in Wisconsin. OF specimens were screened with the SoToxa® for six drugs or drug classes including amphetamine, benzodiazepines, cocaine, methamphetamine, opioids, and tetrahydrocannabinol (THC). OF and blood specimens were collected from 106 participants. Quantisal™ OF and blood specimens were screened for drugs on ultra-performance liquid chromatography coupled to quadrupole time-of-flight high-resolution mass spectrometry (UPLC-QToF-HRMS) using a data independent acquisition mode. UPLC-QToF-HRMS data was compared to comprehensive spectral libraries and drugs were qualitatively identified. Drug Recognition Expert evaluations were performed, and face sheets submitted for 21 participants in this work. In general, the SoToxa® results were consistent with the combined qualitative results observed in Quantisal™ OF specimens and whole blood specimens. Limitations were uncovered for benzodiazepines, opioids, and THC. The SoToxa® benzodiazepine assay has high cutoff concentrations for diazepam and clonazepam, limiting its sensitivity and positive predictive value when considering these drugs. SoToxa® opioid screening did not detect fentanyl, which is increasingly prevalent among drug users. Finally, ∆9-THC and its major metabolite 11-nor-9-carboxy-∆9-THC are lipophilic, limiting partitioning into oral fluid. Despite these limitations, the SoToxa® instrument may be useful in assisting law enforcement with identifying individuals driving under the influence of drugs and establishing probable cause at roadside for making impaired driving arrests. Furthermore, Quantisal™ OF may be useful as screening specimens due to their ease of collection and results consistent with whole blood.
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Affiliation(s)
- Theodore Savage
- University of Wisconsin-Madison, Wisconsin State Laboratory of Hygiene, Forensic Toxicology Section, 2601 Agriculture Drive, Madison, WI 53718, USA
| | - Therese Sanders
- Wisconsin Department of Transportation, Bureau of Transportation Safety and Technical Services, Chemical Testing Section, 3502 Kinsman Boulevard, Madison, WI 53704, USA
| | - Ryan Pieters
- University of Wisconsin-Madison, Wisconsin State Laboratory of Hygiene, Forensic Toxicology Section, 2601 Agriculture Drive, Madison, WI 53718, USA
| | - Amy Miles
- University of Wisconsin-Madison, Wisconsin State Laboratory of Hygiene, Forensic Toxicology Section, 2601 Agriculture Drive, Madison, WI 53718, USA
| | - Heather Barkholtz
- University of Wisconsin-Madison, Wisconsin State Laboratory of Hygiene, Forensic Toxicology Section, 2601 Agriculture Drive, Madison, WI 53718, USA.,Pharmaceutical Sciences Division, University of Wisconsin-Madison, School of Pharmacy, 777 Highland Avenue, Madison, WI 53705, USA
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6
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Alternative matrices in forensic toxicology: a critical review. Forensic Toxicol 2021; 40:1-18. [DOI: 10.1007/s11419-021-00596-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/19/2021] [Indexed: 12/12/2022]
Abstract
Abstract
Purpose
The use of alternative matrices in toxicological analyses has been on the rise in clinical and forensic settings. Specimens alternative to blood and urine are useful in providing additional information regarding drug exposure and analytical benefits. The goal of this paper is to present a critical review on the most recent literature regarding the application of six common alternative matrices, i.e., oral fluid, hair, sweat, meconium, breast milk and vitreous humor in forensic toxicology.
Methods
The recent literature have been searched and reviewed for the characteristics, advantages and limitations of oral fluid, hair, sweat, meconium, breast milk and vitreous humor and its applications in the analysis of traditional drugs of abuse and novel psychoactive substances (NPS).
Results
This paper outlines the properties of six biological matrices that have been used in forensic analyses, as alternatives to whole blood and urine specimens. Each of this matrix has benefits in regards to sampling, extraction, detection window, typical drug levels and other aspects. However, theses matrices have also limitations such as limited incorporation of drugs (according to physical–chemical properties), impossibility to correlate the concentrations for effects, low levels of xenobiotics and ultimately the need for more sensitive analysis. For more traditional drugs of abuse (e.g., cocaine and amphetamines), there are already data available on the detection in alternative matrices. However, data on the determination of emerging drugs such as the NPS in alternative biological matrices are more limited.
Conclusions
Alternative biological fluids are important specimens in forensic toxicology. These matrices have been increasingly reported over the years, and this dynamic will probably continue in the future, especially considering their inherent advantages and the possibility to be used when blood or urine are unavailable. However, one should be aware that these matrices have limitations and particular properties, and the findings obtained from the analysis of these specimens may vary according to the type of matrix. As a potential perspective in forensic toxicology, the topic of alternative matrices will be continuously explored, especially emphasizing NPS.
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7
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Mahowald GK, Khaliq TP, Griggs D, O M, Flood JG, Uljon S. Comparison of Oral Fluid and Urine for Detection of Fentanyl Use Using Liquid Chromatography with Tandem Mass Spectrometry. J Appl Lab Med 2021; 6:1533-1540. [PMID: 34327523 DOI: 10.1093/jalm/jfab068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 06/07/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND We compared oral fluid (OF) and urine (UR) for detection of fentanyl (FEN) use in addiction medicine-psychiatry (AMP) clinics. METHODS We measured FEN and norfentanyl (NRFEN) in UR with a limit of detection (LOD) of 2.0 µg/L and FEN in OF with an LOD of 0.5 µg/L by LC-MS/MS in 311 paired samples and compared the 2 matrices when higher OF and UR LODs were used. RESULTS Urine (UR) detected more FEN use than OF using a LOD of 2.0 µg/L and 0.5 µg/L, respectively. FEN and/or NRFEN were detected in 44 and 59 UR specimens, respectively, and FEN in 46 OF specimens (43 OF+UR+, 3 OF+UR-, 16 OF-UR+, and 249 OF-UR-). In UR there were no instances with FEN positive and NORFEN negative. UR creatinine was <20 mg/dL in the 3 OF+UR- specimen pairs. The median OF/UR analyte concentration ratios in positive sample pairs were 0.23 for OF FEN/UR FEN and 0.02 for OF FEN/UR NRFEN. CONCLUSIONS We demonstrate that UR detects more FEN use than OF in an AMP setting when UR FEN and UR NORFEN LODs of 2.0 µg/L are used. OF is less sensitive than UR in detecting FEN use, but is still valuable for cases with low UR creatinine and/or suspected adulteration or substitution of UR. The UR vs OF comparison statistics are greatly impacted by even minimal adjustments of the LOD.
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Affiliation(s)
- Grace K Mahowald
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Tahira P Khaliq
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - David Griggs
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Mi O
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - James G Flood
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Sacha Uljon
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Rahbar N, Ahmadi F, Ramezani Z, Nourani M. Calcium/Copper Alginate Framework Doped with CuO Nanoparticles as a Novel Adsorbent for Micro-extraction of Benzodiazepines from Human Serum. CURR PHARM ANAL 2021. [DOI: 10.2174/1573412916666200210150914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Sample preparation is one of the most challenging phases in pharmaceutical
analysis, especially in biological matrices, affecting the whole analytical methodology.
Objective:
In this study, a new Ca(II)/Cu(II)/alginate/CuO Nanoparticles Hydrogel Fiber (CCACHF)
was synthesized through a simple, green procedure and applied for fiber micro solid-phase extraction
(FMSPE) of diazepam (DIZ) and oxazepam (OXZ) as model drugs prior to high-performance liquid
chromatography-UV detection (HPLC-UV).
Methods:
Composition and morphology of the prepared fiber were characterized and the effect of
main parameters on the fiber fabrication and extraction efficiency have been studied and optimized.
Results:
In optimal conditions, calibration curves were linear, ranging between 0.1–500 μg L−1 with
regression coefficients of 0.9938 and 0.9968. Limit of Detection (LOD) (S/N=3) and Limit of Quantification
(LOQ) (S/N=10) of the technique for DIZ and OXZ were 0.03 to 0.1 μg L−1. Within-day and
between-day Relative Standard Deviations (RSDs) for DIZ and OXZ were 6.0–12.5% and 3.3–9.4%,
respectively.
Conclusion:
The fabricated adsorbent has been substantially employed to the extraction of selected
benzo-diazepines (BZDs) from human serum real specimens and the obtained recoveries were also
satisfactory (82.1-109.7%).
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Affiliation(s)
- Nadereh Rahbar
- Nanotechnology Research Center, Faculty of Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz,Iran
| | - Fatemeh Ahmadi
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz,Iran
| | - Zahra Ramezani
- Marine Pharmaceutical Science Research Center, Faculty of Pharmacy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz,Iran
| | - Masoumeh Nourani
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz,Iran
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A review of recent advances in microsampling techniques of biological fluids for therapeutic drug monitoring. J Chromatogr A 2020; 1635:461731. [PMID: 33285415 DOI: 10.1016/j.chroma.2020.461731] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/09/2020] [Accepted: 11/12/2020] [Indexed: 12/12/2022]
Abstract
Conventional sampling of biological fluids often involves a bulk quantity of samples that are tedious to collect, deliver and process. Miniaturized sampling approaches have emerged as promising tools for sample collection due to numerous advantages such as minute sample size, patient friendliness and ease of shipment. This article reviews the applications and advances of microsampling techniques in therapeutic drug monitoring (TDM), covering the period January 2015 - August 2020. As whole blood is the gold standard sampling matrix for TDM, this article comprehensively highlights the most historical microsampling technique, the dried blood spot (DBS), and its development. Advanced developments of DBS, ranging from various automation DBS, paper spray mass spectrometry (PS-MS), 3D dried blood spheroids and volumetric absorptive paper disc (VAPD) and mini-disc (VAPDmini) are discussed. The volumetric absorptive microsampling (VAMS) approach, which overcomes the hematocrit effect associated with the DBS sample, has been employed in recent TDM. The sample collection and sample preparation details in DBS and VAMS are outlined and summarized. This review also delineates the involvement of other biological fluids (plasma, urine, breast milk and saliva) and their miniaturized dried matrix forms in TDM. Specific features and challenges of each microsampling technique are identified and comparison studies are reviewed.
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10
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Determination of morphine and its metabolites in the biological samples: an updated review. Bioanalysis 2020; 12:1161-1194. [PMID: 32757855 DOI: 10.4155/bio-2020-0070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Morphine (MO) as an opioid analgesic is used for the treatment of moderate-to-severe pains, particularly cancer-related pains. Pharmacologic studies on MO are complicated due to drugs binding to the protein or metabolization to active metabolites, and even inter-individual variability. This necessitates the selection of a reliable analytical method for monitoring MO and the concentrations of its metabolites in the biological samples for the pharmacokinetic or pharmacodynamic investigations. Therefore, this study was conducted to review all the analytical research carried out on MO and its metabolites in the biological samples during 2007-2019 as an update to the study by Bosch et al. (2007).
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11
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Ransohoff JR, Petrides AK, Piscitello GJ, Flood JG, Melanson SEF. Urine is superior to oral fluid for detecting buprenorphine compliance in patients undergoing treatment for opioid addiction. Drug Alcohol Depend 2019; 203:8-12. [PMID: 31394416 DOI: 10.1016/j.drugalcdep.2019.06.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 06/17/2019] [Accepted: 06/19/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Buprenorphine (BUP) is commonly used in opioid agonist medication-assisted treatment (OA-MAT). Oral fluid (OF) is an attractive option for compliance monitoring during OA-MAT as collections are observed and evidence suggests that OF is less likely to be adulterated than urine (UR). However, the clinical and analytical performance of each matrix for monitoring BUP compliance has not been well studied. METHODS We collected 260 paired OF and UR specimens. Concentrations of buprenorphine (BUP) and norbuprenorphine (NBUP) were measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS) in each matrix. The glucuronide metabolites and naloxone concentrations were also measured in UR by LC-MS/MS. Medications were reviewed and UR creatinine concentrations were determined. RESULTS 147/260 specimens (57%) were positive for BUP and/or metabolites in one or both matrices. BUP and/or metabolites were more likely to be detected in UR (p < 0.001). 1 OF specimen and 12 UR specimens were considered adulterated/substituted. The majority of patients prescribed BUP were positive for BUP in UR (97%) as opposed to OF (78%). The detection of undisclosed use approximately doubled in UR. CONCLUSIONS UR is the preferred matrix for detecting both buprenorphine compliance and undisclosed use. Clinicians should consider the ease of collection, risk of adulteration and detection of illicit drug use when deciding on an appropriate matrix. If OF testing is clinically necessary, UR should be measured in conjunction with OF at least periodically to avoid false negative BUP results.
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Affiliation(s)
- Jaime R Ransohoff
- Department of Pathology, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA; Department of Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - Athena K Petrides
- Department of Pathology, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA; Harvard Medical School, 25 Shattuck St., Boston, MA, 02115, USA
| | - Greg J Piscitello
- Department of Pathology, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA
| | - James G Flood
- Harvard Medical School, 25 Shattuck St., Boston, MA, 02115, USA; Department of Pathology, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA
| | - Stacy E F Melanson
- Department of Pathology, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02115, USA; Harvard Medical School, 25 Shattuck St., Boston, MA, 02115, USA.
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12
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Avataneo V, D’Avolio A, Cusato J, Cantù M, De Nicolò A. LC-MS application for therapeutic drug monitoring in alternative matrices. J Pharm Biomed Anal 2019; 166:40-51. [DOI: 10.1016/j.jpba.2018.12.040] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 12/24/2018] [Accepted: 12/26/2018] [Indexed: 12/14/2022]
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13
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Affiliation(s)
- Alexander Y Walley
- From the Department of Medicine, Boston Medical Center (A.Y.W.), the Department of Medicine, Boston University School of Medicine (A.Y.W.), the Departments of Medicine (S.E.W.) and Pathology (G.E.), Massachusetts General Hospital, and the Departments of Medicine (S.E.W.) and Pathology (G.E.), Harvard Medical School - all in Boston
| | - Sarah E Wakeman
- From the Department of Medicine, Boston Medical Center (A.Y.W.), the Department of Medicine, Boston University School of Medicine (A.Y.W.), the Departments of Medicine (S.E.W.) and Pathology (G.E.), Massachusetts General Hospital, and the Departments of Medicine (S.E.W.) and Pathology (G.E.), Harvard Medical School - all in Boston
| | - George Eng
- From the Department of Medicine, Boston Medical Center (A.Y.W.), the Department of Medicine, Boston University School of Medicine (A.Y.W.), the Departments of Medicine (S.E.W.) and Pathology (G.E.), Massachusetts General Hospital, and the Departments of Medicine (S.E.W.) and Pathology (G.E.), Harvard Medical School - all in Boston
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Wagner E, Raabe F, Martin G, Winter C, Plörer D, Krause DL, Adorjan K, Koller G, Pogarell O. Concomitant drug abuse of opioid dependent patients in maintenance treatment detected with a multi-target screening of oral fluid. Am J Addict 2018; 27:407-412. [PMID: 29797622 DOI: 10.1111/ajad.12737] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 05/08/2018] [Accepted: 05/14/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Numbers of drug-related deaths have been growing in Europe and the USA, especially those attributable to mixed drug consumption. Overdose deaths account for about one third up to one half of all illicit drug deaths worldwide. In most cases opioids are involved. Opioid maintenance treatment (OMT) is a well-established therapy option among people with opioid dependence. The aim of this study was to assess concomitant substance abuse in opioid-dependent patients under OMT in two centers in Munich, Germany. METHODS Oral fluid samples of opioid-dependent patients (n = 388) in OMT were randomly collected and analyzed by a multi-drug screening covering a wide range of psychotropic agents with UPLC-MS/MS techniques. RESULTS Fifty-one percent of the patients had concomitant substance abuse of at least one non-prescribed substance, 32% were positive for substances that were not tested in routine urine diagnostics, especially pregabalin. Fifty-seven percent received take-home opioid medication, and 26% had contact with underage children. Among the take-home subgroup, a concomitant substance abuse of 43.5% was detected. Furthermore 52.5% of the patients with contact to underaged children exhibited concomitant substance abuse. CONCLUSIONS Concomitant substance abuse is a serious issue among OMT patients. Screening for a broader range of substances than usually analyzed, reveals additional relevant abuse among OMT patients, including pregabalin-an anticonvulsant. SCIENTIFIC SIGNIFICANCE Our study underscores the importance of monitoring a broad range of substances including others than usually screened in opioid-dependent patients in OMT. (Am J Addict 2018;XX:1-6).
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Affiliation(s)
- Elias Wagner
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Florian Raabe
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Gabriele Martin
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Catja Winter
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Diana Plörer
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Daniela L Krause
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Kristina Adorjan
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Gabriele Koller
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
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