Cocaine and crack cocaine abuse by pregnant or lactating mothers and analysis of its biomarkers in meconium and breast milk by LC–MS—A review

Psychiatric and obstetric characteristics of pregnant crack users admitted to a referral center in Southern Brazil

BACKGROUND

Psychoactive substance use among pregnant women has reached alarmingly high rates. Our aim was to characterize the psychiatric and clinical profiles of pregnant crack users in Brazil.

METHODS

This was a cross-sectional study of 24 pregnant crack users admitted to a referral hospital for psychiatric disorders in pregnant women, in Porto Alegre, Brazil, over three years. The following instruments were applied: a clinical-obstetric questionnaire; the condensed version of the Addiction Severity Index; a diagnostic interview for psychoactive substance use based on DSM-5; the Mini International Neuropsychiatric Interview for DSM-IV; and the Semi-Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II).

RESULTS

Most patients had severe crack dependence and used other substances, such as tobacco, cannabis, and alcohol. The median duration of crack use was three years, ranging between three and 12 years. Most women subsisted from illegal or informal activities; a fifth had previously been arrested and often had relationship problems. Twenty percent had HIV (n = 5), and 37.5% (n = 9) had syphilis. Borderline personality disorder was the most prevalent mental condition (62.5%), followed by suicidal tendencies (45.8%), hypomanic episodes due to substance use (37.5%), and past major depressive episodes (33.3%).

CONCLUSIONS

An alarmingly high prevalence of consumption of other drugs, psychiatric disorders, and difficult-to-treat personality disorders was observed in our study. Investigating the psychiatric profile of women who use substances is essential to minimize the impacts on the mother and child, optimize therapeutic approaches to comorbidities, and enable more effective relapse prevention.

Lactente em abstinência de cocaína, relato de caso

   Objetivo: descrever o caso de um lactente exposto à cocaína e as repercussões clínicas da sua ingestão por meio do leite materno.Relato do caso: lactente, com um mês e três dias de vida e peso de 3.920g vem à emergência, por quadro de hipoatividade, rebaixamento de sensório, choro e sangramento nasal. Afebril, irritada, chorosa, sem sinais de esforço ventilatório ou sangramentos ativos. Exames mostraram leucocitose 13490/uL, acidose metabólica discreta, aumento de transglutaminase oxalacética e provas de coagulação alargadas. Demais exames laboratoriais sem alterações e culturas negativas. Screening toxicológico revelou cocaína no plasma da lactente. O Centro de Informações Toxicológicas, recomendou monitorização e suporte clínico. A paciente recebeu alta da unidade de terapia intensiva para enfermaria cinco dias após admissão, com melhora do sensório, seguindo acompanhamento com a equipes especializadas.Conclusão: o pronto reconhecimento da síndrome de abstinência neonatal permite o melhor manejo da mesma em benefício dos pacientes. O diagnóstico diferencial com quadro séptico pode ser de grande importância em quadros como este. 

Determination of Prenatal Substance Exposure Using Meconium and Orbitrap Mass Spectrometry

The aim of this study was to develop and to validate a toxicological untargeted screening relying on LC-HRMS in meconium including the detection of the four main classes of drugs of abuse (DoA; amphetamines, cannabinoids, opioids and cocaine). The method was then applied to 29 real samples. Analyses were performed with a liquid chromatography system coupled to a benchtop Orbitrap operating in a data-dependent analysis. The sample amount was 300 mg of meconium extracted twice by solid phase extraction following two distinct procedures. Raw data were processed using the Compound Discoverer 3.2 software (Thermo). The method was evaluated and validated on 15 compounds (6-MAM, morphine, buprenorphine, norbuprenorphine, methadone, EDDP, amphetamine, MDA, MDMA, methamphetamine, cocaine, benzoylecgonine, THC, 11-OH-THC, THC-COOH). Limits of detection were between 0.5 and 5 pg/mg and limits of identification between 5 and 50 pg/mg. Mean matrix effect was between −79 and −19% (n = 6) and mean overall recovery between 18 and 73% (n = 6) at 100 pg/mg. The application allows the detection of 88 substances, including 47 pharmaceuticals and 15 pharmaceutical metabolites, cocaine and its metabolites, THC and its metabolites, and natural (morphine, codeine) and synthetic (methadone, buprenorphine, tramadol, norfentanyl) opioids. This method is now used routinely for toxicological screening in high-risk pregnancies

Psychoactive substances in human breast milk: a review of analytical strategies for their investigation

WHO recommends breastfeeding for the first 6 months of newborn's life. Due to its physicochemical properties, breast milk may contain undesirable components originated from mother's feeding, medication and illicit drugs consumption. Some of these substances transferred from bloodstream to milk and delivered to the infant can cause harmful effects. For the last decades, analytical advances enabled the analysis of several substances in milk using different techniques. Thereby, it is possible to evaluate infant's level of exposure to these substances. This review presents the information published in the main scientific dissemination media about psychoactive drugs investigation in human breast milk, involving the sample preparation techniques and chromatographic validated methods developed in the past 10 years.

A straightforward and semiautomated membrane-based method as efficient tool for the determination of cocaine and its metabolites in urine samples using liquid chromatography coupled to quadrupole time-of-flight-mass spectrometry

In this study, a novel and straightforward analytical methodology was proposed for the determination of cocaine (COC) and its main metabolites benzoylecgonine (BZE) cocaethylene (CE) and hydroxy‑cocaine (COCOH) in urine samples. This approach consisted of a high-throughput and semiautomated configuration based on hollow-fiber renewal liquid membrane extraction (HFRLM) coupled to a 96-well plate system, which was proposed for the first time to analyze complex biological samples such as urine. The analytical determinations were performed using ultra-high performance liquid chromatography coupled to quadrupole time-of-flight-mass spectrometry (LC-ESI-QTOF-MS). The analytical methodology was fully optimized through Doehlert and simplex-centroid designs, and univariate approaches. Polypropylene membranes of 1 cm length were inserted in the pins of an extraction blade combined with a 96-well plate system and its pores were filled with hexane:dichloromethane:ethyl acetate (1:1:1 v/v/v) for 180 s; moreover, 20 µL of this mixture was added to the sample to allow for a renewable liquid membrane. The extraction step was carried out by keeping the blades immersed in vials containing 1.5 mL of diluted urine adjusted at pH 10 with 10% (w/v) of Na₂CO₃ during 20 min, followed by liquid desorption with 100 µL of acetonitrile_. Finally, the extract was dried under N₂ stream and resuspended with 20 µL of ultrapure water. Satisfactory analytical performance was obtained with coefficients of determination ranging from 0.9875 for BZE to 0.9986 for CE; intra-day precision ranged from 1.6 to 13.5%, and inter-day precision varied from 2.2 to 17.5%. Limits of detection ranged from 1.5 to 15.1 ng mL^-1, and limits of quantification varied from 5 to 50 ng mL^-1, with relative recoveries varied from 70.7 to 124.1%.

Efficient extraction method using magnetic carbon nanotubes to analyze cocaine and benzoylecgonine in breast milk by GC/MS

Aim: The increasing use of cocaine (COC) during breastfeeding has led to growing concern about exposure of infants. Therefore, to study this exposure, a new method to analyze COC and benzoylecgonine in breast milk was developed. Methodology: A new extraction method was used for the first time to analyze COC and its major metabolite, benzoylecgonine, in breast milk using magnetic carbon nanotubes partially doped with nitrogen. Results: The calibration curves were linear in the range 5.0–180.0 ng ml-1. The limit of quantification was 5.0 ng ml-1. Coefficients of variation were between 3.2 and 13.9%. Recovery was between 89.6 and 99.2%. Conclusion: The proposed method is simple, efficient and suitable to determine analytes in breast milk.

Bioresponsive controlled glucose release from TiO2 nanotube arrays: a simple and portable biosensing system for cocaine with a glucometer readout

Herein, we design a simple and portable biosensing platform for the quantitative detection of cocaine based on target-triggered glucose release from a TiO₂ nanotube array (TiNTA) with a glucometer readout.