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Pragst F, Niebel A, Thurmann D, Dullin M, Eichberg S, Mörlein F, Hartwig S. Is there a relationship between abuse of alcohol and illicit drugs seen in hair results? Drug Test Anal 2024. [PMID: 38686500 DOI: 10.1002/dta.3702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 05/02/2024]
Abstract
Combined use of alcohol and illicit drugs is a serious health and social problem. In this study, it was examined, whether a relationship between alcohol and drug abuse can be ascertained by comparison of alcohol marker and drug concentrations in hair. In the frame of a social support system for families with parental abuse of illicit drugs, hair samples were analyzed between 2011 and 2022 for methadone, heroin (6-acetylmorphine), cocaine, amphetamine, ecstasy (MDMA), cannabinoids (THC), and the alcohol markers ethyl glucuronide (EtG) and ethyl palmitate (EtPa). For 1314 hair samples from adolescent and adult family members, the hair results show a prevalence of combined occasional or regular drug use and social or abusive alcohol use of 41%-60% except heroin (35%). The drug concentrations were statistically compared in the three categories of abstinence or moderate drinking, social drinking, and alcohol abuse. For the most frequently detected drug cocaine (n = 703), a significant increase of the concentrations with rising alcohol consumption was found. The frequent detection of cocaethylene proved the preferred simultaneous intake of both substances. For THC (n = 489), no significant difference between the alcohol consumer groups was seen. Concerning the less frequently detected methadone (n = 89), 6-acetylmorphine (n = 92), amphetamine (n = 123), and MDMA (n = 105), no clear trend between drug and alcohol marker results was determined. It is concluded that the evaluation of hair results is an appropriate way to study the extent of combined drug-alcohol consumption and complements other studies based on acquisition of consumption data by interview or questionnaire.
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Affiliation(s)
- Fritz Pragst
- Institute of Legal Medicine, University Medicine Charité, Berlin, Germany
| | - André Niebel
- Institute of Legal Medicine, University Medicine Charité, Berlin, Germany
| | - Denise Thurmann
- Institute of Legal Medicine, University Medicine Charité, Berlin, Germany
| | - Monique Dullin
- Institute of Legal Medicine, University Medicine Charité, Berlin, Germany
| | - Susann Eichberg
- Institute of Legal Medicine, University Medicine Charité, Berlin, Germany
| | - Frederike Mörlein
- Institute of Legal Medicine, University Medicine Charité, Berlin, Germany
| | - Sven Hartwig
- Institute of Legal Medicine, University Medicine Charité, Berlin, Germany
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2
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Ruiz MO, Rovnaghi CR, Tembulkar S, Qin F, Truong L, Shen S, Anand KJS. Linear hair growth rates in preschool children. Pediatr Res 2024; 95:359-366. [PMID: 37667034 DOI: 10.1038/s41390-023-02791-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 07/13/2023] [Accepted: 08/15/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Human scalp hair is a validated bio-substrate for monitoring various exposures in childhood including contextual stressors, environmental toxins, prescription or non-prescription drugs. Linear hair growth rates (HGR) are required to accurately interpret hair biomarker concentrations. METHODS We measured HGR in a prospective cohort of preschool children (N = 266) aged 9-72 months and assessed demographic factors, anthropometrics, and hair protein content (HPC). We examined HGR differences by age, sex, race, height, hair pigment, and season, and used univariable and multivariable linear regression models to identify HGR-related factors. RESULTS Infants below 1 year (288 ± 61 μm/day) had slower HGR than children aged 2-5 years (p = 0.0073). Dark-haired children (352 ± 52 μm/day) had higher HGR than light-haired children (325 ± 50 μm/day; p = 0.0019). Asian subjects had the highest HGR overall (p = 0.016). Younger children had higher HPC (p = 0.0014) and their HPC-adjusted HGRs were slower than older children (p = 0.0073). Age, height, hair pigmentation, and HPC were related to HGR in multivariable regression models. CONCLUSIONS We identified age, height, hair pigment, and hair protein concentration as significant determinants of linear HGRs. These findings help explain the known hair biomarker differences between children and adults and aid accurate interpretation of hair biomarker results in preschool children. IMPACT Discovery of hair biomarkers in the past few decades has transformed scientific disciplines like toxicology, pharmacology, epidemiology, forensics, healthcare, and developmental psychology. Identifying determinants of hair growth in children is essential for accurate interpretation of hair biomarker results in pediatric clinical studies. Childhood hair growth rates define the time-periods of biomarker incorporation into growing hair, essential for interpreting the biomarkers associated with environmental exposures and the mind-brain-body connectome. Our study describes age-, sex-, and height-based distributions of linear hair growth rates and provides determinants of linear hair growth rates in a large population of children. Age, height, hair pigmentation, and hair protein content are determinants of hair growth rates and should be accounted for in child hair biomarkers studies. Our findings on hair protein content and linear hair growth rates may provide physiological explanations for differences in hair growth rates and biomarkers in preschool children as compared to adults.
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Affiliation(s)
- Mónica O Ruiz
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
- Stanford Child Wellness Lab, Maternal & Child Health Research Institute, Stanford, CA, USA.
- Department of Pediatrics, Brown University School of Medicine, Rhode Island Hospital & Hasbro Children's Hospital, Providence, RI, USA.
| | - Cynthia R Rovnaghi
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Child Wellness Lab, Maternal & Child Health Research Institute, Stanford, CA, USA
| | - Sahil Tembulkar
- Stanford Child Wellness Lab, Maternal & Child Health Research Institute, Stanford, CA, USA
| | - FeiFei Qin
- Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, CA, USA
| | - Leni Truong
- Stanford Child Wellness Lab, Maternal & Child Health Research Institute, Stanford, CA, USA
| | - Sa Shen
- Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, CA, USA
| | - Kanwaljeet J S Anand
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Stanford Child Wellness Lab, Maternal & Child Health Research Institute, Stanford, CA, USA
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Steinhoff A, Shanahan L, Bechtiger L, Zimmermann J, Ribeaud D, Eisner MP, Baumgartner MR, Quednow BB. When Substance Use Is Underreported: Comparing Self-Reports and Hair Toxicology in an Urban Cohort of Young Adults. J Am Acad Child Adolesc Psychiatry 2023; 62:791-804. [PMID: 36731790 DOI: 10.1016/j.jaac.2022.11.011] [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: 03/29/2022] [Revised: 10/05/2022] [Accepted: 11/02/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Large-scale epidemiological research often uses self-reports to determine the prevalence of illicit substance use. Self-reports may suffer from inaccurate reporting but can be verified with objective measures. This study examined the following: the prevalence of illicit and non-medical substance use with self-reports and hair toxicology, the convergence of self-reported and objectively quantified substance use, and the correlates of under- and overreporting. METHOD The data came from a large urban cohort study of young adults (n = 1,002, mean age = 20.6 years, 50% female). The participants provided 3 cm of hair (covering the previous 3 months) and reported their illicit and non-medical substance use and their sociodemographic, psychological, and behavioral characteristics. Hair toxicology analyses targeted cannabinoids, ketamine, opiates/opioids, stimulants including 3,4-methylenedioxymethamphetamine, and relevant metabolites. RESULTS Self-reports underestimated the prevalence of most substances by 30% to 60% compared to hair tests. The average detection ratio (hair test/self-report) was 1.50. Hair tests were typically more sensitive than self-reports. Underreporting was associated with a low level of that substance in hair. Self-reported delinquency and psychopathology were correlated with an increased likelihood of concordant positive self-reports and hair tests compared to underreporting. Overreporting was associated with infrequent self-reported use. CONCLUSION Our study suggests that self-reports underestimate young adults' exposure to illicit substances and non-medical use of prescription drugs. Consequently, estimates of associations between substance use and risk factors or outcomes are likely biased. Combining self-reports with hair tests may be most beneficial in study samples with occasional substance use. Researchers can use specific factors (eg, detection ratios) to adjust prevalence estimates and correlations based on self-reports.
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Affiliation(s)
- Annekatrin Steinhoff
- Jacobs Center for Productive Youth Development, University of Zurich, Switzerland; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Switzerland
| | - Lilly Shanahan
- Jacobs Center for Productive Youth Development, University of Zurich, Switzerland
| | - Laura Bechtiger
- Jacobs Center for Productive Youth Development, University of Zurich, Switzerland
| | - Josua Zimmermann
- Psychiatric University Hospital Zurich, University of Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Switzerland
| | - Denis Ribeaud
- Jacobs Center for Productive Youth Development, University of Zurich, Switzerland
| | - Manuel P Eisner
- Jacobs Center for Productive Youth Development, University of Zurich, Switzerland; University of Cambridge, United Kingdom
| | - Markus R Baumgartner
- Centre for Forensic Hair Analytics, Zurich Institute of Forensic Medicine, University of Zurich, Switzerland
| | - Boris B Quednow
- Jacobs Center for Productive Youth Development, University of Zurich, Switzerland; Psychiatric University Hospital Zurich, University of Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich and Swiss Federal Institute of Technology Zurich, Switzerland.
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Rubicondo J, Scuffi L, Pietrosemoli L, Mineo M, Terranova F, Bartucca M, Trignano C, Bertol E, Vaiano F. A New Multi-Analyte LC-MS-MS Screening Method for the Detection of 120 NPSs and 49 Drugs in Hair. J Anal Toxicol 2023; 46:e262-e273. [PMID: 36453750 DOI: 10.1093/jat/bkac093] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 11/03/2022] [Accepted: 11/30/2022] [Indexed: 12/03/2022] Open
Abstract
Liquid chromatography coupled with mass spectrometry (LC-MS) has been increasingly used for screening purposes in forensic toxicology. High versatility and low time/resource consumption are the main advantages of this technology. Numerous multi-analyte methods have been validated in order to face the analytical challenge of new psychoactive substances (NPSs). However, forensic toxicologists must focus the attention also on "classical" NPSs and medicines, such as benzodiazepines (BDZs) and prescription opioids. In this paper, a new method for the simultaneous detection of 169 substances (120 NPSs and 49 other drugs) in hair by LC-MS-MS is described. After the decontamination of hair samples with dichloromethane, a 20-mg aliquot of the sample was mixed with 1 mL of methanol (MeOH; 0.1% of formic acid) and then sonicated at room temperature for 2 h. The mixture was then dried under nitrogen stream and reconstituted with 100 µL of MeOH. LC separation was achieved with a 100-mm-long C18 column in 35 min, and mass acquisition was performed in dynamic multiple reaction monitoring mode and in positive ionization. The analysis results were very sensitive, with the limit of quantification ranging from 0.07 to 10.0 pg/mg. Accuracy and precision were always within the acceptable criteria. Matrix effect and recovery rate ranges were from -21.3 to + 21.9% and from 75.0 to 99.3%, respectively. The new method was successfully applied in a preliminary study on the prevalence of NPSs, BDZs and other substances in case of driving license issuance. In 14% of cases, BDZs/antidepressants (mainly trazodone, diazepam/nordiazepam and flunitrazepam) were found. Codeine, ketamine, methylone and mephedrone were also detected.
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Affiliation(s)
- J Rubicondo
- Forensic Toxicology Unit, Department of Health Science, University of Florence, L.go Brambilla 3, Florence 50134, Italy
| | - L Scuffi
- Forensic Toxicology Unit, Department of Health Science, University of Florence, L.go Brambilla 3, Florence 50134, Italy
| | - L Pietrosemoli
- Forensic Toxicology Unit, Department of Health Science, University of Florence, L.go Brambilla 3, Florence 50134, Italy
| | - M Mineo
- Forensic Toxicology Unit, Department of Health Science, University of Florence, L.go Brambilla 3, Florence 50134, Italy
| | - F Terranova
- Forensic Toxicology Unit, Department of Health Science, University of Florence, L.go Brambilla 3, Florence 50134, Italy
| | - M Bartucca
- Forensic Toxicology Unit, Department of Health Science, University of Florence, L.go Brambilla 3, Florence 50134, Italy
| | - C Trignano
- Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43c, Sassari 07100, Italy
| | - E Bertol
- U.R.I.To.N.-Unit of Research, University of Florence, L.go Brambilla 3, Florence 50134, Italy
| | - F Vaiano
- Forensic Toxicology Unit, Department of Health Science, University of Florence, L.go Brambilla 3, Florence 50134, Italy.,U.R.I.To.N.-Unit of Research, University of Florence, L.go Brambilla 3, Florence 50134, Italy
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Aknouche F, Ameline A, Gheddar L, Maruejouls C, Kintz P. Fatal Rectal Injection of 3-MMC in a Sexual Context. Toxicological Investigations Including Metabolites Identification Using LC-HRMS. J Anal Toxicol 2022; 46:949-955. [PMID: 35767277 DOI: 10.1093/jat/bkac048] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/16/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
The dead body of a 59-year-old man was found at his home by his father. The subject was naked in the corridor, wearing a black hood and a collar around the neck where a dog leash was attached. An empty syringe was discovered in the decedent's rectal vein. The autopsy revealed marked asphyxia signs with no indication of violence or trauma. Femoral blood, urine and hair (4 cm, brown) were collected and submitted for comprehensive toxicological investigation. Initial screening did not indicate the presence of ethanol or any other over-the-counter or prescription pharmaceuticals. Routine toxicology screening by liquid chromatography-tandem mass spectrometry (LC-MS-MS) tentatively identified only the cathinone stereoisomer(s), 3-methylmethcathinone (3-MMC) or mephedrone (4-MMC). Analysis by GC-MS to distinguish between the isomers revealed the presence of 3-MMC, which was subsequently quantified by LC-MS-MS. Femoral blood and urine concentrations were 1437 ng/mL and 16733 ng/mL, respectively. In 4 x 1 cm hair segments, 3-MMC was detected at less than 10 pg/mg (LOQ). Further analysis by high-resolution mass spectrometry (LC-HRMS) allowed identification of two metabolites in both blood and urine: desmethyl-3-MMC and hydroxyl-3-MMC. The pathologist established the cause of death in this case as acute 3-MMC poisoning in the context of ChemSex.
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Affiliation(s)
| | - Alice Ameline
- Institut de médecine légale, 11 rue Humann, F-67000 Strasbourg, France
| | - Laurie Gheddar
- Institut de médecine légale, 11 rue Humann, F-67000 Strasbourg, France
| | | | - Pascal Kintz
- Institut de médecine légale, 11 rue Humann, F-67000 Strasbourg, France.,X-Pertise Consulting, 42 rue principale, F-67206 Mittelhausbergen, France
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