1
|
Schubert B, Pitterl F, Saxl B, Pavlic M. A Novel Enzyme Immunoassay for the Detection of Buprenorphine, Norbuprenorphine and Their Glucuronides in Urine. J Anal Toxicol 2019; 43:364-368. [PMID: 30753557 DOI: 10.1093/jat/bkz003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 11/28/2018] [Accepted: 01/09/2019] [Indexed: 12/15/2022] Open
Abstract
Buprenorphine is a commonly used opioid in pain therapy as well as in opiate maintenance therapy. Immunoassays are quick and cost-effective methods for the necessary toxicological urine analysis of maintenance therapy patients. In this study a novel enzymatic immunoassay, the Thermo Fisher Scientific CEDIA Buprenorphine II assay (Bup2) was evaluated for the detection of buprenorphine, norbuprenorphine and their conjugated metabolites in human urine samples. The Bup2 assay has a cut-off of 10 ng/mL with ±25% controls, whereas the existing CEDIA Buprenorphine assay (Bup1) has a cut-off of 5 ng/mL and ±40% controls. Both assays were analyzed on a Thermo Scientific Indiko Plus benchtop analyzer. Seven-day precision studies of Bup2 assay demonstrated excellent precision of 7.2-10.6%. No crossover between control samples and the cut-off level were observed. Urine samples of 120 patients undergoing opiate maintenance therapy were collected. Immunoassay results of Bup1 and Bup2 were confirmed by gas chromatography mass spectrometry (GC/MS) for buprenorphine and norbuprenorphine as well as for their glucuronides. Comparison showed a specificity of 0.99 between the Bup2 assay and GC/MS, whereas the Bup1 assay had a specificity 0.70 due to 21 false positive samples. The reason is a known cross-reactivity of the Bup1 assay to opiate compounds. The Bup2 assay revealed one false positive result close to the cut-off value; no specific candidate possibly causing a cross-reaction was detected by GC/MS and liquid chromatography tandem mass-spectrometry (LC/MS/MS) methods. The data presented demonstrate an excellent correlation of the Bup2 assay to GC/MS, showing improved specificity and sensitivity when compared to the Bup1 assay. Thus, the Bup2 assay is highly suitable for urine testing, even for opiate maintenance patients receiving high doses of morphine.
Collapse
Affiliation(s)
- Birthe Schubert
- Institute of Legal Medicine, Medical University of Innsbruck, Muellerstrasse 44, Innsbruck, Austria
| | - Florian Pitterl
- Institute of Legal Medicine, Medical University of Innsbruck, Muellerstrasse 44, Innsbruck, Austria
| | - Barbara Saxl
- Institute of Legal Medicine, Medical University of Innsbruck, Muellerstrasse 44, Innsbruck, Austria
| | - Marion Pavlic
- Institute of Legal Medicine, Medical University of Innsbruck, Muellerstrasse 44, Innsbruck, Austria
| |
Collapse
|
2
|
Maas A, Madea B, Hess C. Confirmation of recent heroin abuse: Accepting the challenge. Drug Test Anal 2017; 10:54-71. [DOI: 10.1002/dta.2244] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/30/2017] [Accepted: 06/30/2017] [Indexed: 11/11/2022]
Affiliation(s)
- Alexandra Maas
- Department of Forensic Toxicology; University Bonn, Institute of Forensic Medicine; Bonn Germany
| | - Burkhard Madea
- Department of Forensic Toxicology; University Bonn, Institute of Forensic Medicine; Bonn Germany
| | - Cornelius Hess
- Department of Forensic Toxicology; University Bonn, Institute of Forensic Medicine; Bonn Germany
| |
Collapse
|
3
|
Hilario EY, Griffin ML, McHugh RK, McDermott KA, Connery HS, Fitzmaurice GM, Weiss RD. Denial of urinalysis-confirmed opioid use in prescription opioid dependence. J Subst Abuse Treat 2014; 48:85-90. [PMID: 25115135 DOI: 10.1016/j.jsat.2014.07.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 07/02/2014] [Accepted: 07/14/2014] [Indexed: 11/18/2022]
Abstract
Although research has generally supported the validity of substance use self-reports, some patients deny urine-verified substance use. We examined the prevalence and patterns of denying urinalysis-confirmed opioid use in a sample of prescription opioid dependent patients. We also identified characteristics associated with denial in this population of increasing public health concern. Opioid use self-reports were compared with weekly urinalysis results in a 12-week multi-site treatment study for prescription opioid dependence. Among those who used opioids during the trial (n=246/360), 44.3% (n=109) denied urinalysis-confirmed opioid use, although usually only once (78%). Overall, 22.9% of opioid-positive urine tests (149/650) were denied on self-report. Multivariable analysis found that initially using opioids to relieve pain was associated with denying opioid use. These findings support the use of both self-reports and urine testing in treating prescription opioid dependence.
Collapse
Affiliation(s)
- E Yvette Hilario
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, MA 02478, USA
| | - Margaret L Griffin
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - R Kathryn McHugh
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | | | - Hilary S Connery
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Garrett M Fitzmaurice
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA; Laboratory for Psychiatric Biostatistics, McLean Hospital, Belmont, MA 02478, USA; Department of Biostatistics, Harvard School of Public Health, Boston, MA 02115, USA
| | - Roger D Weiss
- Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, MA 02478, USA; Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA.
| |
Collapse
|
4
|
|
5
|
Hair: a complementary source of bioanalytical information in forensic toxicology. Bioanalysis 2011; 3:67-79. [PMID: 21175368 DOI: 10.4155/bio.10.171] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Hair has been used for years in the assessment and documentation of human exposure to drugs, as it presents characteristics that make it extremely valuable for this purpose, namely the fact that sample collection is performed in a noninvasive manner, under close supervision, the possibility of collecting a specimen reflecting a similar timeline in the case of claims or suspicion of a leak in the chain of custody, and the increased window of detection for the drugs. For these reasons, testing for drugs in hair provides unique and useful information in several fields of toxicology, from which the most prominent is the possibility of studying individual drug use histories by means of segmental analysis. This paper will review the unique role of hair as a complementary sample in documenting human exposure to drugs in the fields of clinical and forensic toxicology and workplace drug testing.
Collapse
|
6
|
Opioids and Derivatives. Clin Toxicol (Phila) 2010. [DOI: 10.3109/9781420092264-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
7
|
Kresina TF, Sylvestre D, Seeff L, Litwin AH, Hoffman K, Lubran R, Clark HW. Hepatitis infection in the treatment of opioid dependence and abuse. Subst Abuse 2008; 1:15-61. [PMID: 25977607 PMCID: PMC4395041 DOI: 10.4137/sart.s580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Many new and existing cases of viral hepatitis infections are related to injection drug use. Transmission of these infections can result directly from the use of injection equipment that is contaminated with blood containing the hepatitis B or C virus or through sexual contact with an infected individual. In the latter case, drug use can indirectly contribute to hepatitis transmission through the dis-inhibited at-risk behavior, that is, unprotected sex with an infected partner. Individuals who inject drugs are at-risk for infection from different hepatitis viruses, hepatitis A, B, or C. Those with chronic hepatitis B virus infection also face additional risk should they become co-infected with hepatitis D virus. Protection from the transmission of hepatitis viruses A and B is best achieved by vaccination. For those with a history of or who currently inject drugs, the medical management of viral hepatitis infection comprising screening, testing, counseling and providing care and treatment is evolving. Components of the medical management of hepatitis infection, for persons considering, initiating, or receiving pharmacologic therapy for opioid addiction include: testing for hepatitis B and C infections; education and counseling regarding at-risk behavior and hepatitis transmission, acute and chronic hepatitis infection, liver disease and its care and treatment; vaccination against hepatitis A and B infection; and integrative primary care as part of the comprehensive treatment approach for recovery from opioid abuse and dependence. In addition, participation in a peer support group as part of integrated medical care enhances treatment outcomes. Liver disease is highly prevalent in patient populations seeking recovery from opioid addiction or who are currently receiving pharmacotherapy for opioid addiction. Pharmacotherapy for opioid addiction is not a contraindication to evaluation, care, or treatment of liver disease due to hepatitis virus infection. Successful pharmacotherapy for opioid addiction stabilizes patients and improves patient compliance to care and treatment regimens as well as promotes good patient outcomes. Implementation and integration of effective hepatitis prevention programs, care programs, and treatment regimens in concert with the pharmacological therapy of opioid addiction can reduce the public health burdens of hepatitis and injection drug use.
Collapse
Affiliation(s)
- Thomas F Kresina
- Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Rockville, MD
| | - Diana Sylvestre
- Department of Medicine, University of California, San Francisco and Organization to Achieve Solutions In Substance Abuse (O.A.S.I.S.) Oakland, CA
| | - Leonard Seeff
- Division of Digestive Diseases and Nutrition, National Institute on Diabetes, Digestive, and Kidney Diseases, National Institutes of Health, DHHS, Bethesda, MD
| | - Alain H Litwin
- Division of Substance Abuse, Albert Einstein College of Medicine, Montefiore Medical Center Bronx, NY
| | - Kenneth Hoffman
- Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Rockville, MD
| | - Robert Lubran
- Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Rockville, MD
| | - H Westley Clark
- Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration, Rockville, MD
| |
Collapse
|
8
|
Dams R, Choo RE, Lambert WE, Jones H, Huestis MA. Oral fluid as an alternative matrix to monitor opiate and cocaine use in substance-abuse treatment patients. Drug Alcohol Depend 2007; 87:258-67. [PMID: 17008030 PMCID: PMC1892788 DOI: 10.1016/j.drugalcdep.2006.08.020] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2006] [Revised: 08/24/2006] [Accepted: 08/24/2006] [Indexed: 10/24/2022]
Abstract
Interest in oral fluid as an alternative matrix for monitoring drug use is due to its ease-of-collection and non-invasiveness; however, limited data are available on the disposition of drugs into oral fluid. The objective of this research was to provide data on the presence and concentrations of heroin, cocaine and multiple metabolites in oral fluid after illicit opioid and cocaine use. Thrice weekly oral fluid specimens (N=403) from 16 pregnant opiate-dependent women were obtained with the Salivette oral fluid collection device. Evidence of heroin (N=62) and cocaine (N=130) use was detected in oral fluid by LC-APCI-MS/MS. 6-Acetylmorphine (6-AM), heroin and morphine were the major opiates detected, with median concentrations of 5.2, 2.3, and 7.5 microg/L, respectively. Cocaine and benzoylecgonine (BE) had median concentrations of 6.4 and 3.4 microg/L. Application of the Substance Abuse Mental Health Services Administration (SAMHSA) recommended cutoffs for morphine and codeine (40 microg/L), 6-AM (4 microg/L) and cocaine and BE (8 microg/L), yielded 28 opiate- and 50 cocaine-positive specimens. Oral fluid is a promising alternative matrix to monitor opiate and cocaine use in drug testing programs. These data guide interpretation of oral fluid test results and evaluate currently proposed SAMHSA oral fluid testing cutoffs.
Collapse
Affiliation(s)
- Riet Dams
- Chemistry and Drug Metabolism, National Institute on Drug Abuse, 5500 Nathan Shock Drive, Baltimore, MD 21224, USA
- Laboratory of Toxicology, Ghent University, Harelbekestraat 72, B-9000 Gent, Belgium
| | - Robin E. Choo
- Chemistry and Drug Metabolism, National Institute on Drug Abuse, 5500 Nathan Shock Drive, Baltimore, MD 21224, USA
| | - Willy E. Lambert
- Laboratory of Toxicology, Ghent University, Harelbekestraat 72, B-9000 Gent, Belgium
| | - Hendree Jones
- Center for Addiction and Pregnancy, Johns Hopkins Bayview Medical Center, 4940 Eastern Avenue, Baltimore, MD 21224, USA
| | - Marilyn A. Huestis
- Chemistry and Drug Metabolism, National Institute on Drug Abuse, 5500 Nathan Shock Drive, Baltimore, MD 21224, USA
- * Corresponding author: Dr. Marilyn A. Huestis, Chemistry and Drug Metabolism Section, National Institute on Drug Abuse, 5500 Nathan Shock Drive, Baltimore, MD, 21224, U.S.A. Tel: +1 410 550 2711, Fax: +1 410 550 2971, E-mail:
| |
Collapse
|
9
|
Paterson S, Lintzeris N, Mitchell TB, Cordero R, Nestor L, Strang J. Validation of techniques to detect illicit heroin use in patients prescribed pharmaceutical heroin for the management of opioid dependence. Addiction 2005; 100:1832-9. [PMID: 16367984 DOI: 10.1111/j.1360-0443.2005.01225.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The clinical implementation and evaluation of heroin substitution programmes have been confounded by the lack of objective and validated biomarkers for illicit heroin use in patients prescribed pharmaceutical heroin. This study examined the capacity to detect illicit heroin use by gas chromatography-mass spectrometry (GC-MS) analysis of urine samples for the presence of opium impurities common to illicit, but not pharmaceutical heroin. AIMS To characterize the diagnostic properties of the metabolites of noscapine and papaverine in comparison to morphine as a gold-standard marker of illicit heroin use; and to examine the relationships between the self-reported time since most recent heroin use and the detection of these opioids in urine. DESIGN A cross-sectional study of 52 opioid-dependent patients in treatment (not prescribed heroin), who self-reported illicit heroin use within the preceding 2 weeks. Self-report data regarding recent drug use and a urine sample were collected. GC-MS analyses of urines were conducted and reported by laboratory staff blinded to self-report data. FINDINGS The metabolites of papaverine (hydroxypapaverine and dihydroxypapeverine) were found to have high sensitivity, specificity and negative predictive values as markers for illicit heroin use compared to the 'gold-standard' morphine. Other opioids, including 6-mono-acetylmorphine (6-MAM), codeine and noscapine metabolites (e.g. meconine) were less adequate in detecting heroin use. CONCLUSIONS GC-MS detection of papaverine metabolites in urine appears to be suitable method of identifying illicit heroin use for clinical and research purposes.
Collapse
Affiliation(s)
- S Paterson
- Toxicology Unit, Imperial College London, UK
| | | | | | | | | | | |
Collapse
|
10
|
Cristoni S, Cantu M, Bernardi LR, Gerthoux P, Mocarelli P, Brambilla M, Gonella E, Guidugli F. Surface-activated chemical ionization ion trap mass spectrometry in the analysis of drugs in dilute urine samples. Part II: analysis of morphine and other street drugs. JOURNAL OF MASS SPECTROMETRY : JMS 2005; 40:1609-17. [PMID: 16320295 DOI: 10.1002/jms.963] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The new ionization method, called surface-activated chemical ionization (SACI), was employed for the analysis of fives drugs (morphine, codeine, 6-monoacetylmorphine (6-MAM), benzoylecgonine and cocaine) by ion trap mass spectrometry. The results so obtained have been compared with those achieved by using atmospheric pressure chemical ionization (APCI), no-discharge-APCI and electrospray ionization (ESI) clearly showing that SACI is the most sensible one mainly due to the high ionization efficiency and the lower chemical noise. The performance of SACI in terms of sensitivity and linearity was compared with the sensitivity and linearity obtained using APCI, no-discharge-APCI and ESI, showing that the new SACI approach gives rise to the best results. Then, SACI was used to analyze morphine, codeine, 6-MAM, benzoylecgonine and cocaine in urine samples. After the optimization of the instrumental parameters for a mixture of the standard compounds, eight urine samples were analyzed. They were strongly diluted (1 : 20 and 1 : 100) in order to prevent the chromatographic column damage due to the matrix composition. Furthermore, the diluted urine samples were directly analyzed, without pretreatment, through LC-MS and LC-MS/MS, and the obtained results are reported.
Collapse
Affiliation(s)
- Simone Cristoni
- University of Milan, Centre for bio-molecular Interdisciplinary Studies and Industrial applications CISI, Via Fratelli Cervi 93, 20090 Segrate Milano, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Roberts DM, Meyer-Witting M. High-dose buprenorphine: perioperative precautions and management strategies. Anaesth Intensive Care 2005; 33:17-25. [PMID: 15957687 DOI: 10.1177/0310057x0503300104] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Buprenorphine has been in clinical use in anaesthesia for several decades. Recently, the high-dose sublingual formulation (Subutex, Reckitt Benckiser, Slough, U.K.) has been increasingly used as maintenance therapy in opioid dependence, as an alternative to methadone and other pharmacological therapies. Buprenorphine has unique pharmacological properties making it well suited for use as a maintenance therapy in opioid dependence. However, these same properties may cause difficulty in the perioperative management of pain. Buprenorphine is a partial opioid agonist, attenuating the effects of supplemental illicit or therapeutic opioid agonists. As a result of its high receptor affinity, supplemental opioids do not readily displace buprenorphine from the opioid receptor in standard doses. High-dose buprenorphine has an extended duration of action that prolongs both of these effects. The perioperative management of patients stabilized on high-dose buprenorphine and undergoing surgery requires consideration of the likely analgesic requirements. Where possible the buprenorphine should be continued. Pain management should focus on maximizing non-opioid analgesia, local anaesthesia and non-pharmacological techniques. Where pain may not be adequately relieved by these methods, the addition of a full opioid agonist such as fentanyl or morphine at appropriate doses should be considered, accompanied by close monitoring in a high dependency unit. In situations where this regimen is unlikely to be effective, preoperative conversion to morphine or methadone may be an option. Where available, liaison with a hospital-based alcohol and drug service should always be considered.
Collapse
Affiliation(s)
- D M Roberts
- Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland
| | | |
Collapse
|
12
|
Pavlic M, Libiseller K, Grubwieser P, Rabl W. Cross-reactivity of the CEDIA buprenorphine assay with opiates: an Austrian phenomenon? Int J Legal Med 2005; 119:378-81. [PMID: 15834736 DOI: 10.1007/s00414-005-0544-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2004] [Accepted: 03/29/2005] [Indexed: 11/24/2022]
Abstract
When testing the Microgenics CEDIA assay for immunological buprenorphine analysis, cross-reactivity between the buprenorphine reagents and opiates was observed at concentrations higher than 120 mg/l morphine, 320 mg/l methadone, 30 mg/l codeine, 60 mg/l dihydrocodeine and 520 mg/l morphine-3-glucuronide. The cross-reactivity with morphine has the greatest impact on routine screening as opiate maintenance therapy in Austria is also performed with slow-release oral morphine. The use of a second cutoff value of 30 mug/l for urine samples that are (immunologically) positive for opiates is therefore suggested, compared to the cutoff value of 5 microg/l proposed by the manufacturer.
Collapse
Affiliation(s)
- M Pavlic
- Institute of Legal Medicine, Innsbruck Medical University, Muellerstrabe 44, 6020 Innsbruck, Austria.
| | | | | | | |
Collapse
|
13
|
Scheidweiler KB, Cone EJ, Moolchan ET, Huestis MA. Dose-Related Distribution of Codeine, Cocaine, and Metabolites into Human Hair following Controlled Oral Codeine and Subcutaneous Cocaine Administration. J Pharmacol Exp Ther 2005; 313:909-15. [PMID: 15743923 DOI: 10.1124/jpet.104.082388] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Hair testing for the determination of drug exposure has many useful applications. Drug incorporated into hair can be found for extended periods following drug exposure. There are few controlled drug administration studies investigating drug distribution into human hair. Ten volunteers participated in a 10-week controlled cocaine and codeine administration study while residing in the secure research ward. Weekly hair samples were collected by electric razor. During the low-dose week (week 4), volunteers received 75 mg/70 kg cocaine subcutaneously and 60 mg/70 kg codeine orally on alternating days, a total of three doses for each drug. Similarly, during week 7, volunteers received three doses 150 mg/70 kg cocaine and 120 mg/70 kg codeine. Maximum hair concentrations (C(max)) were found 1 to 3 weeks after low and high doses. Dose-related C(max) values of cocaine, benzoylecgonine, ecgonine methyl ester, norcocaine, cocaethylene, and codeine were found following low and high doses. Hair analysis was performed using liquid chromatography tandem mass spectrometry. A positive linear relationship was found between total melanin content of hair and C(max) of codeine, cocaine, and metabolites following high dosing. This study demonstrated dose-related concentrations of cocaine and metabolites in human hair following controlled cocaine administration. These data are the first demonstrating melanin-related incorporation of cocaine and metabolites into human hair following controlled cocaine administration.
Collapse
Affiliation(s)
- Karl B Scheidweiler
- Chemistry and Drug Metabolism, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD 21224, USA
| | | | | | | |
Collapse
|
14
|
Abstract
Heroin, one of the most addictive and "hardest" drugs of abuse, carries significant morbidity and mortality. Although its use is usually associated with the adult population in the United States, the last decade has witnessed a decrease in the median age of heroin users. An increase in the availability of inexpensive and pure heroin that could be snorted rather than injected made the drug accessible to adolescents and reduced the fear associated with the transmission of the human immunodeficiency virus (HIV). Because of the atypical demographics and the alternative drug use patterns, this young population of heroin users is not easily identified by parents or by healthcare providers. Lack of social support or access to healthcare prevents young heroin users from participation in detoxification programs, suggesting that changes may be needed in our healthcare and social systems to properly target and provide care to the youngest heroin abusers.
Collapse
Affiliation(s)
- Asim F Tarabar
- New York University School of Medicine and New York City Poison Control Center, New York, New York, USA.
| | | |
Collapse
|
15
|
Dams R, Murphy CM, Lambert WE, Huestis MA. Urine drug testing for opioids, cocaine, and metabolites by direct injection liquid chromatography/tandem mass spectrometry. RAPID COMMUNICATIONS IN MASS SPECTROMETRY : RCM 2003; 17:1665-1670. [PMID: 12845594 DOI: 10.1002/rcm.1098] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
A sensitive and specific liquid chromatography/tandem mass spectrometry (LC/MS/MS) method for the simultaneous quantification of opioids, cocaine, and metabolites in urine was developed and validated. A 10-microL aliquot of urine was injected directly onto the LC/MS/MS system. The lack of sample preparation substantially reduced total analysis time. Separation was performed by reversed-phase chromatography with gradient elution for all analytes in 26 min. Atmospheric pressure chemical ionization (APCI) was a rugged and efficient ionization technique for basic drugs. Identification and quantification was based on selected reaction monitoring (SRM). Calibration, with deuterated internal standards, was performed by linear regression analysis (weighting factor 1/x). Limits of quantitation (LOQ) were established between 10-100 ng/mL and linearity was obtained up to a maximum of 10 000 ng/mL with an average correlation coefficient (R(2)) > 0.99. Analytical validation criteria for specificity, precision, accuracy, dilution integrity, matrix effect, and stability were fulfilled. The method proved to be simple and time efficient, and was applicable for illicit drug use monitoring and methadone treatment compliance in clinical research projects at the National Institute on Drug Abuse (NIDA).
Collapse
Affiliation(s)
- Riet Dams
- Chemistry and Drug Metabolism, National Institute on Drug Abuse, 5500 Nathan Shock Drive, Baltimore, MD 21224, USA
| | | | | | | |
Collapse
|
16
|
Maurer HH. Role of gas chromatography-mass spectrometry with negative ion chemical ionization in clinical and forensic toxicology, doping control, and biomonitoring. Ther Drug Monit 2002; 24:247-54. [PMID: 11897971 DOI: 10.1097/00007691-200204000-00007] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This paper reviews procedures for the detection or quantification of drugs, pesticides, pollutants, and/or their metabolites relevant to clinical and forensic toxicology, doping control, or biomonitoring using gas chromatography-mass spectrometry with negative ion chemical ionization (GC-MS-NICI). Papers written in English between 1995 and 2000 are reviewed. Procedures are included for the analysis of the following halogen-containing or derivatizable compounds in common biosamples, such as whole blood, plasma, or urine, and in alternative matrices such as sweat, hair, bone, or muscle samples of humans or rats: benzodiazepines, cannabinoids, opioids, acetylsalicylic acid, angiotensin-converting enzyme inhibitors, ketoprofen, methylphenidate enantiomers, tegafur, zacopride, anabolic steroids, chlorophenols, chlorpyrifos, hexachlorocyclohexanes, organochlorines, and polychlorinated biphenyls. The principal information on each procedure is summarized in three tables to facilitate the selection of a method suitable for a specific analytic problem.
Collapse
Affiliation(s)
- Hans H Maurer
- Department of Experimental and Clinical Toxicology, Institute of Experimental and Clinical Pharmacology and Toxicology, University of Saarland, D-66421 Homburg (Saar), Germany.
| |
Collapse
|