Does ADAM Need a Haircut? A Pilot Study of Self-Reported Drug Use and Hair Analysis in an Arrestee Sample

This article evaluates the potential impact that the use of hair analysis may have on the drug prevalence estimations derived from survey research that has relied upon urinalysis as an indicator of the accuracy of self-reported drug use. The paper reviews the history and nature of the DUF and ADAM programs, the relationship between self-report drug use and urinalysis results for arrestee populations, and the outcome of a pilot study employing hair assays in lieu of urinalysis. The author concludes that hair analysis may have a significant impact on the estimations of drug use for cocaine, heroin, and amphetamines and is less likely to have an effect on estimations of marijuana use. The author recommends consideration of periodic use of hair analysis within the ADAM system to more accurately and effectively monitor drug use.

Organochlorine contaminants in the hair of Iranian pregnant women

In the present study, the hair of pregnant women was sampled between November 2007 and January 2008 in Ahvaz and Noushahr cities and the countryside of Noushahr, Iran. They were analyzed for organochlorine pesticides (OCPs), such as dichlorodiphenyltrichloroethane (DDT) and its metabolites, hexachlorobenzene (HCB), α-, β-, and γ-hexachlorocyclohexane (HCH) isomers and seven polychlorinated (PCBs) congeners (IUPAC Nos. 28, 52, 101, 118, 138, 153 and 180). Significant differences between the concentrations of investigated pollutants were found between the locations (p<0.05). For HCHs, the γ-HCH isomer was measured at higher mean concentrations (6 ng g(-1) hair) compared to the β-HCH isomer (0.03 ng g(-1)), which generally is the most prevalent HCH in biological matrices. Very high mean concentrations of p,p'-DDT in countryside of Noushahr (24 ng g(-1)) combined with lower values (0.6) of ratio p,p'-DDE/p,p'-DDT in the hair samples suggest recent exposure to "fresh" DDT in this region. Significant differences in OCPs and PCBs were found between primiparous and multiparous mothers (p<0.05). There was no correlation between levels of OCPs and PCBs in the hair of Iranian pregnant women and their age. There was a significant difference (p<0.05) in the organochlorine levels, including HCHs, between mothers who have eaten fish once a week and those who consumed fish more than once per week in Noushahr.

Hair-biomonitoring of organic pollutants

This report reviews past research on hair analysis development for organic contaminants from the point of view of analytical procedures, successful applications and their limitations. For the past 20 years, hair analysis for organic pollutants has received more and more attention, since it is non-invasive, easily available and ethically not prioritized. New methods such as SFE, SPME and INAA have been developed to make the analysis more accurate and reliable. Furthermore, the correlation of contamination levels between hair samples and ambient air or internal tissues has been found by hair analysis and short-term and long-term exposure assessment in combination. However, there are still some limitations of hair analysis to be a validated risk assessment tool for many compounds. Some limitations had been of the past, some have not been fully investigated and need still further study. In this way, hair analysis can be the key to successfully biomonitor organic contaminations.

Hair analysis as a novel investigative tool for the detection of historical drug use/misuse in the horse: a pilot study

REASONS FOR PERFORMING STUDY

Analysis of human hair for drug residues is being used increasingly as a diagnostic tool in the investigation of drug use and abuse. Hair analysis is complementary to urine/blood testing in that it can provide an extensive historical record of drug use, is noninvasive, impersonal and can facilitate retesting. However, the technique has not been studied in horses.

HYPOTHESIS

That the systemic administration of drugs in horses could be identified by the detection of drug residues in hair.

OBJECTIVE

To evaluate hair analysis as a potential retrospective diagnostic test for drug administration in horses by studying the deposition of systemically administered drugs in tail hair.

METHODS

Tail hairs (n = 40-50) from 4 horses with known drug histories were washed, chopped into 3-5 mm fragments and extracted overnight, in 0.1 mol/l hydrochloric acid, prior to solid-phase extraction and analysis by high-performance liquid chromatography. Horse 1, a 3-year-old Thoroughbred colt (gastric ulcer), was treated for 14 days with omeprazole; Horse 2, a 3-year-old Thoroughbred colt (anaerobic infection), was treated for 5 days with metronidazole; Horse 3, an 8-year-old Thoroughbred gelding (sinusitis), was treated for 10 days with trimethoprim/sulphadiazine; and Horse 4, a 3-year-old Thoroughbred colt (respiratory infection), was treated for 5 days with procaine benzylpenicillin.

RESULTS

Omeprazole was not detected in tail hair. Metronidazole was detected in tail hair at a concentration of 0.57 ng/mg, trimethoprim and sulphadiazine at concentrations of 9.14 and 2.26 ng/mg, respectively, and procaine at a concentration of 1.66 ng/mg.

CONCLUSIONS

The data presented suggest that hair analysis may become a useable technique for the retrospective detection of drug administration in horses.

POTENTIAL RELEVANCE

This technique could ultimately be used as part of a prepurchase veterinary examination to identify misuse of anti-inflammatory and sedative drugs, in an in-training testing programme to identify use of anabolic agents, or to provide evidence to support post race blood or urine test results. Clearly, more extensive research will be required to evaluate the effectiveness of the technique over a much broader range of drugs.

Determination of tramadol in hair using solid phase extraction and GC-MS

Tramadol is a centrally acting synthetic analgesic with mu-opioid receptor agonist activity, it is a widely prescribed analgesic used in the treatment of moderate to severe pain and as an alternative to opiates. Tramadol causes less respiratory depression than morphine at recommended doses. Its efficacy and low incidence of side effects lead to its unnecessary prescribing in patients with mild pain. Tramadol was classified as a "controlled drug" long after its approval for use in Jordan. Analysis of drugs of abuse in hair has been used in routine forensic toxicology as an alternative to blood in studying addiction history of drug abusers. A method for the determination of tramadol in hair using solid phase extraction and gas chromatography-mass spectrometry (GC-MS) is presented, the method offers excellent precision (3.5-9.8%, (M)=6.77%), accuracy (6.9-12%, M=9.4%) and limit of detection 0.5 ng/mg. The recovery was in the range of 87-94.3% with an average of 90.75%. The calibration curve was linear over the concentration range 0.5-5.0 ng/mg hair with correlation coefficient of 0.998. The developed method was tested on 11 hair samples taken from patients using tramadol as prescribed by their physician along with other different drugs in treating chronic illnesses. Tramadol was detected in all hair samples at a concentration of 0.176-16.3 ng/mg with mean concentration of 4.41 ng/mg. The developed method has the potential of being applied in forensic drug hair testing. In Jordan, hair drug testing started to draw the attention of legal authorities which stimulated forensic toxicologists in recent years to develop methods of analysis of drugs known or have the potential to be abused.

The validity of drug use self-reports among hard core drug users in a household survey in Puerto Rico: comparison of survey responses of cocaine and heroin use with hair tests

The extent to which underreporting of drug use in household surveys affects the validity of epidemiological studies of drug use disorders is largely unknown. We developed a list of known hard core drug users as part of a larger household study in Puerto Rico. The known drug users were recruited and interviewed with the same procedures used for the respondents selected through area-probability sampling. Upon completion of the interview, subjects were asked to provide a sample of scalp hair. A total of 78 hair specimens were collected from the known drug users. Hair specimens were screened for cocaine and heroin using radio immunoassay, and confirmed using gas chromatography/mass spectrometry. Using the cutoff of 0.2 ng/mg of hair, 93.2% of the hair specimens were classified positive for cocaine and 75.7% for heroin. With the hair test results as the gold-standard, we calculated specificity and sensitivity statistics as measures of the validity of self-reports. Self-reports of drug use in the past 3 months had a specificity of 78% or higher for both drugs. The sensitivity of self-reports was 69.6% for reports of recent cocaine use and 78.6% for reports of recent heroin use. Sensitivity increased with reports of use in more remote time periods, among subjects reporting DSM-IV drug disorder symptoms, and among those reporting use of both drugs. The results suggest that while drug reports of hard core drug users interviewed in household surveys might be more valid than those of the general population, there still remains considerable under-reporting.

Polysubstance use among alcoholics

Contemporary alcoholics often use multiple substances, but there is little systematic research on this. This study examines the drug use comorbidity of alcoholics (DSM diagnosis, frequency and quantity of drug use); the relationship between drinking and drug use; the relative severity of alcohol- and drug-related problems; and the validity of reports of illicit drug use. Data on substance use were collected from 248 treatment-seeking alcoholics using an expanded Time-line Follow-Back (TLFB) interview. Self-reports of substance use were validated with data from biological specimens (urine and hair). Lifetime diagnosis of joint alcohol and drug dependence/abuse was 64%. Two-thirds (68%) reported using drugs in the past 90 days: 33% powder cocaine; 29% crack cocaine; 15% heroin, and 24% cannabis. The mean proportions of exposed days on which users reported consuming a substance were 57% (alcohol), 26% (powder cocaine), 46% (crack cocaine), 47% (heroin), and 29% (cannabis). Subjects reported consuming an average of 14 standard drinks on a drinking day and $67 worth of drugs on a using day. Drug users reported drinking less than nonusers on a drinking day. Frequency of drinking and drug use were positively correlated; almost all drug users reported simultaneous drinking and drug use; and they rated drugs as the bigger problem. Considerable under-reporting of drug use occurred for the previous 3-4 days, but was more accurate for the previous month.

Estimates of illicit drug use during pregnancy by maternal interview, hair analysis, and meconium analysis

OBJECTIVE

To compare the sensitivity and specificity of maternal interview, maternal hair analysis, and meconium analysis in detecting perinatal exposure to cocaine, opiate, and cannabinoid.

DESIGN/METHODS

The use of cocaine, opiate, and cannabinoid during pregnancy was determined prospectively in 58 women by 3 methods: structured maternal interview, maternal hair analysis, and meconium analyses. The results of the 3 methods were compared with one another.

RESULTS

The maternal interview showed the lowest sensitivity in detecting cocaine and opiate exposures (65% and 67%, respectively), but it had the highest sensitivity in detecting cannabinoid exposure (58%). Both hair and meconium analyses had high sensitivity for detecting cocaine or opiate exposures. Hair analysis had a sensitivity of 100% for cocaine and 80% for opiate detection. However, it had a false-positive rate of 13% for cocaine and 20% for opiate, probably as a result of passive exposure. Meconium analysis had a sensitivity of 87% for cocaine and 77% for opiate detection, but unlike hair analysis, it had no false-positive test results for cocaine. Both hair and meconium analyses had low sensitivity in detecting cannabinoid exposure (21%-22.7%), most probably because of the sporadic use of cannabinoid.

CONCLUSION

Meconium and hair analyses had the highest sensitivities for detecting perinatal use of cocaine and opiate, but not for cannabinoid. The principal drawback of hair analysis is its potential for false-positive test results associated with passive exposure to drugs. Maternal interview is a time-consuming test of low sensitivity. The high sensitivity of meconium analysis and the ease of collection make this test ideal for perinatal drug screening.

Hair analysis by immunological methods from the beginning to 2000

Immunoassays for hair testing must satisfy three requirements: (1) They must have cross-reactivity with parent drug and lipophilic metabolites actually found in hair (2) they must not experience interference from the dissolved hair matrix and (3) they must be titered for cutoffs appropriate to the drug concentrations found in hair. Because the analytes found in hair after drug use are generally the parent drug or its lipophilic metabolites, immunoassays developed and intended for urine testing are not suitable for hair. Immunoassays whose antibodies are bound to a solid support, such as coated-tube radioimmunoassay or coated-plate ELISA tests, experience less matrix interference than those which use other means of separation of bound and free fractions. Homogenous assays are not suitable for hair testing because the hair matrix frequently interferes in the detection of the signal. Historically radioimmunoassays for drugs of abuse were first used for detecting drugs in hair. Currently ELISAs and coated-plate 96 well microplate EIAs are employed for screening hair digests or extracts for drugs. The optimum cutoffs for immunoassays for drugs in hair should be chosen based on the analyte concentration which produces the fewest false positive or false negative results when applied to tests of hair from known users and non-users of drugs. A hair immunoassay test at these cutoffs should have a sensitivity and specificity of better than 90%. The predictive value of the test will depend on the prevalence of drug use in the tested population. Cutoffs or decision thresholds for immunoassays used for screening for drugs should not be at the limit of detection of the assay because that produces a very large incidence of false positives. Because immunoassays are ligand-binding assays, they have a short range of linearity with low precision at both ends of the range. In the future, immunoassays will continue to be used for screening hair and other matrices for drugs of abuse because they provide rapid, inexpensive automated procedures for separating negative specimens from those which are suspected of containing drugs. For forensic purposes, all positive results must be confirmed by an independent analysis using a procedure based on a different property of the analyte. An immunoassay test should not be confirmed by a second immunoassay test but by a chromatographic test performed on a different dissolved or extracted aliquot of the original specimen.

Analytical strategy for detecting doping agents in hair

Lists of banned classes of doping agents are released by the International Olympic Committee, adopted by other sports authorities and updated regularly, including the substance classes stimulants, narcotics, diuretics, anabolic agents, peptide hormones, beta-blockers etc. There are different classes of restriction: anabolic and masking agents (anabolic steroids, diuretics etc.) are always banned for athletes regardless of their topical activity (training or competition) several substances are permitted with certain restrictions (caffeine below a cut-off value, or inhalation of some beta 2 agonists) beta-blockers are prohibited in competitions of certain sports disciplines the majority of the substances (stimulants, narcotics etc.) is prohibited during competitions, so that they do not have to be analysed in out-of-competition samples. A differentiation between training and competition period is impossible by means of hair analysis due to the uncertainty of (especially short-term) kinetic considerations related to hair growth. Therefore, the analytical identification of doping relevant substances in hair is not always a sufficient criterion for a doping offence and the identification of stimulants, beta-blockers etc. in hair would be entirely irrelevant. The most interesting target substances are certainly the anabolic agents, because their desired action (enhanced muscle strength) lasts longer than the excretion, leading to sophisticated procedures to circumvent positive analytical results in competition control. Besides the analysis of out-of-competition control samples, the long term detection of steroids in hair could provide complementary information. An analytical approach to the identification of exogenous steroids in hair requires consideration of the presence of many other steroids in the hair matrix interfering the analysis at trace levels, and of a limited chemical stability. The analysis of endogenous steroids in hair appears to be even more complicated, because the possibility of many biotransformation reactions from (into) other precursors (metabolites) has to be taken into account. Precursor substances of anabolic steroids (especially esters as application forms) are very promising analytical targets of hair analysis, because they can only be detected after an exogenous intake. The quantitative evaluation of active parent compounds like testosterone (which is actively involved in physiological processes of hair growth) in hair is still controversial. Clinical applications under reproducible conditions can be useful, but the biovariability of these parameters will probably prevent the definition of acceptable cut-off levels as a criterion of abuse.

Hair analysis for abused and therapeutic drugs

This review focuses on basic aspects and recent studies of hair analysis for abused and therapeutic drugs and is discussed with 164 references. Firstly, biology of hair and sampling of hair specimens have been commented for the sake of correct interpretation of the results from hair analysis. Then the usual washing methods of hair samples and the extraction methods for drugs in hair have been shown and commented on. Analytical methods for each drug have been discussed by the grouping of three analytical methods, namely immunoassay, HPLC-CE and GC-MS. The outcomes of hair analysis studies have been reviewed by dividing into six groups; morphine and related, cocaine and related, amphetamines, cannabinoids, the other abused drugs and therapeutic drugs. In addition, reports on stability of drugs in the living hair and studies on drug incorporation into hair and dose-hair concentration relationships have been reviewed. Applications of hair analysis to the estimation of drug history, discrimination between OTC drug use and illegal drug use, drug testing for acute poisoning, gestational drug exposure and drug compliance have also been reviewed. Finally, the promising prospects of hair analysis have been described.

Immunological screening of drugs of abuse and gas chromatographic-mass spectrometric confirmation of opiates and cocaine in hair

The work presents an analytical strategy to detect drugs of abuse in hair. It involves two sequential steps: a screening by a simple enzyme-linked immunosorbent assay (ELISA) methodology to detect opiates, cocaine and its metabolites, and benzodiacepines, followed by confirmation of opiates and cocaine metabolites in positive samples by gas chromatography coupled to mass spectrometry (GC-MS). In the same GC-MS run other drugs for substitution therapy (e.g. methadone and its main metabolite) can also be detected. After a double washing of hair samples with dichloromethane, hair specimens were cut into small pieces and 10 mg samples were incubated in 2 ml of methanol-trifluoroacetic acid (9:1) mixture, overnight at 37 degrees C. Aliquots of the extract were then evaporated, reconstituted in buffer and analysed according to the ELISA procedure. Confirmation involved solid-phase extraction of another fraction of the extract kept at -20 degrees C, derivatization with heptafluorobutyric anhydride and hexafluoroisopropanol and detection of cocaine, benzoylecgonine, ecgonine methylester, cocaethylene, morphine, codeine, 6-monoacetylmorphine, methadone and 2-ethylidene-1.5-dimethyl-3,3-diphenylpirrolidine (methadone metabolite) by selective ion monitoring after gas chromatographic separation. During the development of the method it was verified that no more than 10% of cocaine, opiates and benzodiacepines were lost when dichloromethane was used to wash real samples. The results also confirmed the increase of extractability power of TFA when it was added to methanol: the recovery for the analytes (cocaine and its metabolites and opiates) added to methanol-TFA alone was of the order of 90% except for benzoylecgonine (75%), and the recovery for the analytes added to methanol-TFA extract of drug-free hair was about 90% for all analytes except for benzoylecgonine and 6-MAM (around 70%). Regarding the stability of labile compounds, only small amounts of ecgonine methylester (2.3%) and morphine (7.2%) were produced, from cocaine and 6-MAM respectively, after the whole extraction procedure and two weeks of storage of methanol-TFA extracts at -20 degrees C. Satisfactory results were obtained when the procedures were applied to the analysis of external proficiency testing hair samples and actual specimens from drug addicts.

The measurement of morphine in the hair of heroin abusers

Several techniques have been described for the determination of morphine in hair as a method of monitoring past heroin use. However, although some of the techniques [notably radioimmunoassay (RIA)] may appear relatively simple to perform, any results obtained must be interpreted with caution. In this study, hair specimens from four known heroin abusers were sectionally analysed by a specific RIA for morphine. Prior to analysis, all hair sections were cleaned to remove any possible surface contamination. Five different hair digestion procedures were evaluated to determine the most effective method that could be used to liberate morphine from hair. The greatest analytical recovery was obtained by incubation with 1.0 M sodium hydroxide for 18 h at 55 degrees C, neutralization with 1.0 M hydrochloric acid, and pH adjustment with 0.1 M phosphate buffer (pH 7.0). The morphine concentrations detected in the hair specimens ranged from 0.5 to 13.2 ng/mg of hair. It was also found that the use of shorter length segments (e.g. 1 cm length) gave a clearer, more detailed picture of the historic pattern of heroin use in the four subjects studied.

Cocaine use during pregnancy: sensitive detection by hair assay

OBJECTIVES

This paper compares the sensitivity of two tests of cocaine use, interview and urine test, with that of a radioimmunoassay of hair.

METHODS

Interviews and hair samples were provided by 397 obstetric patients in one New York City hospital; urine samples were obtained in 377. Of these patients, 241 were receiving prenatal care (were registered) and 156 delivered without prenatal care (were unregistered). The 241 registered patients were derived from 400, comprising all reporting use of cocaine ever ("ever-users"), all reporting use by the father but not themselves ("lifestylers"), and a sample of women who were neither ever-users nor lifestylers. The 156 unregistered patients were derived from 352 women interviewed at delivery, unselected for reported use.

RESULTS

Thirty-two percent reported ever using cocaine, 45% of these within 6 months before interview. Urine tests were positive in 20%, hair tests in 59%. The estimated sensitivity of the hair test (92%) was 3.1 times higher than that of the urine test (95% confidence interval [CI] = 2.5, 3.8) and 4 times higher than that of reported use in the past 6 months (95% CI = 3.2, 5.0).

CONCLUSIONS

Self-report and urine tests alone miss most of cocaine users during pregnancy. Hair tests greatly improve detection and thus can enhance evaluations of the effects of prenatal cocaine use on fetal and child development.

Experience with hair testing in the clinical biochemistry laboratory of Ca' Granda Niguarda Hospital, Milan, Italy

In our laboratory, analysis of human hair for drugs of abuse detection was first performed in 1980. In the last 10 years we have processed about 2000 subjects/year ('living subjects' only). In the last 3 years we have also introduced hair analysis of cocaine: at first only in clinical applications, but for the last 2 years this analysis is now routine. Our application of hair analysis includes: clinical toxicology, medico-legal and administrative agencies. Requests come for example from several Committees for Driving Licenses, Addiction Treatment Centers and Legal Authorities. Hair samples are currently collected from the occipital area at the back of the head, which appears to show less variability in hair growth rate. At present we perform hair analysis using highly sensitive radioimmunoassay screening methods for the detection of parent drug and/or metabolites. All positive cases of cocaine and opiates abuse are confirmed by gas chromatography-mass spectrometry in electron impact or chemical ionization mode. Positive cases for opiates are also analysed using a specific morphine radioimmunoassay kit. Data show that, when the opiates/morphine ratio is higher than 6, we are dealing with consumption of codeine and/or dihydrocodeine. In our routine work last year there were 177 (263 samples) positive opiates subjects out of 2244 patients; positive cocaine subjects were 290 (362 samples) out of 2001 patients. Guidelines for hair analysis in Lombardia have been established based on the experience of our laboratory. Furthermore it will be possible to apply a unique protocol for all Committees for Driving Licenses, involving hair testing in addition to urine assay.

Influence of sample preparation on analytical results: drug analysis [GC/MS] on hair snippets versus hair powder using various extraction methods

The comparison of aqueous extraction methods and hair extraction by organic solvents performed on hair powder as well as on hair snippets of the same sample revealed different qualities of the procedures. Qualitative and quantitative results by the same derivatization step and GC/MS detection demonstrated, that the risk of missing a drug substance is higher using hair snippets than after drug extraction on pulverised hair. Drug recovery for opiates, cocaine and benzoylecgonine from hair was found to be best in aqueous solvents or in methanol extracts. The results are discussed under the aspects of solid-phase extraction, the hair sample representing an inhomogenous material. The localisation of drug molecules in hair, the hair swelling and penetration behavior of the particular extraction medium as well as the partition coefficient of solvent/hair phase for a particular drug substance are considered to influence the results.

An assessment of the routes of incorporation of opiates into beard hair after a single oral dose of codeine

The time course of appearance of immunoreactive opiates was monitored in saliva, sweat, and beard hair in six healthy whites who were not opiate users after oral administration of 60 mg of codeine phosphate. The opiate concentration in saliva peaked within 30 min of drug administration and returned to near the predose level within 24 h. Ninety-one percent of the total secretion of opiates in sweat was collected by the skin-collection patch worn during the first 24 h after drug administration. Detectable material was also present in sweat patches on the following 2 days. Opiates were detected in extracts of alkali digests of beard hair in all subjects on the day after drug administration. Hair concentration peaked on day 3 after dosing and then decreased continuously until day 8. From day 8 until the end of the experiment on day 14, beard hair contained opiate concentrations significantly greater than the predose level. From comparison with cotinine pharmacokinetics, it is proposed that an early and the largest transfer of opiates into beard hair is through sweat. Transfer during hair growth is secondary and of comparable importance to a newly identified contribution of long duration that may involve transfer from storage depots within skin.

Evidence for saturable incorporation of methadone into rat hair: relationships among oral dose, plasma concentration, and hair content

Six groups of six male Wistar rats were administered methadone in their drinking water over the concentration range 0-0.25 mg/ml. Hair and trunk blood samples were collected after a 6-week period of drug administration. Immunoreactive methadone was measured by radioimmunoassay and methadone and its major metabolite, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidene (EDDP), by gas chromatography in plasma and alkali digests of hair. Plasma methadone concentration increased with increasing oral dose. The mean hair concentration of methadone increased to a maximum of 5.1 ng/mg at a drinking water concentration of 0.1 mg/ml corresponding to a plasma level of 14.0 ng/ml. No further significant rise in hair content was seen with higher drinking water concentrations despite a continuing increase in oral drug intake and in plasma methadone concentration. EDDP was not detected in plasma but was present at > 2 ng/mg in 25% of hair samples. The mean EDDP concentration in hair peaked at 3.2 ng/mg at the lowest dose level of methadone administered. The data suggest that methadone is incorporated into rat hair via a capacity-limited process that becomes saturated at plasma levels of some 14 ng/ml. Competition for uptake into hair between methadone and EDDP may occur.

Validity of self-reported drug use in high risk populations: a meta-analytical review

Research involving drug users and treatment evaluations continue to rely extensively on self-reports of drug use. This paper presents a meta-analytical review of 24 studies published since 1985 that examined the validity of drug self-reports in high risk populations. Only studies employing a biological criterion of validity (e.g., urinalysis, hair analysis) are included. Coefficients of chance-corrected agreement between self-reports and the validity criteria are calculated from published data to facilitate cross-study comparisons. The median conditional kappa (kappa c) was .42, considerably below the level of kappa c = .80 that represents acceptable reporting accuracy. The magnitude of drug use underreporting documented in this review could seriously bias prevalence estimates and treatment outcome studies.

The effect of chronic cocaine exposure during pregnancy on maternal and infant outcomes in the rhesus monkey

To explore the effects of gestational cocaine exposure in a nonhuman primate model, pregnant rhesus monkeys were treated from about 1 month of gestation until term with either 0 (N = 3), 0.3 (N = 3), 1.0 (N = 3), or escalating doses up to 8.5 (N = 3) mg/kg (IM), three times per day, 5 consecutive days per week. Despite these differences in cocaine exposure, the experimental groups did not differ significantly with respect to maternal outcome, as measured by body weight gain during pregnancy and length of pregnancy. A clear dose-response relationship was observed between the cumulative dose of cocaine administered during gestation and the levels of both cocaine and its major metabolite, benzoylecgonine, in samples of infant hair taken at birth. However, the experimental groups did not differ significantly with respect to infant outcome, as measured at birth by body weight, overall length, crown-to-rump length, rump-to-heel length, biparietal diameter, and crown circumference. Furthermore, the experimental groups did not differ significantly with respect to the integrity of a variety of infant reflexes tested at birth. It was concluded that, in a rhesus monkey model, chronic cocaine exposure during pregnancy had no significant effect on maternal and infant outcomes as assessed in this investigation.

Measuring Cocaine Use by Hair Analysis among Criminally-Involved Youth

The study examined the utility of hair analysis for determining the prevalence of cocaine use in a high-risk population. Personal interviews and scalp hair specimens were obtained from 121 male youths who had been in jail in New York City and were followed-up in the community after their release. Using the standard cutoff, 51% of the hair specimens were classified positive for cocaine at a mean concentration of 87.6 nanograms per 10 milligrams of hair. Using the detection limit of the test, 67% were positive for cocaine. Only 23% of the youths reported any use of cocaine or crack during the previous 3 months and only 36% reported any lifetime use, indicating a substantial rate of underreporting. Associations were found between cocaine in hair and several behavioral variables: number of prior arrests ( p=.08, trend), rearrest after release from jail ( p<.05), not continuing education ( p<.01), and no legal employment ( p<.01). Hair analysis is a promising new epidemiological tool for obtaining more valid measures of illicit drug use in difficult-to-study populations.

Radioimmunoassay of drugs of abuse in hair. Part 2: The determination of methadone in the hair of known drug users

This communication addresses the analytical problems associated with the analysis of hair specimens from known users and misusers of the synthetic opioid methadone. An adapted radioimmunoassay and a previously developed preanalytical decontamination procedure have been applied to samples from known drug users. The removal of drugs from the hair surface by washing and the effect of proprietary hair treatments on methadone entrapped in the hair have also been investigated. Pre-analytical washing reduced methadone levels by up to 29%, whilst hair colouration and peroxide bleaching were found to reduce levels by up to 21% and 50% respectively. Methadone assay of extracts from dated hair segments were shown to provide long-term histories of methadone intake, under controlled and non-controlled conditions. Evidence that a dose relationship between hair drug levels and intake may exist is presented. Results of hair analysis, expressed as ng methadone/mg hair, from drug users (range 0.20-10.63) are compared to a pre-determined cut-off of 0.1 ng methadone/mg hair, obtained from the analysis of a known drug free population (n = 23).

Analytical procedures for determination of opiates in hair: a review

This article reviews the analysis of opiates in hair. Hair matrix pretreatment, hydrolysis, extraction and detection procedures are presented amongst a study of over 70 bibliographic data. In addition, a new method for the extraction of opiates from hair, in which a powdered sample of hair is extracted directly by subcritical fluid, is presented.

The determination of cocaine in hair: a review

The explosion of literature related to the analysis of hair for cocaine and its products is reviewed. In the commonly accepted applications of hair testing for cocaine, those related to criminal or civil investigations and pharmacotoxicologic studies occupy most of the relevant published work. This review uses detailed, 'binary' (yes/no) tables to demonstrate trends in the literature, and allows researchers and caseworkers quick access to the literature most important for answering a variety of questions.

Simultaneous assay of cocaine, heroin and metabolites in hair, plasma, saliva and urine by gas chromatography-mass spectrometry

As part of an ongoing research program on the development of drug detection methodology, we developed an assay for the simultaneous measurement of cocaine, heroin and metabolites in plasma, saliva, urine and hair by solid-phase extraction (SPE) and gas chromatography-mass spectrometry (GC-MS). The analytes that could be measured by this assay were the following: anhydroecgonine methyl ester; ecgonine methyl ester;. ecgonine ethyl ester; cocaine; cocaethylene; benzoylecgonine; cocaethylene; norcocaethylene; benzoylnorecgonine; codeine; morphine; norcodeine; 6-acetylmorphine; normorphine; and heroin. Liquid specimens were diluted, filtered and then extracted by SPE. Additional handling steps were necessary for the analysis of hair samples. An initial wash procedure was utilized to remove surface contaminants. Washed hair samples were extracted with methanol overnight at 40 degrees C. Both wash and extract fractions were collected, evaporated and purified by SPE. All extracts were evaporated, derivatized with N,O-bis(trimethylsilyl)trifluoroacetamide (BSTFA) with 1% trimethylchlorosilane (TMCS) and analyzed by GC-MS. The limit of detection (LOD) for cocaine, heroin and metabolites in biological specimens was approximately 1 ng/ml with the exception of norcodeine, normorphine and benzoylnorecgonine (LOD = 5 ng/ml). The LOD for cocaine, heroin and metabolites in hair was approximately 0.1 ng/mg of hair with the exception of norcodeine (LOD = 0.3 ng/mg) and normorphine and benzoylnorecgonine (LOD = 0.5 ng/mg). Coefficients of variation ranged from 3 to 26.5% in the hair assay. This assay has been successfully utilized in research on the disposition of cocaine, heroin and metabolites in hair, plasma, saliva and urine and in treatment studies.

Radioimmunoassay of drugs of abuse in hair. Part 1: Methadone in human hair, method adaptation and the evaluation of decontamination procedures

A method suitable for the determination of methadone in human hair is presented. Adaptation and evaluation of a solid-phase I125 radioimmunoassay, designed for the quantitative measurement of methadone in urine, and development of a pre-analytical wash procedure has enabled a specific, sensitive and accurate analytical procedure to be developed. The specificity of the antiserum towards other drugs or biologically active compounds is evaluated up to a concentration of 100,000 ng ml-1 and accuracy covering a range of 0-450 ng ml-1 is found to be within 6% of expected methadone concentrations prepared in both drug free hair extract and urine. Inter-assay relative standard deviation (RSD) at concentrations of 5.1, 76.0 and 247 ng ml-1 methadone are 5.5, 2.5 and 3.6% respectively (n = 10) and intra-assay RSD at concentrations 2.3, 25.2 and 217 ng ml-1 are 5.3, 3.6 and 6.8% (n = 5). The limit of detection is 0.5 ng ml-1. Extraction of control drug free hair samples spiked with methadone at concentrations of 100, 250 and 400 ng ml-1 achieved recoveries of 86, 80 and 89%, respectively. Control hair samples contaminated with methadone are examined under differing wash procedures to assess their effectiveness in the removal of methadone contaminant. A suitable pre-analytical wash regime is proposed for removal of contaminant derived from external or environmental sources. The mechanics of the wash action and contaminant application to the hair is discussed. It is concluded that the adapted radioimmunoassay and developed pre-analytical decontamination procedure is a suitable technique to employ for the measurement of methadone in human hair, be it prescribed or abused, with concentrations expressed as ng methadone per mg hair.

Subcritical fluid extraction of opiates in hair of drug addicts

Hair analysis is a useful complement to blood and urine analysis in forensic science, but current procedures are tedious and time consuming. Owing to the difficulty of having a sufficient amount of hair in order to perform the optimization of the extraction method, standard hair was made and the procedure is described. The spiking method is reproducible and linearity can be obtained. Subcritical fluid extraction of opiates from standard and drug addicts' hair was optimized (extraction phase composition, extraction time, etc.) and compared with other extraction techniques (basic and acid hydrolysis, organic solvent and enzymatic digestion) followed by solid-phase extraction. Recovery, coefficient of variation, linearity, detection limits and quantification limits for the subcritical fluid extraction of opiates in hair are described.

Drug Use among Juvenile Arrestees: A Comparison of Self-Report, Urinalysis and Hair Assay

Interviews, urinalysis, and hair assay were conducted with eighty-eight juvenile arrestees in Cleveland over a two-month period. Hair assay revealed that fifty of the eighty-eight subjects (56.8%) had used cocaine; concentration levels were generally moderate to high. In sharp contrast, urinalysis results identified only seven subjects (8%) as having recently used cocaine. Crosstabulations of urinalysis and sectioned hair assay results indicate that the two detection methods are in greatest concordance for subjects who were heavy users of cocaine and who used cocaine in the last thirty days (as determined by hair assay). Even for these subjects, however, concordance is modest. The data show that self-reports of drug use yield severe underestimates of the prevalence of cocaine use in this population. Implications of the general lack of concordance of the two testing methods are discussed, especially in terms of intervention.

Analytical requirements, perspectives and limits of immunological methods for drugs in hair

The analytical requirements for analysis of drugs in hair are sensitivity in the range of picograms per milligram of hair, specificity for lipophilic drugs and absence of matrix effects with hair digests. These requirements are met by immunoassays which are also inexpensive, rapid and easy to use. However, in applying immunoassays to hair testing, certain limitations of the assay and of interpretation of assay results should be kept in perspective. These limitations are illustrated in this review with examples of the analysis of opiates in hair from patients and opiate addicts. The first requirement for immunological analysis of hair digests is that the digest must not denature the antibody proteins of the immunoassay reagents. For this reason enzymatic digests are better for immunological assay than chemical digests. Strongly acidic or alkaline digests must be brought to a neutral pH before immunoassay. Immunoassays used for analysis of hair should be calibrated with spiked hair digest standards to correct for possible matrix effects. The second requirement is that the immunoassay have the sensitivity and specificity to detect the drug in hair. Drugs of abuse are found in hair in the range of 10 pg-10 ng/mg hair. Radioimmunoassays are capable of detection and quantitation in this concentration range. Although the mechanism of drug incorporation into hair is not known, it is now apparent that primarily the parent drug and lipophilic metabolites are found in hair. For example, the ratio of cocaine/benzoylecgonine averages 10 (range 2-50) in published reports of analysis of hair from cocaine users. Therefore, immunoassays which are highly sensitive for the parent drug are required and results of immunoassays should be expressed as equivalents. When spiking standards for calibration of hair digest immunoassays, parent drug known to be present in hair should be used, e.g. cocaine not benzoylecgonine. With immunoassays which are specific for the lipophilic metabolite found in hair such as 6-MAM, differential radioimmunoassay can be used to discriminate between medical and illicit sources for the opiate drugs found in hair. Because of the low concentrations of drugs encountered in hair, immunoassays for hair have been used at cutoff concentrations at their limits of detection. The limit of detection (LOD) has been determined by calculating the mean and standard deviation (S.D.) for the assay response for a number of negative hair samples. The cutoff was then set at a distance of 2, 3, or 5 S.D.s from the mean response.(ABSTRACT TRUNCATED AT 400 WORDS)

Ion trap mass spectrometry, a new tool in the investigation of drugs of abuse in hair

The use of an ion trap mass spectrometer for the detection, via tandem mass spectrometry, of morphine and cocaine in the hair of drug addicts proved to be successful. In particular, detection limits of 1-20 ppb for morphine and 5-30 ppb for cocaine were achieved, with good reproducibility and absence of interferent species.

Rapid and highly selective GC/MS/MS detection of heroin and its metabolites in hair

A direct treatment of methanol-washed hair with a silylating solution is proposed to extract heroin, O-6-monoacetylmorphine, morphine, acetylcodeine, and codeine, obtaining the simultaneous derivatization of the hydroxylated metabolites and reducing potential sample contamination. Analysis is performed by capillary gas chromatography-tandem mass spectrometry (GC/MS/MS) using multiple selected reaction monitoring. Owing to the selectivity and sensitivity of the GC/MS/MS analysis, and to the extremely simple treatment of the sample, the method fulfils the requirements of both clinical and forensic diagnosis of heroin use.

Improved enzymatic hydrolysis of hair

An enzymatic hair extraction method is proposed for drug analysis. Pronase digestion of various aliquots of hair from a cocaine abuser was preceded by a 2-h incubation with a dithiothreitol solution. The extraction solution was tested to identify possible interferences in the radioimmunoassay and was compared with other hydrolysis methods to assess the results of extraction.

Variability of opiates concentrations in human hair according to their anatomical origin: head, axillary and pubic regions

The concentrations of morphine and codeine were investigated in hair from the head, axillary and pubic regions obtained from 20 fatal heroin cases. Hair preparation involves decontamination procedure in dichloromethane at 37 degrees C for 15 min, solubilization in sodium hydroxide at 100 degrees C for 5 min, neutralization with hydrochloric acid and centrifugation. After extraction in chloroform/isopropanol/n-heptane (50:17:33; v/v) at pH 9.2, drugs were derivatized with BSTFA + 1% TMCS and separated on a 12-m BP-5 capillary column. Quantification was done by GC/MS using selected ion monitoring. The highest morphine concentrations were found in public hair (0.80-41.34 ng/mg), followed by hair of the head (0.62-27.10 ng/mg), and axillary hair (0.40-24.20 ng/mg). Codeine was also detected in all samples, and the codeine/morphine ratios ranged from 0.54 to 0.273. The differences observed in drug concentration in the three kinds of hair are discussed in the light of the existing literature.

Overview on extraction procedures

The literature reviewed shows that many of the analytical problems related to the toxicological analysis of hair have been resolved, but in some cases, as for the application of the extraction methods, it is worth highlighting that the parameters must be carefully valued owing to the different operative options that are documented in the literature. Besides, the choice of a suitable extractive procedure may be influenced by various factors, including the following: (i) the type of drug which the analysis is targeted at and its characteristics of stability in different hydrolytic systems; (ii) ratio of distribution of the abused substances and their metabolites in the hair; and (iii) method used for the subsequent qualitative and quantitative analysis. Hence the selection of the extraction method requires some considerations, particularly when this kind of analysis is used in the forensic field. In this regard, emphasis is actually placed on pharmacokinetic incorporation and retention of drugs into hair. Furthermore, lacking any source of certified reference material, more studies concerning the recovery, accuracy and, if possible, quality control programs, could be implemented in order to test each procedure and improve the reliability of the extraction steps in the toxicological analysis of hair.

Challenging declarations of abstinence by the determination of morphine in hair by radioimmunoassay

Morphine extracted from dated hair segments and analysed by adaptation of a specific solid-phase 125I radioimmunoassay for the measurement of morphine in urine has provided long term histories of the heroin usage of individual patients. Results expressed as ng morphine/mg hair are compared with a pre-determined cut-off level of 0.3 ng morphine/mg hair, from a known drug-free population (n = 21). Morphine concentrations in hair samples from known heroin abusers are found to be above the cut-off limit (range 0.6-9.4 ng morphine/mg hair), and suggest a possible correlation between heroin intake and concentration of morphine in hair. Intra-assay relative standard deviation (RSD), at morphine levels of 9.27 and 1.12 ng morphine/mg hair are 2.4 and 5.5%, respectively, and acceptable recoveries from drug-free hair spiked with morphine are also achieved. The developed segmental hair analysis regime has been used successfully to challenge a self-declaration of heroin abstinence. Routine cumulative urine screening was unable to provide such evidence. The potential for hair drug analysis is discussed.

Gas chromatographic detection of cocaine and cocaethylene in hair of mice chronically injected with cocaine or cocaethylene and fed ethanol

GC and GC/MS analysis was used to detect cocaine and cocaethylene in hair extracts of mice injected with 20 mg/kg cocaine hydrochloride or an equivalent dose of cocaethylene fumarate twice daily for 3 weeks. Some mice were fed liquid Lieber-DeCarli diets containing ethanol (26% of total calories) and injected twice daily with the same doses of cocaine or cocaethylene or combination of cocaine and morphine (5 mg/kg). The average concentrations of cocaine in different experimental groups were in the range of 0.9-2.4 ng/mg of hair and for cocaethylene, 2.4-2.8 ng/mg of hair. There were no significant differences in hair concentrations of cocaine among groups receiving cocaine treatment, nor were there significant difference in cocaethylene concentration in hair in the two groups administered cocaethylene. In hair extracts of mice treated with cocaine and ethanol, levels of cocaethylene were below the limit of detection.

Hair analysis for drugs of abuse. IV. Determination of total morphine and confirmation of 6-acetylmorphine in monkey and human hair by GC/MS

The reliable analytical method for total morphine in hair was established by GC/MS-SIM. The calibration curve for morphine in hair showed linear over 0.5-100 ng/mg hair. Though the limit of detection was 0.1 ng/mg hair with an S/N > 3 of the base ion(m/z 429) for morphine, the limit of confirmation by detection of three major ions was 0.5 ng/mg. The hydrolytic extraction of the morphine analogs in hair with 10% HCl for 1 h at 100 degrees C gave quantitative recovery of morphine. The reproducibility of recovery of morphine spiked to the control hair was 2.9-7.3% in a concentration range between 2 and 50 ng/mg hair. The three monkeys were administered once a day with morphine at 10 mg/kg and heroin at 2.5 mg/kg, respectively, for 10 days and their back hair newly grown for 10 weeks was cut for analysis. The levels of total morphine in monkey hair intoxicated with morphine and heroin were 3.4 and 5.2 ng/mg, respectively. Taking their doses into account, it is concluded that the morphine level in hair from monkeys administered with heroin was 6 times higher than that with morphine. In hair from monkeys and humans intoxicated with heroin, 6-acetylmorphine was detected at the level of 0.7-7.2 ng/mg as a major component in hair together with morphine and no heroin. Drug concentrations of sectional hair shaft cut 2 cm each from the root side were compared with the self-reported drug histories of three cases. The results of sectional analysis of heroin abuser's hair suggested that the relationship between the distribution of morphine along hair shaft and the drug use history showed a good correlation, though the accumulation of heroin metabolites in body could result from chronic use of heroin.