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de Jong LAA, Kloost T, Olyslager EJH, Böttcher M, Wieferink JA, Vossenberg P, Belgers M, Beurmanjer H, de Haan HA. Towards adherence monitoring using breath or oral fluid as a matrix in a methadone maintenance treatment program for patients with a chronic heroin use disorder: Issues and interpretation of the results. J Anal Toxicol 2023; 47:842-849. [PMID: 37639616 DOI: 10.1093/jat/bkad060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/13/2023] [Accepted: 08/28/2023] [Indexed: 08/31/2023] Open
Abstract
Urine has been the preferred matrix for monitoring heroin and methadone adherence due to its large detection window. Drawbacks such as privacy concerns and adulteration however require other matrices. The study aims to determine if oral fluid and exhaled breath are suitable alternatives for heroin and methadone monitoring and to assess the detection time in exhaled breath. Forty-three participants, all on methadone and heroin-assisted treatment, were studied. Participants were monitored after the first and right before the second dosage of heroin. At both time points, oral fluid and exhaled breath samples were collected with urine at the second time point. All samples were screened for opiates, methadone and other drugs using immunoassay and LC-MS-MS. At the second time point, 98% of oral fluid samples and all exhaled breath samples tested positive for 6-monoacetylmorphine (6-MAM). Regarding morphine detection, the findings were reversed (100% in oral fluid, 98% in exhaled breath). Methadone-related results were 100% positive across all matrices, as expected. Notable is the detection of the heroin marker acetylcodeine in oral fluid and exhaled breath samples, which resulted in relatively low negative predictive value (average 54.6%). Oral fluid and exhaled breath are suitable alternatives for heroin and methadone maintenance monitoring. Clinicians should consider ease of collection, adulteration risk, costs, turn-around time and the substance of interest while choosing a matrix. In addition, even in cases when medicinal heroin is used, medical professionals should be aware of the presence of acetylcodeine in these alternate matrices.
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Affiliation(s)
- Lutea A A de Jong
- Department of Clinical Pharmacy, Expert center Gelre-iLab, Gelre Hospitals, P.O. Box 9014, Apeldoorn 7300 DS, The Netherlands
| | - Tim Kloost
- Department of Clinical Pharmacy, Expert center Gelre-iLab, Gelre Hospitals, P.O. Box 9014, Apeldoorn 7300 DS, The Netherlands
| | - Erik J H Olyslager
- Department of Clinical Pharmacy, Expert center Gelre-iLab, Gelre Hospitals, P.O. Box 9014, Apeldoorn 7300 DS, The Netherlands
| | - Michael Böttcher
- Department of Toxicology, MVZ Medizinische Labore Dessau Kassel GmbH, Bauhüttenstr. 6, Dessau-Roßlau 06847, Germany
| | - Jan A Wieferink
- Department of Clinical Pharmacy, Expert center Gelre-iLab, Gelre Hospitals, P.O. Box 9014, Apeldoorn 7300 DS, The Netherlands
| | - Peter Vossenberg
- Tactus Addiction Treatment Center, P.O. Box 154, Deventer 7400 AD, The Netherlands
| | - Maarten Belgers
- IrisZorg, Institute for Addiction Care and Sheltered Housing, Mr. B.M. Teldersstraat 7, Arnhem 6842 CT, The Netherlands
| | - Harmen Beurmanjer
- Novadic-Kentron Addictioncare, Hogedwarsstraat 3, Vught AE 5261, The Netherlands
- Behavioural Science Institute, Radboud University Nijmegen, P.O. Box 9104, Nijmegen 6500 HE, The Netherlands
| | - Hein A de Haan
- Tactus Addiction Treatment Center, P.O. Box 154, Deventer 7400 AD, The Netherlands
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Al-Asmari AI, Alharbi H, Al-Zahrani AE, Zughaibi TA. Heroin-Related Fatalities in Jeddah, Saudi Arabia, between 2008 and 2018. TOXICS 2023; 11:248. [PMID: 36977013 PMCID: PMC10099738 DOI: 10.3390/toxics11030248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 02/20/2023] [Accepted: 02/27/2023] [Indexed: 06/18/2023]
Abstract
To date, epidemiological studies have not evaluated heroin-related deaths in the Middle East and North African regions, especially Saudi Arabia. All heroin-related postmortem cases reported at the Jeddah Poison Control Center (JPCC) over a 10-year period (21 January 2008 to 31 July 2018) were reviewed. In addition, liquid chromatography electrospray ionization tandem mass spectrometry (LC/ESI-MS/MS) was utilized to determine the 6-monoacetylmorphine (6-MAM), 6-acetylcodeine (6-AC), morphine (MOR), and codeine contents in unhydrolyzed postmortem specimens. Ninety-seven heroin-related deaths were assessed in this study, and they represented 2% of the total postmortem cases at the JPCC (median age, 38; 98% male). In the blood, urine, vitreous humor, and bile samples, the median morphine concentrations were 280 ng/mL, 1400 ng/mL, 90 ng/mL, and 2200 ng/mL, respectively; 6-MAM was detected in 60%, 100%, 99%, and 59% of the samples, respectively; and 6-AC was detected in 24%, 68%, 50%, and 30% of the samples, respectively. The highest number of deaths (33% of total cases) was observed in the 21-30 age group. In addition, 61% of cases were classified as "rapid deaths," while 24% were classified as "delayed deaths." The majority (76%) of deaths were accidental; 7% were from suicide; 5% were from homicide; and 11% were undetermined. This is the first epidemiological study to investigate heroin-related fatalities in Saudi Arabia and the Middle East and North African region. The rate of heroin-related deaths in Jeddah remained stable but increased slightly at the end of the study period. Most patients were heroin-dependent abusers and from the middle-aged group. The availability of urine, vitreous humor, and bile specimens provided valuable information regarding the opioids that were administered and the survival time following heroin injection.
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Affiliation(s)
- Ahmed I. Al-Asmari
- Laboratory Department, Ministry of Health, King Abdul-Aziz Hospital, Jeddah 21442, Saudi Arabia
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Hassan Alharbi
- Poison Control and Forensic Chemistry Center, Ministry of Health, Jeddah 21176, Saudi Arabia
| | | | - Torki A. Zughaibi
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
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Bollini SM, Banks JF, Hobbs GA. Urine Thebaine Determination by Liquid Chromatography Tandem Mass Spectrometry After Poppy Seed Consumption. Drug Test Anal 2022; 14:1539-1546. [PMID: 35478494 DOI: 10.1002/dta.3274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/25/2022] [Accepted: 04/12/2022] [Indexed: 11/11/2022]
Abstract
Laboratories are challenged to distinguish whether a positive urine morphine result is due to heroin use or possible poppy seed consumption. Thebaine is an opium alkaloid that has been shown to be present in the urine of individuals who have consumed poppy seeds, as well as those who have used opium. It is not present in heroin. We present a sensitive, specific liquid chromatography tandem mass spectrometry (LC-MS/MS) assay for thebaine. We show that thebaine is detectable after consumption of two different poppy seed-containing products for up to 72 hours in urine. We discuss limitations of the assay and suggest how the test might best be used.
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Buchweitz JP, Zyskowski J, Lehner AF. Heroin Fatality in a Feline: A Case Report with Postmortem Liver Concentrations. J Anal Toxicol 2021; 46:e36-e41. [PMID: 33475731 DOI: 10.1093/jat/bkab011] [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: 11/16/2020] [Revised: 01/13/2021] [Accepted: 01/20/2021] [Indexed: 11/12/2022] Open
Abstract
A case of feline intoxication and fatality with the illicit drug heroin is described. A five-year-old castrated male domestic short hair cat was recently diagnosed with an active pneumonitis and left at home for a couple days under the care of another resident. Upon return, the owner found his cat dead with strong suspicion of foul-play. The cat was necropsied by a local veterinary clinic to retrieve the liver for diagnostic toxicology. The postmortem liver sample screened positive for 6-acetylmorphine and 6-acetylcodeine by gas chromatography mass spectrometry (GC-MS). Deconvolution techniques were applied to chromatograms and revealed the additional presence of morphine and mirtazapine. Subsequent quantitation of mirtazapine, heroin, morphine, 6-acetylmorphine, 6-acetylcodeine was performed by gas chromatography tandem quadrupole mass spectrometry (GC-MS/MS). Although companion animal fatalities arising from toxicities are a likely consequence of drug abuse in a home, this is the first reported case of a malicious feline fatality resulting from heroin with quantitation of heroin metabolites.
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Affiliation(s)
- John P Buchweitz
- Michigan State University Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Michigan State University, 4125 Beaumont Rd, Lansing, MI 48910, USA.,Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, 784 Wilson Rd, East Lansing, MI 48824, USA
| | - Justin Zyskowski
- Michigan State University Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Michigan State University, 4125 Beaumont Rd, Lansing, MI 48910, USA
| | - Andreas F Lehner
- Michigan State University Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Michigan State University, 4125 Beaumont Rd, Lansing, MI 48910, USA
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Al-Asmari AI. Postmortem Liver and Kidney Tissue Concentrations of Heroin Biomarkers and Their Metabolites in Heroin-Related Fatalities*†. J Forensic Sci 2020; 65:2087-2093. [PMID: 33460103 DOI: 10.1111/1556-4029.14537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 01/23/2023]
Abstract
A method was developed and validated for analyzing 6-monoacetylmorphine, morphine, 6-acetylcodeine, and codeine in routine postmortem liver and kidney specimens using liquid chromatography-tandem mass spectrometry. Samples were prepared with a Stomacher instrument followed by solid-phase extraction. All calibration curves [0.5-1000 ng/g] were linear with coefficients of determination greater than 0.99 and limits of quantification of 1.0 ng/g. Within-run precision ranged between 2.0% and 8.0%, between-run precision ranged between 1.0% and 9.0%, and accuracy ranged between -5.0% and +3.0%. Matrix effects ranged from -18% to +9%. After matrix effects were excluded, analytical recoveries ranged from 76% to 94%. The distributions of 6-monoacetylmorphine, morphine, 6-acetylcodeine, and codeine were investigated in 31 postmortem cases in which heroin was the primary cause of death. In the current study, the median free morphine ratios were calculated for liver to blood and kidney to blood, which were 2.2 and 4.0, respectively. The current report highlights the importance of testing multiple specimens, including liver and kidney, in heroin-related deaths, especially if no blood samples are available. Furthermore, this work presents new information regarding the distribution of heroin metabolites in liver and kidney.
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Affiliation(s)
- Ahmed I Al-Asmari
- Laboratory Department, King Abdul-AzizHospital-Jeddah Health Affair, Ministry of Health, P.O. BOX 4670, Jeddah, Makkah AL-Mukharmah, 21442, Saudi Arabia
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Al‐Asmari AI. Postmortem Fluid Concentrations of Heroin Biomarkers and Their Metabolites. J Forensic Sci 2019; 65:570-579. [DOI: 10.1111/1556-4029.14200] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 09/06/2019] [Accepted: 09/06/2019] [Indexed: 11/28/2022]
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Metabolism and metabolomics of opiates: A long way of forensic implications to unravel. J Forensic Leg Med 2019; 61:128-140. [DOI: 10.1016/j.jflm.2018.12.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 12/15/2018] [Accepted: 12/17/2018] [Indexed: 12/27/2022]
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Roxburgh A, Pilgrim JL, Hall WD, Burns L, Degenhardt L. Accurate identification of opioid overdose deaths using coronial data. Forensic Sci Int 2018; 287:40-46. [PMID: 29627712 DOI: 10.1016/j.forsciint.2018.03.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 03/15/2018] [Accepted: 03/17/2018] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Defining drug-related mortality is complex as these deaths can include a wide range of diseases and circumstances. This paper outlines a method to identify deaths that are directly due to fatal opioid toxicity (i.e. overdose), utilising coronial data. MATERIALS AND METHODS The National Coronial Information System (NCIS), an online coronial database containing information on all deaths that are reported to a coroner in Australia, is used to develop methods to more accurately identify opioid overdose deaths. The NCIS contains demographic information, Medical Cause of Death, and associated documentation on toxicology, clinical and police investigations. RESULTS Identifying overdose deaths using the coroner determined Medical Cause of Death provided greater capture, and specificity, of opioid overdose deaths. Distinguishing morphine from heroin-related deaths presented challenges, requiring analysis of clinical and investigative information in addition to toxicology results. One-quarter of the deaths attributed to morphine were recorded to heroin as a result of further investigation. There was also some underestimation of codeine-related deaths. Access to clinical and investigative information also yields important information in relation to comorbid conditions among these decedents, such as history of chronic pain, substance use issues and mental health problems. CONCLUSIONS Reliance on toxicology results alone leads to an underestimate of heroin-related deaths. Differentiating between heroin and pharmaceutical opioid (e.g. morphine) overdose deaths has important public health and policy implications, particularly in relation to prescribing practices and development of a strategic response. Understanding comorbidities among these decedents is also important in efforts to reduce preventable causes of death such as opioid overdose.
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Affiliation(s)
- Amanda Roxburgh
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, NSW 2052, Australia.
| | | | - Wayne D Hall
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, NSW 2052, Australia; University of Queensland Clinical Centre for Research, University of Queensland, Brisbane, QLD 4072, Australia; University of Queensland Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, QLD 4006, Australia; National Addiction Centre, Kings College London, WC2R 2LS, United Kingdom
| | - Lucinda Burns
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, NSW 2052, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, NSW 2052, Australia; School of Population and Global Health, University of Melbourne, VIC 3010, Australia
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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
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Liu HC, Yang CA, Liu RH, Lin DL. Developing a UHPLC–QTOF-MS and Automated Library Search Method for Screening Drugs and Toxic Compounds in Postmortem Specimens. J Anal Toxicol 2017; 41:421-430. [DOI: 10.1093/jat/bkx026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Indexed: 11/13/2022] Open
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Maas A, Krämer M, Sydow K, Chen PS, Dame T, Musshoff F, Diehl BW, Madea B, Hess C. Urinary excretion study following consumption of various poppy seed products and investigation of the new potential street heroin marker ATM4G. Drug Test Anal 2016; 9:470-478. [PMID: 27565444 DOI: 10.1002/dta.2058] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 07/08/2016] [Accepted: 08/22/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Alexandra Maas
- University of Bonn, Institute of Forensic Medicine; Department of Forensic Toxicology; Germany
| | - Michael Krämer
- University of Bonn, Institute of Forensic Medicine; Department of Forensic Toxicology; Germany
| | - Konrad Sydow
- University of Bonn, Institute of Forensic Medicine; Department of Forensic Toxicology; Germany
| | - Pai-Shan Chen
- Department and Graduate Institute of Forensic Medicine; National Taiwan University; Taipei 100 Taiwan
| | | | | | | | - Burkhard Madea
- University of Bonn, Institute of Forensic Medicine; Department of Forensic Toxicology; Germany
| | - Cornelius Hess
- University of Bonn, Institute of Forensic Medicine; Department of Forensic Toxicology; Germany
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Prevalence of heroin markers in urine for pain management patients. Forensic Sci Int 2014; 243:79-83. [DOI: 10.1016/j.forsciint.2014.04.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 03/20/2014] [Accepted: 04/28/2014] [Indexed: 11/21/2022]
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13
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Lin HR, Chen CL, Huang CL, Chen ST, Lua AC. Simultaneous determination of opiates, methadone, buprenorphine and metabolites in human urine by superficially porous liquid chromatography tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci 2013; 925:10-5. [PMID: 23507455 DOI: 10.1016/j.jchromb.2013.02.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 02/19/2013] [Accepted: 02/20/2013] [Indexed: 11/16/2022]
Abstract
For monitoring compliance of methadone or buprenorphine maintenance patient, a method for the simultaneous determination of methadone, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP), buprenorphine, norbuprenorphine, opiates (morphine, codeine, 6-monoacetylmorphine) in urine by superficially porous liquid chromatography tandem mass spectrometry was developed and validated. After enzyme digestion and liquid-liquid extraction, reverse-phase separation was achieved in 5.2 min and quantification was performed by multiple reaction monitoring. Chromatographic separation was performed at 40 °C on a reversed phase Poroshell column with gradient elution. The mobile phase consisted of water and methanol, each containing 0.1% formic acid, at a flow rate of 0.32 mL/min. Intra-day and inter-day precision were less than 12.1% and accuracy was between -9.8% and 13.7%. Extraction efficiencies were more than 68%. Although ion suppression was detected, deuterated internal standards compensated for these effects. Carryover was minimal, less than 0.20%. All analytes were stable at room temperature for 16 h, 4 °C for 72 h, and after three freeze-thaw cycles. The assay also fulfilled compound identification criteria in accordance with the European Commission Decision 2002/657/EC. We analyzed 62 urine samples from patients received maintenance therapy and found that 54.8% of the patient samples tested were detected for morphine, codeine, or 6-monoacetylmorphine. This method provides a reliable and simultaneous quantification of opiates, maintenance drugs, and their metabolites in urine samples. It facilitates the routine monitoring in individuals prescribed the drug to ensure compliance and help therapeutic process.
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Affiliation(s)
- Huei-Ru Lin
- Institute of Medical Biotechnology, Tzu Chi University, Hualien, Taiwan.
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Abstract
Urine is recognized as the prime matrix for drug test screening with well-established methods and testing protocols. Its major limitation is with regard to the inconvenience of sample collection and lack of integrity due to adulteration, dilution, drug spiking or sample exchange. The question is whether oral fluid, with its apparent better sample integrity, can replace urine for drug screening. This review examines the sample integrity problems and the advantages and limitations of oral fluid and urine in drug screening programmes. The variety of sample collection devices for oral fluid is shown to be a problem with recovery and detection for some drugs. This is examined in relation to the pharmacokinetics of drug metabolism and excretion in this matrix. Buccal contamination with drugs in oral fluid may also cause problems with interpretation. The clinical advantages of oral fluid analysis compared with urine testing are highlighted. Parent drugs are often found in oral fluid where only their metabolites may be found in urine, for example the benzodiazepines. 6-Monoacetylmorphine, an indicative marker of heroin, has a high prevalence in oral fluid from users of this drug but its detection in urine is limited due to its short half-life. Advances in analytical techniques, particularly chromatography linked to tandem mass spectrometry, are helping to promote oral fluid analysis. However, the lack of concordance studies examining both urine and oral fluid drug levels and kinetics in the clinical setting is of some concern.
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Affiliation(s)
- Keith R Allen
- Department of Specialist Laboratory Medicine, Leeds Teaching Hospitals, Britannia House, Morley, Leeds LS27 0DQ, UK
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Berset JD, Brenneisen R, Mathieu C. Analysis of llicit and illicit drugs in waste, surface and lake water samples using large volume direct injection high performance liquid chromatography--electrospray tandem mass spectrometry (HPLC-MS/MS). CHEMOSPHERE 2010; 81:859-866. [PMID: 20801487 DOI: 10.1016/j.chemosphere.2010.08.011] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Revised: 08/02/2010] [Accepted: 08/03/2010] [Indexed: 05/29/2023]
Abstract
Llicit and illicit drugs represent a recent group of emerging contaminants and have been found in the aquatic environment. A HPLC-MS/MS method was developed using direct injection (DI) of larger volumes and a polar endcapped reversed-phase (RP) column to measure drug components in water samples belonging to the cocaine group, opiates, amphetamine-like stimulants and metabolites thereof. After validation, including sensitivity, linearity, recovery, precision and matrix effect studies, most drugs could be detected with limits of quantitation (LOQ) of 20 ng L(-1) in wastewater (WW) and 0.2 ng L(-1) in surface water. The major substances found in influents and effluents were cocaine (COC), benzoylecgonine (BE), morphine (MO), methadone (MD) and its main metabolite 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP) with concentrations up to 2 μg L(-1), followed by codeine (COD) and the amphetamines which ranged between 20 and 400 ng L(-1). Except for MO, COD and EDDP levels were generally lower in the effluents. River and lake water contained trace amounts of mainly BE, MD and EDDP from the high pg L(-1) to the low ng L(-1) level. Monitoring COC and BE levels over 11 consecutive days in influents and effluents suggests a consumption preference on week-end days. Finally, measuring an influent after a major music event revealed that sewage treatment plants (STPs) are exposed, for a limited period of time, to high concentration peaks of COC and BE as well as amphetamine-like stimulants such as ecstasy (MDMA).
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Affiliation(s)
- Jean-Daniel Berset
- Water and Soil Protection Laboratory (WSPL), Environmental Organic Chemistry Group (EOCG), Office of Water and Waste (OWW), Schermenweg 11, 3014 Bern, Switzerland.
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Duxbury K, Romagnoli C, Anderson M, Watts R, Waite G. Development of a clinically relevant liquid chromatography tandem mass spectrometry assay for 13 drugs of abuse in urine, designed to meet the needs of the service users. Ann Clin Biochem 2010; 47:415-22. [DOI: 10.1258/acb.2010.010049] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background The clinical requirements of the users of assay results must be at the centre of assay development. We aimed to develop a single liquid chromatography tandem mass spectrometry (LC-MS/MS) assay for drugs of abuse in urine that would meet the needs of our service users and replace the multiple screening and confirmatory techniques previously in use. Methods After discussion with our users, it was decided that 13 drugs and metabolites should be measured in our panel: morphine, codeine, norcodeine, dihydrocodeine, 6-monoacetylmorphine, acetyl codeine, methadone and its metabolite, buprenorphine and its metabolite, amphetamine, benzoylecgonine and cotinine. Urine samples were prepared by the addition of internal standard, enzymatic hydrolysis and solid-phase extraction. Chromatography conditions were optimized so that the analytes were separated within a run time of 6 min. Optimal parent to daughter m/z ion transitions were chosen for all drugs and daughter ion ratios were used. Results The LC-MS/MS assay was successfully validated with acceptable precision and lower limits of quantification for all drugs. No matrix effects were seen. The results produced by the LC-MS/MS assay compared well with the previous combination of techniques in use. Conclusions We have developed and validated a fit-for-purpose LC-MS/MS assay for 13 drugs of abuse in urine that obviates the need for multiple screening and confirmatory analytical techniques.
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Affiliation(s)
- K Duxbury
- Department of Clinical Biochemistry, Salford Royal NHS Foundation Trust, Stott Lane, Salford M6 8HD, UK
| | - C Romagnoli
- Department of Clinical Biochemistry, Salford Royal NHS Foundation Trust, Stott Lane, Salford M6 8HD, UK
| | - M Anderson
- Department of Clinical Biochemistry, Salford Royal NHS Foundation Trust, Stott Lane, Salford M6 8HD, UK
| | - R Watts
- Waters Corporation, MS Technologies Centre, Atlas Park, Simonsway, Manchester, M22 5PP, UK
| | - G Waite
- Department of Clinical Biochemistry, Salford Royal NHS Foundation Trust, Stott Lane, Salford M6 8HD, UK
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Abstract
Seeds of the opium poppy plant are legally sold and widely consumed as food. Due to contamination during harvesting, the seeds can contain morphine and other opiate alkaloids. The objective of this study is to review the toxicology of poppy seed foods regarding influence on opiate drug tests. Computer-assisted literature review resulted in 95 identified references. Normal poppy seed consumption is generally regarded as safe. During food processing, the morphine content is considerably reduced (up to 90%). The possibility of false-positive opiate drug tests after poppy food ingestion exists. There are no unambiguous markers available to differentiate poppy food ingestion from heroin or pharmaceutical morphine use. This is also a problem in heroin-assisted maintenance programs. A basic requirement in such substitution programs is the patients' abstinence from any other drugs, including additional illicit heroin. Also a lack of forensic ingestion trials was detected that consider all factors influencing the morphine content in biologic matrices after consumption. Most studies did not control for the losses during food processing, so that the initial morphine dosage was overestimated. The large reduction of the morphine content during past years raises questions about the validity of the "poppy seed defence." However, a threshold of food use that would not lead to positive drug tests with certainty is currently unavailable. Research is needed to prove if the morphine contents in today's foods still pose the possibility of influencing drug tests. Future trials should consider processing-related morphine losses.
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Liu HC, Liu RH, Ho HO, Lin DL. Development of an Information-Rich LC−MS/MS Database for the Analysis of Drugs in Postmortem Specimens. Anal Chem 2009; 81:9002-11. [DOI: 10.1021/ac901599d] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Hsiu-Chuan Liu
- College of Pharmacy, Taipei Medical University, Taipei 110, Taiwan, Department of Forensic Toxicology, Institute of Forensic Medicine, Ministry of Justice, Taipei 106, Taiwan, Department of Medical Technology, Taipei Medical University, Taipei 110, Taiwan, Department of Medical Technology, Fooyin University, Kaohsiung Hsien 831, Taiwan, and Department of Forensic Medicine, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Ray H. Liu
- College of Pharmacy, Taipei Medical University, Taipei 110, Taiwan, Department of Forensic Toxicology, Institute of Forensic Medicine, Ministry of Justice, Taipei 106, Taiwan, Department of Medical Technology, Taipei Medical University, Taipei 110, Taiwan, Department of Medical Technology, Fooyin University, Kaohsiung Hsien 831, Taiwan, and Department of Forensic Medicine, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Hsiu-O Ho
- College of Pharmacy, Taipei Medical University, Taipei 110, Taiwan, Department of Forensic Toxicology, Institute of Forensic Medicine, Ministry of Justice, Taipei 106, Taiwan, Department of Medical Technology, Taipei Medical University, Taipei 110, Taiwan, Department of Medical Technology, Fooyin University, Kaohsiung Hsien 831, Taiwan, and Department of Forensic Medicine, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Dong-Liang Lin
- College of Pharmacy, Taipei Medical University, Taipei 110, Taiwan, Department of Forensic Toxicology, Institute of Forensic Medicine, Ministry of Justice, Taipei 106, Taiwan, Department of Medical Technology, Taipei Medical University, Taipei 110, Taiwan, Department of Medical Technology, Fooyin University, Kaohsiung Hsien 831, Taiwan, and Department of Forensic Medicine, College of Medicine, National Taiwan University, Taipei 100, Taiwan
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Kongenitale Zwerchfellhernie. Rechtsmedizin (Berl) 2009. [DOI: 10.1007/s00194-009-0625-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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21
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Musshoff F, Trafkowski J, Lichtermann D, Madea B. Comparison of urine results concerning co-consumption of illicit heroin and other drugs in heroin and methadone maintenance programs. Int J Legal Med 2009; 124:499-503. [PMID: 19672612 DOI: 10.1007/s00414-009-0361-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2009] [Accepted: 06/15/2009] [Indexed: 11/26/2022]
Abstract
Urine samples of patients from a heroin maintenance program (HMP) and a methadone maintenance program (MMP) were chromatographically analyzed 1 month before and 6 and 12 months into treatment for the presence of classical markers of heroin use as well as for the presence of markers for illicit heroin abuse. Furthermore, the samples were immunochemically tested for cannabinoids, cocaine metabolites, amphetamine, methylendioxyamphetamines and benzodiazepines. A co-consumption of illicit heroin (HER) in the HMP was determined to be 50% but was significantly lower compared to the MMP with a co-use of 71%. The incidence was high because not only acetylcodeine (AC) as a very specific marker was considered but also other marker substances for illicit HER use. Amphetamines played only a minor part in both collectives, and the proportion of HER and methadone patients using cocaine was similar and decreased during treatment. Also, the benzodiazepine use decreased, and cannabis use was high in both collectives during treatment. Considering only the AC in the present study, a co-use of illicit HER in the HMP was similar to previous reports concerning HER-assisted treatment programs. If additional marker substances were examined, the suspicion of a co-use of illicit HER is markedly enhanced.
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Affiliation(s)
- Frank Musshoff
- Institute of Forensic Medicine, University of Bonn, Stiftsplatz 12, 53111, Bonn, Germany.
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22
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‘False-positive’ and ‘false-negative’ test results in clinical urine drug testing. Bioanalysis 2009; 1:937-52. [DOI: 10.4155/bio.09.81] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The terms ‘false-positive’ and ‘false-negative’ are widely used in discussions of urine drug test (UDT) results. These terms are inadequate because they are used in different ways by physicians and laboratory professionals and they are too narrow to encompass the larger universe of potentially misleading, inappropriate and unexpected drug test results. This larger universe, while not solely comprised of technically ‘true’ or ‘false’ positive or negative test results, presents comparable interpretive challenges with corresponding clinical implications. In this review, we propose the terms ‘potentially inappropriate’ positive or negative test results in reference to UDT results that are ambiguous or unexpected and subject to misinterpretation. Causes of potentially inappropriate positive UDT results include in vivo metabolic conversions of a drug, exposure to nonillicit sources of a drug and laboratory error. Causes of potentially inappropriate negative UDT results include limited assay specificity, absence of drug in the urine, presence of drug in the urine, but below established assay cutoff, specimen manipulation and laboratory error. Clinical UDT interpretation is a complicated task requiring knowledge of recent prescription, over-the-counter and herbal drug administration, drug metabolism and analytical sensitivities and specificities.
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Trathen B, Paterson S, Cordero R, Luty J. Validity of noscapine and papaverine metabolites as markers of heroin misuse in the context of diamorphine treatment. A survey of urine samples from non‐substance misusing patients prescribed diamorphine. JOURNAL OF SUBSTANCE USE 2009. [DOI: 10.1080/14659890802581628] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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24
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Guthery B, Bassindale A, Pillinger CT, Morgan GH. The detection of various opiates and benzodiazepines by comprehensive two-dimensional gas chromatography/time-of-flight mass spectrometry. RAPID COMMUNICATIONS IN MASS SPECTROMETRY : RCM 2009; 23:340-348. [PMID: 19125414 DOI: 10.1002/rcm.3883] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
A technique using comprehensive two-dimensional gas chromatography/time-of-flight mass spectrometry (GC x GC/TOFMS) is applied to qualitative and quantitative drug testing. Human serum was 'spiked' with known quantities of benzodiazepines and a 'street heroin' mixture including some of the major metabolites and impurities. The sample components were extracted from the matrix by solid-phase extraction (SPE). Constituents containing polar hydroxyl and/or secondary amine groups were derivatised with N-methyl-N-(tert-butyldimethyl)trifluoroacetamide (MTBSTFA) to improve the chromatographic performance. An orthogonal separation of the matrix constituents was achieved by coupling a DB-5ms (5% phenyl) to a BPX50 (50% phenyl) GC column. The eluant was focused onto the second column by a twin-stage cryo-modulator. Rapid 6 s modulation times were achieved by transfer from a 30 m x 0.25 mm (length x internal diameter) to a 2 m x 0.1 mm column. TOFMS with rapid spectral acquisition (< or =500 spectra/s) was employed in the mass range m/z 40-650. A clean mass spectrum was obtained for each analyte using mass spectral deconvolution software. The sensitivity and repeatability of the method were evaluated by the preparation of calibration standards for two benzodiazepines, flunitrazepam and its major metabolite 7-aminoflunitrazepam (7-amino-FN), in the concentration range 5-1000 ng/mL. The limits of detection (LODs) and limits of quantitation (LOQs), calculated by repeat injections (x10) of the lowest standard, were 1.6 and 5.4 ng/mL (flunitrazepam); 2.5 and 8.5 ng/mL (7-amino-FN), respectively. There is scope to extend this protocol to screen a large number of drugs and metabolites stored in a library database.
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Affiliation(s)
- Bill Guthery
- Planetary and Space Sciences Research Institute, The Open University, Milton Keynes, UK.
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25
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Development and validation of a solid-phase extraction gas chromatography-mass spectrometry method for the simultaneous quantification of methadone, heroin, cocaine and metabolites in sweat. Anal Bioanal Chem 2008; 392:115-27. [PMID: 18607576 DOI: 10.1007/s00216-008-2228-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Revised: 05/30/2008] [Accepted: 06/02/2008] [Indexed: 10/21/2022]
Abstract
A sensitive and specific method is presented to simultaneously quantify methadone, heroin, cocaine and metabolites in sweat. Drugs were eluted from sweat patches with sodium acetate buffer, followed by SPE and quantification by GC/MS with electron impact ionization and selected ion monitoring. Daily calibration for anhydroecgonine methyl ester, ecgonine methyl ester, cocaine, benzoylecgonine (BE), codeine, morphine, 6-acetylcodeine, 6-acetylmorphine (6AM), heroin (5-1000 ng/patch) and methadone (10-1000 ng/patch) achieved determination coefficients of >0.995, and calibrators quantified to within +/-20% of the target concentrations. Extended calibration curves (1000-10,000 ng/patch) were constructed for methadone, cocaine, BE and 6AM by modifying injection techniques. Within (N = 5) and between-run (N = 20) imprecisions were calculated at six control levels across the dynamic ranges with coefficients of variation of <6.5%. Accuracies at these concentrations were +/-11.9% of target. Heroin hydrolysis during specimen processing was <11%. This novel assay offers effective monitoring of drug exposure during drug treatment, workplace and criminal justice monitoring programs.
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El-Haj BM, Al-Amri AM, Ali HS, Ahmed I. GC-MS detection and characterization of thebaine as a urinary marker of opium use. Forensic Toxicol 2007. [DOI: 10.1007/s11419-007-0028-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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El-Haj BM, Al-Amri AM, Ali HS. GC-MS detection and tentative characterization of two noscapine metabolites in human urine and their potential as markers for opium and illicit heroin use. Forensic Toxicol 2007. [DOI: 10.1007/s11419-007-0023-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Trafkowski J, Madea B, Musshoff F. The Significance of Putative Urinary Markers of Illicit Heroin Use After Consumption of Poppy Seed Products. Ther Drug Monit 2006; 28:552-8. [PMID: 16885724 DOI: 10.1097/00007691-200608000-00011] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
After consumption of poppy seeds various substances were detected in urine or blood samples using an immunoassay and a sophisticated liquid chromatographic-tandem mass spectrometric procedure. These compounds are widely considered to be putative markers of heroin (HER) abuse whereas acetylcodeine was regarded as a marker for illicit preparations ("street HER"). Besides positive urinary opiate immunoassay results during a 48 hours monitoring period, peak concentrations of morphine (MOR), codeine and their glucuronides appeared 4 to 8 hours after ingestion of poppy seeds, and concentrations of total MOR higher than 10 microg/mL were observed. Also, in serum samples taken up to 6 hours after consumption, MOR glucuronides were found. Free MOR was only detected in traces (1 to 3 ng/mL) within 2 hours of consumption. In addition, 3 of 6 onsite opiate sweat tests revealed positive results 6.5 hours after ingestion. Furthermore, it was demonstrated that neither noscapine (NOS) nor papaverine (PAP) was detectable in urine or blood samples after the consumption of poppy seeds containing up to 94 microg NOS and up to 3.3 mug PAP. NOS and PAP were rapidly metabolized, whereas desmethylpapaverine and, especially, its glucuronide were found in urine samples of poppy seed consumers even 48 hours after consumption. According to these results PAP metabolites should not be regarded as markers of illicit HER abuse. In conclusion, only acetylcodeine can be regarded as a specific marker but has the problem of a short half-life. Therefore, we suggest that NOS and PAP, but not their metabolites, might be used cautiously as additional markers of illicit HER abuse as they have not been detected after oral intake of poppy seeds in normal doses. But it must be kept in mind that in some cases poppy seeds with an unusually high content of these alkaloids could be available, and that these substances are also agents in some pharmaceuticals.
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Affiliation(s)
- Jens Trafkowski
- Institute of Forensic Medicine, University Bonn, Stiftsplatz 12, 53111 Bonn, Germany
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Rook EJ, Huitema ADR, van den Brink W, van Ree JM, Beijnen JH. Population Pharmacokinetics of Heroin and its Major Metabolites. Clin Pharmacokinet 2006; 45:401-17. [PMID: 16584286 DOI: 10.2165/00003088-200645040-00005] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND In several European countries and in Canada, clinical trials are being conducted in which heroin-addicted patients are treated with pharmaceutically prepared heroin in order to reduce the destructive behaviour that is so often associated with this drug. OBJECTIVE To develop an integrated population pharmacokinetic model for heroin (diamorphine) and its pharmacodynamically active metabolites 6-acetylmorphine, morphine, morphine-3-glucuronide and morphine-6-glucuronide. Additionally, the influence on heroin pharmacokinetics of several covariates that are typical for this population was determined. METHOD Plasma concentration data from 106 heroin-dependent patients in The Netherlands (74 heroin inhalers and 32 injectors) were obtained. The 'chasing the dragon' technique was used for inhalation, in which the fumes of heroin base, heated on aluminum foil, were inhaled. Heroin doses varied between 66 and 450 mg. Heroin, 6-acetylmorphine and morphine data were fitted simultaneously using sequential two-compartment models. Morphine-3-glucuronide and morphine-6-glucuronide data were fitted separately to one-compartment models. All data analysis was performed using nonlinear mixed-effect modelling. RESULTS The bioavailability of inhaled heroin was estimated to be 53% (95% CI 43.7, 62.3). The terminal half-lives of heroin and 6-acetylmorphine were estimated to be 7.6 and 21.8 minutes, respectively. The clearances of morphine and the morphine-glucuronides were estimated to be 73.6 L/h (95% CI 62.8, 84.4) and between 6 and 10 L/h, respectively. The terminal half-life of 6-acetylmorphine was 13% lower in cocaine users (p < 0.05). No other significant relationships between covariates and pharmacokinetic parameters were discovered. CONCLUSIONS Pharmacokinetic parameters of heroin and its five major metabolites were assessed simultaneously in one integrated model. Covariate analyses revealed that sex, bodyweight, benzodiazepine use and creatinine clearance (>60 mL/min) do not need to be taken into account in the medical prescription of pharmaceutically prepared heroin for the treatment of heroin dependency.
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Affiliation(s)
- Elisabeth J Rook
- Department of Pharmacy and Pharmacology, Slotervaart Hospital, Amsterdam, The Netherlands.
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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.
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Affiliation(s)
- S Paterson
- Toxicology Unit, Imperial College London, UK
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Affiliation(s)
- T A Brettell
- Office of Forensic Sciences, New Jersey State Police, New Jersey Forensic Science and Technology Complex, 1200 Negron Road, Horizon Center, Hamilton, New Jersey 08691, USA
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Al-Amri AM, Smith RM, El-Haj BM. The GC-MS detection and characterization of neopine resulting from opium use and codeine metabolism and its potential as an opiate-product-use marker. Anal Bioanal Chem 2005; 382:830-5. [PMID: 15782326 DOI: 10.1007/s00216-005-3168-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2004] [Revised: 02/07/2005] [Accepted: 02/15/2005] [Indexed: 11/30/2022]
Abstract
Neopine, a minor opium alkaloid and an isomer of codeine (also known as beta-codeine), has been detected in both the urine of opium users and pharmaceutical codeine users. The characterization of neopine was achieved by comparison of the mass spectra and GC retention times of the trimethylsilyl derivative. The presence of neopine in the urine of pharmaceutical codeine users was attributed to the metabolism of codeine through a double bond migration in ring C, from the 7-8 to the 8-14 position. The potential use of the alkaloid as a confirmation marker of opium and/or pharmaceutical codeine use and the ability to differentiate these from heroin use has been discussed.
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Affiliation(s)
- Abdel M Al-Amri
- Sharjah Police Forensic Science Laboratory, Sharjah, United Arab Emirates.
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