Determination of cocaine usage in pregnant women by a urinary EMIT drug screen and GC-MS analyses

Analytical Methods for Determining Psychoactive Substances in Various Matrices: A Review

Psychoactive substances pose significant challenges and dangers to society due to their impact on perception, mood, and behavior, leading to health and life disturbances. The consumption of these substances is largely influenced by their legal status, cultural norms, and religious beliefs. Continuous development and chemical modifications of psychoactive substances complicate their control, detection, and determination in the human body. This paper addresses the terminological distinctions between psychoactive and psychotropic substances and drugs. It provides a comprehensive review of analytical methods used to identify and quantify 25 psychoactive substances in various biological matrices, including blood, urine, saliva, hair, and nails. The analysis categorizes these substances into four primary groups: stimulants, neuroleptics, depressants, and hallucinogens. The study specifically focuses on chromatographic and spectrophotometric methods, as well as other novel analytical techniques. Methodology includes a review of scientific articles containing validation studies of these methods and innovative approaches to psychoactive substance determination. Articles were sourced from the PubMed database, with most research originating from the twenty first century. The paper discusses the limits of detection and quantitation for each method, along with current trends and challenges in the analytical determination of evolving psychoactive substances.

Hair as a Biological Indicator of Drug Use, Drug Abuse or Chronic Exposure to Environmental Toxicants

In recent years hair has become a fundamental biological specimen, alternative to the usual samples blood and urine, for drug testing in the fields of forensic toxicology, clinical toxicology and clinical chemistry. Moreover, hair-testing is now extensively used in workplace testing, as well as, on legal cases, historical research etc. This article reviews methodological and practical issues related to the application of hair as a biological indicator of drug use/abuse or of chronic exposure to environmental toxicants. Hair structure and the mechanisms of drug incorporation into it are commented. The usual preparation and extraction methods as well as the analytical techniques of hair samples are presented and commented on. The outcomes of hair analysis have been reviewed for the following categories: drugs of abuse (opiates, cocaine and related, amphetamines, cannabinoids), benzodiazepines, prescribed drugs, pesticides and organic pollutants, doping agents and other drugs or substances. Finally, the specific purpose of the hair testing is discussed along with the interpretation of hair analysis results regarding the limitations of the applied procedures.

Assessment of exposure to drugs of abuse during pregnancy by hair analysis in a Mediterranean island

AIMS

  This study aims to estimate the prevalence of drug use by pregnant women living in Ibiza, using structured interviews and biomarkers in maternal hair. In addition, the potentially detrimental effects of maternal drug abuse on their newborns were investigated. Ibiza has a large international night-life resort associated with clubs, music and use of recreational drugs.

DESIGN, SETTING AND PARTICIPANTS

  Hair samples were collected prospectively from January to March 2010 from a cohort of consecutive mothers after giving birth in the Hospital Can Misses in Ibiza.

MEASUREMENTS

  Opiates, cocaine, cannabis, methadone, amphetamines, 3,4-methylenedioxymethamphetamine (MDMA) and their metabolites were detected in a 3-cm-long proximal segment of maternal hair corresponding to the last trimester of pregnancy by gas chromatography coupled to mass spectrometry (n = 107). Data on socio-demographic characteristics and on tobacco, alcohol, drugs of prescription and drugs of abuse consumption during pregnancy were collected using a structured questionnaire.

FINDINGS

  Hair analysis showed an overall 16% positivity for drugs of abuse in the third trimester of pregnancy, with a specific prevalence of cannabis, cocaine, MDMA and opiates use of 10.3, 6.4, 0.9 and 0%, respectively. In the questionnaires, only 1.9% of mothers declared using drugs of abuse during pregnancy. Gestational drug of abuse consumption was associated with active tobacco smoking, a higher number of smoked cigarettes and the mother being Spanish.

CONCLUSIONS

  Illicit drug use is substantially under-reported among pregnant women living in Ibiza, particularly among Spanish nationals. Voluntary, routine objective biological toxicology screening should be considered as part of routine examinations in antenatal clinics on this Mediterranean island.

Cocaine use during pregnancy assessed by hair analysis in a Canary Islands cohort

BACKGROUND

Drug use during pregnancy is difficult to ascertain, and maternal reports are likely to be inaccurate. The aim of this study was to estimate the prevalence of illicit drug use among pregnant women by using maternal hair analysis.

METHODS

A toxicological analysis of hair was used to detect chronic recreational drug use during pregnancy. In 2007, 347 mother-infant dyads were included from the Hospital La Candelaria, Santa Cruz de Tenerife, Canary Islands (Spain). Data on socioeconomic characteristics and on substance misuse during pregnancy were collected using a structured questionnaire. Drugs of abuse: opiates, cocaine, cannabinoids and amphetamines were detected in maternal hair by immunoassay followed by gas chromatography-mass spectrometry for confirmation and quantitation.

RESULTS

Hair analysis revealed 2.6% positivity for cocaine and its metabolites. Use of cocaine during pregnancy was associated with unusual behaviour with potentially harmful effects on the baby.

CONCLUSIONS

The results of the study demonstrate significant cocaine use by pregnant women in Canary Islands. The data should be used for the purpose of preventive health and policy strategies aimed to detect and possibly to avoid in the future prenatal exposure to drugs of abuse.

Relative ability of biologic specimens and interviews to detect prenatal cocaine use

For this study, we recruited women admitted to our labor and delivery service, enrolling all consenting patients with a history of prenatal cocaine use and the next admission with no recorded use. During the immediate postpartum period, experienced researchers conducted private, structured interviews to obtain details of prenatal cocaine use and to identify a priori exclusion criteria (other illicit drug use, high alcohol use and chronic illnesses and medications). Specific protocols were used to collect amniotic fluid, cord blood, infant urine, meconium and maternal hair. All specimens were analyzed blind with respect to exposure using gas chromatography/mass spectrometry. Of 115 subjects, 46 had one or more biologic specimens positive for cocaine metabolites and five admitted prenatal use, but had negative specimens. Of these 51 identified as users by any method, 38 admitted, 32 were positive for urine, 28 for hair and 25 for meconium. Of the 38 admitters, 87% had positive specimens; of the 77 denying use, 17% were positive. Urine was most frequently positive in identified users, 67% overall and 62% of users who denied. Hair was next, positive in 65% of all users and 50% of users who denied. Of the 13 subjects who denied use but were positive on at least one specimen, four were identified solely by urine, two only by hair and one only by meconium. Self-report identified five users with all negative specimens. Although no one method identified all users, the single method that maximally identified users was detailed history taken by experienced interviewers.

Drug abuse's smallest victims: in utero drug exposure

The social and economic impact of drug use on our global population continues to increase leaving no geographical, social or cultural group untouched. The National Institute on Drug Abuse (NIDA), in one of the few large surveys of maternal abuse, found that 5.5% of mothers reported taking an illicit substance during gestation. These figures certainly are underestimates due to the stigma of drug use during pregnancy and the accompanying legal, ethical and economic issues. Although drugs of choice and routes of administration vary by country, exposure of our most valuable resource, our children, to the developmental effects of drugs is an enormous problem. In utero drug exposure can have a severe impact not only on the development of the fetus, but also on the child during later stages of life. More than 75% of infants exposed to drugs have major medical problems as compared to 27% of unexposed infants. The cost of treating drug-affected infants was twice the cost of non-affected infants. Obstetrical complications including placental insufficiency, miscarriage, intrauterine death, and increased incidence of infectious and sexually-transmitted diseases are higher in the drug-abusing mother. Treatment for pregnant addicts should be a high priority for our governments. Increased awareness and improvement in our understanding of drug abuse in the medical, legal and social realms will enable us to reduce the barriers to treatment for this important population.Accurate identification of in utero drug exposure has important implications for the care of the mother and child, but can raise difficult legal issues. Society discourages prenatal care with the infliction of harsh criminal penalties. Maternal drug use during pregnancy can be monitored with urine, sweat, oral fluid and/or hair testing. Detection of in utero drug exposure has traditionally been accomplished through urine testing; however, the window of detection is short, reflecting drug use for only a few days before delivery. Monitoring exposure through testing of alternative matrices, such as neonatal meconium and hair, offers advantages including non-invasive collection and detection earlier in gestation. There are many unresolved issues in monitoring in utero drug exposure that urgently require research. These can be divided into research to definitively differentiate drug exposed and non-drug-exposed fetuses, determine the most efficient methods to routinely monitor women's drug use, and determine how these drug test results relate to neonatal and maternal outcomes. Research in this area is difficult and expensive to perform, but necessary to assess accurately drug effects on the fetus. By increasing our understanding of the physiological, biochemical and behavioral effects of gestational drug exposure, we may ultimately provide solutions for better drug prevention, treatment and a reduction in the number of drug-exposed children.

Fetal effects of cocaine: an updated meta-analysis

BACKGROUND

A very large number of women in the reproductive age group consume cocaine, leading to grave concerns regarding the long term health of millions of children after in utero exposure. The results of controlled studies have been contradictory, leading to confusion, and, possible, misinformation and misperception of teratogenic risk.

OBJECTIVE

To systematically review available data on pregnancy outcome when the mother consumed cocaine.

METHODS

A meta-analysis of all epidemiologic studies based on a priori criteria was conducted. Comparisons of adverse events in subgroups of exposed vs. unexposed children were performed. Analyses were based on several exposure groups: mainly cocaine, cocaine plus polydrug, polydrug but no cocaine, and drug free.

RESULTS

Thirty three studies met our inclusion criteria. For all end points of interest (rates of major malformations, low birth weight, prematurity, placental abruption, premature rupture of membrane [PROM], and mean birth weight, length and head circumference), cocaine-exposed infants had higher risks than children of women not exposed to any drug. However, most of these adverse effects were nullified when cocaine exposed children were compared to children exposed to polydrug but no cocaine. Only the risk of placental abruption and premature rupture of membranes were statistically associated with cocaine use itself.

CONCLUSIONS

Many of the perinatal adverse effects commonly attributed to cocaine may be caused by the multiple confounders that can occur in a cocaine using mother. Only the risk for placental abruption and PROM could be statistically related to cocaine. For other adverse effects, additional studies will be needed to ensure adequate statistical power.

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.

Detection of fluoxetine in brain, blood, liver and hair of rats using gas chromatography-mass spectrometry

This study reports the measurements of fluoxetine in discrete brain regions, blood, liver and hair of male rats injected with 10 mg/kg fluoxetine HCl for 15 consecutive days. Concentrations of the antidepressant were obtained by gas chromatography-mass spectrometry (GC-MS) methodology. In brain, fluoxetine levels were unevenly distributed, with the raphé nucleus containing the highest amounts relative to the hypothalamus or striatum. Fluoxetine was also measured in blood and liver roughly paralleling those ratios described in previous rodent studies. Of potential interest, fluoxetine was found to accumulate in rat hair after chronic treatment. Detection of fluoxetine in hair by GC-MS could be used as a marker for probative analyses.

Methods used to detect drug abuse in pregnancy: a brief review

A brief review of different methods adopted to assess foetal drug exposure is reported here. Various operative procedures have been described in the literature to detect drug abuse in pregnancy. All protocols can be clustered into two main groups: self-report and interview procedures and analytical methods. The latter can be performed on tissues and/or fluids withdrawn from the mother, from the new-born or both. The aim of this review is to analyse the capability of these different techniques and the suitability of the biological specimens in view of the lack of consensus on a method of choice. The results obtained and the conclusions are different between various authors. A brief discussion on the capability of the different techniques and biological specimens adopted for this purpose is presented.

Hair analysis, a novel tool in forensic and biomedical sciences: new chromatographic and electrophoretic/electrokinetic analytical strategies

Hair analysis for abused drugs is recognized as a powerful tool to investigate exposure of subjects to these substances. In fact, drugs permeate the hair matrix at the root level and above. Evidence of their presence remains incorporated into the hair stalk for the entire life of this structure. Most abusive drugs (e.g. opiates, cocaine, amphetamines, cannabinoids etc.) and several therapeutic drugs (e.g. antibiotics, theophylline, beta 2-agonists, etc.) have been demonstrated to be detectable in the hair of chronic users. Hence, hair analysis has been proposed to investigate drug abuses for epidemiological, clinical, administrative and forensic purposes, such as in questions of drug-related fatalities and revocation of driving licences, alleged drug addiction or drug abstinence in criminal or civil cases and for the follow-up of detoxication treatments. However, analytical and interpretative problems still remain and these limit the acceptance of this methodology, especially when the results from hair analysis represent a single piece of evidence and can not be supported by concurrent data. The present paper presents an updated review (with 102 references) of the modern techniques for hair analysis, including screening methods (e.g. immunoassays) and more sophisticated methodologies adopted for results confirmation and/or for research purposes, with special emphasis on gas chromatography-mass spectrometry, liquid chromatography and capillary electrophoresis.