Genetic susceptibility in pharmacodynamic and pharmacokinetic pathways underlying drug-induced arrhythmia and sudden unexplained deaths

ABSTRACT: Drug-induced arrhythmia is an adverse drug reaction that can be potentially fatal since it is mostly related to drug-induced QT prolongation, a known risk factor for Torsade de Pointes and sudden cardiac death (SCD). Several risk factors have been described in association to these drug-induced events, such as preexistent cardiac disease and genetic variation. Our objective was to study the genetic susceptibility in pharmacodynamic and pharmacokinetic pathways underlying suspected drug-induced arrhythmias and sudden unexplained deaths in 32 patients. The genetic component in the pharmacodynamic pathway was studied by analysing 96 genes associated with higher risk of SCD through massive parallel sequencing. Pharmacokinetic-mediated genetic susceptibility was investigated by studying the genes encoding cytochrome P450 enzymes using mediumthroughput genotyping. Pharmacodynamic analysis showed three probably pathogenic variants and 45 variants of uncertain significance in 28 patients, several of them previously described in relation to mild or late onset cardiomyopathies. These results suggest that genetic variants in cardiomyopathy genes, in addition to those related with channelopathies, could be relevant to drug-induced cardiotoxicity and contribute to the arrhythmogenic phenotype. Pharmacokinetic analysis showed three patients that could have an altered metabolism of the drugs they received involving CYP2C19 and/or CYP2D6, probably contributing to the arrhythmogenic phenotype. The study of genetic variants in both pharmacodynamic and pharmacokinetic pathways may be a useful strategy to understand the multifactorial mechanism of drug-induced events in both clinical practice and forensic field. However, it is necessary to comprehensively study and evaluate the contribution of the genetic susceptibility to drug-induced cardiotoxicity. (AU)

Perfil de alcaloides de la hoja de coca en el fluido oral de un mascador de hoja de coca y un bebedor de té de coca: Estudio preliminar / Coca alkaloids profile in oral fluid from people chewing coca leaves and drinking coca tea: Preliminary study

Actualmente el fluido oral (FO) es aceptado como una matriz biológica alternativa para detectar drogas en toxicología clínica y forense. En países como Argentina donde el uso de hojas de coca (mascar hojas de coca o beber té de coca) es legal son necesarios procedimientos adecuados para logar una clara diferenciación entre los individuos que usan las hojas de coca de manera legal de aquéllos que usan cocaína en forma ilegal. Poca es la información que hay en la literatura sobre el perfil de los alcaloides de la hoja de coca en FO de personas que mascan hojas de coca o toman té de coca y hasta el presente trabajo no se hallaron datos sobre el perfil en FO de la higrina (HIG) y cuscohigrina (CUS). De este estudio preliminar participaron dos voluntarios. Los resultados mostraron que la CUS e HIG siguieron siendo positivas después que la cocaína (COC) y benzoilecgonina (BE) cayeron por debajo de los valores cut- off propuestos por las guías internacionales para FO en casos de screening (15 a 20 ng/ mL) y de confirmación (8 a 10 ng/mL) en el caso del mascador de coca. En el participante que tomó una taza de té de coca, en el último punto examinado (1 h) resultó ser positivo para la COC y BE y también para la CUS e HIG. El FO podría ser una muestra útil para confirmar el uso legal de la hoja de coca, aun cuando futuros estudios son necesarios para corroborar estos primeros datos.

Nowadays oral fluid (OF) is accepted as an alternative biological sample for detecting drugs in clinical and forensic toxicology. In countries like Argentina, where the use of coca leaves (coca leaves chewing and coca tea drinking) is legal, adequate procedures are required to allow a clear differentiation between people who use coca leaves (legal practice) and those who use cocaine (illicit practice). There is scarce literature regarding coca leaf alkaloids profile in OF from people who chew coca leaves and drink coca tea. Until now, coca leaf alkaloids profile of hygrine (HYG) and cuscohygrine (CUS) in OF were not described in the literature. The current preliminary study was performed with two healthy volunteers. In this research CUS and HYG have been found to be positive (detectable) even when cocaine (COC) and benzoylecgonine (BE) are dropped below the cut-off values proposed by international guidelines for screening (15 to 20 ng/mL), and confirmation (8 to 10 ng/mL) in OF. In addition, CUS and HYG were also found to be positive at the same time of the last detection of COC and BE after coca tea consumption. The OF would be a useful sample to confirm the legal use of coca leaf, even when more researches are therefore needed.

Genetic susceptibility in pharmacodynamic and pharmacokinetic pathways underlying drug-induced arrhythmia and sudden unexplained deaths.

Drug-induced arrhythmia is an adverse drug reaction that can be potentially fatal since it is mostly related to drug-induced QT prolongation, a known risk factor for Torsade de Pointes and sudden cardiac death (SCD). Several risk factors have been described in association to these drug-induced events, such as preexistent cardiac disease and genetic variation. Our objective was to study the genetic susceptibility in pharmacodynamic and pharmacokinetic pathways underlying suspected drug-induced arrhythmias and sudden unexplained deaths in 32 patients. The genetic component in the pharmacodynamic pathway was studied by analysing 96 genes associated with higher risk of SCD through massive parallel sequencing. Pharmacokinetic-mediated genetic susceptibility was investigated by studying the genes encoding cytochrome P450 enzymes using medium-throughput genotyping. Pharmacodynamic analysis showed three probably pathogenic variants and 45 variants of uncertain significance in 28 patients, several of them previously described in relation to mild or late onset cardiomyopathies. These results suggest that genetic variants in cardiomyopathy genes, in addition to those related with channelopathies, could be relevant to drug-induced cardiotoxicity and contribute to the arrhythmogenic phenotype. Pharmacokinetic analysis showed three patients that could have an altered metabolism of the drugs they received involving CYP2C19 and/or CYP2D6, probably contributing to the arrhythmogenic phenotype. The study of genetic variants in both pharmacodynamic and pharmacokinetic pathways may be a useful strategy to understand the multifactorial mechanism of drug-induced events in both clinical practice and forensic field. However, it is necessary to comprehensively study and evaluate the contribution of the genetic susceptibility to drug-induced cardiotoxicity.

Analysis of drugs of abuse in human plasma by dispersive liquid-liquid microextraction and high-performance liquid chromatography.

Opioids and cocaine are widely used at present, both for recreational purposes and as drugs of abuse. This raises the need to develop new analytical methods specifically designed for the simultaneous detection of several drugs of abuse in biological samples. In this work, dispersive liquid-liquid microextraction (DLLME) was assessed as a new sample treatment for the simultaneous extraction of morphine (MOR), 6-acetylmorphine (6AM), cocaine (COC), benzoylecgonine (BZE) and methadone (MET) from human plasma. Preliminary assays were done before developing an experimental design based on a Uniform Network Doehlert which allowed the optimum extraction conditions to be identified, namely: a volume of extractant solvent (chloroform) and dispersant solvent (acetonitrile) of 220 µl and 3.2 ml, respectively; 0.2 g of NaCl as a salting-out additive; pH 10.6 and ultrasound stirring for 3.5 min. The resulting extracts were analyzed by high-performance liquid chromatography with photodiode array detection (HPLC-PDA), using an XBridge® RP18 column (250 × 4.6 mm i.d., 5 µm particle size). Calibration graphs were linear over the concentration range 0.1-10 µg ml⁻¹, and detection limits ranged from 13.9 to 28.5 ng ml⁻¹. Precision calculated at three different concentration levels in plasma was included in the range 0.1-6.8% RSD. Recoveries of the five drugs were all higher than 84% on average. Finally the proposed method was successfully applied to 22 plasma samples from heroin, cocaine and/or methadone users, and the most frequently detected drug was benzoylecgonine, followed by methadone, cocaine and morphine.

Application of hygrine and cuscohygrine as possible markers to distinguish coca chewing from cocaine abuse on WDT and forensic cases.

The objectives of present work are twofold. First, we want to verify that hygrine and cuscohygrine are good markers to distinguish between chewing coca leaves and cocaine abuse. Secondly, we try to develop a quick and easy qualitative method to determine the two mentioned markers. We analyzed two kinds of urine samples: the first group consisted of twenty-four (24) subjects: urine samples were obtained from various types of workers (e.g. doctors, chemists, nurses, technicians, painters, contractors, employees and some retired persons) who admitted chewing coca leaves. Frequency of the habit of chewing coca leaves was variable. They practiced "coqueo" between two (2) and forty-four (44) years. Sixteen (16) of them used alkaline substances to enhance the extraction of cocaine from the leaves The second group of urine samples consisted on thirty-eight (38) cocaine abusers, from forensic cases from Spain and Argentina. A GC/MS qualitative method, performed after liquid-liquid extraction, was developed and validated (the parameters studied were selectivity/specificity, LOD and stability), and then applied to the urine samples. Hygrine and cuscohygrine are good markers to distinguish between chewing coca leaves and cocaine abuse, and the qualitative method presented can be used successfully in workplace drug testing and forensic cases.

Hair testing for cocaine and metabolites by GC/MS: criteria to quantitatively assess cocaine use.

A simple, rapid and sensitive method has been developed and validated for the determination of cocaine and its main metabolites (benzoylecgonine and cocaethylene) in human hair. The method involved solid-phase extraction with an Oasis HLB extraction cartridge and subsequent analysis by GC/MS. The limit of detection was 0.01 ng mg(-1) for cocaine, 0.04 for benzoylecgonine and 0.03 for cocaethylene. The method validation included linearity (with a correlation coefficient >0.99 over the range 0.2-50 ng mg(-1) ), intra- and inter-day precision (always lower than 12%) and accuracy (mean relative error always below 17%) to meet the bioanalytical acceptance criteria. The procedure was further applied to 40 hair samples from self-reported cocaine users arrested by the police who provided a positive urine-analysis for cocaine, and was demonstrated to be suitable for its application in forensic toxicology. New approaches were raised to detect false-negative results that allow a better interpretation of hair testing results.

Hygrine and cuscohygrine as possible markers to distinguish coca chewing from cocaine abuse in workplace drug testing.

Cocaine abuse is widespread all over the world, and is performed generally by sniffing, injecting or smoking cocaine or crack. The distinction between the recreational use of cocaine from the practice of the so called "coqueo" is still an issue in those countries where this habit is diffused and where it is not considered an addiction, by this reason is necessary to develop a method for to distinguish the coca chewers and cocaine abusers. The use of an unique marker to distinguish between cocaine abuse and chewing of coca leaves is of fundamental importance in those countries where this habit is diffused. Certain alkaloids of the leaves of Erythroxylum coca are lost during the process of extraction/purification of cocaine and it is not possible to find them neither in seizures of chlorhidrate of cocaine nor urine samples of cocaine abusers. These markers are the hygrine and cuscohygrine that are present in the leaves of E. coca. A fast GC/MS method involving a liquid:liquid extraction procedure with tertbutylmethylether (TBME) is proposed for the determination of some alkaloids in cocaine leaves, cocaine seizures and biological samples. All specimens were alkalinized to pH 9 with a carbonate/bicarbonate buffer and then extracted with TBME. The analysis was carry out by GC/MS with electron impact at 70 eV and in full scan mode. The results demonstrate that hygrine and cuscohygrine are not found neither in the urine of cocaine abusers nor in cocaine seizures. For this reason this compounds could be considered as markers of coca chewing. This developed method permits to distinguish coca chewing from cocaine abuse in workplace drug testing through the analysis of urine samples.

Analysis of six benzodiazepines in vitreous humor by high-performance liquid chromatography-photodiode-array detection.

The purpose of this study was to validate a high-performance liquid chromatography-photodiode-array detetion method for the determination of six benzodiazepines in vitreous humor. The sample preparation was carried out using solid-phase extraction with Oasis HLB cartridges and 10% acetic acid/MeOH as elution solvent. The vitreous humor is less affected by postmortem changes and is a very useful sample when blood or urine specimens are not available. Linear curves for bromazepam, alprazolam, lorazepam, lormetazepam, diazepam, and tetrazepam were obtained within the range 0.03-3 µg/mL, with coefficients of correlation lower than 0.999. The limit of detection was 3 ng/mL, and the lower limit of quantification was 30 ng/mL for each benzodiazepine. Intra- and interassay for precision and accuracy provided results less than 16.81% and 16.78%, respectively. Recoveries were higher than 68.51% in all cases. Finally, the method was applied to determine benzodiazepines in vitreous humor from intoxicated patients.

Validation of ELISA screening and LC-MS/MS confirmation methods for cocaine in hair after simple extraction.

This article describes an easy and innovative extraction procedure for cocaine and its primary metabolite, benzoylecgonine (BE), from hair consisting of sonication with H(2)O/0.1% formic acid for 4 h. The same extract was used for screening with an enzyme-linked immunoassay (ELISA) and confirmation by liquid chromatography-tandem mass spectrometry (LC-MS/MS). For the ELISA screening test a cutoff of 0.5 ng/mg was used according to the Society of Hair Testing recommendations. LC-MS/MS limits of detection (LODs) were established to be 10 pg/mg and 1 pg/mg for cocaine and BE, respectively. Linearity was obtained over a range of 0.2-5 ng/mg for BE (target analyte) in the ELISA screening test, while in the LC-MS/MS method the range was 0.10-10 ng/mg for cocaine and 0.01-10 ng/mg for BE. Intra- and interbatch coefficients of variation and mean relative errors were less than 20% for all analytes and concentrations studied. The validated ELISA and LC-MS/MS methods were applied to 48 hair samples and the results of both methods were compared; ELISA demonstrated a sensitivity and specificity of 89.2% and 10.8%.

Cocaine and opiates use in pregnancy: detection of drugs in neonatal meconium and urine.

In this study, the case of a newborn with symptoms of hyperexcitability was analyzed. After it was confirmed in the hospital that the mother had consumed drugs during pregnancy using an enzyme multiplied immunoassay technique, samples of the newborn's urine and meconium were sent to our laboratory to observe the evolution in the distribution of cocaine and opiates during the days following birth. For urine analysis, screening was done with an immunoassay technique, and the confirmation was done by gas chromatography-mass spectrometry (GC-MS) according to a published method. A GC-MS method for simultaneous analysis of cocaine, benzoylecgonine, codeine, morphine, and 6-acetylmorphine in meconium is described. GC-MS confirmation of urine and meconium results showed consumption of cocaine and codeine during pregnancy and also showed the levels of drugs gradually declined, totally disappearing by the third day.

Optimization of a rapid microwave-assisted extraction method for the simultaneous determination of opiates, cocaine and their metabolites in human hair.

A rapid and cleanup-free microwave-assisted extraction (MAE) method is proposed for the simultaneous extraction of six illegal drugs of abuse - cocaine, benzoylecgonine (BZE), cocaethylene (CCE), morphine, 6-monoacethylmorphine (6AM) and codeine - from human hair samples. The analytes were determined using high performance liquid chromatography (HPLC) with photodiode array UV detection. The influence of several variables on the efficiency of the MAE procedure was investigated in detail by a multi-objective optimization approach based on a hybrid experimental design (17 experiments) and desirability functions. Six drugs were successfully extracted from human hair with recoveries close to 100% and good reproducibility (<3.6% RSD) under the optimal MAE conditions: 11 mL dichloromethane (DCM) extraction solvent, 60 degrees C extraction temperature, 9 min extraction time and 0.5 mL of methanol (MeOH) added to 50mg of the hair sample in the extraction vessels. Limits of quantification of 0.2 ng mg(-1) were found for the studied compounds. A comparison of sample preparation procedures, including MAE, enzymatic digestion and digestion by aqueous acids, was also conducted. The results indicated that the global behaviour of sample procedures provided similar satisfactory recoveries ranging from 86 to 100%. Indeed, the MAE procedure resulted in a reduction of extraction time by 100-fold and the elimination of cleanup steps. Slightly higher recoveries of morphine, 6AM, BZE and CCE, at 1 ng mg(-1) concentration level and cocaine at 40 ng mg(-1) concentration level, were achieved using MAE. Lastly, the proposed MAE method was applied to several human hair samples from multidrug abusers.

Comparison of two extraction procedures for determination of drugs of abuse in human saliva by high-performance liquid chromatography.

High performance liquid chromatography in combination with diode array detection (HPLC-DAD) was used to determine morphine, 6-acetylmorphine, cocaine, benzoylecgonine, cocaethylene, methadone and 2-ethylene-1,5-dimethyl-3,3,-diphenylpyrrolidine in human saliva. For comparison, samples were prepared by either liquid-liquid extraction in Toxitubes A or microwave-assisted extraction (MAE), by mixing 1 ml of saliva with 10 ml of chloroform and operating at 100 degrees C for 10 min. Acetonitrile and 0.02 m phosphate buffer at pH 6.5 were used as mobile phase in HPLC in gradient mode. The detector response was linear over the drug concentration range of 0.05-2.0 microg ml(-1) in human saliva. The analytical method was validated by determining its precision and accuracy (n = 5), which were lower than 5% as relative standard deviation and 6% as relative error. Limits of detection ranged from 10 to 35 ng ml(-1); mean recoveries of drugs were from 53 to 95% with Toxitubes A and from 83 to 100% with MAE at two different concentrations (0.1 and 1.0 microg ml(-1)). The proposed method was applied to 24 saliva samples from individuals poisoned with opiates and/or cocaine.

Determination of cocaine and heroin with their respective metabolites in meconium by gas chromatography-mass spectrometry.

The analysis of meconium specimens is a relatively accurate method for the detection of fetal exposure to drugs. The purpose of this study was to develop and validate a method for meconium sample preparation for a gas chromatography-mass spectrometry (GC-MS) confirmation of meconium extracts for cocaine, benzoylecgonine, codeine, morphine and 6-monoacetylmorphine. The analytes were initially extracted from the matrix by methanol. Subsequently a solid-phase extraction with Waters Oasis HLB cartridges was applied. Analytes were determined in GC-MS single monitoring mode. The method was validated in the range 40-2000 ng g(-1) using 0.5 g of meconium per assay. The detector response was linear over the studied range, and limits of quantitation and detection were found to be acceptable. Intra- and inter-batch coefficients of variation oscillated between 2.54% and 20.5%, and mean relative errors were in the range 0.79%-19.9%. The recoveries were higher than 42.1% in all cases. Finally the method was applied to analysis of meconium in newborns to assess fetal exposure to cocaine and opiates.

Determination of methadone, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine and alprazolam in human plasma by liquid chromatography-electrospray ionization mass spectrometry.

A fast liquid chromatographic assay with mass spectrometric detection (LC/MS) has been developed and validated for the simultaneous determination of methadone (MT), its primary metabolite, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP) and alprazolam, in human plasma. The extraction procedure was performed with automatic solid phase extraction, and the compounds were separated with a Sunfire column using a gradient mode. Deuterated analogues for all of the analytes of interest were used for quantitation. Limits of detection (LOD) were established between 0.5 and 1 ng/ml. Linearity was obtained over a range of 2-2,000 ng/ml with an average correlation coefficient (R(2)) of >0.99. Intra- and inter-batch coefficients of variation and relative mean errors were less than 10% for all analytes and concentrations. The recoveries were higher than 50.0% in all cases. The method proved to be suitable for evaluation of plasma obtained from patients enrolled in a MT-maintenance program who are frequently treated with alprazolam as a sedative.

GC-FID determination of cocaine and its metabolites in human bile and vitreous humor.

Gas chromatography was used in combination with flame ionization detection (GC-FID) to develop a method for determining cocaine and its two metabolites, benzoylecgonine (BEG) and ecgonine methyl ester (EME), in bile and vitreous humor. The method used a 12 m x 0.2 mm i.d. column of 0.33 microm film thickness packed with 5% phenylmethylsiloxane, and proadifen as a reference compound. Drug-free bile and vitreous humor samples were used to prepare solutions of the target compounds at concentrations over the range 0.1-4 microg ml(-1) that were subjected to solid-phase extraction through Bond Elut Certify columns and derivatized with 99:1 (v/v) N,O-bis-trimethylsilyltrifluoroacetamide (BSTFA)/trimethylchlorosilane (TMCS). Calibration graphs were highly linear, with correlation coefficients above 0.99 in all instances. Also, the precision of the method was found to be quite acceptable, with coefficients of variation less than 5% for bile and less than 7% for vitreous humor. The average extraction yields ranged from 73.6% to 91.2% for bile and from 71.5% to 92.2% for vitreous humor. The proposed method was used to analyse 26 samples of bile and as many of vitreous humor from individuals fatally poisoned by cocaine, whether alone or in combination with other drugs. The mean drug levels found were 0.75 and 1.54 microg ml(-1) for cocaine in bile and vitreous humor, respectively, 6.35 and 0.94 microg ml(-1) for BEG, and 2.18 and 0.61 microg ml(-1) for EME.

HPLC-DAD determination of opioids, cocaine and their metabolites in plasma.

High performance liquid chromatography with diode array detection (HPLC-DAD) was used to develop a method for the simultaneous determination of morphine, codeine, 6-acetylmorphine (6AM), cocaine, benzoylecgonine (BEG), cocaethylene, methadone and its metabolite, 2-ethylidene-1,5-dimethyldiphenylpyrrolidine (EDDP), in plasma. Following solid-phase extraction with Bond Elut Certify cartridges, chromatography was performed on an X-Terra RP8 column (250 mm x 4.6 mm i.d., 5 microm particle size), using acetonitrile-phosphate buffer pH 6.53 as mobile phase and elution in the gradient mode. The detector response was linear at concentrations over the range 0.1-10 microg/mL in plasma, and the correlation coefficients for the eight drugs studied were all higher than 0.99. The average extraction recoveries from plasma ranged from 60% for BEG to 95% for methadone. The precision was acceptable, with coefficients of variation oscillating between 2.55% and 6.45%. The accuracy was found to be within satisfactory limits (+/- 8.1%). Finally, the method was applied to 21 plasma samples from fatal overdoses, obtaining positive results for two or more drugs.

A new GC-MS method for the determination of five amphetamines in human hair.

A new gas chromatography-mass spectrometry method for the simultaneous identification and quantitation of amphetamine (AP), methamphetamine (MA), 3,4-methylenedioxyamphetamine (MDA), 3,4-methylenedioxymethamphetamine (MDMA), and 3,4-methylenedioxyethamphetamine (MDEA) in hair is proposed. Hair was hydrolyzed in 1 M NaOH at 40 degrees C, subjected to extraction with 4:1 (v/v) methylene chloride/isopropanol, and derivatized with pentafluoropropionic anhydride (PFPA) and ethyl acetate. Calibration curves for the five analytes were constructed over the concentration range 0.5-25.0 ng/mg, using their pentadeuterated analogues as internal standards. The limits of detection and quantitation obtained were 0.045 and 0.151 ng/mg for AP; 0.014 and 0.048 ng/mg for MA; 0.013 and 0.043 ng/mg for MDA; 0.017 and 0.057 ng/mg for MDMA; and 0.007 and 0.023 ng/mg for MDEA. The accuracy of the method was found to be in the range +/- 9%, and the coefficients of variation were less than 8%. Overall, 24 hair specimens tested positive for one or more amphetamines, with average concentrations of 0.88 ng/mg for AP, 10.14 ng/mg for MA, 1.30 ng/mg for MDA, and 8.87 ng/mg for MDMA. Only one specimen tested positive for MDEA with a concentration of 0.84 ng/mg.

Analysis of opiates, cocaine and metabolites in urine by high-performance liquid chromatography with diode array detection (HPLC-DAD).

An analytical method is proposed for the simultaneous determination of morphine, codeine, 6-acetyl-morphine (MAM), cocaine, benzoylecgonine (BEG), cocaethylene, methadone and 2-ethylen-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP) in urine using high performance liquid chromatography coupled to a diode array detector (HPLC-DAD). The selection of working wavelengths is based on the highest chromatographic response for each component: 233 nm for cocaine, BEG and cocaethylene; 285 nm for morphine, codeine and MAM; and 292 nm for methadone and EDDP. The mobile phase, which is a mixture of acetonitrile and 0.02 M phosphate buffer at pH 6.53, was eluted in gradient mode through an XTerra RP-8 column (250 mm x 4.6 mm i.d., 5 microm particle size). After applying a solid-phase extraction procedure with Bond Elut Certify cartridges, the recoveries obtained were between 60% (EDDP) and 97% (cocaethylene). A good linearity of the method in the 0.1-10 microg mL(-1) range of urinary concentrations was obtained because the coefficient of correlation exceeded 0.99 for each drug. The precision and accuracy were quite good, with values of <7% and within the range +/- 6%, respectively. Finally, the proposed method was applied to 23 urine samples from fatal intoxications related to methadone, heroin and[sol ]or cocaine.

Gas chromatographic determination of cocaine and its metabolites in blood and urine from cocaine users in northwestern Spain.

A gas chromatographic method with fl ame ionization detection (GC/FID) was developed for the determination of cocaine and its metabolites in blood and urine samples from cocaine users in Northwestern Spain. After a solid-phase extraction with Bond Elut Certify cartridges and a derivatization with bis-trimethylsilyltrifluoroacetamide-trimethylchlorosilane (1%), calibration curves were constructed over 0.4-4 micro g ml(-1) for urine and 0.1-2 micro g ml(-1) for blood, using proadifen as the reference compound. The average extraction recoveries were 75% for urine and 78% for blood. The limits of detection and quantitation were 0.071 and 0.24 micro g ml(-1), respectively. Coefficients of variation were <10% and accuracy was within +/-12%. The average blood concentrations of cocaine, benzoylecgonine and ecgonine methyl ester in 42 living patients were 0.22, 1.43 and 0.16 micro g ml(-1), respectively. Urine samples were collected from individuals in the criminal justice system (70 cases), from drug abusers admitted to emergency rooms (36 cases) and from patients under detoxification treatment (36 cases). The second group exhibited the highest average concentrations (e.g. 0.97 micro g ml(-1) for cocaine, 5.23 micro g ml(-1) for benzoylecgonine and 0.39 micro g ml(-1) for ecgonine methyl ester). Sixty- five fatal intoxications due to cocaine alone or in combination with other drugs were studied, and average blood levels were found to be higher in the deaths related to cocaine alone (e.g. 0.40 micro g ml(-1) for cocaine, 2.38 micro g ml(-1) for benzoylecgonine and 0.38 micro g ml(-1) for ecgonine methyl ester).