RESUMO
BACKGROUND: The aim of the present study is to describe the prevalence of NPS and conventional DOA in Paris and its suburbs over a six-year period using hair testing approach. METHOD: Hair was sampled in patients admitted to different departments of Paris hospitals between 2012 and 2017. Two high-risk populations were mainly considered: 1) drug-dependent and 2) acutely intoxicated patients. Segmental hair analysis was performed by validated LC-MS/MS method to screen for DOA and 83 NPS. RESULTS: 480 patients (280â¯M/200â¯F, 15-70 years) were included. 141 patients tested positive for NPS (99â¯M/42â¯F; median age: 33). NPS prevalence was 29%, that of amphetamines, cocaine and opioids were 32%, 38.5% and 52%, respectively. 27 NPS were identified, 4-MEC and mephedrone (number of cases nâ¯=â¯24 each) were the most detected cathinones. JWH-122 (nâ¯=â¯1) was the only detected synthetic cannabinoid while ketamine (nâ¯=â¯104) was present in numerous NPS users (67%). 3-fluorofentanyl (nâ¯=â¯1), furanylfentanyl (nâ¯=â¯1), N-ethylpentylone (nâ¯=â¯2), pentedrone (nâ¯=â¯2), mexedrone (nâ¯=â¯1), methcathinone (nâ¯=â¯3), 6-APDB (nâ¯=â¯2), TFMPP (nâ¯=â¯2), 2-CE (nâ¯=â¯1), 3,4-MD-αPHP (nâ¯=â¯1) and dextromethorphan (nâ¯=â¯27) were identified for the first time in hair. Users were found to have more than one NPS in 53% of cases, mostly in combination with conventional DOA. The number of detected NPS rose from 5 in 2012 to 42 in 2017. A broad range of hair concentrations (0.001-318â¯ng/mg) was found, but the low median concentrations seem to show an occasional exposure more than chronic use. CONCLUSION: NPS screening should be assessed in routine clinical practice, especially in high-risk populations.
Assuntos
Drogas Ilícitas/análise , Detecção do Abuso de Substâncias/métodos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Anfetaminas/análise , Analgésicos Opioides/análise , Cromatografia Líquida/métodos , Cocaína/análise , Estudos Transversais , Feminino , Cabelo/química , Humanos , Masculino , Paris/epidemiologia , Prevalência , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Espectrometria de Massas em Tandem/métodosRESUMO
To evaluate adherence to treatment, we developed and validated a novel liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for baclofen quantification in hair.Twenty mg was washed twice with dichloromethane, incubated in phosphate buffer (pH 5) for 10 minutes at 95°C, then extracted by liquid-liquid extraction in alkaline condition. Baclofen-d4 was used as the internal standard. This method was applied to assess compliance in4 treated alcohol-dependent patients (3 dead and one living). Blood quantification of baclofen and ethanol were performed in the 4 cases. Hair ethylglucuronide (ethanol metabolite, EtG) measurement (2x3 cm) was associated in 1 patient. Baclofen quantification in hair was validated over the range 10-5000 pg/mg. The accuracy was within 96.0%-110.9% and the precision was less than 9.3%. Baclofen segmental (3x2cm) hair concentrations found in the living patient were 4420, 4260, and 4380 pg/mg, reflecting a regular exposure over the last 6 months and suggesting patient compliance. However, the high EtG level found in this patient in the analyzed segments (225 pg/mg and 215 pg/mg) showed excessive alcohol consumption during the same period, suggesting therapeutic failure. In the 3 deceased patients, the non-segmental analysis of hair showed baclofen concentrations of 15, 545, and 2475 pg/mg. The low concentrations in the 2 first cases are compatible either with a poor compliance or to a beginning of a treatment. This is the first measurement of baclofen in hair of alcohol dependent patients. It could be used as a monitoring biomarker to assess patient's compliance.