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.

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.

Analytical techniques in androgen anabolic steroids (AASs) analysis for antidoping and forensic purposes.

A survey on the main analytical challenges related to the analysis of Androgen Anabolic Steroids (AASs) is reported. AASs analysis is an issue regarding antidoping analyses as well as forensic toxicology applications. This paper reports an overview of the more recent literature regarding various aspects of sample preparation, analytical techniques and interpretation of results for AASs identification in biological samples. New analytical approaches, mainly for their application to the antidoping field, are reported. The application of AASs analysis in forensic cases is also described, taking into consideration mainly the different biological samples that can be analysed for forensic purposes. Particular attention was played on the application of hair analysis as alternative biological specimen for the determination of AASs abuse.

LC-MS-MS method for simultaneous determination of THCCOOH and THCCOOH-glucuronide in urine: Application to workplace confirmation tests.

Cannabis is the one of the most frequently detected drug in workplace drug testing and in cases of driving under influence of drugs, and there is a greater demand for sensitive, rapid and reliable methods for confirming the presence of this drug in biological samples. This paper describes an LC-MS-MS procedure for direct analysis of cTHC and cTHC-glucuronide in urine, without hydrolysis of the samples or derivatisation. The sample preparation is very simple and consist only in a dilution of urine with methanol 1:1 (v/v) after adding the deuterated internal standard (cTHC-d3); then 10µl of the final solution is injected in LC-MS-MS. Chromatographic separation was performed using a reversed-phase column and gradient elution with 0.01% formic acid/acetonitrile/methanol and two MS-MS transitions for each substance were monitored. The method was fully validated and proved to be accurate (RSD <15%), precise (intra-day CV <10%) and sensitive with a limit of detection (LOD) of 5ng/ml for both the compounds studied. Linearity was tested in the range 5-1000ng/ml and the values of R(2) resulted >0.99. The developed method was applied to several authentic samples of urine which tested positive in the immunoassay screening and 98% of them was confirmed.

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%.

[Workers with alcohol and drug addiction problems. Consensus Document of the Study Group on Hazardous Workers]. / Lavoratori con problemi di alcol e dipendenze. Documento di Consenso del gruppo La.R.A. (Lavoratori Rischiosi per gli Altri).

BACKGROUND: Italian Law 81/08 (so-called "Unified Text of Laws on Health and Safety at Work"), came into force on 15 May 2008 and incorporates provisions related to medical surveillance of drug and alcohol dependency at the workplace. OBJECTIVES: Occupational health traditionally addresses the issue of protection of worker from occupational hazards. The issue of protection of third parties from behaviour of workers resulting from drug and alcohol dependency implies an original methodological approach, involving full cooperation of employer, employees, and health and safety consultants. METHODS: A consensus development meeting was organized under the leadership of the Italian Study Group on Hazardous Workers (La.R.A. group). The meeting brought together physicians of different specialties, legal experts and bioethicists, labour and management policy-makers, to discuss the issue and define the research data available, the standards that were appropriate, and which policies were fair. RESULTS: The efficacy of medical surveillance, including workplace drug-testing, relies on a comprehensive policy, including written and verbal information on the use of alcohol and drugs on the job, training for supervisors and management, employee education, and employee assistance structures. Sample collection and testing should be carried out in accordance with standardized and tested procedures. Small businesses will need assistance, including development of model policies, setting up consortia for testing services and if necessary request for National Insurance benefits to reduce costs. CONCLUSIONS: The recently introduced Italian legislation on occupational safety and health closely resembles Finnish law since it consists of a "double channel" for workplace drug testing. At recruitment, the employer is entitled to ask a job applicant for a certificate of "Job fitness", including drug tests, that can be issued only by a public health institution, where the job applicant works on a well-defined set of tasks which require accuracy, trustworthiness, independent judgement or a very good reaction capacity. The employer may also refer the employee to the public health institution to obtain a certificate in the course of an employment contract when there is a legitimate suspicion that the employee is working while under the effects of drugs or alcohol or that the employee is a drug addict. After recruitment, the physician responsible for medical surveillance of workers (the so-called "Competent Physician") is entitled to perform drug tests on employees. The need for a test is decided by the health care professional, not by the employer, and only a general report on the health of the employee ("fit", fit with restrictions" or "unfit") may be given to the employer. Workers positive for drug tests will be referred to a public health institution for re-testing and treatment.

Survey of nutritional supplements for selected illegal anabolic steroids and ephedrine using LC-MS/MS and GC-MS methods, respectively.

Several studies have highlighted that nutritional supplements may contain undeclared substances that are banned by the International Olympic Committee (IOC)/World Anti-Doping Agency (WADA). This paper describes a qualitative liquid chromatography coupled with tandem mass spectrometry detection (LC-MS/MS) method to detect anabolic androgenic steroids (4-androsten-3,17-dion, 4-oestren-3,17-dion, 5alpha-androsten-17beta-ol-3-one, boldenone, nandrolone, nandrolone decanoate, testosterone, and testosterone decanoate) and ephedrine in food supplements. The products are dissolved in methanol and analysed by gas chromatography-mass spectrometry (GC-MS). The methanolic solution was added to testosterone-d(3), evaporated to dryness, mixed with NaOH and extracted with n-pentane:diethylether (9:1). LC-MS/MS analyses were performed in selected reaction monitoring (SRM) on an ion-trap equipped with an atmospheric pressure chemical ionization (APCI) probe operating in positive-ion mode. The method was applied to 64 nutritional supplements. A total of 12.5% of the nutritional supplements analysed contained banned substances not declared on the label (anabolic steroids and ephedrine). Detection limits were in the range 1-25 ng g(-1).

An evaluation of the Cozart RapiScan system as an on-site screening tool for drugs of abuse in a non-conventional biological matrix: vitreous humor.

The aim of this project was to evaluate the Cozart RapiScan Oral fluid Drug Testing System as an on-site screening tool for vitreous humor samples collected during post-mortem examinations. Vitreous humor is easy to collect and as it is contained within the eye it is almost completely unaffected by post-mortem redistribution. The ability to carry out an initial drug screen on vitreous humor at the earliest stage of the death investigation process could contribute significantly to the assessment of the role drugs may have played prior to confirmation with toxicological analyses at the laboratory. Vitreous humor (n = 146) was collected from autopsy examinations (111 males and 35 females) with a specific focus on cases where death occurred following a road traffic accident or where an overdose was suspected. All samples were screened using the five-panel methadone Cozart RapiScan Cartridge with an overall positive rate of 29%. Of the positive results, 43% screened positive for benzodiazepines, 17% for cocaine, 7% for methadone and 33% for opiates. Positive samples, with the exception of benzodiazepines, and 20% of negative samples were analysed by GC/MS. This is the first reported use of this system as an on-site forensic tool in death investigation and for screening for drugs of abuse in vitreous humor. The conclusions from this study show that the Cozart RapiScan System could play an important role in obtaining information on the toxicological state of the person at the time of death.

Disappearance of cocaine from human hair after abstinence.

In this work the study of the disappearance of cocaine in hair is reported. The subject of the study is a woman who stopped the consumption of cocaine after a period of drug abuse of over 1 year. Hair samples were collected over a period of 10 months. During this time the absence of cocaine intake was monitored by the toxicological analysis of urine, performed every 2 days. After decontamination with methanol, the hair sample, cut in two segments (0-1.5 and 1.5-3 cm from the hair root) was added with cocaine-D(3) (internal standard), hydrolyzed and extracted with chloroform/isopropanol (9:1). The extract was evaporated to dryness, reconstituted in 25 microl of ethyl acetate and analyzed by GC-MS in SIM mode. The obtained results show that the incorporation of cocaine in hair decreased during the first 3 months after the last consumption and after this period of time no cocaine was found in the hair sections closest to the root.

SPME-GC analysis of THC in saliva samples collected with "EPITOPE" device.

In this study we examined the presence of cannabinoids in saliva samples obtained from 24 drug-abusers. The saliva specimens were collected by "EPITOPE" system and the subsequent elution of samples was achieved by centrifugation. The resulting ultrafiltrates have been directly sampled with solid phase micro-extraction (SPME) and then analyzed by GC/MS. Saliva sampling is less invasive than collection of blood.

Analysis of 11-nor-9-carboxy-delta(9)-tetrahydrocannabinol in biological samples by gas chromatography tandem mass spectrometry (GC/MS-MS).

Gas chromatography tandem mass spectrometry (GC/MS-MS) analysis of 11-nor-carboxy-delta(9)-tetrahydrocannabinol (delta(9)-THC-COOH), the major metabolite of delta(9)-tetrahydrocannabinol, in biological samples is reported. The proposed method, using deuterated delta(9)-THC-COOH as an internal standard, is able to detect the major metabolite of cannabis derivatives at very low levels (picograms/millilitre) with high specificity. These characteristics render the proposed analytical procedure suitable for confirmatory analysis in drug testing for cannabis use.

Evaluation of cocaine, amphetamines and cannabis use in university students through hair analysis: preliminary results.

The evaluation of drug abuse in a defined population was performed through toxicological hair analysis. Hair samples from university students ranging from 18 to 25 years of age were anonymously collected and screened for cocaine, amphetamines and cannabinoids by radioimmunoassay (RIA). Positive results (cut-off values adopted were 2 ng/mg for cocaine and amphetamines and 0.5 ng/mg for cannabinoids) were confirmed by GC/MS. Preliminary results showed 19% of positive results for cocaine on 200 samples analysed. No confirmed positive results were obtained for amphetamine analysis. RIA technique demonstrated its unsuitability for cannabinoids preliminary screening on hair, giving a high percent of false positive results.

Comparative analysis of heroin and cocaine seizures.

In this brief review the analytical techniques mainly used for comparative analysis of both cocaine and heroin seizures are reported. The characterization of illicit samples is carried out by means of a variety of techniques including thin-layer chromatography, high-performance liquid chromatography, gas chromatography and capillary electrophoresis. By means of these technique it is possible to resolve some component in illicit drugs and their application for comparative analyses is described in this review. Owing to the complexity and the variability of the mixture related to the origin and manufacturing impurities a unique analytical approach based on the application of a single technique it is not sufficient to achieve the requested global characterization of the sample for comparative purposes. Generally a complete characterization is obtained focusing on the identification of minor and major components, origin and manufacturing impurities other than trace compounds such as solvent residues. Nevertheless the application of a single robust methods able to resolve any possible significant marker compounds, is still not described and there is a need for a standardized general procedure suitable for a complete cross-examination of analytical data related to comparative analyses that can be carried out at an international level.

Solid-phase microextraction for cannabinoids analysis in hair and its possible application to other drugs.

This paper describes the application of solid-phase microextraction (SPME) to cannabis testing in hair. Fifty milligrams of hair was washed with petroleum ether, hydrolyzed with NaOH, neutralized, deuterated internal standard was added and directly submitted to SPME. The SPME was analyzed by GC-MS. The limit of detection was 0.1 ng/mg for cannabinol (CBN) and delta9-tetrahydrocannabinol (THC) and 0.2 ng/mg for cannabidiol (CBD). THC was detected in a range spanning from 0.1 to 0.7 ng/mg. CBD concentrations ranged from 0.7 to 14.1 ng/mg, and CBN concentrations ranged from 0.4 to 0.7 ng/mg. The effectiveness of different decontamination procedures was also studied on passively contaminated hair. The proposed method is also suitable for the analysis of methadone in hair; cocaine and cocaethylene can be detected in hair with SPME extraction after enzymatic hydrolysis.

Application of hair analysis to document coercive heroin administration to a child.

This paper describes the application of hair analysis in a judicial case to document coercive heroin administration to a 5-year-old child, who was admitted with overdose symptoms to an intensive care division. Segmental hair analysis was performed in order to determine if drug consumption had continued. Quantitative results showed the presence of morphine and O-6-monoacetylmorphine (MAM) in increasing amounts from the second to the distal segment of hair, each approximately corresponding to a period of time of one month. MAM concentrations ranged from 0.2 ng/mg in the second segment of hair to 0.6 ng/mg in the distal segment; morphine concentrations ranged from 0.1 to 0.3 ng/mg. Limits of detection were 0.1 ng/mg for morphine and 0.2 ng/mg for MAM. The proximal segment of hair, which corresponded to the period that the child was housed in a social center, was negative for opiates.

Evaluation of cocaine use during pregnancy through toxicological analysis of hair.

Toxicological analysis of hair was used to detect cocaine use in a group of 615 pregnant women. Hair samples were washed, enzymatically digested, and analyzed by radioimmunoassay for cocaine. Positive results were confirmed by gas chromatography-mass spectrometry after a solid-phase extraction. Benzoylecgonine (BZE) and cocaine were detected after derivatization with pentafluoropropionic-anhydride-pentafluoropropanol. Deuterated cocaine and BZE were used as internal standards. This study demonstrated a mean frequency of 1.9% cases positive for cocaine in all the hair samples examined. The positive rate was 6% among women admitted for spontaneous abortion (66 cases), and the positive rate was 1.4% for those who carried to full term (549 cases). These data underline the usefulness of hair analysis for the diagnosis of drug abuse and demonstrate that there is significant use of cocaine in the Italian population.

Cocaine abuse in pregnancy: its evaluation through hair analysis of pathological new-borns.

Cocaine abuse in pregnancy has been evaluated through toxicological analysis of hair from 123 pathological new-borns admitted in an intensive care division. The new-borns were affected with malformations, low gestational age, low birth weight, respiratory distress. A control group of 39 healthy new-borns was also analysed. Hair samples (about 50 mg) were enzymatically digested and directly analysed by RIA. Samples positive to the preliminary screening were extracted by SPE columns and injected in GC/MS. Results obtained showed 3 positive samples (2.4%). All cocaine babies had low gestational age, low birth weight, two of them showed heart malformation, one kidney malformation and one genital malformation. None of the control new-born resulted positive for cocaine. These results show a worrying trend of cocaine diffusion in the Italian population.

Preparation of Hair Samples for Drug Analysis.

Toxicological hair analysis has attracted substantial attention because of its promising diagnostic power. Analysis of drugs in hair, even though widely studied since 1970, is still not standardized; many different sample preparation and analytical procedures are practiced. To obtain reliable results, hair analysis requires preparation steps that are not necessary for conventional biological samples such as blood or urine. Pretreatment procedures are mainly conducted to decontaminate hair samples and to isolate drugs from the solid hair structure before instrumental analysis. Many types of sample preparation procedures have been reported in the literature. Selecting an appropriate one can be difficult because the choice depends on different factors, including decontamination efficiency, analytical recovery, and chemical stability of the target drug and its metabolites. This review discusses the main aspects of hair sample preparation procedures through a critical evaluation of literature data, focusing on the procedures, reliability, advantages, and result interpretation.

Cocaine during pregnancy: a critical review of the literature.

A number of epidemiological indices suggest that the use of cocaine in Italy is increasing, thus explaining the importance of scientific interest in this field. There is considerable disparity between the scientific papers published in the literature concerning the damaging effects on fetus and mother linked to the use of cocaine during pregnancy. The main problem consists of the method used to identify those patients using cocaine. These methods are burdened by a high level of false negatives: subjects who often use a variety of active pharmacological substances are identified and the methods are not always suitable for classifying subjects according to useful clinical parameters. This is reflected in the poor quality of data concerning the epidemiology and clinical aspects of cocaine abuse during pregnancy. A careful selection of the best scientific papers published in the literature shows that the effects on the maternal organism are slight, whereas those on the fetus are more severe. Compared to controls, the use of cocaine is associated with a high percentage of cardiac malformations, preterm delivery, low birth weight and minor anomalies of the nervous system. Results relating to sudden neonatal death are discordant. This paper shows that the use of cocaine is often underestimated both in epidemiological terms and from the fetal point of view. This behaviour is linked to the belief that the effects of cocaine are benign.