Roadside drug testing: An evaluation of the Alere DDS® 2 mobile test system.

The number of drivers using drugs has increased over the last few years, and is likely to continue its upward trend. Testing drivers for alcohol use is routine and standardized, but the same is not true for the identification of driving under the influence of drugs (DUID). The Drug Evaluation and Classification Program (DECP) was developed to train police officers to recognize the signs and symptoms of recent drug use and remains an invaluable program; however, there are insufficient numbers of these highly trained drug recognition experts (DREs) available to attend every potential drug involved traffic incident. While blood and urine samples are used to test for drugs in a driver, both have disadvantages, particularly as they pertain to the length of time required after a traffic stop to sample collection. Therefore, the development of oral fluid testing devices which can be operated at the roadside and have the potential to assist officers in the identification of drug use is a major advancement in DUID cases. This project evaluated the performance of one instrumental oral fluid roadside testing device (Alere DDS®2) compared to DRE opinion, oral fluid laboratory-based analysis, and routine blood testing. The results showed that there was a good correlation with DRE observations and the device performance was >80% in all drug categories compared to laboratory-based analytical testing, both in oral fluid and blood, with few exceptions. The instrument can be considered a useful tool to assist law enforcement in identifying a drugged driver. Because the device does not test for all potentially impairing drugs, the opinion of the police officer regarding the condition of the driver should still be considered the most important aspect for arrest and further action.

Development of a new immunoassay for the detection of ethyl glucuronide (EtG) in meconium: validation with authentic specimens analyzed using LC-MS/MS. Preliminary results.

BACKGROUND: Ethyl glucuronide (EtG) measurement in neonatal meconium has emerged as a reliable marker to objectively assess prenatal exposure to maternal ethanol complementary to fatty acid ethyl ester (FAEEs) measurement. The detection of EtG in meconium is currently a lengthy, difficult and expensive process using liquid chromatography tandem mass spectrometry (LC-MS/MS) as the analytical procedure. An enzyme-linked immunosorbent assay (ELISA) for the identification of EtG in meconium was developed, validated and applied to authentic meconium specimens from newborns collected in Europe. METHODS: The ELISA procedure was calibrated using 0.45, 0.9, 1.35 and 1.8 nmol/g (100, 200 300 and 400 ng/g) standards. Meconium (0.25 g) was mixed thoroughly, with extraction buffer (pH 7.3; 0.5 mL). The tube was capped, sonicated, centrifuged and the supernatant was decanted. An aliquot of the extract (50 µL) was placed in the well of the microplate followed by enzyme conjugate (150 µL). The plate was incubated for 1 h, washed with deionized water, dried and substrate (200 µL) was added. After 30 min incubation, stop solution was added and the plate was read at 450 nm and 650 nm. Samples were also analyzed for EtG and FAEEs by validated LC-MS/MS assays. RESULTS: Using an EtG cut-off of 0.9 nmol/g for both ELISA screening test and confirmatory LC-MS/MS, immunoassay sensitivity was 100%; specificity 78%; positive-predictive value (PPV) 29% and negative-predictive value (NPV) 100%. CONCLUSIONS: The assay is proposed as a preliminary screening test for the meconium of newborns suspected of being born to mothers drinking alcohol during pregnancy.

Disposition of opioids in oral fluid: Importance of chromatography and mass spectral transitions in LC-MS/MS.

The use of prescription pain relievers, specifically opioids, has been increasing over the last few years. Oral fluid is easier to collect than urine, is difficult to adulterate, and is a reflection of free drug in the body, so its analysis is becoming more widespread in the monitoring of opioids. The demethylated metabolites of oxycodone, hydrocodone, and codeine are present at higher concentrations in oral fluid than oxymorphone, hydromorphone, and morphine, respectively; therefore, their detection in saliva indicates ingestion of the medication rather than diversion, and should be included in the analysis of opioids in this matrix. Since the compounds have the same nominal molecular weights, the same M + H(+) precursor ions in positive electrospray mode, and potentially identical collisionally activated fragmentation patterns, the importance of chromatography to separate the various opioids as well as the selection of mass spectral transitions is critical for correct identification. A procedure for the simultaneous determination of 12 opioid related compounds in oral fluid using liquid chromatography with tandem mass spectrometry (LC-MS/MS) is presented. The recovery of opioids from the collection device was over 80% at 20 ng/ml; intra-day imprecision was less than 6.8%; inter-day imprecision less than 6.2%. In authentic specimens, the predominant metabolite of oxycodone was noroxycodone; for specimens containing codeine, no morphine was detected; and for hydrocodone positives, norhydrocodone was detected at significantly higher levels than hydromorphone. The importance of monitoring specific mass spectral transitions and chromatographic separation is demonstrated.

Determination of carisoprodol and meprobamate in oral fluid.

The determination of carisoprodol and its metabolite meprobamate in oral fluid using solid-phase extraction and liquid chromatography with tandem mass spectral detection (LC-MS-MS) and its application to authentic specimens is described. The method employs collection of oral fluid with the Quantisal device, extraction using cation exchange/hydrophobic solid-phase columns, and LC-MS-MS in positive ion electrospray mode. The method was fully validated using various parameters, including selectivity, linearity, accuracy, intra-day and inter-day imprecision, drug recovery from the collection pad, limit of quantitation and matrix effects. The method was applied to both routine research specimens and an authentic specimen taken from an individual prescribed a daily dose of 350 mg carisoprodol following surgery.

Cannabinoids in oral fluid following passive exposure to marijuana smoke.

The concentration of tetrahydrocannabinol (THC) and its main metabolite 11-nor-Δ(9)-tetrahydrocannabinol-9-carboxylic acid (THC-COOH) as well as cannabinol (CBN), and cannabidiol (CBD) were measured in oral fluid following realistic exposure to marijuana in a Dutch coffee-shop. Ten healthy subjects, who were not marijuana smokers, volunteered to spend 3h in two different coffee shops in Groningen, The Netherlands. Subjects gave two oral fluid specimens at each time point: before entering the store, after 20 min, 40 min, 1h, 2h, and 3h of exposure. The specimens were collected outside the shop. Volunteers left the shop completely after 3h and also provided specimens approximately 12-22 h after beginning the exposure. The oral fluid specimens were subjected to immunoassay screening; confirmation for THC, cannabinol and cannabidiol using GC/MS; and THC-COOH using two-dimensional GC-GC/MS. THC was detectable in all oral fluid specimens taken 3h after exposure to smoke from recreationally used marijuana. In 50% of the volunteers, the concentration at the 3h time-point exceeded 4 ng/mL of THC, which is the current recommended cut-off concentration for immunoassay screening; the concentration of THC in 70% of the oral fluid specimens exceeded 2 ng/mL, currently proposed as the confirmatory cut-off concentration. THC-COOH was not detected in any specimens from passively exposed individuals. Therefore it is recommended that in order to avoid false positive oral fluid results assigned to marijuana use, by analyzing for only THC, the metabolite THC-COOH should also be monitored.

Antidepressant drugs in oral fluid using liquid chromatography-tandem mass spectrometry.

An analytical procedure for the determination of widely prescribed drugs for the treatment of depression and anxiety disorders, including amitriptyline, cyclobenzaprine, imipramine, dothiepin, doxepin, fluoxetine, sertraline, trimipramine, protriptyline, chlorpromazine, clomipramine, and some of their metabolites (nortriptyline, desmethyldoxepin, desipramine, desmethyltrimipramine, norclomipramine) in oral fluid has been developed and validated using liquid chromatography with tandem mass spectral detection. The oral fluid samples were collected using the Quantisal device and screened with enzyme-linked immunosorbent assay. Any drugs present were quantified using mixed-mode solid-phase extraction followed by mass spectrometric detection in positive electrospray ionization mode. For confirmation, two transitions were monitored, and the ratio between the two was required to be within 20% of the known calibration standard. Because of the worldwide shortage of acetonitrile, which was first reported in October 2008, the mobile phase was optimized to use methanol as the organic component. For all compounds, the lower limit of quantitation was 5 ng/mL; the intraday precision ranged from 2.9 to 8.2% (n = 6); interday precision from 1.5 to 6.2% (n = 30) at a concentration of 40 ng/mL. The percentage recovery of antidepressants from the oral fluid collection pad was calculated at a concentration of 40 ng/mL and ranged from 51.4 to 84.1% (n = 6). The aim of the study was to develop a confirmatory procedure for drugs in oral fluid that had been identified as presumptively positive for antidepressants and related compounds. The methods were applied to research oral fluid specimens received into our facility for testing.

Semi-quantitative analysis of drugs of abuse, including tetrahydrocannabinol in hair using aqueous extraction and immunoassay.

A semi-quantitative analytical screening procedure for the determination of cocaine, amphetamines, opiates, and delta-9-tetrahydrocannabinol in hair has been developed. The procedure employs an aqueous extraction buffer, uses only 10mg of hair, requires 2h of incubation for the extraction to occur, and multiple drug classes can be screened using enzyme linked immunosorbent assays. Hair calibration standards were prepared around the recommended cut-off concentrations of the Society of Hair Testing. All drug classes showed excellent linearity over the concentration range tested, indicating that immunochemical screening can be used in a semi-quantitative mode for hair analysis using an aqueous buffer, rapid extraction and a small amount of hair.

Determination of tapentadol and its metabolite N-desmethyltapentadol in urine and oral fluid using liquid chromatography with tandem mass spectral detection.

An analytical procedure for the determination of the new pain medication tapentadol and its main metabolite N-desmethyltapentadol (DMT), in urine and oral fluid has been developed and validated using liquid chromatography with tandem mass spectral detection (LC-MS-MS). Oral fluid was collected using Quantisal™ devices, and drugs present were quantified using solid-phase extraction followed by LC-MS-MS. For confirmation, two transitions were monitored and one ratio determined which had to be within 20% of that of the known calibration standard. For tapentadol, 222.1 > 107 was used as the quantifying transition; 222.1 > 121 for the qualifier. For DMT, 208.1 > 107 was used for quantification; 208.1 > 121 as the qualifier. For saliva, the linear range was 10-100 ng/mL; the lower limit of quantitation (LLOQ) was 10 ng/mL; the intraday precision was 3.6% (n = 6) and interday precision was 13.6% (n = 24). The recovery of tapentadol and DMT from the oral fluid collection pad was > 99%. For urine, the specimens were diluted and injected directly into the LC-MS-MS. The LLOQ was 50 ng/mL; the intraday and interday precisions were 2.1% and 4.4%, respectively, for tapentadol and 2.9% and 5.7%, respectively, for DMT. This is the first analytical procedure for tapentadol and DMT in urine and oral fluid.

Quantitation of tetrahydrocannabinol in hair using immunoassay and liquid chromatography with tandem mass spectrometric detection.

A quantitative analytical procedure for the determination of Delta(9)-tetrahydrocannabinol (THC) in hair has been developed and validated using liquid chromatography with tandem mass spectral detection (LC-MS/MS). Specimens that were determined as containing cannabinoids following immunoassay testing were quantified using solid-phase extraction followed by liquid chromatographic separation and tandem mass spectral detection in positive electrospray ionization mode. For confirmation, two transitions were monitored and one ratio determined. Samples being reported as positive were required to have both transitions present, the ratio of quantifying transition to qualifying transition being within 20% of that determined from known calibration standards. The limit of quantitation and the limit of detection was 10 pg/mg. The percentage recovery of the THC from hair at 20 pg/mg was 56% and a matrix effect of the hair showed an ion suppression percentage of -51%. The immunochemical screening method was performed following a rapid aqueous extraction, requiring only 10 mg of hair; the confirmatory procedure required 20 mg of hair. The methods were applied to proficiency specimens from the Society of Hair Testing, which had been received in August 2008.