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1.
Sud Med Ekspert ; 63(1): 36-41, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32040086

RESUMO

Data on the detection of joint presence of pregabalin and lorazepam in the biological objects and material evidence. Aim of this study is to develop a method of the detection of pregabalin and lorazepam in urine. The proposed approach to sample preparation of a biological object and the detection of lorazepam and pregabalin allows the detection of toxicants in cases of their joint presence. It can be used in the analysis of urine in cases of acute poisoning for detoxification therapy or chemical toxicological analysis as a preliminary and confirmatory study for the presence of abuse of these drugs.


Assuntos
Lorazepam/urina , Envenenamento/diagnóstico , Pregabalina/urina , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Cromatografia Gasosa , Humanos , Lorazepam/envenenamento , Envenenamento/urina , Pregabalina/envenenamento , Transtornos Relacionados ao Uso de Substâncias/urina
2.
Clin Biochem ; 75: 70-77, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31707014

RESUMO

BACKGROUND: Dried specimens have been proposed in multiple environments to minimize costs associated with specimen storage and shipping in clinical studies. This report describes the development and validation of an automated method for qualitative toxicology screening of dried urine samples using LC-MS/MS. METHODS: Urine standards containing 41 compounds were prepared and applied to filter paper cards. Dried urine was eluted from the cards using a Dried Blood Spot (DBS) autosampler from Spark Holland, which was plumbed inline with a Thermo Scientific Turboflow chromatography system for subsequent MS/MS detection with selected reaction monitoring. Limits of detection, precision of peak areas, repeatability, and carryover studies were conducted. Concordance with a reference LC-MS/MS method using liquid samples was evaluated using remnant discarded specimens. RESULTS: The limit of detection ranged from 5 to 75 ng/mL for most compounds. At the LOD for each analyte, the peak area precision ranged from 8 to 29%. For 20 repeat injections of samples spiked at ±25% of the LOD, there was a 4% false positive rate for the 75% × LOD samples, and a 0.4% false negative rate for the +125% × LOD samples. In comparing 40 known positive specimens analyzed with the DUS method and a liquid urine reference method, there was 88% agreement. Analysis of 10 known negative specimens yielded negative results. There was no significant carryover detected up to 2000 ng/mL for any of the analytes in the assay. CONCLUSION: Using a robotic DUS sampling an inline HTLC-MS/MS system, we have developed and validated a fully-automated and robust method for multi-analyte detection of drugs of abuse in dried urine specimens.


Assuntos
Cromatografia Líquida/métodos , Ensaios de Triagem em Larga Escala , Detecção do Abuso de Substâncias/métodos , Transtornos Relacionados ao Uso de Substâncias/urina , Espectrometria de Massas em Tandem/métodos , Urinálise/métodos , Ensaios de Triagem em Larga Escala/instrumentação , Ensaios de Triagem em Larga Escala/métodos , Humanos , Limite de Detecção , Robótica/métodos
3.
Intern Med ; 58(18): 2627-2632, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31527368

RESUMO

Objective In the management of patients with suspected acute drug poisoning, a screening test using the patient's urine is usually performed. The Triage DOA® and INSTANT-VIEW M-1® kits are two commonly used point-of-care screening kits in Japan. However, the relationship between the results of these screening kits and the blood concentration of the poisoning drug is not clear. In this study, we evaluated which kit is more useful for acute drug poisoning screening based on a comparison of their results with the results of a serum drug analysis. Methods This prospective cross-sectional study investigated all patients with acute drug poisoning admitted to a general hospital in Tokyo, Japan, over a nine-month period. The Triage DOA® and INSTANT-VIEW M-1® screening kits were used, and a qualitative serum analysis was conducted simultaneously in all cases. We compared the kits for use in screening patients with acute drug poisoning and evaluated the utility of the kits. Results For the 117 patients enrolled in this study, the 2 kits showed different sensitivities to benzodiazepines (Triage®, 78.6%; INSTANT-VIEW®, 90.5%). Both kits showed high sensitivity to barbiturates (Triage®, 87.0%; INSTANT-VIEW®, 91.3%) but low sensitivity to tricyclic antidepressants (Triage®, 25.0%; INSTANT-VIEW®, 45.8%). Conclusion Because the sensitivity varies depending on the kind of drug, it is difficult to discuss the superiority of these kits. However, this study compared the results of two types of urinary drug screening kits with the results of qualitative analysis of drugs in serum as a gold standard, providing important reference data.


Assuntos
Programas de Rastreamento/métodos , Kit de Reagentes para Diagnóstico , Transtornos Relacionados ao Uso de Substâncias/sangue , Transtornos Relacionados ao Uso de Substâncias/urina , Triagem/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antidepressivos Tricíclicos/sangue , Antidepressivos Tricíclicos/urina , Barbitúricos/sangue , Barbitúricos/urina , Benzodiazepinas/sangue , Benzodiazepinas/urina , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tóquio , Adulto Jovem
4.
Mikrochim Acta ; 186(9): 621, 2019 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-31410571

RESUMO

A rapid lateral flow immunoassay is presented that uses carboxyl-modified superparamagnetic nanoparticles as labels that can be quantified by highly sensitive multi-channel electronic readers. The approach is generic in that it is likely to be applicable to numerous small molecules. The method permits both single- and multiplex assays at a point-of-need without sample pretreatment. It is user-friendly and offers attractive characteristics demonstrated here for detection of morphine, fentanyl and methamphetamine in urine. The competitive immunoassay uses commercially available reagents that do not require special permissions. After migration of sample, the lateral flow test strips are subjected to an alternating magnetic field at two frequencies. The response from the nanolabels is readout at a combinatorial frequency from the entire volume of a porous immunochromatographic membrane by the magnetic particle quantification technique. Even trace concentrations can be quantified within ≤20 min with the limits of detection (LOD) of 0.20 ng·mL-1, 0.36 ng·mL-1 and 1.30 ng·mL-1 for morphine, fentanyl and methamphetamine, respectively. The second variant presented here features highly sensitive quantification of haptens (LOD for fentanyl - 0.05 ng·mL-1). This is due to high-affinity trapping of magnetic nanolabels in a universal streptavidin-based test strip, which can be also used for detection of virtually any other small molecule. The third variant is of the multiplexed type and intended for rapid and simultaneous detection of the drugs of abuse in human urine with LODs equal to 0.60 ng·mL-1 and 3.0 ng·mL-1 for morphine and methamphetamine, respectively. In addition to the low LODs, the RSDs did not exceed 7%, 9%, and 11% for methamphetamine, morphine and fentanyl, respectively. Graphical abstract Three variants of small molecule detection in competitive format at a point-of-need. Single-plex variants feature antibody and high-affinity streptavidin test lines, while multiplex variant - several antibody test lines. Magnetic nanolabels are quantified from the whole volume of test strip.


Assuntos
Imunoensaio/métodos , Nanopartículas de Magnetita/química , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Fentanila/urina , Humanos , Limite de Detecção , Metanfetamina/urina , Morfina/urina , Transtornos Relacionados ao Uso de Substâncias/urina , Fatores de Tempo
5.
J Vis Exp ; (146)2019 04 23.
Artigo em Inglês | MEDLINE | ID: mdl-31081805

RESUMO

New analytical methods are urgently needed to enable high-throughput, yet comprehensive drug screening, given an alarming opioid and prescription drug crisis in public health. Conventional urine drug testing based on a two-tier immunoassay screen followed by a gas chromatography-tandem mass spectrometry (GC-MS/MS) or liquid chromatography-tandem mass spectrometry (LC-MS/MS) method are expensive and prone to bias while being limited to targeted panels of known drugs of abuse (DoA). Herein, we outline an improved method for drug surveillance that allows for the resolution and detection of an expanded panel of DoA and their metabolites when using multisegment injection-capillary electrophoresis-mass spectrometry (MSI-CE-MS). Multiplexed separations of ten urine samples with a quality control by CE (< 3 min/sample) in conjunction with full-scan data acquisition using a time-of-flight mass spectrometer (TOF-MS) under positive ion mode detection allows for the identification and quantification of DoA above recommended cut-off levels. An excellent resolution of drug isomers and isobars, including background interferences, are achieved when using MSI-CE-MS with an electrokinetic spacer between sample segments, where accurate mass/molecular formula together with the comigration of a matching deuterated internal standard and the detection of one or more bio-transformed metabolites facilitate DoA identification over a wider detection window. Additionally, urine samples can be analyzed directly without enzyme deconjugation for the rapid screening without complicated sample workup. MSI-CE-MS enables the surveillance of a broad spectrum of DoA that is required for the treatment monitoring of high-risk patients, including confirming prescribed drug adherence, revealing illicit drug use/substitution, and evaluating optimal dosage regimes as required for new advances in precision medicine.


Assuntos
Eletroforese Capilar , Espectrometria de Massas , Transtornos Relacionados ao Uso de Substâncias/urina , Humanos , Injeções , Controle de Qualidade
6.
Forensic Sci Int ; 299: 6-16, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30954006

RESUMO

The study investigates the prevalence of drugs of abuse detected from 2011 to 2015 through (i) forensic drug testing of illicit drug seizures from law enforcement agencies; and (ii) analysis of common drugs of abuse in urine samples obtained from offenders/probationers under mandatory drug-use surveillance programmes. Under the selected drug testing groups, there were an average of 5334 cases/year of illicit drug seizures examined and 28,438 samples/year requiring drugs of abuse analysis in urine, from 2011 to 2015. The drug positive rates for urinalysis in the selected population group (i.e., offenders/probationers requiring mandatory drug testing) were steady with an average of about 22%. The ratio of single drug use to more than one drug was about 4:1, showing predominant use of single drug. Ketamine, methamphetamine (MA) and heroin were the three most commonly encountered abused drugs through laboratory testing. During the period, identification of ketamine was shown to decline continuously in both illicit drug testing and urinalysis while there was substantial increase in detection of MA. A rising trend was noted for cases identified with new psychotropic substances (NPS) in illicit drug seizures although NPS cases contributed to a small proportion of overall drug seizure cases examined (<5%) in the study period. A total of 47 substances classified as NPS were encountered with cathinones, either synthetic or plant-based, contributed to the majority of NPS cases (˜77%) followed by synthetic cannabinoids and phenethylamines.


Assuntos
Drogas Ilícitas/urina , Detecção do Abuso de Substâncias , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Urinálise , Cromatografia Líquida , Cromatografia Gasosa-Espectrometria de Massas , Hong Kong/epidemiologia , Humanos , Polícia , Psicotrópicos/urina , Estudos Retrospectivos , Espectroscopia de Infravermelho com Transformada de Fourier , Transtornos Relacionados ao Uso de Substâncias/urina
7.
J Anal Toxicol ; 43(5): 392-398, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-30767008

RESUMO

In 2013, the Centers for Disease Control and Prevention released a warning regarding a new recreational drug, acetyl fentanyl. Acetyl fentanyl is a µ-opioid receptor agonist, and its pharmacological effects include euphoria, altered mood, miosis and central nervous system depression. The objective of this report was to develop a sensitive and specific method for the quantitation of acetyl fentanyl by gas chromatography-mass spectrometry in postmortem casework. Acetyl fentanyl was isolated from biological matrices using solid-phase extraction and acetyl fentanyl-13C6 was employed as an internal standard. The method was validated utilizing the Scientific Working Group for Forensic Toxicology's published method validation parameters, and the biological matrices used for analysis were postmortem blood and urine. In addition to the quantitation of acetyl fentanyl, a demographic study of cases obtained from the Rhode Island Office of State Medical Examiners and the University of Florida Health Pathology Laboratories-Forensic Toxicology Laboratory was performed to examine potential risk factors for acetyl fentanyl use. The results from this study found that the blood concentrations in these individuals ranged from 17 to 945 ng/mL. This suggests acetyl fentanyl is less potent than its prototype drug, fentanyl and requires an increased dose to achieve its desired effects. The demographic analysis indicated white males aged 21-40 years and individuals with a previous history of drug use have the highest risk for acetyl fentanyl abuse.


Assuntos
Fentanila/análogos & derivados , Toxicologia Forense/métodos , Detecção do Abuso de Substâncias/métodos , Transtornos Relacionados ao Uso de Substâncias , Adulto , Fentanila/sangue , Fentanila/urina , Toxicologia Forense/instrumentação , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Limite de Detecção , Masculino , Mudanças Depois da Morte , Reprodutibilidade dos Testes , Extração em Fase Sólida , Detecção do Abuso de Substâncias/instrumentação , Transtornos Relacionados ao Uso de Substâncias/sangue , Transtornos Relacionados ao Uso de Substâncias/urina , Adulto Jovem
8.
Am Fam Physician ; 99(1): 33-39, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-30600984

RESUMO

Urine drug testing is an essential component of monitoring patients who are receiving long-term opioid therapy, and it has been suggested for patients receiving long-term benzodiazepine or stimulant therapy. Family physicians should be familiar with the characteristics and capabilities of screening and confirmatory drug tests. Immunoassays are qualitative tests used for initial screening of urine samples. They can give false-positive and false-negative results, so all results are considered presumptive until confirmatory testing is performed. Immunoassays for opioids may not detect commonly prescribed semisynthetic and synthetic opioids such as methadone and fentanyl; similarly, immunoassays for benzodiazepines may not detect alprazolam or clonazepam. Immunoassays can cross-react with other medications and give false-positive results, which have important implications for a patient's pain treatment plan. False-negative results can cause missed opportunities to detect misuse. Urine samples can be adulterated with other substances to mask positive results on urine drug testing. Family physicians must be familiar with these substances, the methods to detect them, and their effects on urine drug testing.


Assuntos
Analgésicos Opioides/urina , Benzodiazepinas/urina , Fármacos do Sistema Nervoso Central/urina , Detecção do Abuso de Substâncias/métodos , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Ansiolíticos/urina , Monitoramento de Medicamentos , Reações Falso-Negativas , Reações Falso-Positivas , Medicina de Família e Comunidade , Humanos , Imunoensaio , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/urina
9.
Clin Toxicol (Phila) ; 57(3): 149-163, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30307336

RESUMO

INTRODUCTION: γ-Hydroxybutyric acid is an endogenous substance, a therapeutic agent, and a recreational drug of abuse. This psychoactive substance acts as a depressant of the central nervous system and is commonly encountered in clinical and forensic practice, including impaired drivers, poisoned patients, and drug-related intoxication deaths. OBJECTIVE: The aim of this review is to assist clinical and forensic practitioners with the interpretation of γ-hydroxybutyric acid concentrations in blood, urine, and alternative biological specimens from living and deceased persons. METHODS: The information sources used to prepare this review were PubMed, Scopus, and Web-of-Science. These databases were searched using keywords γ-hydroxybutyrate (GHB), blood, urine, alternative specimens, non-conventional biological matrices, saliva, oral fluid, sweat, hair, vitreous humor (VH), brain, cerebrospinal fluid (CSF), dried blood spots (DBS), breast milk, and various combinations thereof. The resulting 4228 references were screened to exclude duplicates, which left 1980 articles for further consideration. These publications were carefully evaluated by taking into account the main aims of the review and 143 scientific papers were considered relevant. Analytical methods: The analytical methods used to determine γ-hydroxybutyric acid in blood and other biological specimens make use of gas- or liquid-chromatography coupled to mass spectrometry. These hyphenated techniques are accurate, precise, and specific for their intended purposes and the lower limit of quantitation in blood and other specimens is 0.5 mg/L or less. Human pharmacokinetics: GHB is rapidly absorbed from the gut and distributes into the total body water compartment. Only a small fraction of the dose (1-2%) is excreted unchanged in the urine. The plasma elimination half-life of γ-hydroxybutyric acid is short, being only about 0.5-0.9 h, which requires timely sampling of blood and other biological specimens for clinical and forensic analysis. Endogenous concentrations of GHB in blood: GHB is both an endogenous metabolite and a drug of abuse, which complicates interpretation of the laboratory results of analysis. Moreover, the concentrations of GHB in blood and other specimens tend to increase after sampling, especially in autopsy cases. This requires the use of practical "cut-off" concentrations to avoid reporting false positive results. These cut-offs are different for different biological specimen types. Concentrations of GHB in clinical and forensic practice: As a recreational drug GHB is predominantly used by young males (94%) with a mean age of 27.1 years. The mean (median) and range of concentrations in blood from apprehended drivers was 90 mg/L (82 mg/L) and 8-600 mg/L, respectively. The concentration distributions in blood taken from living and deceased persons overlapped, although the mean (median) and range of concentrations were higher in intoxication deaths; 640 mg/L (280 mg/L) and 30-9200 mg/L, respectively. Analysis of GHB in alternative specimens: All biological fluids and tissue containing water are suitable for the analysis of GHB. Examples of alternative specimens discussed in this review are CSF, saliva, hair strands, breast milk, DBS, VH, and brain tissue. CONCLUSIONS: Body fluids for the analysis of GHB must be obtained as quickly as possible after a poisoned patient is admitted to hospital or after a person is arrested for a drug-related crime to enhance chances of detecting the drug. The sampling of urine lengthens the window of detection by 3-4 h compared with blood samples, but with longer delays between last intake of GHB and obtaining specimens, hair strands, and/or nails might be the only option. In postmortem toxicology, the concentrations of drugs tend to be more stable in bladder urine, VH, and CSF compared with blood, because these sampling sites are protected from the spread of bacteria from the gut. Accordingly, the relationship between blood and urine concentrations of GHB furnishes useful information when drug intoxication deaths are investigated.


Assuntos
Toxicologia Forense/métodos , Oxibato de Sódio/análise , Adulto , Feminino , Humanos , Drogas Ilícitas , Masculino , Oxibato de Sódio/farmacocinética , Detecção do Abuso de Substâncias , Transtornos Relacionados ao Uso de Substâncias/sangue , Transtornos Relacionados ao Uso de Substâncias/urina , Adulto Jovem
10.
Int J Legal Med ; 133(2): 475-478, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30039274

RESUMO

The abuse of new psychoactive substances (NPS) has been dramatically increasing all around the world since the late 2000s. The availability of hundreds of NPS in the past decade is challenging for both public health and global drug policies. A 39-year-old woman, known as a multidrug addict, was murdered by her partner by ligature strangulation. A comprehensive toxicological screening by gas chromatography and ultra-high performance liquid chromatography with tandem mass spectrometry revealed the simultaneous presence of ethanol (1.37 g/L), diazepam (157 ng/mL) and nordiazepam (204 ng/mL), cocaine (25 ng/mL) and benzoylecgonine (544 ng/mL), and (3-methoxy-(1-(1-phenylcyclohexyl)piperidine) or 3-MeO-PCP, a dissociative hallucinogen anesthetic drug. Concentrations of 3-MeO-PCP were 63, 64, and 94 ng/mL in femoral blood, bile, and urine, respectively. Hair tested also positive for 3-MeO-PCP on 3 × 2-cm segments at 731, 893, and 846 pg/mg, indicating long-term abuse of the drug. This seems to be the first ever reported hair concentrations. Major impairment of the victim, including visual hallucinations and alteration of behavior, was attributed to the mixture of all the drugs, with a major contribution of 3-MeO-PCP. The toxicological findings were compared to the few reports available in the medical literature.


Assuntos
Drogas Desenhadas/análise , Usuários de Drogas , Alucinógenos/análise , Homicídio , Fenciclidina/análogos & derivados , Adulto , Bile/química , Cromatografia Líquida , Feminino , Cromatografia Gasosa-Espectrometria de Massas , Cabelo/química , Humanos , Fenciclidina/análise , Detecção do Abuso de Substâncias , Transtornos Relacionados ao Uso de Substâncias/sangue , Transtornos Relacionados ao Uso de Substâncias/urina , Espectrometria de Massas em Tandem
11.
Addict Behav ; 88: 6-14, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30099289

RESUMO

It is unknown if estimates of illicit drug use among young men who have sex with men and transgender women (YMSM/TW) may be biased due to historical distrust of research or reliable due to more accepting norms for use. Research is needed to examine the validity of drug use self-reports among YMSM/TW. Data came from an ongoing longitudinal study of YMSM/TW aged 16-29 living in Chicago (analytic N = 1029). Baseline urinalysis screens for marijuana, ecstasy, amphetamine, methamphetamine, cocaine, benzodiazepine, and opiate metabolites were compared to self-reported use within different recall periods using measures of concordance. Generalized estimating equations logistic regressions were conducted on three waves of data to identify predictors of disclosing past-6-month use of marijuana and non-marijuana drugs. Past-6-month self-reported use of all non-marijuana substances was <15%. There was excellent agreement between self-reported and drug-tested marijuana use. For other substances, sensitivities within the urinalysis detection window were <0.5 but increased with longer recall periods. Black participants had lower odds of disclosing non-marijuana drug use. Gender minority participants had lower odds of disclosing marijuana use. Participants with a history of arrest had higher odds of disclosing both marijuana and non-marijuana drug use. Wave and year of first research participation were non-significant, suggesting no systematic bias or increasing honesty associated with longer research participation. Programs that rely on self-identification of non-marijuana illicit substance use may be missing a substantial portion of drug-using YMSM/TW. Future epidemiological studies should work to reduce social desirability biases and include biomarker-based drug screenings to increase validity.


Assuntos
Uso da Maconha/epidemiologia , Autorrelato , Minorias Sexuais e de Gênero/estatística & dados numéricos , Detecção do Abuso de Substâncias , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Afro-Americanos , Chicago/epidemiologia , Grupo com Ancestrais do Continente Europeu , Feminino , Hispano-Americanos , Humanos , Masculino , Uso da Maconha/urina , Reprodutibilidade dos Testes , Desejabilidade Social , Transtornos Relacionados ao Uso de Substâncias/urina , Adulto Jovem
12.
J Anal Toxicol ; 43(4): e23-e27, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-30566569

RESUMO

BACKGROUND: Ayahausca is an ethnobotanical drink of South America and the compound dimethyltryptamine (DMT) is primarily responsible for the hallucinogenic effects. DMT has a short half-life and its detection in urinary drug screens is challenging. We investigate a simple alternate approach to detect ayahuasca consumption by relying on other constituents of the drink, the ß-carboline harmala alkaloids. METHODS: Three commercially sourced harmala alkaloids were characterized and added to a non-targeted high-resolution mass spectrometry urine drug screening method. All analyses were performed on a Waters Xevo G2-XS LC-QTof, in positive electrospray ionization mode. The mass detector was operated in MSE mode and data processed with UNIFI™ software. A urine specimen from a patient suspected to have consumed ayahuasca was analyzed by a non-targeted drug screen. RESULTS: The harmala alkaloids: harmine, harmaline and tetrohydroharmaline (THH) were characterized and their detection data added to the toxicology screening library. Harmaline and THH were detected in the patient's urine specimen. CONCLUSION: The inclusion of the harmala alkaloids into the drug screen method library may enable the detection of ayahuasca use in patients that undergo non-targeted drug screen.


Assuntos
Banisteriopsis/química , Alcaloides de Harmala/urina , Extratos Vegetais/urina , Detecção do Abuso de Substâncias/métodos , Transtornos Relacionados ao Uso de Substâncias/urina , Adulto , Antimaníacos/uso terapêutico , Antipsicóticos/uso terapêutico , Cromatografia Líquida , Alucinógenos/toxicidade , Alucinógenos/urina , Humanos , Masculino , Espectrometria de Massas , N,N-Dimetiltriptamina/toxicidade , N,N-Dimetiltriptamina/urina , Olanzapina/uso terapêutico , Psicoses Induzidas por Substâncias/tratamento farmacológico , Resultado do Tratamento , Ácido Valproico/uso terapêutico
13.
Pain Physician ; 21(6): E583-E592, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30508989

RESUMO

BACKGROUND: The technical advantages of direct-to-definitive liquid chromatography-tandem mass spectrometry (LC-MS/MS) urine testing for monitoring patient compliance in pain management are well known. However, the design and implementation of LC-MS/MS methods are more controversial, including factors such as determining appropriate cutoffs, specimen processing (e.g., specimen hydrolysis), reporting of qualitative and/or quantitative results, and test menu. OBJECTIVES: The objective of the research was to compare the clinical performance of our previous urine pain toxicology panel, a combination of immunoassay (IA) screens and LC-MS/MS, to our current pain toxicology panel, which features direct-to-definitive LC-MS/MS for 34 drugs and metabolites. STUDY DESIGN: Six months of results from our previous pain toxicology panel were compared to 5.5 months of results from our current pain toxicology panel, enabling us to make conclusions regarding clinical performance. SETTING: The research took place at Brigham and Women's Hospital in Boston, MA. METHODS: The percentage of false positive IA results was evaluated for our previous pain toxicology panel. The positivity rates for each drug and/or metabolite were calculated for both the previous and current panels, including rates of detection of both prescribed and illicit drugs. The turnaround time (TAT), direct and send-out costs associated with each approach, as well as projected cost savings were also determined. RESULTS: False positive rates with IA ranged from 0% to 29%; the highest false positive rate was seen for 6-acetylmorphine (6-AM). The elimination of IA, addition of metabolites, and/or lowering of cutoffs increased the detection rate of 6-AM, benzoylecgonine (cocaine metabolite), fentanyl, morphine, and oxycodone. The ability to differentiate compliance from simulated compliance improved after eliminating specimen hydrolysis. The TAT improved significantly and projected yearly cost savings with the current panel was $95,003 (USD). In our opinion, qualitative results appeared sufficient to assess compliance in the majority of cases. LIMITATIONS: Our study was performed in a single academic center in a specific geographic region; therefore, our results may not be generalizable to other types of centers or regions. CONCLUSION: Direct-to-definitive LC-MS/MS testing has several clinical benefits, including reduction of false positive results, improved assessment of patient compliance, decreased TAT, and increased detection of drug use and abuse. Cost savings were also realized using this approach. KEY WORDS: Direct-to-definitive, LC-MS/MS, immunoassay, sensitivity, cost, pain management, turnaround time, patient compliance.


Assuntos
Cromatografia Líquida/métodos , Imunoensaio/métodos , Detecção do Abuso de Substâncias/métodos , Espectrometria de Massas em Tandem/métodos , Urinálise/métodos , Cromatografia Líquida/economia , Reações Falso-Positivas , Feminino , Humanos , Drogas Ilícitas/urina , Imunoensaio/economia , Manejo da Dor , Detecção do Abuso de Substâncias/economia , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/urina , Espectrometria de Massas em Tandem/economia , Urinálise/economia
14.
Expert Rev Proteomics ; 15(10): 781-789, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30223684

RESUMO

INTRODUCTION: Paper spray mass spectrometry has provided a rapid, quantitative ambient ionization method for xenobiotic and biomolecule analysis. As an alternative to traditional sample preparation and chromatography, paper spray demonstrates the sampling ionization of a wide range of molecules and significant sensitivity from complex biofluids. The amenability of paper spray with dried blood spots and other sampling types shows strong potential for rapid, point-of-care (POC) analysis without time-consuming separation procedures. Areas covered: This special report summarizes the current state and advances in paper spray mass spectrometry that relate to its applicability for clinical analysis. It also provides our perspectives on the future development of paper spray mass spectrometry and its potential roles in clinical settings. Expert commentary: Paper spray has provided the fundamental aspects of ambient ionization needed for implementation at the POC. With further clinical management and standardization, paper spray has the potential to replace traditional complex analysis procedure for rapid quantitative detection of illicit drugs, therapeutic drugs and metabolites. Surface and substrate modifications also offer significant improvement in desorption and ionization efficiencies, resulting in enhanced sensitivity. Comprehensive analysis of metabolites and lipids will further extend the implementation of paper spray ionization mass spectrometry into clinical applications.


Assuntos
Técnicas de Diagnóstico Molecular/métodos , Proteômica/métodos , Espectrometria de Massas por Ionização por Electrospray/métodos , Transtornos Relacionados ao Uso de Substâncias/sangue , Humanos , Técnicas de Diagnóstico Molecular/normas , Proteômica/normas , Espectrometria de Massas por Ionização por Electrospray/normas , Transtornos Relacionados ao Uso de Substâncias/metabolismo , Transtornos Relacionados ao Uso de Substâncias/urina
15.
Community Ment Health J ; 54(7): 959-966, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30083831

RESUMO

Substance use disorder remains a pervasive problem in the U.S. and elsewhere. Recent scholarship has explored therapist characteristics and evidence based intervention implementation in an attempt to improve client outcomes. One such construct that has received considerable attention is grit. People with high levels of grit tend to remain determined despite setbacks. This study sought to elucidate the relationship of grit to therapeutic alliance and attitudes towards evidence-based interventions in a sample of front-line therapist (n = 240). Grit was found to be positively associated with therapeutic alliance and correlated with favorable attitudes towards using proven practice. Findings suggest that gritty therapists may sustain the use of evidence based interventions in their usual services and have better client outcomes.


Assuntos
Prática Clínica Baseada em Evidências , Personalidade , Psicoterapia , Transtornos Relacionados ao Uso de Substâncias/urina , Adulto , Atitude do Pessoal de Saúde , Estudos Transversais , Prática Clínica Baseada em Evidências/estatística & dados numéricos , Feminino , Humanos , Masculino , Testes de Personalidade , Padrões de Prática Médica/estatística & dados numéricos , Psicoterapia/métodos , Psicoterapia/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/terapia , Inquéritos e Questionários , Aliança Terapêutica
16.
Anesthesiology ; 129(4): 821-828, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30020101

RESUMO

WHAT WE ALREADY KNOW ABOUT THIS TOPIC: WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: The incidence of substance use disorders in the United States among residents in anesthesiology is between 1% and 2%. A recent study reported that the incidence of substance use disorders in U.S. anesthesiology residents has been increasing. There are no reports of effective methods to prevent substance use disorder in residents. A comprehensive drug testing program including a random component may reduce the incidence of substance use disorders. METHODS: The authors initiated a comprehensive urine drug screening program of residents, fellows, faculty physicians, and certified nurse anesthetists. The authors performed 3,190 tests over 13 yr. The authors determined the incidence of substance use disorders among residents in our large anesthesiology residency program during the decade before (January 1, 1994, to December 31, 2003) and for the 13 yr after (January 1, 2004 to December 31, 2016) instituting a random urine drug testing program. A total of 628 residents trained in the program over these 23 yr; they contributed a total of 1,721 resident years for analysis. Fewer faculty and certified nurse anesthetists were studied, so we do not include them in our analysis. RESULTS: The incidence of substance use disorders among trainees in our department during the 10 yr before initiation of urine drug screening was four incidents in 719 resident years or 0.0056 incidents per resident-year. In the 13 yr after the introduction of urine drug screening, there have been zero incidents in 1,002 resident years in our residency program (P = 0.0305). CONCLUSIONS: This single-center, comprehensive program including preplacement and random drug testing was associated with a reduction of the incidence of substance use disorders among our residents in anesthesiology. There were no instances of substance use disorders in our residents over the recent 13 yr. A large, multicenter trial of a more diverse sample of academic, government, and community institutions is needed to determine if such a program can predictably reduce the incidence of substance use disorders in a larger group of anesthesiology residents.


Assuntos
Anestesiologistas/normas , Anestesiologia/normas , Internato e Residência/normas , Detecção do Abuso de Substâncias/normas , Transtornos Relacionados ao Uso de Substâncias/urina , Anestesiologistas/tendências , Anestesiologia/tendências , Humanos , Incidência , Internato e Residência/tendências , Detecção do Abuso de Substâncias/tendências , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Fatores de Tempo
17.
J Anal Toxicol ; 42(9): 625-629, 2018 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-29945182

RESUMO

In this work, an alternative LC-MS-MS strategy for the analysis of urinary creatinine in abstinence control was presented and discussed. The two-way electrospray ionization consisted of two different precursor ions in which fragmentation was used in multiple reaction monitoring experiments. A creatinine adduct ion with sodium and sodium acetate together with the conventional analyte protonation was investigated. Adduct formation and fragmentation was explored by appropriate infusion experiments performed with analyte solutions prepared in different concentrations. The analytical signal was compensated by the application of appropriate isotopically labeled internal standard. The advantages of information carried by precursor ions separated in the mass spectra were pointed out. Sample preparation based solely on sample dilution performed in the final HPLC vial directly. A Luna 5 µm C18 (2) 100 A, 150 mm × 2 mm analytical column together with a mobile phase consisted of H2O/methanol = 3%/97% (v/v) with 10 mmol/L ammonium acetate and 0.1% acetic acid (flow = 0.4 mL/min) were used for the separation performed during a run of 5 min. The linearity was examined in the range of 100-3,000 mg/L. The limit of detection (13 mg/L), limit of quantification (43 mg/L) together with method precision/accuracy, selectivity, stability and matrix effect were tested to be appropriate for forensic applications. The applicability of water as surrogate matrix for method calibration was also examined successfully. The presented strategy was used in the analysis of real samples. No interferences with the creatinine peak eluted at about 1.0 min could be recorded.


Assuntos
Creatinina/urina , Toxicologia Forense/métodos , Transtornos Relacionados ao Uso de Substâncias/urina , Biomarcadores/urina , Calibragem , Cromatografia Líquida de Alta Pressão , Indicadores e Reagentes , Limite de Detecção , Metanol/química , Padrões de Referência , Manejo de Espécimes , Espectrometria de Massas por Ionização por Electrospray
18.
Drug Alcohol Depend ; 189: 8-11, 2018 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-29857329

RESUMO

BACKGROUND: Drug users reportedly abuse pregabalin, and its combination with opiates was related to fatalities. We aimed to estimate the prevalence of pregabalin misuse and risk factors among patients in methadone maintenance treatment (MMT). METHODS: A cross-sectional study included all current MMT patients (n = 300) after excluding 9 with prescriptions, from a large tertiary medical center university-affiliated MMT clinic in Israel. Pregabalin was tested in one of the routine urine tests for other substances in December 2017. Data on urine results and patients' characteristics were retrieved from the patients' records. RESULTS: Pregabalin was detected among 53 (17.7%) patients. The group had higher depressive symptoms severity score (21-HAM-D) (11.1 ±â€¯8.4 vs. 8.3 ±â€¯7.8, p = 0.03), a higher prevalence of sero-positive HIV (13.7% vs. 4.2%, p = 0.02), sero-positive hepatitis C (66.7% vs. 50.4%, p = 0.04), DSM-IV-TR Axis I psychiatric diagnosis (54.0% vs. 41.7%, p = 0.03), and positive urine for opiates (22.6% vs. 8.9%, p = 0.008), cannabis (39.6% vs. 4.0 p < 0.0005) benzodiazepine (BDZ) (77.4% vs. 18.2%, p < 0.0005) and oxycodone (11.3% vs. 0.4%, p < 0.0005). Logistic regression found pregabalin group as more likely to be urine positive to BDZ (OR = 12.8 95%CI 5.0-32.5) cannabis (OR = 22.7, 95%CI 6.3-81.6) and oxycodone (OR = 43.9, 95%CI 3.6-541.4), with higher 21-HAM-D scores (OR = 1.1, 95%CI 1.04-1.2) and hepatitis C sera-positive (OR = 4.1, 95% CI 1.5-11.4). Unexpectedly, 13.2% of the pregabalin group had take-home dose privileges, which are rewards to non-drug abusers. CONCLUSIONS: High prevalence of pregabalin misuse among both BDZ abusers and non-abusers and patients with depressive symptoms supports both the inclusion of routine monitoring for pregabalin and intervention in MMT population.


Assuntos
Analgésicos , Metadona , Tratamento de Substituição de Opiáceos , Pregabalina , Uso Indevido de Medicamentos sob Prescrição/estatística & dados numéricos , Adulto , Analgésicos/uso terapêutico , Estudos Transversais , Feminino , Humanos , Israel/epidemiologia , Masculino , Metadona/uso terapêutico , Pessoa de Meia-Idade , Pregabalina/uso terapêutico , Pregabalina/urina , Prevalência , Fatores de Risco , Detecção do Abuso de Substâncias/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/psicologia , Transtornos Relacionados ao Uso de Substâncias/urina
20.
Subst Use Misuse ; 53(10): 1756-1761, 2018 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-29419341

RESUMO

BACKGROUND: Problems with self-reported drug use include difficulties with recall and recognition as well as the desire to respond to questions in a socially desirable manner. Various methods have been developed to improve and/or validate estimates based on direct questioning of individuals regarding their substance use. For this study, we were interested in validating self-reported use of: 1) tobacco, 2) marijuana, and 3) other substances (i.e., heroin, cocaine, opiates, oxycodone, benzodiazepines, methamphetamine, phencyclidine, and barbiturates) employing urinalysis among inmates who participated in a randomized controlled trial of a smoking abstinence intervention in a tobacco-free prison located in the northeastern United States. METHODS: Two-hundred and seven men and women with a mean age of 34.9 (standard deviation = 9.0) completed questions regarding their substance use on a 7-day Timeline Follow-Back and provided urine specimens three weeks following prison release. RESULTS: Self-reported tobacco and marijuana use were highly consistent with urine drug testing in terms of overall agreement and Kappa (93.7% and.804 for tobacco, respectively; and 90.3% and.804 for marijuana, respectively); however, consistency was much lower for other drug use grouped together (62.7% and.270). DISCUSSION: Although some former inmates may not accurately report substance use, our findings indicate that they are in the minority, suggesting that self-report is valid for tobacco and marijuana use but much less so for other drugs grouped together. Future research should be conducted with a larger and more diverse sample of former inmates to establish the generalizability of our findings from this study.


Assuntos
Autorrelato/estatística & dados numéricos , Detecção do Abuso de Substâncias/métodos , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/urina , Adulto , Feminino , Humanos , Masculino , Abuso de Maconha/urina , Pessoa de Meia-Idade , New England , Prisioneiros , Prisões , Fumar Tabaco/urina , Urinálise
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