High prevalence of 6-acetylmorphine in morphine-positive oral fluid specimens

Presley, Lance; Lehrer, Michael; Seiter, William; Hahn, Dawn; Rowland, Barbara; Smith, Melissa; Kardos, Keith; Fritch, Dean; Salamone, Sal; Niedbala, R. Sam; Cone, Edward J.

doi:10.1016/s0379-0738(03)00045-8

Cited by 32 publications

(14 citation statements)

References 10 publications

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“…Thus, 77.5% of all morphine positive specimens (N = 4575), were positive for 6-acetylmorphine. This finding is consistent with the report by Prestley et al (26), who found 66.7% of all oral fluid specimens positive for morphine were positive for 6-acetylmorphine. Another heroin-associated analyte, 6-acetylcodeine, also was reported at relatively high frequency.…”

supporting

confidence: 93%

Prevalence and Disposition of Drugs of Abuse and Opioid Treatment Drugs in Oral Fluid

Cone

Clarke²,

Tsanaclis³

2007

Journal of Analytical Toxicology

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ITesting oral fluid for drugs of abuse has been studied under many conditions but rarely has been evaluated in large population databases. We evaluated oral fluid tests in a database from a commercial laboratory in the United Kingdom composed of 8679 confirmed positive results. The results originated from 635,000 specimens collected over the period of May 2004 through September 2006. Oral fluid specimens were collected with the Intercept | oral fluid collection device, screened by enzyme immunoassay, and confirmed by GC-MS or GC-MS-MS. The database was organized by collection settings (legal/treatment, N = 8198 specimens; and workplace, N = 481 specimens) and by drug groups (without consideration of collection setting). The drug groups were as follows (number of confirmed positives): amphetamines (468); benzodiazepines (892); buprenorphine (276); cannabinoids (725); cocaine (1443); methadone (998); and opiates (5739). The goal of the study was to provide drug/metabolite prevalence data, concentrations, and drugs/metabolite patterns encountered in oral fluid. Comparison of results by collection setting indicated differences in relative frequency, primarily for opiates and cannabinoids. Opiate positives were most frequently observed for specimens collected in legal/treatment settings, whereas cannabinoids were most frequently reported in the workplace. An array of information on drug and metabolite occurrences and concentration arose from evaluation of the data by drug groups. Amphetamine was the predominant drug reported for the Amphetamines Group; approximately 10% were also positive for MDA and/or MDMA; and methamphetamine was rarely reported. Multiple combinations of diazepam, nordiazepam, oxazepam, temazepam, chlordiazepoxide, and Iorazepam were reported for the Benzodiazepine Group. Buprenorphine, an opioid treatment drug, was the predominant analyte reported, but low concentrations of norbuprenorphine were frequently reported. THC was the predominant analyte reported in the Cannabinoids Group and was

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supporting

confidence: 93%

Prevalence and Disposition of Drugs of Abuse and Opioid Treatment Drugs in Oral Fluid

Cone

Clarke²,

Tsanaclis³

2007

Journal of Analytical Toxicology

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“…Due to the mildly acidic pH of saliva, basic drugs such as opioids may even show higher concentrations for longer periods of time following use compared to blood due to an "ion trapping" effect of weakly basic drugs like morphine within mildly acidic saliva [84,86]. This advantage is suggested by the high frequency of detecting 6-monoacetyl-morphine with morphine in oral fluid compared with typical frequencies in urine of patients using heroin [87,88]. One of the major challenges for oral fluid analysis is the generally small specimen size and consistent collection [89], which limits the ability to perform multidrug testing and especially limits the definitive identification of drugs following positive screening tests.…”

Section: Sample Adulteration and Alternative Matrix Testingmentioning

confidence: 99%

Laboratory Testing for Prescription Opioids

Milone

2012

J. Med. Toxicol.

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Opioid analgesic misuse has risen significantly over the past two decades, and these drugs now represent the most commonly abused class of prescription medications. They are a major cause of poisoning deaths in the USA exceeding heroin and cocaine. Laboratory testing plays a role in the detection of opioid misuse and the evaluation of patients with opioid intoxication. Laboratories use both immunoassay and chromatographic methods (e.g., liquid chromatography with mass spectrometry detection), often in combination, to yield high detection sensitivity and drug specificity. Testing methods for opioids originated in the workplace-testing arena and focused on detection of illicit heroin use. Analysis for a wide range of opioids is now required in the context of the prescription opioid epidemic. Testing methods have also been primarily based upon urine screening; however, methods for analyzing alternative samples such as saliva, sweat, and hair are available. Application of testing to monitor prescription opioid drug therapy is an increasingly important use of drug testing, and this area of testing introduces new interpretative challenges. In particular, drug metabolism may transform one clinically available opioid into another. The sensitivity of testing methods also varies considerably across the spectrum of opioid drugs. An understanding of opioid metabolism and method sensitivity towards different opioid drugs is therefore essential to effective use of these tests. Improved testing algorithms and more research into the effective use of drug testing in the clinical setting, particularly in pain medicine and substance abuse, are needed.

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“…4 shows the typical MRM transitions of an Intercept 1 sample of a mixed cocaine/heroin user. The presence of 6-AM is an important feature of oral fluid analysis in comparison to blood, and has been demonstrated with this collection device in a previously published paper [20]. In Table 7 a summary of the quantitative results for the positive samples is presented.…”

Section: Samplesmentioning

confidence: 72%