The New Substance Abuse and Mental Health Services Administration Oral Fluid Cutoffs for Cocaine and Heroin-Related Analytes Applied to an Addiction Medicine Setting: Important, Unanticipated Findings with LC-MS/MS

Flood, James G.; Khaliq, Tahira; Bishop, Kenneth A.; Griggs, David A.

doi:10.1373/clinchem.2015.251066

Cited by 16 publications

(4 citation statements)

References 19 publications

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“…We conducted a retrospective cohort study of adult patients initiating office-based buprenorphine treatment across a large academic health system based on oral fluid toxicology data between August 2016 and January 31, 2018. Oral fluid toxicology testing was performed using liquid chromatography-tandem mass spectrometry (Flood et al, 2016).…”

Section: Methodsmentioning

confidence: 99%

“…We used morphine, codeine, or 6-monoacetylmorphine as a proxy for heroin use because of the short half-life of 6-monoacetylmorphine alone and its rapid metabolism to morphine and codeine. Cutoffs used for a negative test were less than 2.0 ng/mL for 6-monoacetylmorphine (6-MAM) and fentanyl and less than 4.0 ng/mL for codeine and morphine (Flood et al, 2016). We did not examine toxicology outcomes for prescription opioids, including oxycodone, hydromorphone, and hydrocodone, as previous research has demonstrated worse treatment outcomes among individuals using heroin compared to individuals using prescription opioids, thus we would expect that individuals exclusively using prescription opioids would have better treatment outcomes than individuals using fentanyl (Weiss et al, 2015).…”

Section: Study Participantsmentioning

confidence: 99%

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Impact of Fentanyl Use on Buprenorphine Treatment Retention and Opioid Abstinence

Wakeman

Chang

Regan

et al. 2019

Journal of Addiction Medicine

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Objectives: There has been a rapid increase in the presence of illicitly manufactured fentanyl in the heroin drug supply. Buprenorphine is an effective treatment for heroin and prescription opioid use disorder; however, little is known about treatment outcomes among people using fentanyl. We compared 6-month treatment retention and opioid abstinence among people initiating buprenorphine treatment who had toxicology positive for heroin compared to fentanyl at baseline. Methods: Retrospective cohort study of 251 adult patients initiating office-based buprenorphine treatment who had available toxicology testing across an academic health system between August 2016 and July 2017. Exposure was assessed at baseline before initiating buprenorphine and was categorized as negative toxicology (n ¼ 184) versus fentanyl positive toxicology (n ¼ 48) versus heroin positive toxicology (n ¼ 19). Results: Six-month treatment retention rates were not different between the fentanyl positive and heroin positive groups [38% (n ¼ 18) vs 47% (n ¼ 9); P ¼ 0.58], or between the fentanyl positive and the negative toxicology group [38% (n ¼ 18) vs 51% (n ¼ 93); P ¼ 0.14]. Opioid abstinence at 6 months among those who had testing did not differ between the fentanyl positive and the heroin positive group [55% (n ¼ 6) vs 60% (n ¼ 6); P ¼ 0.99]. The fentanyl positive group had a lower abstinence rate at 6 months compared to those with negative toxicology at baseline [55% (n ¼ 6) vs 93% (n ¼ 63); P ¼ 0.004]. Mean initial buprenophine dosage did not differ between groups. Conclusions: Buprenorphine treatment retention and abstinence among those retained in treatment is not worse between people using fentanyl compared to heroin at treatment initiation. Both groups have lower abstinence rates at 6 months compared to individuals with negative toxicology at baseline. These findings suggest that people exposed to fentanyl still benefit from buprenorphine treatment.

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Section: Methodsmentioning

confidence: 99%

Section: Study Participantsmentioning

confidence: 99%

Impact of Fentanyl Use on Buprenorphine Treatment Retention and Opioid Abstinence

Wakeman

Chang

Regan

et al. 2019

Journal of Addiction Medicine

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“…Our workflow works efficiently in the logP range 0.5 to 5.5. This enables the detection of almost all important illegal drug classes, except cannabinoids, with LOI values that are sufficiently low to fulfill the requirements for screening and confirmation methods issued by regulating authorities, including the Substance Abuse and Mental Health Services Administration (SAMSHA) and the European Workplace Drug Testing Society [ 37 , 38 ].…”

Section: Resultsmentioning

confidence: 99%

A validated workflow for drug detection in oral fluid by non-targeted liquid chromatography-tandem mass spectrometry

et al. 2018

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Oral fluid is recognized as an important specimen for drug testing. Common applications are monitoring in substance abuse treatment programs, therapeutic drug monitoring, pain management, workplace drug testing, clinical toxicology, and driving under the influence of drugs (DRUID). In this study, we demonstrate that non-targeted LC-MS/MS with subsequent compound identification by tandem mass spectral library search is a valuable tool for comprehensive detection and confirmation of drugs in oral fluid samples. The workflow developed involves solid-phase extraction and chromatographic separation on reversed phase materials. Mass spectrometric detection is accomplished on a quadrupole–quadrupole-time-of-flight instrument operated with data-dependent acquisition control. The workflow was optimized for 500 μl of neat oral fluid collected with the Greiner Bio-One saliva collection system. The fitness of the developed method was tested and proven by analyzing blank and spiked samples as well as 59 authentic patient samples. We could demonstrate that compounds with logP values in the range 0.5–5.5 are efficiently detected at low nanograms per milliliter concentrations. The true positive and true negative rates of automated library search were equal or close to 100%. The beauty of the non-targeted LC-MS/MS approach is the ability to detect compounds hardly included in routinely applied targeted assays, and this was demonstrated by detecting the synthetic opioid U-47700 in two patient samples. Graphical abstractᅟ Electronic supplementary materialThe online version of this article (10.1007/s00216-018-1504-x) contains supplementary material, which is available to authorized users.

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“…However, plasma collection is modestly invasive and requires extensive sensitivity and strong technical reproducibility to overcome the large dynamic range of protein abundance to capture low-abundance biomarkers. The use of oral or salivary fluid is both less invasive and less technically difficult than blood collection, and is susceptible to very rapid turnover in response to physiological processes [11][12][13][14][15]. Measuring biomarkers is unlike the detection of opioid drugs, which is static and drugs can be present for days.…”

Section: Introductionmentioning

confidence: 99%

Assessment of the Utility of the Oral Fluid and Plasma Proteomes for Hydrocodone Exposure

et al. 2019

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Introduction Non-medical use and abuse of prescription opioids is a growing problem in both the civilian and military communities, with minimal technologies for detecting hydrocodone use. This study explored the proteomic changes that occur in the oral fluid and blood plasma following controlled hydrocodone administration in 20 subjects. Methods The global proteomic profile was determined for samples taken at four time points per subject: pre-exposure and 4, 6, or 168 hours post-exposure. The oral fluid samples analyzed herein provided greater differentiation between baseline and response time points than was observed with blood plasma, at least partially due to significant person-to-person relative variability in the plasma proteome.Results A total of 399 proteins were identified from oral fluid samples, and the abundance of 118 of those proteins was determined to be significantly different upon metabolism of hydrocodone (4 and 6 hour time points) as compared to baseline levels in the oral fluid (pre-dose and 168 hours). Conclusions We present an assessment of the oral fluid and plasma proteome following hydrocodone administration, which demonstrates the potential of oral fluid as a noninvasive sample that may reveal features of hydrocodone in opioid use, and with additional study, may be useful for other opioids and in settings of misuse.

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The New Substance Abuse and Mental Health Services Administration Oral Fluid Cutoffs for Cocaine and Heroin-Related Analytes Applied to an Addiction Medicine Setting: Important, Unanticipated Findings with LC-MS/MS

Abstract: BACKGROUND:We implemented oral fluid (OF) as an alternative specimen type to urine for detection of cocaine (COC) and opiate abuse in outpatient addiction medicine clinics.

Cited by 16 publications

References 19 publications

Impact of Fentanyl Use on Buprenorphine Treatment Retention and Opioid Abstinence

Impact of Fentanyl Use on Buprenorphine Treatment Retention and Opioid Abstinence

A validated workflow for drug detection in oral fluid by non-targeted liquid chromatography-tandem mass spectrometry

Assessment of the Utility of the Oral Fluid and Plasma Proteomes for Hydrocodone Exposure

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