6-o-monoacetylmorphine and Cocaine-Related-Disorders

Although self reports of illicit drug use may not be reliable, this information is frequently collected and relied upon by national drug surveys and by counselors in drug treatment programs. The addition of oral fluid testing to these programs would provide objective information on recent drug use.. The goal of this study was to compare oral fluid tests for cocaine, benzoylecgonine, 6-acetylmorphine, morphine, codeine and 6-acetylcodeine to self reports of recent cocaine and heroin use by patients in an outpatient methadone treatment program.. Patients (n=400) provided an oral fluid specimen and completed a short questionnaire on illicit drug use over the last seven days. Oral fluid was collected with the Intercept Oral Fluid Collection device. Oral fluid was analyzed by a validated assay using liquid chromatography coupled with tandem mass spectrometry. The presence of an analyte was confirmed if all identification criteria were met and its concentration (ng/mL) was ≥ LOQ (cocaine, 0.4; benzoylecgonine, 0.4; morphine, 2; codeine, 2; 6-acetylmorphine, 0.4; and 6-acetylcodeine, 1).. Analyses of oral fluid specimens collected from the 400 methadone maintained patients revealed that a majority (95%) of subjects who admitted to recent cocaine use were confirmed positive, whereas slightly more than 50% were confirmed positive who admitted to heroin over the last seven days. For those patients who denied recent cocaine and heroin use, approximately 30% were positive for cocaine and 14% were positive for heroin.. Oral fluid testing provides an objective means of verifying recent drug use and for assessment of patients in treatment for substance use disorders.

Topics: Cocaine; Cocaine-Related Disorders; Codeine; Heroin; Heroin Dependence; Humans; Methadone; Morphine; Morphine Derivatives; Narcotics; Opiate Substitution Treatment; Saliva; Self Report; Substance Abuse Detection

Heroin, with a plasma half-life of approximately 5 min, is rapidly metabolized to 6-acetylmorphine (6-AM). 6-AM, a specific marker for heroin use, which also has a short half-life of only 0.6 h, is detected in urine for only a few hours after heroin exposure. Ingestion of poppy seeds and/or licit opiate analgesics can produce positive urine opiate tests. This has complicated the interpretation of positive opiate results and contributed to the decision to raise opiate cutoff concentrations and to require 6-AM confirmation in federally mandated workplace drug-testing programs. Microgenics Corp. has developed the CEDIA 6-AM assay, a homogeneous enzyme immunoassay for semiquantitative determination of 6-AM in human urine, in addition to its CEDIA DAU opiate assay. Urine specimens were collected 3 times per week from 27 participants enrolled in a clinical research trial evaluating a contingency management treatment program for heroin and cocaine abuse. Of the 1377 urine specimens screened, 261 (18.9%) were positive for opiates at > or = 300 ng/mL, 153 (11.1%) were positive for opiates at > or = 2000 ng/mL, and 55 (4.0%) were positive for 6-AM at > or = 10 ng/mL. For opiate-positive screens > or = 300 and > or = 2000 ng/mL, 91.3% and 80.8% confirmed positive for morphine or codeine at the respective gas chromatography-mass spectrometry (GC-MS) cutoffs. All specimens screening positive for 6-AM also confirmed positive by GC-MS at > or = 10 ng/mL. Increasing the opiate screening and confirmation cutoffs for the federal workplace drug-testing program resulted in 8% fewer opiate-positive tests; however, recent heroin use was not affected by this change.

Topics: Adolescent; Adult; Cocaine-Related Disorders; Codeine; False Positive Reactions; Female; Gas Chromatography-Mass Spectrometry; Heroin Dependence; Humans; Immunoenzyme Techniques; Male; Methadone; Middle Aged; Morphine; Morphine Derivatives; Narcotics; Sensitivity and Specificity; Substance Abuse Detection; Workplace

A diagnostic system to predict the presence of 6-acetylmorphine (6AM) in opiate-positive urines was recently proposed. A twofold criterion based on the total morphine concentration and the total codeine to total morphine concentration ratio was identified. Using relative operating characteristic (ROC) analysis, it was determined that the diagnostic system had a sensitivity of 92%, a specificity of 79%, and an overall accuracy of 73%. We applied similar decision criteria to a study population of 125 opiate-positive urines collected from criminal justice clients of a West Coast reference laboratory. ROC analysis on this population produced very different results: a sensitivity of 91%, a specificity of 49%, and an accuracy of 45%. These data illustrate the importance of choosing a representative study population without any selection biases that may compromise the validity of the accuracy measure. The ROC plot is an important tool for assessing a clinical test's performance, but in order for toxicologists and Medical Review Officers to benefit from the diagnostic test results, they must also know the predictive value (based on test accuracy and the prevalence of heroin use) of the test results. They need to know how well the test predicts the presence of 6AM, and therefore, the illicit use of heroin, in the population of interest whether it be workplace, criminal justice, hospital emergency department clients, or a combination of all populations.

Topics: Cocaine-Related Disorders; Codeine; Evaluation Studies as Topic; Gas Chromatography-Mass Spectrometry; Heroin Dependence; Humans; Morphine; Morphine Derivatives; Narcotics; ROC Curve; Selection Bias; Sensitivity and Specificity; Substance Abuse Detection

A new method for the fast screening of cocaine and 6-monoacetylmorphine (6-MAM) in a single hair, using gas chromatography/mass spectrometry (GC/MS), is described. The analyses are conducted in less than 10 min with minimal sample preparation. The novel method combines the ChromatoProbe direct sample introduction device for intrainjector thermal extraction, fast GC separation, a supersonic molecular beam GC/MS interface and hyperthermal surface ionization (HSI). The technique has been successfully employed for the detection of cocaine in as little as a 1-mm section of hair using selected ion monitoring (SIM). Unambiguous full scan mass spectra of cocaine and 6-MAM were obtained on a single hair for cocaine and heroin users, respectively. HSI was found to be almost 3 orders of magnitude more selective than electron impact ionization for cocaine compared with the major hair constituents, with a minimum detected concentration of approximately 10 ppb in the SIM mode. Results obtained for 12 drugs users showed full qualitative agreement with similar results using rigorous solvent extraction followed by electrospray-liquid chromatography/mass spectrometry analysis. However, quantitative studies showed only partial agreement. No false positives were observed for 10 drugs free subjects. This method enables fast drug monitoring along the hair length which permits time correlation studies.

Topics: Adult; Chromatography, High Pressure Liquid; Cocaine; Cocaine-Related Disorders; Female; Gas Chromatography-Mass Spectrometry; Hair; Heroin; Heroin Dependence; Humans; Male; Morphine Derivatives; Substance Abuse Detection