Advancing the Use of Oral Fluid to Monitor Therapeutic and Illicit Drugs in Outpatient Clinical and Field Settings

促进在门诊临床和现场环境中使用口服液来监测治疗药物和非法药物

• 批准号: 10161959
• 负责人: Stephen Magura
• 金额: $ 12.88万
• 依托单位: WESTERN MICHIGAN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-30 至 2022-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10161959
• 关键词: Admission activity; Amphetamines; Biology; Bladder; Client; Clinical; Clinical Research; Cocaine; Collection; Cone; Data; Designer Drugs; Detection; Drug Compounding; Drug Courts; Drug Monitoring; Drug Screening; Drug usage; Drug user; Early Diagnosis; Employee; Epidemic; Epidemiology; Ethanol; Ethnic Origin; Fentanyl; Gender; Hour; Household; Illicit Drugs; Immunoassay; Individual; Ingestion; Lead; Liquid Chromatography; Liquid substance; Low Prevalence; Marijuana; Measurement; Methadone; Methamphetamine; Monitor; Oral; Outcome; Outpatients; Oxycodone; Parents; Patient Self-Report; Patients; Pharmaceutical Preparations; Privacy; Public Health; Race; Research; Research Personnel; Safety; Sample Size; Sampling; Sampling Studies; Specimen; Substance Abuse Detection; Surveys; Techniques; Technology; Testing; Therapeutic; Time; United States Substance Abuse and Mental Health Services Administration; Urinalysis; Urine; Workplace; addiction; child protective service; chronic pain patient; drug misuse; drug of abuse; drug testing; epidemiology study; improved; liquid chromatography mass spectrometry; methadone patient; methadone treatment; opioid epidemic; parole; probation; programs; recruit; research study; sample collection; screening; synthetic opioid; tandem mass spectrometry; virtual

The technology of oral fluid testing for drugs of abuse has been advancing, but urinalysis remains the standard matrix for drug screening in most settings, including methadone maintenance and other outpatient addiction treatment, despite major practical advantages of oral fluid over urine specimen collection. These are specifically the elimination of privacy issues (and increase in patient dignity), the need for a dedicated bathroom, the need for a same-gender observer (if observation is done), no effects of “shy bladder”, and the near elimination of potential adulteration of specimens, the latter requiring numerous validity tests to detect for urine. Recent research indicates that with the use of state of art techniques (liquid chromatography with tandem mass spectrometry- LC/MS/MS), the overall window of detection has become similar for oral fluid and urine. Despite these advantages, oral fluid is still not widely used in methadone treatment, other outpatient addiction treatment, and other settings such as probation/parole programs, drug courts, safety-sensitive workplaces, and child protective services, that need to monitor the drug use of their clients or employees. In addition, there is great potential for using oral fluid in drug epidemiological studies, such as household surveys and “street studies,” where urinalysis is largely impractical, but where timely drug surveillance is critical for early detection of and changes in local and national drug epidemics. In particular, expansion of oral fluid drug testing would contribute to “real time surveillance of the opioid crisis” (President’s Commission, 2017), including better monitoring of the abuse of powerful synthetic opioids (e.g., fentanyl, oxycodone). One important barrier to the wider use of oral fluid is a paucity of contemporary data comparing the results of oral fluid analysis to urinalysis, the current standard, for large samples of paired specimens provided by the same individuals at the same time. Consequently, the specific aims of this application are: 1. Identify differences (if any) between oral fluid analysis and urinalysis in the detection of different major drug classes and the most common drug compounds within a set of 123 possible compounds, including recent “designer drugs.” The study will compare the results between state-of-the-art oral fluid testing and urinalysis for new patients admitted to methadone maintenance treatment nationally (n = 1,000), selected for regional diversity. 2. Determine the utility of oral fluid and urine drug screening by LC/MS/MS-only as compared with standard immunoassay screening followed by LC/MS/MS confirmation of positives only. 3. Determine the sensitivity of oral fluid analysis and urinalysis as compared with self-reports of recent drug use obtained at admission to methadone treatment. If oral fluid analysis yields results at least equivalent to accepted standard urinalysis, then the use of oral fluid both in addiction treatment and other settings where urinalysis is commonly used today, and settings where any matrix other than oral fluid is impractical (e.g., most epidemiological research), would be highly supported.

滥用药物的口服液检测技术一直在进步，但尿液分析仍然是 大多数情况下的药物筛选标准矩阵，包括美沙酮维持治疗和其他门诊 成瘾治疗，尽管口腔液体比尿液样本采集具有重大的实际优势。这些是 具体地说，消除隐私问题(增加病人尊严)，需要专用卫生间， 需要同性观察员(如果进行了观察)，没有“羞涩的膀胱”的影响，几乎消除了 可能存在标本掺假的可能性，后者需要进行多次有效性测试才能检测出尿液。近期 研究表明，使用最先进的技术(串联质谱液相色谱) 随着LC/MS/MS)的出现，口腔液体和尿液的整体检测窗口变得相似。尽管 这些优点，口服液目前仍未广泛用于美沙酮治疗、其他门诊成瘾治疗、 以及其他环境，如缓刑/假释计划、毒品法庭、安全敏感的工作场所和儿童 保护性服务，需要监控其客户或员工的药物使用情况。此外，还有很棒的 在药物流行病学研究中使用口服液的可能性，例如家庭调查和“街头研究”， 尿检在很大程度上是不切实际的，但及时的药物监测对于早期发现和 地方和国家毒品流行的变化。特别是，扩大口服液药物测试将有助于 到“阿片类药物危机的实时监测”(总统委员会，2017年)，包括更好地监测 滥用强力合成阿片类药物(如芬太尼、羟考酮)。 口服液广泛使用的一个重要障碍是缺乏当代数据比较 口腔液分析尿液分析，现行标准，大样本的配对样本提供相同 多个个体同时进行。因此，本申请的具体目标是： 1.确定口服液分析和尿液分析在检测不同主要药物方面的差异(如果有) 分类和123种可能化合物中最常见的药物化合物，包括最近的 “特制毒品。”这项研究将比较最先进的口腔液检测和尿液分析的结果 在全国范围内接受美沙酮维持治疗的新患者(n=1,000)，因区域多样性而被选中。 2.确定LC/MS/MS-Only用于口服液和尿液药物筛选的有效性，并与标准对照 免疫分析筛选，然后LC/MS/MS仅确认阳性。 3.确定口服液分析和尿液分析的灵敏度，并与新药的自我报告进行比较 在接受美沙酮治疗时获得的用法。 如果口服液分析的结果至少与公认的标准尿液分析结果相同，那么使用口服 在成瘾治疗和今天通常使用尿液分析的其他环境中的液体，以及环境 在口服液以外的任何基质都不切实际的情况下(例如，大多数流行病学研究)，将高度 支持。

项目成果

Gender Differences in Drug Use among Individuals Under Arrest.

被捕者吸毒的性别差异。

• DOI: 10.1080/14659891.2022.2070872
• 发表时间: 2023
• 期刊: Journal of substance use
• 影响因子: 0.8
• 作者: Weller,BridgetE;Magura,Stephen;Smith,DawnR;Saxton,MatthewM;Amaratunga,Piyadarsha
• 通讯作者: Amaratunga,Piyadarsha