PSYCHOLOGICAL AND METHODOLOGICAL ISSUES IN SUBSTANCE ABUSE TREATMENT/RESEARCH

在临床试验的范围内，该科评估与研究和治疗有关的方法学问题，例如药物监测方面的创新。在一项研究中，44名美沙酮维持患者的汗液和尿液样本被收集，以监测可卡因的使用情况。将每周(周二)涂抹和移除的成对汗片与周三、周五和周一收集的尿样进行比较。检测汗片中的可卡因、苯甲酰卵磷脂(BZE)和蜕皮素甲酯(EME)，对930块汗片进行酶联免疫分析(截止浓度为10 ng/mL)，对部分汗片(N=591块)进行GC-MS分析(截止浓度为5 ng/mL)。对尿样进行BZE定性检测(截止浓度为300 ng/m L)，同时采用荧光免疫分析法(FP IA)半定量检测BZE(LOD=30 ng/m L)，用气相色谱-质谱仪(GC-MS)检测可卡因(LOD=5 ng/m L)。评估的结果是：1)确定汗液中可卡因及其代谢物的相对量；2)评估重复汗片的可重复性；3)比较汗液中可卡因的ELISA法和GC-MS结果；以及4)比较汗液和尿液检测可卡因使用情况。GC-MS在99%的ELISA阳性汗片中检测到可卡因；可卡因、BZE和EME的中位浓度分别为393、79和74 ng/毫升。结果在重复贴片中有很好的重复性。与汗液GC-MS结果相比，汗液可卡因检测结果的敏感性、特异性和有效性分别为93.1%、90.5%和93.5%。汗液酶联免疫吸附试验检测可卡因的敏感性、特异性和效率分别为97.6%、60.5%和77.7%。这些发现支持使用汗片监测可卡因的使用，尽管还需要进一步的评估。(Preston KL，Huestis MA，Wong CJ，Umbricht A，Goldberger BA和Cone EJ。监测药物滥用治疗患者汗液和尿液中可卡因的使用情况。分析毒理学杂志23：313-322,1999)-结果预测，可卡因，药物使用监测，尿液分析，物质滥用，物质滥用治疗，汗水-人类受试者

Within the context of clinical trials, the section evaluates methodological issues relevant to both research and treatment, for example innovations in drug monitoring. In one study, sweat and urine specimens were collected from 44 methadone-maintenance patients to monitor cocaine use. Paired sweat patches that were applied and removed weekly (Tuesday) were compared to urine specimens collected Wednesday, Friday and Monday. Sweat patches were analyzed for cocaine, benzoylecgonine (BZE), and ecgonine methyl ester (EME); all patches (N=930) were analyzed by ELISA immunoassay (cutoff concentration 10 ng/ mL), and a subset of patches (N = 591) were also analyzed by GC-MS (cutoff concentration 5 ng/mL). Urine specimens were analyzed qualitatively for BZE by EMIT (cutoff 300 ng/mL), and a subset were also analyzed semiquantitatively for BZE by FPIA (LOD = 30 ng/mL) and quantitatively for cocaine by GC-MS (LOD = 5 ng/mL). Results were evaluated to: 1) determine the relative amounts of cocaine and its metabolites in sweat; 2) assess replicability in duplicate sweat patches; 3) compare ELISA and GC-MS results for cocaine in sweat; and 4) compare the detection of cocaine use by sweat and urine testing. Cocaine was detected by GC-MS in 99% of ELISA-positive sweat patches; median concentrations of cocaine, BZE, and EME were 393, 79, and 74 ng/mL. There was good replication of results in duplicate patches. The sensitivity, specificity, and efficiency of sweat ELISA cocaine results compared to sweat GC-MS results were 93.1%, 90.5%, and 93.5%. The sensitivity, specificity, and efficiency of sweat ELISA results for cocaine compared to urine EMIT results were 97.6%, 60.5%, and 77.7%. These findings support the utility of sweat patches for monitoring cocaine use, though further evaluation is needed. (Preston KL, Huestis MA, Wong CJ, Umbricht A, Goldberger BA, and Cone EJ. Monitoring cocaine use in sweat and urine of substance abuse treatment patients. Journal of Analytical Toxicology 23: 313-322, 1999.) - outcome predictor, cocaine, drug use monitoring, urinalysis, substance abuse, substance abuse treatment, sweat - Human Subjects