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.

口服液体测试的技术对ABRUG擦伤的药物的药物，但尿液分析仍然是您的 在大多数情况下，用于药物滚动的标准矩阵，包括甲基酮维护和门诊 成瘾治疗，尽管口服液体比尿液采集的主要优势 特别是消除隐私问题（以及患者尊严的提高），需要专门的浴室， 需要同性观察者（如果完成观察），没有“害羞膀胱”的影响，近消除 在潜在的标本中，后者需要众多测试才能检测到尿液。 研究表明，使用最先进的技术 光谱LC/MS/MS），口服流体和尿液的总检测窗口相似。 这些优点，口服液体仍未广泛用于美沙酮治疗，门诊成瘾治疗， 以及其他环境，例如缓刑/假释计划，毒品法庭，对安全敏感的工作场所和儿童 保护服务，需要监视其客户或员工的吸毒。 在药物流动性研究中使用口服液体的潜力，例如家庭调查和“街头研究，街头研究”， 尿液分析更大的不切实际，但是及时的药物监测对于早期检测和 局部和国家药物流行的变化。 要“对阿片类药物危机的实时监视”（《媒体委员会》，2017年），包括更好地监控 滥用强大的合成阿片类药物（例如芬太尼，羟考酮）。 更广泛使用口服流体的一个重要障碍是，当代数据的匮乏构成了 对尿液分析的口服流体分析，当前标准，用于由相同的配对标本的大样本 因此，个人的特定目的是： 1.在不同的主要药物中，口服液体分析和尿液分析之间存在差异（如果有） 班级和最常见的药物化合物一组123种可能的化合物，包括最近 “设计师药物。”该研究将比较最先进的口服液体测试和尿液分析的结果 在全国范围内接受美沙酮维持治疗的新患者（n = 1,000），以区域多样性选择。 2。与标准 免疫测定筛查，然后仅对阳性确认。 3。与最近药物的自我报告相比，确定口服液体分析和尿液分析的敏感性 进入美沙酮治疗时获得的使用。 如果口服流体分析至少相当于接受的标准尿液分析，则使用口服 流体以及当今通常使用尿液分析的其他治疗以及其他设置 除了口服液体以外的任何基质都是不切实际的（例如，大多数流行病学研究），伤口高度很高 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