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.

口服液体测试对滥用药物的技术一直在进步，但是尿液分析仍然 在大多数情况下进行药物筛查的标准矩阵，包括Meadadone维护和其他门诊 成瘾治疗，目的地与尿液标本收集相比，口服流体的主要实用优势。这些都是 特别是消除隐私问题（以及增加患者命运），需要专门的浴室， 对同性观察者的需求（如果完成观察），没有“害羞膀胱”的影响，近乎紧急情况 标本的潜在掺假，后者需要大量有效性测试才能检测尿液。最近的 研究表明，使用最先进的技术（具有串联质量的液相色谱） 光谱 - LC/MS/MS），口服流体和尿液的总检测窗口相似。尽管 这些优点，口服液体仍未广泛用于方法治疗，其他门诊成瘾治疗， 以及其他设置，例如探针/假释计划，毒品法庭，对安全敏感的作品以及儿童 保护服务，需要监视其客户或员工的吸毒。此外，还有很棒的 在药物流行病学研究中使用口服液体的潜力，例如家庭调查和“街头研究”， 尿液分析在很大程度上是不切实际的，但是及时的药物监测对于早期发现和 地方和国家药物流行病的变化。特别是，口服液体药物测试的膨胀将有助于 “对阿片类药物危机的实时监视”（总统委员会，2017年），包括更好地监视 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比较了 针对尿液分析的口服流体分析，当前标准，用于相同提供的大型配对样品样本 同时。因此，本应用程序的具体目的是： 1。在检测不同的主要药物中确定口服液体分析和尿液分析之间的差异（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MethodOne维护治疗的新患者（n = 1,000），选择用于区域多样性。 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 入院治疗时获得的使用。 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 在成瘾治疗和当今常用尿液分析的其他环境中的流体和设置 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）将是高度的 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