No abstract

The use of prescription drugs, including synthetic opiates, is increasing in the U.S., with emergency room reports showing a dramatic rise in prescription opiate abuse. As part of an ongoing study, the hair of admitted opiate users was analyzed for hydrocodone and hydromorphone, as well as codeine, morphine, and 6-acetylmorphine in order to determine if there was any correlation between self-reported frequency of opiate intake and the concentration of drug detected in hair. The hairs were confirmed using gas chromatography-mass spectrometry following screening by enzyme linked immunosorbent assay (ELISA). Twenty-four hair specimens collected from volunteers showed the presence of hydrocodone (130-15,933 pg/mg); four of those also contained hydromorphone (59-504 pg/mg). The specimens were also analyzed for morphine, codeine, and 6-acetylmorphine. Hair specimens from five self-reported codeine users showed concentrations of hydrocodone between 592 and 15,933 pg/mg. In addition, codeine was present at concentrations of 575-20,543 pg/mg, but neither morphine nor hydromorphone were present in any of those hair specimens. Though the analysis of some opiates in hair has been previously published, this is the first study where the hydrocodone and hydromorphone concentrations have been measured following self-reported opiate intake.

Background: Single test procedures for screening GDM in Indian women will help in its management.This study was aimed to compare the accuracy measures of the random glucose test and the Diabetes In Pregnancy Study group India (DIPSI) recommended glucose challenge test as screening tests for Gestational Diabetes Mellitus (GDM) between 24 and 28 weeks of pregnancy and to study the prevalence of GDM and associated risk factors. Methods: In this prospective cohort study, all pregnant women without pre-existing diabetes underwent a random glucose test first followed by DIPSI recommended method (2 hours after a 75 g oral glucose load, without regard to the time of the last meal). All the pregnant women were subjected to 2-h 75-g oral glucose tolerance test for diagnosis of GDM within one week. Receiver Operating Characteristic (ROC) analysis was used to evaluate the discriminatory power of the two screening tests. Results: The OGTT was performed in 576 women. The area under the ROC curve was larger for the DIPSI test [0.97 (95% CI 0.95-0.98)] than for the random glucose test [0.76 (95% CI 0.72-0.79)]. There was a significant difference in the areas under the curve of the two tests of 0.21 (0.14 to 0.28) (P <0.0001) in favour of the DIPSI recommended method. GDM was present in 8.9% women confirmed by 75 g 2 hour OGTT using the WHO criteria. Age ≥30 years, BMI ≥25 and family history of diabetes were found to be risk factors for GDM. Conclusions: In screening for GDM, the DIPSI procedure test was more useful than the random glucose test.

The objective of this preliminary study was to identify and quantify potential nicotine (NIC) biomarkers in post-exposure oral fluid samples collected from 10 NIC-abstinent human participants administered 7 mg transdermal NIC using liquid chromatography-tandem mass spectrometry (LC-MS-MS). Oral fluid samples were collected prior to NIC patch application and at 0.5 and 0.75 h after patch removal using the Quantisal() oral fluid collection device. The validated LC-MS-MS analyte panel included nicotine-Nbeta-D-glucuronide, cotinine-N-oxide, trans-3-hydroxycotinine, norcotinine, trans-nicotine-1'-N-oxide, cotinine (COT), nornicotine, NIC, anatabine, anabasine, and cotinine-N-beta-D-glucuronide. Analytes and corresponding deuterated internal standards were extracted by solid-phase extraction. NIC and COT concentrations were quantifiable in oral fluid samples collected from 6 of the 10 participants 0.5 h after patch removal and in oral fluid samples collected from 7 of the 10 participants 0.75 h after patch removal. Based on the mean NIC and COT concentrations in oral fluid and plasma for the participants with both quantifiable NIC and COT at the 0.5 and 0.75 h collection times, the oral fluid-plasma ratio was 6.4 for NIC and 3.3 for COT. An ELISA procedure was also validated and successfully applied as a screening tool for these oral fluid samples in conjunction with LC-MS-MS confirmation. An ELISA cut-off concentration of 5.0 ng/mL provided excellent sensitivity for discrimination of COT-positive post-exposure oral fluid samples collected after low-level transdermal NIC exposure and oral fluid samples collected prior to patch application.

I AbstractThe development of a highly sensitive enzyme-linked immunosorbent assay and gas chromatography-mass spectrometry confirmation method for the detection of dextromethorphan and its major metabolite dextrorphan in urine and oral fluid is described. For the screening assay, the intraday precision was less than 8% for urine and less than 5% for oral fluid. The interday precision was less than 10% for both drugs in urine and oral fluid. For the confirmatory procedure, both inter-and intraday precision was less than 5% for both matrices. The detection limit for both methods was 1 ng/mL. The quantifying ions chosen from the full scan mass spectra were m/z 271 for dextromethorphan, m/z 329 for dextrorphan, and m/z 332 for tri-deuterated dextrorphan-d3. A high recovery yield (> 93%) from the Quantisal TM oral fluid collection device was achieved, and the drugs were stable in the collection device for at least 10 days at room temperature. The extracted drugs from both matrices were stable for at least 48 h while kept at room temperature. Both screening and confirmatory procedures were applied to authentic urine and oral fluid specimens obtained from volunteers following therapeutic ingestion of dextromethorphan.illicit use, referred to as "robotripping", is becoming popular among teenagers because of the ease of its availability, being a non-controlled substance. The California Poison Control System reported a 10-fold increase in DXM abuse cases from 1999 to 2004, with the median age of abusers being 16 (2). This makes it increasingly important to develop better analytical methods to easily and rapidly test for DXM usage as part of a teenage drug of abuse panel. Although urine analysis has been the preferred method of testing for drugs of abuse, oral fluid is increasingly useful matrix for drug testing because of its ease of observed collection and difficulty of adulteration.Dextromethorphan is metabolized in the liver by cytochrome P450-2D6, into three metabolites: the major metabolite dextrorphan (DXO) and two minor metabolites 3-methoxymorphinan and 3-hydroxymorphinan. In addition, some is excreted as the conjugated glucuronides (Figure 1).Both DXM and DXO act as potent blockers of the N-methyld-aspartate (NMDA) receptor. At high doses, the pharmacology of DXM is similar to that of the controlled substances phencyclidine (PCP) and ketamine. It has been found that approximately 10% of the population (depending on race) are poor metabolizers and hence are susceptible to greater toxicity due