Detection of drugs of abuse in exhaled breath using a device for rapid collection: comparison with plasma, urine and self-reporting in 47 drug users

Abstract

Exhaled breath has recently been identified as a matrix for the detection of drugs of abuse. This work aims to further document this application using a new and simple collection device in patients following recovery from acute intoxication. Breath, plasma and urine samples were collected from 47 patients (38 males, age range 25-74) together with interview data. Analysis of breath and plasma samples was done by liquid chromatography-mass spectrometry methods. Urine was screened using immunochemical reagents and positive findings confirmed with liquid chromatography-mass spectrometry methods. The 12 analytes investigated were: methadone, amphetamine, methamphetamine, 6-acetylmorphine, morphine, benzoylecgonine, cocaine, diazepam, oxazepam, alprazolam, buprenorphine and tetrahydrocannabinol. In all 47 cases, recent intake of an abused substance prior to admission was reported, but in one case the substance (ketobemidone) was not investigated. In 40 of the remaining cases (87%) breath analysis gave a positive finding of any of the substances that were part of the analytical investigation. Identifications were based on correct chromatographic retention time and product ion ratios obtained in selected reaction monitoring mode. In general, data from breath, plasma, urine and self-reporting were in good agreement, but in 23% of the cases substances were detected that had not been self-reported. All substances covered were detected in a number of breath samples. Considering that breath sampling was often done about 24 h after intake, the detection rate was considered to be high for most substances. Analytes with low detection rates were benzodiazepines, and a further increase in analytical sensitivity is needed to overcome this. This study further supports use of exhaled breath as a new matrix in clinical toxicology.

Potential of Mass Spectrometry in Developing Clinical Laboratory Biomarkers of Nonvolatiles in Exhaled Breath

“…Drugs of abuse are also transported from the body in the PEx fraction (12,13 ). The work with drug testing has resulted in the development of a simple and disposable sampling device based on the use of a microparticle filter (13 ).…”

“…They have a large capacity and are used for cleaning of indoor air (20 ) and also as exhaust filters in respirator systems. A commercial sampling device based on this technology was used in a clinical study of illicit drug users recovering from acute intoxication (13 ). The results demonstrated that all 12 studied drug substances (Table 1) were detected in the collected exhaled breath sample at the time they were clinically recovered, which was estimated to be 12-24 h after drug intake.…”

Phosphatidylethanols in Breath: A Possible Noninvasive Screening Test for Heavy Alcohol Consumption

“…When mass spectrometric assays give unexpectedly low results, one should contemplate the possibility of the presence of variants and scan for them. One reason for doing this is that a "missed" pathogenic variant would give the clinically correct result for the wrong reason, which might result in a failed opportunity for definitive genetic family testing (4,5 ). The other reason is that several of the variants are either nonpathogenic or of uncertain significance, leading to a potentially falsely low IGF-1 result being reported.…”

“…Breath testing has also been successfully explored as an alternative method for drugs of abuse, since low molecular weight substances circulating in the body are to some extent exhaled in breath as part of aerosol particles (3 ). A variety of abused substances, including amphetamines, benzodiazepines, cannabis, cocaine, and opiates, are detectable in breath samples (4,5 ).…”

“…The specimen consists of aerosol microparticles originating mainly from the airway lining fluid (surfactant) (3 ), and each sample corresponds to approximately 30 L exhaled air. Samples were prepared for LC-MS/MS analysis, as detailed elsewhere (4 ). Briefly, the device was uncapped and 2 mL methanol carefully applied directly onto the filter, avoiding contact with the wall.…”