Hair Analysis Versus Conventional Methods of Drug Testing in Substance Abusers Seeking Organ Transplantation

Haller, Deborah L.; Acosta, Mark; Lewis, Douglas; Miles, Donna R.; Schiano, Thomas D.; Shapiro, Peter A.; Gomez, Jorge; Sabag-Cohen, S.; Newville, Howard

doi:10.1111/j.1600-6143.2010.03090.x

Cited by 36 publications

(28 citation statements)

References 30 publications

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“…Other matrices such as oral fluid and hair are now rapidly gaining recognition and their use in forensic sciences is growing. Several papers recently addressed the question of whether urine or hair is more effective in disclosing drug of abuse consumption in pre‐employment testing, in driver's license re‐granting, in patients participating in methadone‐substitution programme, and prior to organ transplantation . Generally these studies revealed that hair analysis identified illegal drugs more often than urine testing.…”

Section: Introductionmentioning

confidence: 99%

Comparison of urine and hair testing for drugs of abuse in the control of abstinence in driver's license re‐granting

Dufaux

Agius

Nadulski

et al. 2012

Drug Testing and Analysis

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The purpose of the study was to compare the detection rate of illicit drugs in urine and hair specimens. The samples were taken from subjects trying to regain their revoked driver's license after a drug- or alcohol-related traffic offence. In 2010, we screened 14 000 urine and 3900 hair samples for amphetamines, methamphetamines, cannabinoids, cocaine, opiates, methadone, and benzodiazepines as well as for ethylglucuronide. We used the low threshold values of the new German guidelines for Medical Psychological Assessment (MPA). Positive screening tests were confirmed with gas chromatography-mass spectrometry (GC-MS), gas chromatography-tandem mass spectrometry (GC-MS/MS) or liquid chromatography-tandem mass spectrometry (LC-MS/MS). The results show that positivity rates for methamphetamines, MDMA, cocaine, and monoacetylmorphine were 1.7-, 5.7-, 3.8- and 9.3-fold higher in hair than in urine. In contrast, the detection rate for benzodiazepines was higher in urine than in hair (oxazepam, 0.21% versus 0%, nordiazepam 0.10% versus 0.03%). The positivity rate in hair for ethylglucuronide was 6-fold (12.7%) that for urine testing (2.1%). The study reveals that in the control of abstinence in the context of driving license re-granting there are in part large differences of positivity rates for some drugs or metabolites between hair and urine samples. These differences should be kept in mind by physicians and psychologists in traffic medicine who are ordering the drug testing.

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Section: Introductionmentioning

confidence: 99%

Comparison of urine and hair testing for drugs of abuse in the control of abstinence in driver's license re‐granting

Dufaux

Agius

Nadulski

et al. 2012

Drug Testing and Analysis

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“…While an attractive alternative, application of sweat testing in clinical treatment settings suggest that patch collection of sweat is poorly accepted and less sensitive than frequent urine testing for opioid detection [93,94]. The reduced sensitivity may in part be due to differences in drug distribution to sweat, which seems to be good for some opioids such as heroin and codeine but poorer for morphine [92,95]. Hair analysis has the potential advantage of permitting detection of drug use over much longer periods that are on the order of weeks to months translating into greater detection of aberrant drug use compared with urine testing [96,97].…”

Section: Sample Adulteration and Alternative Matrix Testingmentioning

confidence: 99%

Laboratory Testing for Prescription Opioids

Milone

2012

J. Med. Toxicol.

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Opioid analgesic misuse has risen significantly over the past two decades, and these drugs now represent the most commonly abused class of prescription medications. They are a major cause of poisoning deaths in the USA exceeding heroin and cocaine. Laboratory testing plays a role in the detection of opioid misuse and the evaluation of patients with opioid intoxication. Laboratories use both immunoassay and chromatographic methods (e.g., liquid chromatography with mass spectrometry detection), often in combination, to yield high detection sensitivity and drug specificity. Testing methods for opioids originated in the workplace-testing arena and focused on detection of illicit heroin use. Analysis for a wide range of opioids is now required in the context of the prescription opioid epidemic. Testing methods have also been primarily based upon urine screening; however, methods for analyzing alternative samples such as saliva, sweat, and hair are available. Application of testing to monitor prescription opioid drug therapy is an increasingly important use of drug testing, and this area of testing introduces new interpretative challenges. In particular, drug metabolism may transform one clinically available opioid into another. The sensitivity of testing methods also varies considerably across the spectrum of opioid drugs. An understanding of opioid metabolism and method sensitivity towards different opioid drugs is therefore essential to effective use of these tests. Improved testing algorithms and more research into the effective use of drug testing in the clinical setting, particularly in pain medicine and substance abuse, are needed.

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“…Toxicological urinalysis is cost‐effective, sensitive, and specific and improves the detection rates of substance use, but the window of opportunity for detecting substance use is limited. The detected prevalence rate is probably an underestimation of the true rate of substance use if this is measurable over a longer period of time (eg, hair analysis31, 32). Because the admission for these patients is planned, it is also possible that patients may cease using alcohol and illicit drugs before admission to avoid detection; therefore, the results may be biased.…”

Section: Discussionmentioning

confidence: 99%

Substance use by liver transplant candidates: An anonymous urinalysis study

Webzell¹,

Ball²,

Bell³

et al. 2011

Liver Transpl

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Toxicological urinalysis is a highly sensitive and specific test that detects recent substance use. It has been established for substance misuse treatment but has not been routinely used at liver transplantation (LT) centers. Patients with a history of substance misuse are required to be abstinent from alcohol and illicit drugs before they are listed for LT. In this cross-sectional study, we sought to determine the prevalence of recent substance use in LT candidates via toxicological urinalysis. One hundred nine adults who were admitted for an LT assessment provided data, and they were categorized by the etiology of their liver disease [alcohol-related liver disease (ALD), hepatitis C virus (HCV), or other liver diseases]. Urine was toxicologically screened for drugs and their metabolites as well as the urinary alcohol metabolites ethyl glucuronide and ethyl sulfate. The prevalence of alcohol metabolites in patients with ALD was 20%. Licit and illicit substances together provided a positive toxicological result in 30% of the patients. Positive results were more common among patients with HCV (40%) and ALD (38%) versus patients with other liver diseases (18%). During the clinical assessment, 4% of the patients with ALD or HCV self-reported current alcohol or illicit drug use. These results correspond to the findings of other studies and emphasize the uncertainty of self-reported substance use data for LT candidates. Liver transplantation (LT) for end-stage liver disease is a well-established lifesaving treatment option that provides recipients with improved quality of life and longevity.1,2 The success of LT has traditionally been related to survival. Survival rates have continuously improved; across the United States, the United Kingdom, and Ireland, the 1-, 5-, 10-, and 20-year patient survival rates are 90%, 70%, 65%, and 50%, respectively.2-4 Furthermore, longitudinal data have shown remarkable improvements in quality-of-life domains after LT. The consideration of candidates for LT whose liver disease etiology is related to substance misuse remains controversial. Surveys of public and professional attitudes toward organ allocation to patients with different causes of liver disease have demonstrated that abstinent patients with a history of alcohol dependence or injecting drug use are considered a low priority in comparison with other patient groups. 5,6 There is also evidence suggesting that patients with chronic alcohol-related liver disease (ALD) are not being referred for an LT assessment even though they are considered good candidates within the transplant community. 5,7 In practice, patients with a history of substance misuse who are assessed for LT must currently be abstaining from alcohol and illicit drugs (except for occasional cannabis use, which is not contraindicated in the UK guidelines 8,9 ); after the LT assessment, alcohol or illicit drug use is a contraindication for transplantation.Abbreviations: ALD, alcohol-related liver disease; HCV, hepatitis C virus; LT, liver transplantation. James Bell...

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Hair Analysis Versus Conventional Methods of Drug Testing in Substance Abusers Seeking Organ Transplantation

Cited by 36 publications

References 30 publications

Comparison of urine and hair testing for drugs of abuse in the control of abstinence in driver's license re‐granting

Comparison of urine and hair testing for drugs of abuse in the control of abstinence in driver's license re‐granting

Laboratory Testing for Prescription Opioids

Substance use by liver transplant candidates: An anonymous urinalysis study

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