2017
DOI: 10.1515/cclm-2016-0831
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Immunoassay screening in urine for synthetic cannabinoids – an evaluation of the diagnostic efficiency

Abstract: Background:The abuse of synthetic cannabinoids (SCs) as presumed legal alternative to cannabis poses a great risk to public health. For economic reasons many laboratories use immunoassays (IAs) to screen for these substances in urine. However, the structural diversity and high potency of these designer drugs places high demands on IAs regarding cross-reactivity of the antibodies used and detection limits.Methods:Two retrospective studies were carried out in order to evaluate the capability of two homogenous en… Show more

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Cited by 50 publications
(45 citation statements)
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“…In our case, the presumptive diagnosis of synthetic cannabinoid-induced myocardial infarction and ischaemic stroke was made based on a clinical history. Despite the negative urine toxicology, the suspicion of synthetic cannabinoids use remained the most probable diagnosis since traditional toxicology immunoassays aimed at detecting tetrahydrocannabinol (THC), the active ingredient in marijuana, are often not able to detect synthetic variants of illicit drugs 5. An interesting finding in this case was the high level of factor VIII protein activity which is associated with venous thromboembolism but arterial clot formation is rare.…”
Section: Discussionmentioning
confidence: 89%
“…In our case, the presumptive diagnosis of synthetic cannabinoid-induced myocardial infarction and ischaemic stroke was made based on a clinical history. Despite the negative urine toxicology, the suspicion of synthetic cannabinoids use remained the most probable diagnosis since traditional toxicology immunoassays aimed at detecting tetrahydrocannabinol (THC), the active ingredient in marijuana, are often not able to detect synthetic variants of illicit drugs 5. An interesting finding in this case was the high level of factor VIII protein activity which is associated with venous thromboembolism but arterial clot formation is rare.…”
Section: Discussionmentioning
confidence: 89%
“…In contrast, some novel benzodiazepines may produce a positive benzodiazepine class screening test result. To be able to detect or exclude NPS using an immunoassay, further antibodies specifically binding to the new structures would have to be developed, which is time consuming and results in delays (thus not keeping up with the dynamic NPS market) and higher costs . Although some actions have been undertaken in this direction during recent years with some immunoassays being developed for the detection of commonly used NPS such as some of the SCRAs, NPS immunoassays are currently clearly not part of the clinical routine.…”
Section: Analyticsmentioning
confidence: 99%
“…Kronstrand et al concluded in their evaluation of the Immunalysis Spice K2 homogenous enzyme immunoassay (HEIA; Pomona, CA, USA) that an LC–MS/MS screening approach is a superior strategy to immunoassays, because of the rapid change of synthetic cannabinoid structures. Similarly, Franz et al evaluated the diagnostic efficiency of immunoassays for screening urine for SCRAs and their results showed an insufficient cross‐reactivity for the SCRAs available on the market at the time of the study and their metabolites. Furthermore, the investigated immunoassays had a high cut‐off, which also contributed to a high proportion of false‐negative results.…”
Section: Analyticsmentioning
confidence: 99%
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“…Additionally, designer benzodiazepines such as flubromazolam have been detected in fake alprazolam tablets and according to the EMCDDA these counterfeit medicines have become an important part of the illicit drug market in some European countries. 6,7 In contrast to cannabinoid receptor agonists ('synthetic cannabinoids') 8 , immunochemical screening seems to be a feasible approach for initial drug screening, as studies have shown mostly good cross-reactivity for the compounds offered to date. 4,5 Appearance of highly potent triazolo-compounds such as flubromazolam as pure powder may lead to the abuse of such compounds in a drug-facilitated crime context and can easily lead to severe intoxications due to dosing errors.…”
Section: Introductionmentioning
confidence: 99%