Methamphetamine and Amphetamine Isomer Concentrations in Human Urine Following Controlled Vicks VapoInhaler Administration

Abstract

Legitimate use of legal intranasal decongestants containing l-methamphetamine may complicate interpretation of urine drug tests positive for amphetamines. Our study hypotheses were that commonly used immunoassays would produce no false-positive results and a recently developed enantiomer-specific gas chromatography-mass spectrometry (GC-MS) procedure would find no d-amphetamine or d-methamphetamine in urine following controlled Vicks VapoInhaler administration at manufacturer's recommended doses. To evaluate these hypotheses, 22 healthy adults were each administered one dose (two inhalations in each nostril) of a Vicks VapoInhaler every 2 h for 10 h on Day 1 (six doses), followed by a single dose on Day 2. Every urine specimen was collected as an individual void for 32 h after the first dose and assayed for d- and l-amphetamines specific isomers with a GC-MS method with >99% purity of R-(-)-α-methoxy-α-(trifluoromethyl)phenylacetyl derivatives and 10 µg/L lower limits of quantification. No d-methamphetamine or d-amphetamine was detected in any urine specimen by GC-MS. The median l-methamphetamine maximum concentration was 62.8 µg/L (range: 11.0-1,440). Only two subjects had detectable l-amphetamine, with maximum concentrations coinciding with l-methamphetamine peak levels, and always ≤ 4% of the parent's maximum. Three commercial immunoassays for amphetamines EMIT(®) II Plus, KIMS(®) II and DRI(®) had sensitivities, specificities and efficiencies of 100, 97.8, 97.8; 100, 99.6, 99.6 and 100, 100, 100%, respectively. The immunoassays had high efficiencies, but our first hypothesis was not affirmed. The EMIT(®) II Plus assay produced 2.2% false-positive results, requiring an enantiomer-specific confirmation.

Molecular, Behavioral, and Physiological Consequences of Methamphetamine Neurotoxicity: Implications for Treatment

“…l-METH, a vasoconstrictor, is the active constituent of the Vicks Inhaler decongestant (Proctor & Gamble, Cincinnati, OH), an over-the-counter product containing about 50 mg of the drug (Smith et al, 2014). Desoxyn, which is d-METH, is rarely medically prescribed due to its strong reinforcing properties.…”

Oral fluid with three modes of collection and plasma methamphetamine and amphetamine enantiomer concentrations after controlled intranasal l‐methamphetamine administration

“…Previously, we published urine amphetamines concentrations following controlled Vicks® VapoInhaler ™ administration from these participants. [13] True positive results were those with a positive immunoassay result (d-methamphetamine target) and ≥250 μg/L d-methamphetamine by gas chromatography-mass spectrometry (GC-MS) confirmation; all urine specimens were analyzed via GC-MS regardless of immunoassay result. Urine specimens were screened with 3 different immunoassays and sensitivities, specificities, and efficiencies were 100%, 97.8-100%, and 97.8-100%, respectively.…”

Current and Emerging Treatments for Methamphetamine Use Disorder

“…Therapeutic doses of Desoxyn are 20-25 mg daily, taken every 12 hours, with dose not exceeding 60 mg/day (reference.medscape.com/drugs). l-METH, a vasoconstrictor, is the active constituent of the Vicks Inhaler decongestant, an over-the-counter product containing about 50 mg of the drug [ 7 ].…”