Patterns of drug abuse among drug users with regular and irregular attendance for treatment as detected by comprehensive UHPLC‐HR‐TOF‐MS

Abstract

The most severe consequences of drug abuse include infectious diseases, overdoses, and drug-related deaths. As the range of toxicologically relevant compounds is continually changing due to the emergence of new psychoactive substances (NPS), laboratories are encountering analytical challenges. Current immunoassays are insufficient for determining the whole range of the drugs abused, and a broad-spectrum screening method is therefore needed. Here, the patterns of drug abuse in two groups of drug users were studied from urine samples using a comprehensive screening method based on high-resolution time-of-flight mass spectrometry. The two groups comprised drug abusers undergoing opioid maintenance treatment (OMT) or drug withdrawal therapy and routinely visiting a rehabilitation clinic, and drug abusers with irregular attendance at a harm reduction unit (HRU) and suspected of potential NPS abuse. Polydrug abuse was observed in both groups, but was more pronounced among the HRU subjects with a mean number of concurrent drugs per sample of 3.9, whereas among the regularly treated subjects the corresponding number was 2.1. NPS and pregabalin were more frequent among HRU subjects, and their abuse was always related to drug co-use. The most common drug combination for an HRU subject included amphetamine, cannabis, buprenorphine, benzodiazepine, and alpha-pyrrolidinovalerophenone. A typical set of drugs for treated subjects was buprenorphine, benzodiazepine, and occasionally amphetamine. Abuse of several concurrent drugs poses a higher risk of drug intoxication and a threat of premature termination of OMT. Since the subjects attending treatment used fewer concurrent drugs, this treatment could be valuable in reducing polydrug abuse.

Pregabalin Abuse in Combination With Other Drugs: Monitoring Among Methadone Patients

“…Non-prescribed PGB was found in 14% of the MTT patients. The data on PGB obtained here aligned with those of other studies conducted on patients with past or present histories of misuse or abuse of other substances (30,32,38,(43)(44)(45)(46). A survey of MTT and buprenorphine patients in Georgia (47) revealed PGB misuse in 8.2% of the 506 participants.…”

“…A Finnish study analyzed 200 urine samples from 82 methadone and buprenorphine/naloxone patients and reported PGB in 4% of the cases (48). Another Finnish study (44) tested 101 urine samples from 68 anonymous substance abuse patients detected PGB in 9% of the subjects from an opiate withdrawal facility and in 31% of the patients in a harm reduction facility. In Germany, 12.1% of 124 patients undergoing methadone or buprenorphine therapy were PGB-positive (15).…”

GC‐MS/MS detects potential pregabalin abuse in susceptible subjects’ hair

“…Without prescription, these subjects were probably using PGB of their own volition, after acquiring it on the illicit marketplace, which is easily accessed on‐line . Present data on PGB misuse were in good accordance with other studies that were conducted in patients with a previous or present history of misuse or abuse of other substances, but they do not concur with a recent report that PGB was not found in hair samples from 109 patients in opioid substitution therapy …”

Current applications of high-resolution mass spectrometry for the analysis of new psychoactive substances: a critical review

“…Enzymatic hydrolysis with β-glucuronidase has been performed in a limited number of cases prior to SPE. [42,43].…”

“…LC has been the most commonly adopted conventional separation technique coupled to HRMS for the analysis of NPS due to the well-recognized fact that analytes of interest do not need to be volatile and do not require derivatization [15,28,30,33,39,42,43,[46][47][48].…”