McLachlan-Troup Neil, Taylor Graham W., Trathen Bruce C.
The Toxicology Unit, Imperial College School of Medicine, Charing Cross Campus, London, UK.
Addict Biol. 2001 Jul;6(3):223-231. doi: 10.1080/13556210120056553.
The supply of substitute opioid medication as a treatment for heroin dependence is now common practice. There is growing international interest in the prescription of injectable diamorphine for subgroups of patients who are unable to stop injecting opiate drugs; in the United Kingdom it is estimated that there are currently 300 patients prescribed diamorphine for this purpose. The detection of illicit heroin misuse (through urinary diamorphine metabolites) is confounded in subjects prescribed diamorphine. We investigated the potential to distinguish between the use of street heroin and pharmaceutical diamorphine through the detection in urine of various opiate alkaloids originating in the opium poppy, Papaver somniferum. Over a 7-week period, 532 clients of an urban substance misuse service provided a total of 1122 urine samples for clinical purposes. Using a novel mixed-mode solid-phase extraction and gas chromatography/mass spectrometry technique, we screened samples for morphine, 6-monoacetylmorphine, codeine, meconine, papaverine, noscapine, thebaine and their metabolites. All urine samples from diamorphine-treated patients were positive for morphine. Of samples from patients receiving other treatments, 30% (95%CI: 27-33%) were positive for morphine, indicating probable street heroin misuse. Of morphine-positive samples, 61% (95%CI: 55-67%), from the "other treatments" group were positive for at least one of codeine, meconine and putative noscapine or papaverine metabolites. This was reduced to 56% (95%CI: 50-62%) when excluding codeine. Only one sample (0.1%) was positive for any one of these putative markers in the absence of morphine, when excluding codeine. These findings show that the detection of urinary noscapine and papaverine metabolites is useful in distinguishing between use of pharmaceutical diamorphine and street heroin. This may be of benefit to promote safer and more effective prescribing of diamorphine in opiate dependency, and as an outcome measure in trials of diamorphine prescribing.
提供替代阿片类药物作为海洛因依赖的治疗方法现已成为常见做法。对于无法停止注射阿片类药物的部分患者，开具注射用二醋吗啡的处方在国际上越来越受到关注；据估计，在英国目前有300名患者为此目的而被开具二醋吗啡。在开具二醋吗啡的患者中，非法滥用海洛因（通过尿液中的二醋吗啡代谢物检测）的情况变得复杂。我们研究了通过检测尿液中源自罂粟（Papaver somniferum）的各种阿片生物碱来区分街头海洛因和药用二醋吗啡使用情况的可能性。在7周的时间里，一家城市药物滥用服务机构的532名客户为临床目的共提供了1122份尿液样本。我们使用一种新型的混合模式固相萃取和气相色谱/质谱技术，对样本进行吗啡、6-单乙酰吗啡、可待因、甲氧基啡啶、罂粟碱、那可丁、蒂巴因及其代谢物的筛查。所有接受二醋吗啡治疗患者的尿液样本吗啡检测均呈阳性。在接受其他治疗的患者样本中，30%（95%置信区间：27 - 33%）吗啡检测呈阳性，表明可能存在街头海洛因滥用情况。在“其他治疗”组的吗啡阳性样本中，61%（95%置信区间：55 - 67%）至少对可待因、甲氧基啡啶以及假定的那可丁或罂粟碱代谢物中的一种检测呈阳性。排除可待因后，这一比例降至56%（95%置信区间：50 - 62%）。在排除可待因且不存在吗啡的情况下，只有一个样本（0.1%）对这些假定标志物中的任何一种检测呈阳性。这些发现表明，尿液中那可丁和罂粟碱代谢物的检测有助于区分药用二醋吗啡和街头海洛因的使用情况。这可能有利于在阿片类药物依赖中促进更安全、更有效的二醋吗啡处方开具，并作为二醋吗啡处方试验的一项结果指标。
