St Luke's-Roosevelt Hospital Center, New York, NY, USA.
Am J Transplant. 2010 May;10(5):1305-11. doi: 10.1111/j.1600-6143.2010.03090.x. Epub 2010 Mar 26.
As substance abusers need to demonstrate abstinence prior to transplant, valid/reliable drug tests are needed. Patients may deny use, fearing surgery will be delayed. Breath, blood and urine tests have brief detection windows that allow patients to evade detection. Routine laboratory tests do not include all substances of abuse. Hair analysis overcomes these barriers, increasing the likelihood that active users will be identified. This study compared results for alcohol, opioids and cocaine based on 445 self-report, breath, urine and hair samples from 42 patients who had been denied a transplant due to recent substance abuse. Compared to hair toxicology, sensitivity for conventional drug tests was moderate for cocaine and opioids, but poor for alcohol. Of positive hair tests, only half were corroborated through other tests. In contrast, specificity was high across tests and substances, with positive findings from conventional tests confirmed through hair toxicology. Based on a 90-day detection window for hair analysis, two negative tests suggest 6 months of continuous abstinence. Hair testing should be considered as an alternative approach for monitoring substance use in the transplant population, either as a routine procedure or when the veracity of findings from conventional tests is in doubt.
由于药物滥用者在移植前需要证明戒断，因此需要有效的/可靠的药物检测。患者可能会因为担心手术会被推迟而否认使用药物。呼吸、血液和尿液检测的检测窗口很短，使患者能够逃避检测。常规实验室检测不包括所有滥用的物质。毛发分析克服了这些障碍，增加了发现活跃使用者的可能性。本研究比较了基于 445 名自我报告、呼吸、尿液和头发样本的 42 名因近期药物滥用而被拒绝移植的患者的酒精、阿片类药物和可卡因的结果。与毛发毒理学相比，常规药物检测对可卡因和阿片类药物的敏感性为中度，但对酒精的敏感性较差。在阳性毛发检测中，只有一半通过其他检测得到证实。相比之下，所有检测和物质的特异性都很高，常规检测的阳性结果通过毛发毒理学得到证实。基于毛发分析 90 天的检测窗口，两次阴性检测提示连续 6 个月的戒断。毛发检测应被视为监测移植人群中药物使用的替代方法，无论是作为常规程序，还是在常规检测结果的真实性受到怀疑时。
