Aegis Sciences Corporation, 515 Great Circle Road, Nashville, Tennessee, USA.
J Anal Toxicol. 2011 Oct;35(8):529-40. doi: 10.1093/anatox/35.8.529.
Oral fluid compliance monitoring of chronic pain patients is an analytical challenge because of the limited specimen volume and the number of drugs that require detection. This study evaluated oral fluid for monitoring pain patients and compared results to urine studies of similar populations. Oral fluid specimens were analyzed from 6441 pain patients from 231 pain clinics in 20 states. Specimens were screened with 14 ELISA assays and non-negative specimens were confirmed by LC-MS-MS for 40 licit and illicit drugs and metabolites. There was an 83.9% positive screening rate (n=5401) of which 98.7% (n=5329) were confirmed at ≥ LOQ concentrations for at least one analyte. The prevalence of confirmed positive drug groups was as follows: opiates > oxycodone > benzodiazepines > methadone ≈ carisoprodol > fentanyl > cannabinoids ≈ tramadol > cocaine > amphetamines ≈ propoxyphene ≈ buprenorphine > barbiturates > methamphetamine. Approximately 11.5% of the study population of pain patients apparently used one or more illicit drugs (cannabis, cocaine, methamphetamine and/or MDMA). Overall, the pattern of licit and illicit drugs and metabolites observed in oral fluid paralleled results reported earlier for urine, indicating that oral fluid is a viable option for use in compliance monitoring programs of chronic pain patients.
慢性疼痛患者的口服液合规监测是一项分析挑战，因为样本量有限，需要检测的药物数量众多。本研究评估了口服液在监测疼痛患者方面的应用，并将结果与来自 20 个州的 231 个疼痛诊所的相似人群的尿液研究进行了比较。对来自 6441 名疼痛患者的口服液标本进行了分析。使用 14 种 ELISA 检测法对标本进行了筛查，对非阴性标本通过 LC-MS-MS 进行了 40 种合法和非法药物及代谢物的确认。有 83.9%（n=5401）的标本呈阳性筛查结果，其中 98.7%（n=5329）在至少一种分析物的 LOQ 浓度以上得到了确认。确认阳性药物组的流行率如下：阿片类药物 > 羟考酮 > 苯二氮䓬类药物 > 美沙酮 ≈ 卡马西平 > 芬太尼 > 大麻类物质 ≈ 曲马多 > 可卡因 > 苯丙胺类物质 > 丙氧芬 > 丁丙诺啡 > 巴比妥类药物 > 甲基苯丙胺。约 11.5%的疼痛患者研究人群显然使用了一种或多种非法药物（大麻、可卡因、甲基苯丙胺和/或 MDMA）。总体而言，口服液中观察到的合法和非法药物及代谢物的模式与先前报告的尿液结果相似，这表明口服液是慢性疼痛患者合规监测计划的一种可行选择。
