Moore Christine, Kelley-Baker Tara, Lacey John
Immunalysis Corporation, Pomona, CA, USA.
J Opioid Manag. 2012 May-Jun;8(3):161-6. doi: 10.5055/jom.2012.0112.
The purpose of this retrospective study was to compare oxycodone concentrations in saliva and whole blood with a view to propose therapeutic concentrations in oral fluid. Oral fluid is an easy specimen to collect with several advantages over urine, including ease of collection and difficulty of adulteration. As oral fluid is a reflection of free drug circulating in the blood, drug concentrations in saliva are more closely related to blood levels than urine concentrations. The number of testing laboratories offering the analysis of prescription pain medications in urine has increased significantly over the last few years, along with the overuse and abuse of pain killing drugs, specifically oxycodone. Hence, the utility of oral fluid analysis in this field was assessed.
Paired specimens of blood and oral fluid were retrospectively studied in an attempt to establish a range for oxycodone concentrations in oral fluid reflective of therapeutic intake. Twenty-three paired oral fluid-blood specimens were studied. Oral fluid samples had been collected with the Quantisal™ oral fluid device, stored cold and shipped overnight to the laboratory prior to testing. Blood specimens were collected simultaneously in gray top tubes.
From 23 pairs of samples, the median concentration in oral fluid was 524 μg/L and blood was 53 μg/L. The whole blood to plasma ratio for oxycodone was 1.3, so the median plasma concentration was 41 μg/L projecting a saliva to plasma ratio (S:P ratio) of 12. The comparison of oral fluid-blood concentrations allowed the projection of a S:P ratio for oxycodone and the development of a potential therapeutic range for oxycodone in oral fluid.
Saliva drug concentrations in pain management are more closely related to blood levels than urine so can be more easily interpreted. These data provide a foundation for interpretative advances; however, further research surrounding other pain medications and controlled studies are necessary.
本回顾性研究旨在比较唾液和全血中羟考酮的浓度，以期提出口腔液中的治疗浓度。口腔液是一种易于采集的样本，与尿液相比有多个优点，包括采集方便和不易掺假。由于口腔液反映了血液中游离药物的情况，唾液中的药物浓度比尿液浓度与血液水平的关系更为密切。在过去几年中，提供尿液中处方止痛药物分析的检测实验室数量显著增加，与此同时，止痛药物，特别是羟考酮的过度使用和滥用现象也日益严重。因此，对口腔液分析在该领域的实用性进行了评估。
对血液和口腔液的配对样本进行回顾性研究，试图确定反映治疗摄入量的口腔液中羟考酮浓度范围。研究了23对口腔液 - 血液样本。口腔液样本使用Quantisal™口腔液采集装置采集，冷藏保存，并在检测前隔夜运送至实验室。血液样本同时采集于灰色顶管中。
在23对样本中，口腔液的中位浓度为524μg/L，血液为53μg/L。羟考酮的全血与血浆比值为1.3，因此中位血浆浓度为41μg/L，唾液与血浆比值（S:P比值）为12。口腔液 - 血液浓度的比较得出了羟考酮的S:P比值，并确定了口腔液中羟考酮的潜在治疗范围。
在疼痛管理中，唾液药物浓度比尿液与血液水平的关系更密切，因此更容易解读。这些数据为解释性进展奠定了基础；然而，围绕其他止痛药物的进一步研究和对照研究是必要的。
