疼痛管理患者尿液中 heroin 标志物的流行情况。

Prevalence of heroin markers in urine for pain management patients.

作者信息

Knight Julie, Puet Brandi L, DePriest Anne, Heltsley Rebecca, Hild Cheryl, Black David L, Robert Timothy, Caplan Yale H, Cone Edward J

机构信息

Aegis Sciences Corporation, 515 Great Circle Road, Nashville, TN 37228, USA.

出版信息

Forensic Sci Int. 2014 Oct;243:79-83. doi: 10.1016/j.forsciint.2014.04.037. Epub 2014 May 9.

DOI:10.1016/j.forsciint.2014.04.037

PMID:24858136

Abstract

Surveys of current trends indicate heroin abuse is associated with nonmedical use of pain relievers. Consequently, there is an interest in evaluating the presence of heroin-specific markers in chronic pain patients who are prescribed controlled substances. A total of 926,084 urine specimens from chronic pain patients were tested for heroin/diacetylmorphine (DAM), 6-acetylmorphine (6AM), 6-acetylcodeine (6AC), codeine (COD), and morphine (MOR). Heroin and markers were analyzed using liquid chromatography tandem mass spectrometry (LC-MS-MS). Opiates were analyzed following hydrolysis using LC-MS-MS. The prevalence of heroin use was 0.31%, as 2871 were positive for one or more heroin-specific markers including DAM, 6AM, or 6AC (a known contaminant of illicit heroin). Of these, 1884 were additionally tested for the following markers of illicit drug use: 3,4-methylenedioxymethamphetamine (MDMA), 3,4-methylenedioxyamphetamine (MDA), methamphetamine (MAMP), 11-nor-9-carboxy-Δ(9)-tetracannabinol (THCCOOH), and benzoylecgonine (BZE); 654 (34.7%) had positive findings for one or more of these analytes. The overall prevalence of heroin markers were as follows: DAM 1203 (41.9%), 6AM 2570 (89.5%), 6AC 1082 (37.7%). MOR was present in 2194 (76.4%) and absent (<LOQ) in 677 (23.6%) of the heroin-positive specimens. COD was present in 1218 (42.4%) specimens. Prevalence of combinations for specimens containing MOR were as follows: DAM only 13 (0.59%), 6AM only 1140 (52.0%), 6AC only 24 (1.1%), DAM/6AM/6AC 710 (32.4%), 6AM/6AC 188 (8.6%), DAM/6AM 113 (5.2%), DAM/6AC 6 (0.27%). Importantly, the prevalence of combinations for specimens without MOR were as follows: DAM only 161 (23.8%), 6AM only 217 (32.1%), 6AC only 92 (13.6%), DAM/6AM/6AC 50 (7.4%), 6AM/6AC 7 (1.0%), DAM/6AM 145 (21.4%), DAM/6AC 5 (0.74%). Unexpected patterns of excretion were observed, such as the presence of DAM and 6AC in the absence of 6AM and MOR; therefore, multiple heroin markers may be useful to assess for heroin use.

摘要

当前趋势调查表明，海洛因滥用与非医疗用途的止痛剂使用有关。因此，人们有兴趣评估开具管制药物的慢性疼痛患者体内海洛因特异性标志物的存在情况。对来自慢性疼痛患者的总共926,084份尿液标本进行了海洛因/二乙酰吗啡（DAM）、6-乙酰吗啡（6AM）、6-乙酰可待因（6AC）、可待因（COD）和吗啡（MOR）检测。使用液相色谱串联质谱法（LC-MS-MS）分析海洛因和标志物。使用LC-MS-MS在水解后分析阿片类药物。海洛因使用的患病率为0.31%，因为有2871份标本对一种或多种海洛因特异性标志物呈阳性，包括DAM、6AM或6AC（非法海洛因的一种已知污染物）。其中，另外1884份标本检测了以下非法药物使用标志物：3,4-亚甲基二氧甲基苯丙胺（摇头丸）、3,4-亚甲基二氧苯丙胺（MDA）、甲基苯丙胺（MAMP）、11-去甲-9-羧基-Δ(9)-四氢大麻酚（THCCOOH）和苯甲酰爱康宁（BZE）；654份（34.7%）对这些分析物中的一种或多种有阳性结果。海洛因标志物的总体患病率如下：DAM 1203（41.9%），6AM 2570（89.5%），6AC 1082（37.7%）。在海洛因阳性标本中，MOR存在于2194份（76.4%）中，不存在（<最低定量限）于677份（23.6%）中。COD存在于1218份（42.4%）标本中。含有MOR的标本的组合患病率如下：仅DAM 13份（0.59%），仅6AM 1140份（52.0%），仅6AC 24份（1.1%），DAM/6AM/6AC 710份（32.4%），6AM/6AC 188份（8.6%），DAM/6AM