Shu Irene, Jones Joseph, Jones Mary, Lewis Douglas, Negrusz Adam
United States Drug Testing Laboratories, Inc., 1700 South Mount Prospect Road, Des Plaines, IL 60017, USA.
United States Drug Testing Laboratories, Inc., 1700 South Mount Prospect Road, Des Plaines, IL 60017, USA
J Anal Toxicol. 2015 Oct;39(8):624-8. doi: 10.1093/jat/bkv067.
Nails (fingernails and toenails) are made of keratin. As the nail grows, substances incorporate into the keratin fibers where they can be detected 3-6 months after use. Samples are collected by clipping of 2-3 mm of nail from all fingers (100 mg). We present drug testing results from 10,349 nail samples collected from high-risk cases during a 3-year period of time. Samples were analyzed by validated analytical methods. The initial testing was performed mostly using enzyme-linked immunosorbent assay, but by liquid chromatography-tandem mass spectrometry (LC-MS-MS) as well. Presumptive positive samples were subjected to confirmatory testing with sample preparation procedures including washing, pulverizing, digestion and extraction optimized for each drug class. The total of 7,799 samples was analyzed for amphetamines. The concentrations ranged from 40 to 572,865 pg/mg (median, 100-3,687) for all amphetamine analytes. Amphetamine and methamphetamine were present in 14% of the samples, 22 samples were positive for 3,4-methylenedioxymethamphetamine (0.3%), 7 for methylenedioxyamphetamine (0.09%) and 4 for 3,4-methylenedioxy-N-ethylamphetamine (0.05%). Cocaine and related analytes were found in 5% samples (7,787 total), and the concentration range was 20-265,063 pg/mg (median 84-1,768). Opioids overall ranged from 40 to 118,229 pg/mg (median 123-830). The most prevalent opioid was oxycodone (15.1%) and hydrocodone (11.4%) compared with 1.0-3.6% for the others, including morphine, codeine, hydromorphone, methadone, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine and oxymorphone. Carboxy-Δ-9-tetrahydrocannabinol positivity rate was 18.1% (0.04-262 pg/mg, median 6.41). Out of 3,039 samples, 756 were positive (24.9%) for ethyl glucuronide (20-3,754 pg/mg, median 88). Other drugs found in nails included barbiturates, benzodiazepines, ketamine, meperidine, tramadol, zolpidem, propoxyphene, naltrexone and buprenorphine. Nail analyses have become a reliable way of determining the long-term use and abuse of drugs. Extraction techniques are simple and produce accurate and precise results. Sensitive analytical instrumentation, mainly LC-MS-MS, allows for detection of femtogram (10(-15) g) quantities of substances in nails. Samples were from a high-risk population, therefore the extraordinary positivity rate was observed.
指甲（手指甲和脚趾甲）由角蛋白构成。随着指甲生长，物质会融入角蛋白纤维中，使用后3至6个月就能在其中检测到这些物质。样本采集方法是从所有手指上剪下2至3毫米的指甲（100毫克）。我们展示了在3年时间里从高危病例中采集的10349份指甲样本的药物检测结果。样本通过经过验证的分析方法进行分析。最初的检测大多使用酶联免疫吸附测定法，但也采用了液相色谱 - 串联质谱法（LC-MS-MS）。推定阳性的样本要经过确证检测，样本制备程序包括针对每种药物类别进行优化的清洗、粉碎、消化和提取。总共7799份样本接受了苯丙胺类药物分析。所有苯丙胺类分析物的浓度范围为40至572865皮克/毫克（中位数为100至3687）。苯丙胺和甲基苯丙胺存在于14%的样本中，22份样本对3,4 - 亚甲基二氧基甲基苯丙胺呈阳性（0.3%），7份对亚甲基二氧基苯丙胺呈阳性（0.09%），4份对3,4 - 亚甲基二氧基 - N - 乙基苯丙胺呈阳性（0.05%）。在5%的样本（共7787份）中发现了可卡因及相关分析物，浓度范围为20至265063皮克/毫克（中位数为84至1768）。阿片类药物总体浓度范围为40至118229皮克/毫克（中位数为123至830）。最常见的阿片类药物是羟考酮（15.1%）和氢可酮（11.4%），而其他药物，包括吗啡、可待因、氢吗啡酮、美沙酮、2 - 亚乙基 - 1,5 - 二甲基 - 3,3 - 二苯基吡咯烷和羟吗啡酮的阳性率为1.0%至3.6%。羧基 - Δ - 9 - 四氢大麻酚阳性率为18.1%（0.04至262皮克/毫克，中位数为6.41）。在3039份样本中，756份对葡萄糖醛酸乙酯呈阳性（24.9%）（20至3754皮克/毫克，中位数为88）。在指甲中发现的其他药物包括巴比妥类、苯二氮䓬类药物、氯胺酮、哌替啶、曲马多、唑吡坦、丙氧芬、纳曲酮和丁丙诺啡。指甲分析已成为确定药物长期使用和滥用情况的可靠方法。提取技术简单，能产生准确且精确的结果。灵敏的分析仪器，主要是LC-MS-MS，能够检测出指甲中飞克（10⁻¹⁵克）数量级的物质。样本来自高危人群，因此观察到了极高的阳性率。
