Kunkel Frank, Fey Elizabeth, Borg Damon, Stripp Richard, Getto Christine
Accessible Recovery Services, Pittsburgh, Pennsylvania.
Sterling Healthcare, Huntington, New York.
J Opioid Manag. 2015 Sep-Oct;11(5):435-42. doi: 10.5055/jom.2015.0293.
Drug testing is an important clinical tool that is available to physicians who are assessing the effectiveness of drug treatment as well as patient compliance to the administered program. While urine has traditionally been the matrix of choice for drug monitoring, oral fluid, a filtrate of the blood, has shown great promise as an alternative matrix for such applications. Oral fluid collection can be accomplished without the need for highly trained medical staff through the use of a simple, noninvasive oral fluid collection device, which obtains an adequate sample in only a few minutes. There has been a significant amount of research performed on the use of oral fluid for forensic toxicology application; however, more studies assessing the use of oral fluid drug testing are required to validate its ability to achieve clinical drug monitoring goals. Testing for various drugs in oral fluid may yield a different result when compared to the same drugs in urine, requiring an assessment of the utility of oral fluid for such practices. The purpose of this study was to examine the application of oral fluid drug testing in patients undergoing buprenorphine treatment for opioid dependence. A retrospective analysis of drug testing results obtained from 6,928 patients (4,560 unobserved urine collections and 2,368 observed oral fluid collections) monitored for heroin metabolite, amphetamine, benzodiazepines, buprenorphine, tetrahydrocannabinol, cocaine, codeine, hydrocodone, hydromorphone, methadone, morphine, oxycodone, and oxymorphone was completed. Results of this statistical exercise indicated that patients undergoing observed oral fluid collection tested positive more frequently than those unobserved urine collections for several illicit drugs and prescription medications targeted. Oral fluid was shown to detect illicit drug use as well as noncompliance in this patient population under the studied conditions more often than the urine specimens.
药物检测是一种重要的临床工具，可供评估药物治疗效果以及患者对给药方案依从性的医生使用。虽然尿液传统上一直是药物监测的首选基质，但口腔液（血液的一种滤出液）作为此类应用的替代基质已显示出巨大潜力。通过使用简单、无创的口腔液采集装置，无需训练有素的医务人员即可完成口腔液采集，该装置只需几分钟就能获取足够的样本。针对口腔液在法医毒理学应用方面已经开展了大量研究；然而，需要更多评估口腔液药物检测用途的研究来验证其实现临床药物监测目标的能力。与尿液中相同药物相比，检测口腔液中的各种药物可能会得出不同结果，这就需要评估口腔液在此类检测中的效用。本研究的目的是考察口腔液药物检测在接受丁丙诺啡治疗阿片类物质依赖患者中的应用。对6928例患者（4560例未观察的尿液采集和2368例观察的口腔液采集）的药物检测结果进行了回顾性分析，这些患者接受了针对海洛因代谢物、苯丙胺、苯二氮䓬类、丁丙诺啡、四氢大麻酚、可卡因、可待因、氢可酮、氢吗啡酮、美沙酮、吗啡、羟考酮和羟吗啡酮的监测。这项统计分析的结果表明，在接受观察的口腔液采集的患者中，针对几种非法药物和目标处方药检测呈阳性的频率高于未观察的尿液采集患者。在所研究的条件下，与尿液样本相比，口腔液在该患者群体中更常检测到非法药物使用以及不依从情况。
