Department of Pathology, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
Department of Pathology, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States.
Clin Chim Acta. 2018 Jun;481:75-82. doi: 10.1016/j.cca.2018.02.034. Epub 2018 Feb 27.
Oral fluid (OF) has become an increasingly popular matrix to assess compliance in pain management and addiction settings as it reduces the likelihood of adulteration. However, drug concentrations and windows of detection are not as well studied in OF as in urine (UR). We compared the clinical utility and analytical performance of OF and UR as matrices for detecting common benzodiazepines and opioids.
OF and UR concentrations of 5 benzodiazepines and 7 opioids were measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS) in 263 paired OF and UR specimens. UR creatinine was measured and prescription medications were reviewed.
The benzodiazepines 7-aminoclonazepam, lorazepam, and oxazepam exhibited statistically higher detection rates in UR. For opioids, 6-AM was statistically more likely to be detected in OF, while hydromorphone and oxymorphone were statistically more likely to be detected in UR. Chemical properties including glucuronidation explain preferential detection in each matrix, not UR creatinine nor prescription status.
We found that OF is the preferred matrix for 6-AM, while UR is preferred for 7-aminoclonazepam, lorazepam, oxazepam, hydromorphone, and oxymorphone. However, OF should be considered if the risk of adulteration is high and use and/or misuse of benzodiazepines, hydromorphone, and oxymorphone is low.
口服液（OF）已成为评估疼痛管理和成瘾环境中依从性的越来越受欢迎的基质，因为它降低了掺假的可能性。然而，与尿液（UR）相比，OF 中药物浓度和检测窗口尚未得到很好的研究。我们比较了 OF 和 UR 作为基质检测常见苯二氮䓬类药物和阿片类药物的临床实用性和分析性能。
通过液相色谱-串联质谱法（LC-MS/MS）测量 263 对 OF 和 UR 标本中的 5 种苯二氮䓬类药物和 7 种阿片类药物的浓度。UR 肌酐进行了测量，并审查了处方药物。
苯二氮䓬类药物 7-氨基氯硝西泮、劳拉西泮和奥沙西泮在 UR 中具有统计学上更高的检测率。对于阿片类药物，6-AM 更有可能在 OF 中被检测到，而氢吗啡酮和羟吗啡酮更有可能在 UR 中被检测到。包括葡萄糖醛酸化在内的化学性质解释了在每种基质中优先检测的原因，而不是 UR 肌酐或处方状态。
我们发现 OF 是 6-AM 的首选基质，而 UR 则是 7-氨基氯硝西泮、劳拉西泮、奥沙西泮、氢吗啡酮和羟吗啡酮的首选基质。然而，如果掺假的风险很高，且苯二氮䓬类药物、氢吗啡酮和羟吗啡酮的使用和/或滥用率较低，则应考虑使用 OF。
