Arvidsson Michel, Ullah Shahid, Franck Johan, Dahl Marja-Liisa, Beck Olof
Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Drug Test Anal. 2019 Jan;11(1):27-32. doi: 10.1002/dta.2384. Epub 2018 Apr 29.
In the treatment of substance use disorder, regular laboratory-based testing has the dual purpose of monitoring compliance with the prescribed medication and abstention from medically non-motivated substances (ie, drug abuse screening). The principal specimen for testing is urine, but collection of urine has some disadvantages, for example being more time-consuming and more intrusive compared to other matrices. There is also the risk of adulteration. This project compared exhaled breath and oral fluid as alternative matrices for drug abuse screening in patients with substance use disorder. All 51 subjects included in the study were enrolled at the Drug Addiction Emergency Unit in Stockholm. Exhaled breath, oral fluid, and urine samples were collected together with a self-report. Of all 117 self-reported drug intakes during the previous week, 72% were confirmed in urine, 73% in oral fluid and 39% in exhaled breath. In 31% of the subjects, additional substances other than those self-reported were detected analytically. For substance abuse screening, urine had the highest detection rate for buprenorphine, cannabis, and benzodiazepines, while oral fluid had the highest detection rate for amphetamines and methadone. Exhaled breath showed the highest detection rate of all matrices for cocaine. To identify significant differences in detection rates between the matrices future studies with larger sampling sizes are needed. Both oral fluid and exhaled breath are viable alternative specimens to urine, depending on the circumstances and purpose of the testing.
在物质使用障碍的治疗中，基于实验室的定期检测具有双重目的，即监测对规定药物的依从性以及避免使用非医疗目的物质（即药物滥用筛查）。检测的主要样本是尿液，但尿液采集存在一些缺点，例如与其他样本基质相比，耗时更长且更具侵入性。此外还存在掺假的风险。本项目比较了呼出气和口腔液作为物质使用障碍患者药物滥用筛查的替代样本基质。该研究纳入的所有51名受试者均在斯德哥尔摩的药物成瘾急诊科登记入组。同时采集呼出气、口腔液、尿液样本以及一份自我报告。在前一周自我报告的所有117次药物摄入中，尿液中确认的占72%，口腔液中占73%，呼出气中占39%。在31%的受试者中，分析检测出了自我报告之外的其他物质。对于药物滥用筛查，尿液对丁丙诺啡、大麻和苯二氮䓬类药物的检出率最高，而口腔液对苯丙胺类和美沙酮的检出率最高。呼出气对可卡因的检出率在所有样本基质中最高。为了确定不同样本基质在检出率上的显著差异，需要开展更大样本量的后续研究。根据检测的情况和目的，口腔液和呼出气都是尿液可行的替代样本。
