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Elisabeth Leere Øiestad - One of the best experts on this subject based on the ideXlab platform.
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detection time of oxazepam and zopiclone in urine and Oral Fluid after experimental Oral dosing
Journal of Analytical Toxicology, 2019Co-Authors: Lina Dorthea Bruun, Elisabeth Leere Øiestad, Kari Kjeldstadli, Vidar Temte, Morris Birdal, Liliana Bachs, Marit Langodegard, Dag Helge Strand, Kristin Irene GaareAbstract:Data from previous experimental studies on the detection time of oxazepam and zopiclone in biological matrices are limited. The aim of this study was to examine the detection time in urine and Oral Fluid after single Oral doses of oxazepam and zopiclone. Ten healthy volunteers received 25 mg of oxazepam in the evening of Day 1 and 7.5 mg of zopiclone in the evening of Day 3. Urine and Oral Fluid samples were collected twice daily for 9 days, with an additional sampling the day after ingestion of zopiclone. A total of 19 samples of both urine and Oral Fluid from each participant were analyzed using fully validated chromatographic methods. The median detection time for oxazepam was 91 h (range 73-108) in urine and 67 h (range 50-98) in Oral Fluid. The median detection time for zopiclone in urine was 49 h (range 25-98) and 59 h (range 48-146) in Oral Fluid. The metabolite zopiclone N-oxide showed a detection time of 36 h (range 25-84) in urine. The area under the concentration-time curve (AUCTotal) in urine corrected for creatinine was 150 μmol/L/mmol/L*h (range 105-216) for oxazepam and 1.60 μmol/L/mmol/L*h (range 0.79-4.53) for zopiclone. In Oral Fluid, the AUCtotal was 673 nmol/L*h (range 339-1,316) for oxazepam and 2,150 nmol/L*h (range 493-4,240) for zopiclone. In conclusion, oxazepam can be detected longer in urine than in Oral Fluid, while zopiclone can be detected longer in Oral Fluid than in urine. The high AUCTotal for zopiclone in Oral Fluid shows that the transfer into Oral Fluid is significant. In certain individuals the detection time of zopiclone in Oral Fluid is long. These results can be helpful when interpreting drug testing analyzes.
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Extended Detection of Amphetamine and Methamphetamine in Oral Fluid.
Therapeutic drug monitoring, 2016Co-Authors: Hilde T. Andås, Asbjorg S Christophersen, Marilyn A Huestis, Asle Enger, Åse Marit Leere Øiestad, Vigdis Vindenes, Elisabeth Leere ØiestadAbstract:Background Amphetamine and methamphetamine are popular drugs of abuse worldwide and are important components of drug monitoring programs. Windows of detection for amphetamine and methamphetamine in Oral Fluid after high doses have not been investigated. Repeated high-dose ingestions are likely to cause positive samples for extended periods. Common routes of administration of amphetamine/methamphetamine in Norway are Oral intake or injection. The aim of this study was to investigate windows of detection for amphetamine and methamphetamine in Oral Fluid from drug addicts under sustained abstinence during detoxification. Methods Twenty-five patients admitted to a closed detoxification unit were included in this study. Oral Fluid samples were collected daily in the morning and evening, and urine every morning for 10 days. A blood sample was drawn during the first 5 days after admission if the patient consented. Oral Fluid results were compared with urine results to determine whether a new ingestion occurred. Oral Fluid was collected with the Intercept Oral Fluid collection device. In-house cutoff concentrations for amphetamine and methamphetamine were 6.8 and 7.5 mcg/L, respectively, in Oral Fluid, and 135 and 149 mcg/L, respectively, in urine. Results Amphetamines were detected in 11 Oral Fluid, 5 urine, and 2 blood specimens from 25 patients. Patients self-reported amphetamines intake of up to 0.5-2 g daily. Windows of detection for amphetamine and methamphetamine in Oral Fluid were up to 8 days, longer than in urine at the applied cutoff values. Conclusions These data confirm that Oral Fluid is a viable alternative to urine for monitoring amphetamine abuse, and that these substances might be detected in Oral Fluid for at least 1 week after ingestion of high doses. Such long detection times were, as far as we are aware, never reported previously for Oral Fluid amphetamines.
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Screening of synthetic cannabinoids in preserved Oral Fluid by UPLC–MS/MS
Bioanalysis, 2013Co-Authors: Elisabeth Leere Øiestad, Unni Johansen, Asbjorg S Christophersen, Ritva KarinenAbstract:Background: The abuse of a rapidly changing range of synthetic cannabinoids is increasing worldwide. Oral Fluid, which contains the parent compounds and is easily collected, could be a good alternative medium for drug screening for synthetic cannabinoids. Results: A method for screening of 18 synthetic cannabinoids in preserved Oral Fluid collected with the Intercept® collection device, using UPLC–MS/MS, was validated. Limits of quantification ranged from 0.2 to 2 ng/ml in Oral Fluid. In several real cases, AM-2201 and/or JWH-018 were found. Conclusion: The presented method allowed rapid and sensitive screening of synthetic cannabinoids in preserved Oral Fluid collected with the Intercept collection device.
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Comparison of drug concentrations between whole blood and Oral Fluid
Drug testing and analysis, 2013Co-Authors: Kaarina Langel, Elisabeth Leere Øiestad, Hallvard Gjerde, Donata Favretto, Pirjo Lillsunde, Santo Davide Ferrara, Alain VerstraeteAbstract:The relationship of drug concentrations between Oral Fluid and whole blood was evaluated by studying the linear correlation of concentrations and calculating the Oral Fluid to blood concentration ratios (OF/B) for different substances. Paired Oral Fluid and whole blood samples were collected from volunteers and persons suspected of drug use in four European countries. Oral Fluid samples were collected with the Saliva∙Sampler™ device. All samples were analyzed for drugs of abuse and psychoactive medicines with validated gas and liquid chromatography-mass spectrometric methods. The median OF/B ratios were, for amphetamines 19-22, for opioids 1.8-11, for cocaine and metabolites 1.7-17, for tetrahydrocannabinol (THC) 14, for benzodiazepines 0.035-0.33, and for other psychoactive medicines 0.24-3.7. Most of the these results were close to theoretical values based on the physicochemical properties of the drugs and to values presented earlier, but there was a lot of inter-individual variation in the OF/B ratios. For all substances, except for lorazepam (R(2) = 0.031) and THC (R(2) = 0.030), a correlation between the Oral Fluid and whole blood concentrations was observed. Due to large variation seen here, drug findings in Oral Fluid should not be used to estimate the corresponding concentrations in whole blood (or vice versa). However, detection of drugs in Oral Fluid is a sign of recent drug use and Oral Fluid can be used for qualitative detection of several drugs, e.g. in epidemiological prevalence studies. By optimizing the sampling and the analytical cut-offs, the potential of Oral Fluid as a confirmation matrix could be enhanced.
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Screening of synthetic cannabinoids in preserved Oral Fluid by UPLC-MS/MS.
Bioanalysis, 2013Co-Authors: Elisabeth Leere Øiestad, Unni Johansen, Asbjorg S Christophersen, Ritva KarinenAbstract:Background: The abuse of a rapidly changing range of synthetic cannabinoids is increasing worldwide. Oral Fluid, which contains the parent compounds and is easily collected, could be a good alternative medium for drug screening for synthetic cannabinoids. Results: A method for screening of 18 synthetic cannabinoids in preserved Oral Fluid collected with the Intercept® collection device, using UPLC–MS/MS, was validated. Limits of quantification ranged from 0.2 to 2 ng/ml in Oral Fluid. In several real cases, AM-2201 and/or JWH-018 were found. Conclusion: The presented method allowed rapid and sensitive screening of synthetic cannabinoids in preserved Oral Fluid collected with the Intercept collection device.
Asbjorg S Christophersen - One of the best experts on this subject based on the ideXlab platform.
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Inc. Comparison of drug concentrations in blood and Oral Fluid collected with the Intercept ® sampling device
2016Co-Authors: Hallvard Gjerde, Asbjorg S Christophersen, Jon Mordal, Jørgen G. BramnessAbstract:The aim of the study was to determine drug concentration ratios between Oral Fluid collected with the Intercept ® device and whole blood. Samples of blood and Oral Fluid were obtained from patients admitted to acute psychiatric treatment and drivers suspected of drugged driving, and were analysed for illegal drugs, benzodiazepines, opioids, carisoprodol and meprobamate. Drugs were detected in samples of both blood and Oral Fluid from 59 subjects; altogether 17 different drugs were found. Concentration ratios between Oral Fluid and blood were determined for all cases. The distributions of drug concentration ratios were wide for most drugs, and do not allow reliable estimations of drug concentrations in blood using concentrations in Oral Fluid. The median Oral Fluid/blood drug concentration ratios for the most prevalent drugs were: diazepam 0.036, nordiazepam 0.027, amphetamine 7.1, methamphetamine 2.9, codeine 5.4, morphine 1.9, and tetrahydrocannabinol 4.7. The correlation coefficients between drug concentrations in Oral Fluid and blood ranged from 0.15 to 0.96 for the six most prevalent drugs
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Extended Detection of Amphetamine and Methamphetamine in Oral Fluid.
Therapeutic drug monitoring, 2016Co-Authors: Hilde T. Andås, Asbjorg S Christophersen, Marilyn A Huestis, Asle Enger, Åse Marit Leere Øiestad, Vigdis Vindenes, Elisabeth Leere ØiestadAbstract:Background Amphetamine and methamphetamine are popular drugs of abuse worldwide and are important components of drug monitoring programs. Windows of detection for amphetamine and methamphetamine in Oral Fluid after high doses have not been investigated. Repeated high-dose ingestions are likely to cause positive samples for extended periods. Common routes of administration of amphetamine/methamphetamine in Norway are Oral intake or injection. The aim of this study was to investigate windows of detection for amphetamine and methamphetamine in Oral Fluid from drug addicts under sustained abstinence during detoxification. Methods Twenty-five patients admitted to a closed detoxification unit were included in this study. Oral Fluid samples were collected daily in the morning and evening, and urine every morning for 10 days. A blood sample was drawn during the first 5 days after admission if the patient consented. Oral Fluid results were compared with urine results to determine whether a new ingestion occurred. Oral Fluid was collected with the Intercept Oral Fluid collection device. In-house cutoff concentrations for amphetamine and methamphetamine were 6.8 and 7.5 mcg/L, respectively, in Oral Fluid, and 135 and 149 mcg/L, respectively, in urine. Results Amphetamines were detected in 11 Oral Fluid, 5 urine, and 2 blood specimens from 25 patients. Patients self-reported amphetamines intake of up to 0.5-2 g daily. Windows of detection for amphetamine and methamphetamine in Oral Fluid were up to 8 days, longer than in urine at the applied cutoff values. Conclusions These data confirm that Oral Fluid is a viable alternative to urine for monitoring amphetamine abuse, and that these substances might be detected in Oral Fluid for at least 1 week after ingestion of high doses. Such long detection times were, as far as we are aware, never reported previously for Oral Fluid amphetamines.
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Screening of synthetic cannabinoids in preserved Oral Fluid by UPLC–MS/MS
Bioanalysis, 2013Co-Authors: Elisabeth Leere Øiestad, Unni Johansen, Asbjorg S Christophersen, Ritva KarinenAbstract:Background: The abuse of a rapidly changing range of synthetic cannabinoids is increasing worldwide. Oral Fluid, which contains the parent compounds and is easily collected, could be a good alternative medium for drug screening for synthetic cannabinoids. Results: A method for screening of 18 synthetic cannabinoids in preserved Oral Fluid collected with the Intercept® collection device, using UPLC–MS/MS, was validated. Limits of quantification ranged from 0.2 to 2 ng/ml in Oral Fluid. In several real cases, AM-2201 and/or JWH-018 were found. Conclusion: The presented method allowed rapid and sensitive screening of synthetic cannabinoids in preserved Oral Fluid collected with the Intercept collection device.
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Screening of synthetic cannabinoids in preserved Oral Fluid by UPLC-MS/MS.
Bioanalysis, 2013Co-Authors: Elisabeth Leere Øiestad, Unni Johansen, Asbjorg S Christophersen, Ritva KarinenAbstract:Background: The abuse of a rapidly changing range of synthetic cannabinoids is increasing worldwide. Oral Fluid, which contains the parent compounds and is easily collected, could be a good alternative medium for drug screening for synthetic cannabinoids. Results: A method for screening of 18 synthetic cannabinoids in preserved Oral Fluid collected with the Intercept® collection device, using UPLC–MS/MS, was validated. Limits of quantification ranged from 0.2 to 2 ng/ml in Oral Fluid. In several real cases, AM-2201 and/or JWH-018 were found. Conclusion: The presented method allowed rapid and sensitive screening of synthetic cannabinoids in preserved Oral Fluid collected with the Intercept collection device.
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detection of drugs of abuse in simultaneously collected Oral Fluid urine and blood from norwegian drug drivers
Forensic Science International, 2012Co-Authors: Vigdis Vindenes, Asbjorg S Christophersen, Hallvard Gjerde, Hilde Marie Eroy Lund, Wenche Andresen, S E Ikdahl, Elisabeth Leere ØiestadAbstract:Blood and urine samples are collected when the Norwegian police apprehend a person suspected of driving under the influence of drugs other than alcohol. Impairment is judged from the findings in blood. In our routine samples, urine is analysed if morphine is detected in blood to differentiate between ingestion of heroin, morphine or codeine and also in cases where the amount of blood is too low to perform both screening and quantification analysis. In several cases, the collection of urine might be time consuming and challenging. The aim of this study was to investigate if drugs detected in blood were found in Oral Fluid and if interpretation of opiate findings in Oral Fluid is as conclusive as in urine. Blood, urine and Oral Fluid samples were collected from 100 drivers suspected of drugged driving. Oral Fluid and blood were screened using LC-MS/MS methods and urine by immunological methods. Positive findings in blood and urine were confirmed with chromatographic methods. The analytical method for Oral Fluid included 25 of the most commonly abused drugs in Norway and some metabolites. The analysis showed a good correlation between the findings in urine and Oral Fluid for amphetamines, cocaine/benzoylecgonine, methadone, opiates, zopiclone and benzodiazepines including the 7-amino-benzodiazepines. Cocaine and the heroin marker 6-monoacetylmorphine (6-MAM) were more frequently detected in Oral Fluid than in urine. Drug concentrations above the cut-off values were found in both samples of Oral Fluid and urine in 15 of 22 cases positive for morphine, in 18 of 20 cases positive for codeine and in 19 of 26 cases positive for 6-MAM. The use of cannabis was confirmed by detecting THC in Oral Fluid and THC-COOH in urine. In 34 of 46 cases the use of cannabis was confirmed both in Oral Fluid and urine. The use of cannabis was confirmed by a positive finding in only urine in 11 cases and in only Oral Fluid in one case. All the drug groups detected in blood were also found in Oral Fluid. Since all relevant drugs detected in blood were possible to find in Oral Fluid and the interpretation of the opiate findings in Oral Fluid was more conclusive than in urine, Oral Fluid might replace urine in driving under the influence cases. The fast and easy sampling is time saving and less intrusive for the drivers.
Ritva Karinen - One of the best experts on this subject based on the ideXlab platform.
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Screening of synthetic cannabinoids in preserved Oral Fluid by UPLC–MS/MS
Bioanalysis, 2013Co-Authors: Elisabeth Leere Øiestad, Unni Johansen, Asbjorg S Christophersen, Ritva KarinenAbstract:Background: The abuse of a rapidly changing range of synthetic cannabinoids is increasing worldwide. Oral Fluid, which contains the parent compounds and is easily collected, could be a good alternative medium for drug screening for synthetic cannabinoids. Results: A method for screening of 18 synthetic cannabinoids in preserved Oral Fluid collected with the Intercept® collection device, using UPLC–MS/MS, was validated. Limits of quantification ranged from 0.2 to 2 ng/ml in Oral Fluid. In several real cases, AM-2201 and/or JWH-018 were found. Conclusion: The presented method allowed rapid and sensitive screening of synthetic cannabinoids in preserved Oral Fluid collected with the Intercept collection device.
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Screening of synthetic cannabinoids in preserved Oral Fluid by UPLC-MS/MS.
Bioanalysis, 2013Co-Authors: Elisabeth Leere Øiestad, Unni Johansen, Asbjorg S Christophersen, Ritva KarinenAbstract:Background: The abuse of a rapidly changing range of synthetic cannabinoids is increasing worldwide. Oral Fluid, which contains the parent compounds and is easily collected, could be a good alternative medium for drug screening for synthetic cannabinoids. Results: A method for screening of 18 synthetic cannabinoids in preserved Oral Fluid collected with the Intercept® collection device, using UPLC–MS/MS, was validated. Limits of quantification ranged from 0.2 to 2 ng/ml in Oral Fluid. In several real cases, AM-2201 and/or JWH-018 were found. Conclusion: The presented method allowed rapid and sensitive screening of synthetic cannabinoids in preserved Oral Fluid collected with the Intercept collection device.
Marilyn A Huestis - One of the best experts on this subject based on the ideXlab platform.
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Extended Detection of Amphetamine and Methamphetamine in Oral Fluid.
Therapeutic drug monitoring, 2016Co-Authors: Hilde T. Andås, Asbjorg S Christophersen, Marilyn A Huestis, Asle Enger, Åse Marit Leere Øiestad, Vigdis Vindenes, Elisabeth Leere ØiestadAbstract:Background Amphetamine and methamphetamine are popular drugs of abuse worldwide and are important components of drug monitoring programs. Windows of detection for amphetamine and methamphetamine in Oral Fluid after high doses have not been investigated. Repeated high-dose ingestions are likely to cause positive samples for extended periods. Common routes of administration of amphetamine/methamphetamine in Norway are Oral intake or injection. The aim of this study was to investigate windows of detection for amphetamine and methamphetamine in Oral Fluid from drug addicts under sustained abstinence during detoxification. Methods Twenty-five patients admitted to a closed detoxification unit were included in this study. Oral Fluid samples were collected daily in the morning and evening, and urine every morning for 10 days. A blood sample was drawn during the first 5 days after admission if the patient consented. Oral Fluid results were compared with urine results to determine whether a new ingestion occurred. Oral Fluid was collected with the Intercept Oral Fluid collection device. In-house cutoff concentrations for amphetamine and methamphetamine were 6.8 and 7.5 mcg/L, respectively, in Oral Fluid, and 135 and 149 mcg/L, respectively, in urine. Results Amphetamines were detected in 11 Oral Fluid, 5 urine, and 2 blood specimens from 25 patients. Patients self-reported amphetamines intake of up to 0.5-2 g daily. Windows of detection for amphetamine and methamphetamine in Oral Fluid were up to 8 days, longer than in urine at the applied cutoff values. Conclusions These data confirm that Oral Fluid is a viable alternative to urine for monitoring amphetamine abuse, and that these substances might be detected in Oral Fluid for at least 1 week after ingestion of high doses. Such long detection times were, as far as we are aware, never reported previously for Oral Fluid amphetamines.
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Plasma and Oral Fluid Pharmacokinetics and Pharmacodynamics after Oral Codeine Administration
2015Co-Authors: Marilyn A HuestisAbstract:Oral Fluid collection have increased the use of this alternative matrix for drugs-of-abuse testing; however, few controlled drug administration data are available to aid in the interpretation of Oral Fluid results. Methods: Single Oral codeine doses (60 and 120 mg/70 kg) were administered to 19 volunteers. Oral Fluid and plasma were analyzed for free codeine, norcodeine, morphine, and normorphine by solid-phase extraction combined with gas chromatography–mass spectrometry (SPE/GC-MS). Physiologic and subjective effects were examined. Results: Mean (SE) peak codeine concentrations were 214.2 27.6 and 474.3 77.0 g/L in plasma and 638.4 64.4 and 1599.3 241.0 g/L in Oral Fluid. The Oral Fluid-to-plasma ratio for codeine was relatively constan
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Oral Fluid nicotine markers to assess smoking status and recency of use.
Therapeutic Drug Monitoring, 2011Co-Authors: Karl B. Scheidweiler, Stephen J. Heishman, Gina F Marrone, Edward G. Singleton, Diaa M. Shakleya, Marilyn A HuestisAbstract:Oral Fluid collection is non-invasive and easily observed making it an attractive matrix for objectively determining smoking status. Despite large inter-subject variability, cotinine Oral Fluid concentrations correlate with cigarettes smoked per day (CPD). Few studies, however, assessed nicotine markers in Oral Fluid other than cotinine; other markers might improve smoking status assessment and/or time of last cigarette. Materials and Methods Smoking histories and Oral Fluid specimens were collected from non-treatment-seeking light (1–10 CPD) and heavy smokers (>10 CPD), and from environmentally exposed and nonexposed nonsmokers who provided written informed consent for this Institutional Review Board-approved study. Nicotine, cotinine, hydroxycotinine (OH-cotinine) and norcotinine Oral Fluid concentrations were quantified via liquid chromatography tandem mass spectrometry (LCMSMS).
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Oral Fluid Testing: Promises and Pitfalls
Clinical chemistry, 2011Co-Authors: Marilyn A Huestis, Jørg Mørland, Alain Verstraete, Tai C. Kwong, Michael Vincent, Raphael De La TorreAbstract:Oral Fluid is a promising new matrix for drug-testing programs for drug treatment, the workplace, pain management, and driving under the influence of drugs (DUID)7. As with any new technology, there are strengths and limitations. We discuss with international experts the role this new alternative matrix will play in diverse drug-monitoring settings, and the research, development, and legislation needed to permit Oral Fluid testing to best take its place in the modern laboratory armamentarium.8 Do you believe Oral Fluid testing will become the most prevalent matrix tested in these programs and why? What are the strengths and limitations of Oral Fluid testing for each type of program? Alain Verstraete: Oral Fluid will probably become the most prevalent matrix for DUID, certainly for roadside screening. Legislators and police officers want to rapidly perform DUID testing at the roadside, eliminating transport to hospitals or police stations. Oral Fluid is used for DUID in 5 Australian states, Belgium, and France and is described in Swiss and United Kingdom legislation. The main advantages are ease of collection and a generally shorter window of drug detection than urine, hence a better correlation with duration of impairment. Limitations include difficulty of collection following recent drug use and the potential for passive contamination. For DUID confirmation, presently only Belgium and 4 Australian states utilize Oral Fluid; in other jurisdictions, positive Oral Fluid presumptive test results are confirmed with blood tests. Oral Fluid also could become the most prevalent matrix for drug treatment due to ease of sampling, despite the shorter drug-detection window. In this setting, cost may play a more important role. If additional visits are required for Oral Fluid testing, urine testing might remain dominant. A strong advantage of Oral Fluid testing for drug treatment is the greater detection of 6-acetylmorphine, a marker …
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Methadone disposition in Oral Fluid during pharmacotherapy for opioid-dependence.
Forensic science international, 2010Co-Authors: Teresa R Gray, Robin E. Choo, Riet Dams, Hendree E Jones, Marilyn A HuestisAbstract:Oral Fluid testing is widely used for detecting drug exposure, but data describing methadone and metabolites in Oral Fluid during pharmacotherapy for opioid-dependence are relatively limited. 414 Oral Fluid specimens from 16 opioid-dependent pregnant women receiving daily methadone were analyzed for methadone, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP), and methadol by liquid chromatography-mass spectrometry. All Oral Fluid specimens contained methadone greater than 1 ng/mL; 88% were positive for EDDP and 12% for methadol. Over 95% of Oral Fluid specimens exceeded the 20 ng/mL methadone cutoff set by the European Driving Under the Influence of Drugs, Alcohol and Medicines (DRUID) study. Methadone and EDDP Oral Fluid concentrations were highly variable within and between participants, did not predict methadone dose, but were negatively correlated with pH. Methadone was readily identified in Oral Fluid at concentrations greater than 20 ng/mL following daily 30-110 mg/day methadone pharmacotherapy. As no specimens contained only EDDP or methadol, there was no advantage to including these analytes for identification of methadone exposure. As nearly all Oral Fluid specimens from methadone-maintained patients exceeded the DRUID guideline, the 20 ng/mL cutoff appears to be sensitive enough to detect daily methadone exposure; however, additional indicators of behaviOral and/or motor impairment would be necessary to provide evidence of driving impairment. Published by Elsevier Ireland Ltd.
Edward J Cone - One of the best experts on this subject based on the ideXlab platform.
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Oral Fluid drug testing of chronic pain patients ii comparison of paired Oral Fluid and urine specimens
Journal of Analytical Toxicology, 2012Co-Authors: Rebecca Heltsley, Anne Z Depriest, David L Black, Dennis J Crouch, Tim Robert, Lucas Marshall, Viola M Meadors, Yale H Caplan, Edward J ConeAbstract:A clinical study was conducted to compare the use of Oral Fluid to urine for compliance monitoring of pain patients. Patients (n = 133) undergoing treatment for chronic pain at four clinics participated in the study and provided paired Oral Fluid and urine specimens. Oral Fluid specimens were collected with Quantisal(TM) saliva collection devices immediately following urine collection. Oral Fluid specimens were analyzed for 42 drugs and/or metabolites by validated liquid chromatography-tandem mass spectrometry procedures. Accompanying urine specimens were initially screened by immunoassay and non-negative results were confirmed. Of the 1544 paired tests, 329 (21.3%) drug analytes were positive, and 984 (63.7%) were negative for both specimens resulting in an overall agreement of 85%. There were 83 (5.4%) analyte results that were positive in Oral Fluid and negative in urine, and 148 (9.6%) were negative in Oral Fluid and positive in urine for an overall disagreement of 15%. Cohen's Kappa value was 0.64, indicating "substantial" agreement. The primary exceptions to agreement were the lower detection rates for hydromorphone, oxymorphone, and benzodiazepines in Oral Fluid compared to urine. The authors conclude that, overall, Oral Fluid tests produced comparable results to urine tests with some minor differences in detection rates for different drug classes.
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Methamphetamine disposition in Oral Fluid, plasma, and urine.
Annals of the New York Academy of Sciences, 2007Co-Authors: Marilyn A Huestis, Edward J ConeAbstract:This review of the disposition of methamphetamine in Oral Fluid, plasma, and urine is based on a comprehensive controlled dosing study involving five healthy, drug-free research volunteers who resided on a closed clinical ward for 12 weeks. Subjects were administered four low (10 mg) and high (20 mg) daily Oral doses of methamphetamine in two separate sessions. Near-simultaneous collections of Oral Fluid and plasma were performed on the first day of each low- and high-dose session. Thereafter, Oral Fluid was provided on each day of dosing by different Oral Fluid collection methods. All urine specimens were collected on an ad libitum basis throughout the study. Specimens were analyzed by gas-chromatography mass spectrometry for methamphetamine and the metabolite, amphetamine, with a limit of quantification of 2.5 ng/mL for each analyte. Methamphetamine and metabolite concentrations in Oral Fluid appeared to follow a similar time course in Oral Fluid as in plasma and were dose-proportional, but Oral Fluid concentrations exceeded plasma concentrations. Urine drug concentrations were substantially higher than those in Oral Fluid. Some drug accumulation was noted with daily dosing, but generally did not markedly influence detection times or detection rates of Oral Fluid tests. Detection times and detection rates for Oral Fluid and urine were determined at cessation of 4 days of dosing. Generally, detection times and rates for urine were longer than those observed for Oral Fluid at conventional cutoff concentrations. When contemplating selection of Oral Fluid as a test matrix, the advantages of Oral Fluid collection should be weighed against its shorter time of detection compared to that of urine.
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Interpretation of Oral Fluid Tests for Drugs of Abuse
Annals of the New York Academy of Sciences, 2007Co-Authors: Edward J Cone, Marilyn A HuestisAbstract:Oral Fluid testing for drugs of abuse offers significant advantages over urine as a test matrix. Collection can be performed under direct observation with reduced risk of adulteration and substitution. Drugs generally appear in Oral Fluid by passive diffusion from blood, but also may be deposited in the Oral cavity during Oral, smoked, and intranasal administration. Drug metabolites also can be detected in Oral Fluid. Unlike urine testing, there may be a close correspondence between drug and metabolite concentrations in Oral Fluid and in blood. Interpretation of Oral Fluid results for drugs of abuse should be an iterative process whereby one considers the test results in the context of program requirements and a broad scientific knowledge of the many factors involved in determining test outcome. This review delineates many of the chemical and metabolic processes involved in the disposition of drugs and metabolites in Oral Fluid that are important to the appropriate interpretation of Oral Fluid tests. Chemical, metabolic, kinetic, and analytic parameters are summarized for selected drugs of abuse, and general guidelines are offered for understanding the significance of Oral Fluid tests.
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Passive cannabis smoke exposure and Oral Fluid testing.
Journal of analytical toxicology, 2004Co-Authors: Sam Niedbala, Keith W. Kardos, Sal Salamone, Dean Fritch, Matth Bronsgeest, Edward J ConeAbstract:Oral Fluid testing for Delta(9)-tetrahydrocannabinol (THC) provides a convenient means of detection of recent cannabis usage. In this study, the risk of positive Oral Fluid tests from passive cannabis smoke exposure was investigated by housing four cannabis-free volunteers in a small, unventilated, and sealed room with an approximate volume of 36 m(3). Five active cannabis smokers were also present in the room, and each smoked a single cannabis cigarette (1.75% THC). Cannabis smoking occurred over the first 20 min of the study session. All subjects remained in the room for approximately 4 h. Oral Fluid specimens were collected with the Intercept DOA Oral Specimen Collection Device. Three urine specimens were collected (0, 20, and 245 min). In addition, three air samples were collected for measurement of THC content. All Oral Fluid specimens were screened by enzyme immunoassay (EIA) for cannabinoids (cutoff concentration = 3 ng/mL) and tested by gas chromatography-tandem mass spectrometry (GC-MS-MS) for THC (LOQ/LOD = 0.75 ng/mL). All urine specimens were screened by EIA for cannabinoids (cutoff concentration = 50 ng/mL) and tested by GC-MS-MS for THCCOOH (LOQ/LOD = 1 ng/mL). Air samples were measured for THC by GC-MS (LOD = 1 ng/L). A total of eight Oral Fluid specimens (collected 20 to 50 min following initiation of smoking) from the four passive subjects screened and confirmed positive for THC at concentrations ranging from 3.6 to 26.4 ng/mL. Two additional specimens from one passive subject, collected at 50 and 65 min, screened negative but contained THC in concentrations of 4.2 and 1.1 ng/mL, respectively. All subsequent specimens for passive participants tested negative by EIA and GC-MS-MS for the remainder of the 4-h session. In contrast, Oral Fluid specimens collected from the five cannabis smokers generally screened and confirmed positive for THC throughout the session at concentrations substantially higher than observed for passive subjects. Urine specimens from active cannabis smokers also screened and confirmed positive at conventional cutoff concentrations. A biphasic pattern of decline for THC was observed in Oral Fluid specimens collected from cannabis smokers, whereas a linear decline was seen for passive subjects suggesting that initial Oral Fluid contamination is cleared rapidly and is followed by THC sequestration in the Oral mucosa. It is concluded that the risk of positive Oral Fluid tests from passive cannabis smoke inhalation is limited to a period of approximately 30 min following exposure.
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relationship of δ9 tetrahydrocannabinol concentrations in Oral Fluid and plasma after controlled administration of smoked cannabis
Journal of Analytical Toxicology, 2004Co-Authors: Marilyn A Huestis, Edward J ConeAbstract:Understanding the relationship of Δ 9 -tetrahydrocannabinol (THC) concentrations in Oral Fluid and plasma is important in interpretation of Oral Fluid test results. Current evidence suggests that THC is deposited in the Oral cavity during cannabis smoking. This depot represents the primary or sole source of THC found when Oral Fluid is collected and analyzed. In this research, Oral Fluid and plasma specimens were collected from six subjects following smoking of cannabis cigarettes containing 1.75% and 3.55% THC. There was at least one week between each cannabis administration. Plasma specimens were analyzed by gas chromatography-mass spectrometry (GC-MS) and paired Oral Fluid specimens were analyzed by radioimmunoassay (RIA). In addition, one individual's Oral Fluid specimens were also analyzed by GC-MS. These data are unique in that they represent simultaneous or near simultaneous collection of Oral Fluid and plasma specimens in subjects following controlled cannabis dosing. The first Oral Fluid specimen, collected from one subject at 0.2 h following initiation of smoking, contained a THC concentration of 5800 ng/mL (GC-MS). By 0.33 h, the THC concentration in Oral Fluid had fallen to 81 ng/mL. From approximately 0.3 h through 4.0 h, the mean (± SD) THC ratio of Oral Fluid to plasma THC concentrations was 1.18 (0.62) with a range of 0.5 to 2.2. Within 12 h, both Oral Fluid and plasma THC concentrations generally declined below 1 ng/mL. RIA analyses of Oral Fluid specimens for six subjects demonstrated the same pattern of initial high levels of contamination immediately after smoking, followed by rapid clearing, and a slower decline over 12 h. Mean THC Oral Fluid concentrations by RIA at 0.2 h were 864 ng/mL and 4167 ng/mL compared to plasma concentrations of 52 ng/mL and 230 ng/mL at 0.27 h following the low- and high-dose cannabis cigarettes, respectively. The similarity in Oral Fluid and plasma THC concentrations following the dissipation of the initial contamination indicates the likelihood of a physiological link between these specimens. Recent studies have shown that sublingual or transmucosal administration of pure THC results in direct absorption of intact THC into the bloodstream, thereby bypassing the gastrointestinal tract. The current study demonstrates that THC is deposited in the Oral cavity and remains for up to 24 h following cannabis smoking. The decline in THC Oral Fluid concentration over this time suggests that there may be absorption of THC into blood as previously shown with pure THC. Passive cannabis exposure studies appear to indicate that positive Oral Fluid tests for THC can occur shortly after cannabis smoke exposure, but results were negative within 1 h. Consequently, when very recent passive exposure to cannabis smoke can be ruled out, it is concluded that a positive Oral Fluid test provides credible evidence of active cannabis use.