Urine testing and abuse patterns of drugs and new psychoactive substances : application of comprehensive time-of-flight mass spectrometry

Mira Sundström

Research output: ThesisDoctoral ThesisCollection of Articles

Abstract

In Finland, the number of problem opioid and amphetamine users lies between 18,000 and 30,000, whereby only 20% receive treatment for their dependence. Annually illicit or medicinal drugs are found in the blood samples of more than 6,000 drivers, and approximately 500 fatal poisonings result from drugs. Drug testing attempts to unravel the role of psychoactive substances—whether used for therapeutic purposes or abused—under various circumstances. Such occasions requiring drug testing include treatment for drug users and poisoned patients, patient compliance, driving under the influence of drugs, and post-mortem toxicology. Although various techniques are available for the determination of a range of psychoactive substances, few methods provide cost-efficient means to detect the wide range of abused drugs. Many conventional methods remain too narrow in scope, complicated, or lead to false-positive or false-negative results. A current challenge for drug testing laboratories is the wide and changing panel of abused drugs. New psychoactive substances (NPS) continually emerge on the drug scene, requiring analytical methods not necessary ten years ago. These chemically diverse substances typically remain undetected by common drug testing methods, whereby reference standards are often insufficiently available further impeding method development. NPS are manufactured to mimic the effects of conventional drugs, while circumventing narcotic laws and drug testing. Due to their rapid appearance and disappearance, NPS display a challenging group of analytes to detect. A comprehensive drug testing method based on ultra-high performance liquid chromatography/high-resolution quadrupole time-of-flight mass spectrometry (UHPLC-HR-QTOFMS) in the positive ionization mode was developed for hundreds of drugs. The coverage of the method appeared more extensive than for most previous methods, enabling sensitive and cost-effective drug testing in a single analytical run from a single urine sample. Due to the utilization of mass fragmentation, isotopic pattern, and metabolite pattern, the method produced testing results with an identification reliability comparable to dedicated target analysis. The method outperformed immunoassay drug testing as well as a pretargeted QTOFMS approach performed on the same platform in terms of specificity, sensitivity, and scope. The study of drug abuse patterns revealed a high prevalence of multiple drug abuse among all study subjects regardless of their treatment status. In particular, it was common among those subjects not routinely attending medical treatment for their drug problem. The most common set of abused substances consisted of buprenorphine, benzodiazepines, amphetamine, and cannabis. Other drugs of abuse always accompanied NPS findings, and NPS were most commonly identified in samples from individuals not receiving treatment. The analytically confirmed drug profiles of problematic Finnish drug users are reported here for the first time with a substantial accuracy, and the findings suggest that treatment for drug dependence helps reduce drug abuse. It is anticipated that the urine drug testing method presented in this thesis will find additional applications in future forensic and clinical toxicology contexts.
Original languageEnglish
Place of PublicationHelsinki
Publisher
Print ISBNs978-951-51-3566-7
Electronic ISBNs978-951-51-3567-4
Publication statusPublished - 2017
MoE publication typeG5 Doctoral dissertation (article)

Fields of Science

  • 319 Forensic science and other medical sciences

Cite this

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title = "Urine testing and abuse patterns of drugs and new psychoactive substances : application of comprehensive time-of-flight mass spectrometry",
abstract = "In Finland, the number of problem opioid and amphetamine users lies between 18,000 and 30,000, whereby only 20{\%} receive treatment for their dependence. Annually illicit or medicinal drugs are found in the blood samples of more than 6,000 drivers, and approximately 500 fatal poisonings result from drugs. Drug testing attempts to unravel the role of psychoactive substances—whether used for therapeutic purposes or abused—under various circumstances. Such occasions requiring drug testing include treatment for drug users and poisoned patients, patient compliance, driving under the influence of drugs, and post-mortem toxicology. Although various techniques are available for the determination of a range of psychoactive substances, few methods provide cost-efficient means to detect the wide range of abused drugs. Many conventional methods remain too narrow in scope, complicated, or lead to false-positive or false-negative results. A current challenge for drug testing laboratories is the wide and changing panel of abused drugs. New psychoactive substances (NPS) continually emerge on the drug scene, requiring analytical methods not necessary ten years ago. These chemically diverse substances typically remain undetected by common drug testing methods, whereby reference standards are often insufficiently available further impeding method development. NPS are manufactured to mimic the effects of conventional drugs, while circumventing narcotic laws and drug testing. Due to their rapid appearance and disappearance, NPS display a challenging group of analytes to detect. A comprehensive drug testing method based on ultra-high performance liquid chromatography/high-resolution quadrupole time-of-flight mass spectrometry (UHPLC-HR-QTOFMS) in the positive ionization mode was developed for hundreds of drugs. The coverage of the method appeared more extensive than for most previous methods, enabling sensitive and cost-effective drug testing in a single analytical run from a single urine sample. Due to the utilization of mass fragmentation, isotopic pattern, and metabolite pattern, the method produced testing results with an identification reliability comparable to dedicated target analysis. The method outperformed immunoassay drug testing as well as a pretargeted QTOFMS approach performed on the same platform in terms of specificity, sensitivity, and scope. The study of drug abuse patterns revealed a high prevalence of multiple drug abuse among all study subjects regardless of their treatment status. In particular, it was common among those subjects not routinely attending medical treatment for their drug problem. The most common set of abused substances consisted of buprenorphine, benzodiazepines, amphetamine, and cannabis. Other drugs of abuse always accompanied NPS findings, and NPS were most commonly identified in samples from individuals not receiving treatment. The analytically confirmed drug profiles of problematic Finnish drug users are reported here for the first time with a substantial accuracy, and the findings suggest that treatment for drug dependence helps reduce drug abuse. It is anticipated that the urine drug testing method presented in this thesis will find additional applications in future forensic and clinical toxicology contexts.",
keywords = "Amphetamines, +urine, Buprenorphine, Cannabinoids, Chromatography, High Pressure Liquid, +methods, Designer Drugs, Immunoassay, Mass Spectrometry, Narcotics, Opiate Substitution Treatment, Psychotropic Drugs, Sensitivity and Specificity, Solid Phase Extraction, Substance Abuse Detection, Street Drugs, Substance-Related Disorders, +epidemiology, Urinalysis, 319 Forensic science and other medical sciences",
author = "Mira Sundstr{\"o}m",
note = "M1 - 65 s. + liitteet",
year = "2017",
language = "English",
isbn = "978-951-51-3566-7",
series = "Dissertationes Scholae Doctoralis Ad Sanitatem Investigadam Universitatis Helsinkiensis",
publisher = "University of Helsinki",
number = "49/2017",
address = "Finland",

}

Urine testing and abuse patterns of drugs and new psychoactive substances : application of comprehensive time-of-flight mass spectrometry. / Sundström, Mira.

Helsinki : University of Helsinki, 2017. 65 p.

Research output: ThesisDoctoral ThesisCollection of Articles

TY - THES

T1 - Urine testing and abuse patterns of drugs and new psychoactive substances : application of comprehensive time-of-flight mass spectrometry

AU - Sundström, Mira

N1 - M1 - 65 s. + liitteet

PY - 2017

Y1 - 2017

N2 - In Finland, the number of problem opioid and amphetamine users lies between 18,000 and 30,000, whereby only 20% receive treatment for their dependence. Annually illicit or medicinal drugs are found in the blood samples of more than 6,000 drivers, and approximately 500 fatal poisonings result from drugs. Drug testing attempts to unravel the role of psychoactive substances—whether used for therapeutic purposes or abused—under various circumstances. Such occasions requiring drug testing include treatment for drug users and poisoned patients, patient compliance, driving under the influence of drugs, and post-mortem toxicology. Although various techniques are available for the determination of a range of psychoactive substances, few methods provide cost-efficient means to detect the wide range of abused drugs. Many conventional methods remain too narrow in scope, complicated, or lead to false-positive or false-negative results. A current challenge for drug testing laboratories is the wide and changing panel of abused drugs. New psychoactive substances (NPS) continually emerge on the drug scene, requiring analytical methods not necessary ten years ago. These chemically diverse substances typically remain undetected by common drug testing methods, whereby reference standards are often insufficiently available further impeding method development. NPS are manufactured to mimic the effects of conventional drugs, while circumventing narcotic laws and drug testing. Due to their rapid appearance and disappearance, NPS display a challenging group of analytes to detect. A comprehensive drug testing method based on ultra-high performance liquid chromatography/high-resolution quadrupole time-of-flight mass spectrometry (UHPLC-HR-QTOFMS) in the positive ionization mode was developed for hundreds of drugs. The coverage of the method appeared more extensive than for most previous methods, enabling sensitive and cost-effective drug testing in a single analytical run from a single urine sample. Due to the utilization of mass fragmentation, isotopic pattern, and metabolite pattern, the method produced testing results with an identification reliability comparable to dedicated target analysis. The method outperformed immunoassay drug testing as well as a pretargeted QTOFMS approach performed on the same platform in terms of specificity, sensitivity, and scope. The study of drug abuse patterns revealed a high prevalence of multiple drug abuse among all study subjects regardless of their treatment status. In particular, it was common among those subjects not routinely attending medical treatment for their drug problem. The most common set of abused substances consisted of buprenorphine, benzodiazepines, amphetamine, and cannabis. Other drugs of abuse always accompanied NPS findings, and NPS were most commonly identified in samples from individuals not receiving treatment. The analytically confirmed drug profiles of problematic Finnish drug users are reported here for the first time with a substantial accuracy, and the findings suggest that treatment for drug dependence helps reduce drug abuse. It is anticipated that the urine drug testing method presented in this thesis will find additional applications in future forensic and clinical toxicology contexts.

AB - In Finland, the number of problem opioid and amphetamine users lies between 18,000 and 30,000, whereby only 20% receive treatment for their dependence. Annually illicit or medicinal drugs are found in the blood samples of more than 6,000 drivers, and approximately 500 fatal poisonings result from drugs. Drug testing attempts to unravel the role of psychoactive substances—whether used for therapeutic purposes or abused—under various circumstances. Such occasions requiring drug testing include treatment for drug users and poisoned patients, patient compliance, driving under the influence of drugs, and post-mortem toxicology. Although various techniques are available for the determination of a range of psychoactive substances, few methods provide cost-efficient means to detect the wide range of abused drugs. Many conventional methods remain too narrow in scope, complicated, or lead to false-positive or false-negative results. A current challenge for drug testing laboratories is the wide and changing panel of abused drugs. New psychoactive substances (NPS) continually emerge on the drug scene, requiring analytical methods not necessary ten years ago. These chemically diverse substances typically remain undetected by common drug testing methods, whereby reference standards are often insufficiently available further impeding method development. NPS are manufactured to mimic the effects of conventional drugs, while circumventing narcotic laws and drug testing. Due to their rapid appearance and disappearance, NPS display a challenging group of analytes to detect. A comprehensive drug testing method based on ultra-high performance liquid chromatography/high-resolution quadrupole time-of-flight mass spectrometry (UHPLC-HR-QTOFMS) in the positive ionization mode was developed for hundreds of drugs. The coverage of the method appeared more extensive than for most previous methods, enabling sensitive and cost-effective drug testing in a single analytical run from a single urine sample. Due to the utilization of mass fragmentation, isotopic pattern, and metabolite pattern, the method produced testing results with an identification reliability comparable to dedicated target analysis. The method outperformed immunoassay drug testing as well as a pretargeted QTOFMS approach performed on the same platform in terms of specificity, sensitivity, and scope. The study of drug abuse patterns revealed a high prevalence of multiple drug abuse among all study subjects regardless of their treatment status. In particular, it was common among those subjects not routinely attending medical treatment for their drug problem. The most common set of abused substances consisted of buprenorphine, benzodiazepines, amphetamine, and cannabis. Other drugs of abuse always accompanied NPS findings, and NPS were most commonly identified in samples from individuals not receiving treatment. The analytically confirmed drug profiles of problematic Finnish drug users are reported here for the first time with a substantial accuracy, and the findings suggest that treatment for drug dependence helps reduce drug abuse. It is anticipated that the urine drug testing method presented in this thesis will find additional applications in future forensic and clinical toxicology contexts.

KW - Amphetamines

KW - +urine

KW - Buprenorphine

KW - Cannabinoids

KW - Chromatography, High Pressure Liquid

KW - +methods

KW - Designer Drugs

KW - Immunoassay

KW - Mass Spectrometry

KW - Narcotics

KW - Opiate Substitution Treatment

KW - Psychotropic Drugs

KW - Sensitivity and Specificity

KW - Solid Phase Extraction

KW - Substance Abuse Detection

KW - Street Drugs

KW - Substance-Related Disorders

KW - +epidemiology

KW - Urinalysis

KW - 319 Forensic science and other medical sciences

M3 - Doctoral Thesis

SN - 978-951-51-3566-7

T3 - Dissertationes Scholae Doctoralis Ad Sanitatem Investigadam Universitatis Helsinkiensis

PB - University of Helsinki

CY - Helsinki

ER -

Sundström M. Urine testing and abuse patterns of drugs and new psychoactive substances : application of comprehensive time-of-flight mass spectrometry. Helsinki: University of Helsinki, 2017. 65 p. (Dissertationes Scholae Doctoralis Ad Sanitatem Investigadam Universitatis Helsinkiensis; 49/2017).