Bertrand Brunet

Monitoring pregnant women's illicit opiate and cocaine use with sweat testing.

Dependence on illicit drugs during pregnancy is a major public health concern as there may be associated adverse maternal, fetal, and neonatal consequences. Sweat patches (n = 389) were collected from 39 pregnant volunteers who provided written informed consent for this Institutional Review Board-approved protocol and wore patches, replaced approximately weekly, from study entry until delivery. Patches were analyzed for opiates (heroin, 6-acetylmorphine, 6-acetylcodeine, morphine and codeine) and cocaine (cocaine, benzoylecgonine, ecgonine methyl ester, anhydroecgonine methyl ester) by solid phase extraction and gas chromatography mass spectrometry. Seventy-one percent (276) of collected sweat patches were ≥5 ng per patch (limit of quantification) for one or more analytes. Cocaine was present in 254 (65.3%) patches in concentrations ranging from 5.2 to 11,835 ng per patch with 154 of these high enough to satisfy the proposed Substance Abuse and Mental Health Services Administration guidelines for a confirmatory drug test (25 ng per patch). Interestingly, 6-acetylmorphine was the most prominent opiate analyte documented in 134 patches (34.4%) with 11.3% exceeding the proposed opiate Substance Abuse and Mental Health Services Administration cut-off (25 ng per patch). Heroin was identified in fewer patches (77), but in a similar concentration range (5.3-345.4 ng per patch). Polydrug use was evident by the presence of both cocaine and opiate metabolites in 136 (35.0%) patches. Sweat testing is an effective method for monitoring abstinence or illicit drug use relapse in this high-risk population of pregnant opiate- and/or cocaine-dependent women.

Evaluation of the Cozart DDSV test for cannabis in oral fluid.

Saliva or “oral fluid” has been presented as an alternative matrix to establish drug exposure. The noninvasive collection of an oral fluid sample, which is relatively easy to perform and can be achieved under close supervision, is one of the most important benefits when testing for driving under the influence of drugs. Moreover, the detection of Δ9-tetrahydrocannabinol (THC) in oral fluid is a better indication of recent use than a positive urine test, so there is a higher probability that the subject is experiencing pharmacological effects at the time of sampling. Twenty-five subjects (5 free and 20 addicts from a heroin detoxification center) were included in a study to evaluate the potential application of a new device, the Cozart DDSV (drug detection system visual), to detect cannabis in oral fluid. The time cannabis was last smoked was recorded by the medical staff after interview with each subject. Samples were collected with the Cozart DDS Oral Swab and diluted with the Cozart DDS buffer as proposed by the manufacturer. The Cozart DDSV test was conducted on site at the time of collection, and the remainder of the sample retained for confirmation analysis by gas chromatography with mass spectrometry (GC/MS) after methylation of THC (limit of quantitation 0.5 ng/mL). All 25 samples were analyzed by GC/MS. On-site results were obtained within 10 minutes. The 5 drug-free subjects were negative for cannabis, irrespective of the method. From the 20 subjects declaring that they had smoked cannabis between 30 minutes and 24 hours previously, the DDSV device identified 8 positive subjects (with THC concentrations in the buffer in the range 15-219 ng/mL), whereas 18 subjects tested positive using GC/MS. THC concentrations in the Cozart buffer using GC/MS analysis ranged from 0.7 to 219 ng/mL. These concentrations represent about one third the authentic THC concentrations in oral fluid due to the dilution by the liquid of the device. Given the results, the DDSV device was considered as an acceptable tool to detect cannabis abuse in oral fluid within a period of 2-3 hours after smoking.

Excretion of methadone in sweat of pregnant women throughout gestation after controlled methadone administration

Sweat patches (n = 350) were collected throughout gestation from 29 opioid-dependent pregnant women participating in an outpatient methadone-assisted therapy program. Volunteers provided informed consent to participate in institutional review board-approved protocols. Methadone was eluted from sweat patches with sodium acetate buffer, followed by solid-phase extraction and quantification by gas chromatography mass spectrometry (limit of quantification ≥ 10 ng/patch). Methadone was present in all weekly patches (n = 311) in concentrations ranging from 10.2 to 12,129.7 nanograms per patch and in 92.3% of short-term patches (n = 39, worn for 12 or 24 hours) in concentrations up to 3303.9 nanograms per patch. Correlation between patch concentrations and total amount of drug administered (r = 0.224), and concentrations and duration of patch wear (r = 0.129) were both weak. Although there were large intra- and intersubject variations in sweat drug concentrations, sweat testing was an effective alternative technique to qualitatively monitor illicit drug use and simultaneously document methadone medication-assisted treatment.

Cannabis et accidents de la voie publique : résultats des dernières études françaises

The clarification of the mechanisms of action of cannabis and its effects on motor and cognitive functions, the results of previous studies performed on driving simulators and closed or open-road driving trials, are important criteria for highlighting the increased risk of road crashes for drivers after a recent use of cannabis. In addition epidemiological studies allow to measure the magnitude of the problem. A survey of French epidemiological studies performed from 1999 to 2004, as well as the data of THC distribution in tissues studies performed on man and animal allowed us to draw a number of conclusions. The risk of road crash after a recent use of cannabis is increased by more than 2.4 in all studies. The prevalence of cannabis use in drivers involved in a road crash has dramatically increased during the last years. For methodological reasons (a too high threshold for THC positivity, a too long time delay between accident and blood sampling), the annual number of fatal cases induced by a cannabis use was likely underestimated. This assessment is consistent with recent data which indicate that THC could be still present in brain while absent in blood. A positivity threshold for THC in blood of 0.5 ng/mL would be more appropriated. So, all recent French studies highlighted that a recent use of cannabis impairs driving ability and that it would be advisable to intensify roadside testing for drugs of abuse.Resume La connaissance des mecanismes d′action du cannabis et de ses effets sur les fonctions cognitives et motrices, les resultats des etudes faites sur simulateurs de conduite ou en situation reelle, constituent des arguments majeurs visant a demontrer l′influence nefaste d′un usage recent de cannabis sur l′aptitude a conduire un vehicule en toute securite. En complement, les etudes epidemiologiques permettent de quantifier le phenomene. L′analyse des etudes epidemiologiques realisees en France depuis 1999 ainsi que les resultats d′etudes de distribution tissulaire des cannabinoides chez l′homme et l′animal ont permis aux auteurs d′apporter un certain nombre de conclusions. Le sur-risque d′accident apres usage de cannabis est bien une realite, puisque superieur a 2,4 dans toutes les etudes. La prevalence de consommation de cannabis chez les conducteurs impliques dans un accident de la voie publique a augmente de maniere tres importante ces dernieres annees. Pour des raisons d′ordre methodologiques (seuil de positivite au tetrahydrocannabinol (THC) trop eleve, delai trop long entre le moment de l′accident et celui du prelevement), le nombre annuel de deces imputables au cannabis a ete minimise. Cette notion est renforcee par le fait que le THC pouvait etre encore present dans le cerveau alors qu′il n′etait plus detectable dans le sang. Un seuil sanguin de positivite de 0,5 ng/mL pour le THC serait mieux adapte. Toutes les etudes francaises recentes ont donc confirme qu′un usage recent de cannabis est totalement incompatible avec une conduite automobile en toute securite et qu′il convient aujourd′hui de renforcer les mesures legislatives prises dans le cadre de la loi de 2003.

Cannabis and Drug-Facilitated Crimes

Cannabis is by far the most widely used drug of abuse in the world. Thus, it is not surprising to find THC or its metabolites in biological samples taken from victims of drug-facilitated crimes. Cannabis can be administered surreptitiously in pastries but those cases are rare. Like alcohol, most of the time cannabis is used by the offender and shared with the “agreement” of the victim resulting in what is called incapacitated rape or crime. Some of the psychoactive effects of THC such as euphoria, drowsiness, visual disorders and short memory troubles are expected by the perpetrator to facilitate the crime. This chapter emphasizes the role of cannabis in drug-facilitated or incapacitated crime situations with details on the products that can be used, the metabolism, the effects of cannabis and the interpretation of toxicological analysis.