SOFT 2004 Meeting Abstracts - Society of Forensic Toxicologists

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THE VOLUNTARY DETOXIFICATION PROGRAMME - A SURVEY OF THE EFFICIENCY
V.Vorisekl' ,J.Cizek 2 , V.Palicka l
I Institute ofClinical Biochemistry and Diagnostics, University Hospital and Medical Faculty of Charles
University, Hradec Kralove; 2Detoxification Centre, Department of Psychiatry, University Hospital, Hradec
Kralove, Czech Republic
Aims: The object of this survey was to evaluate the effectiveness of our detoxification strategy for future
planning and corrections on the basis of the analytical results. Methadone and buprenorphine programme
applied to opiate and amphetamine abusers in the detoxification centre for north-east area of the Czech
Republic ( Hradec Kralove county) is based on the voluntary and liberal principle. However a common
problem related to this approach is a relapse to drug abuse. Detection of the key analytes
(methylamphetamine, amphetamine,MDMA, MDA, 6-MAM, morphine, codeine, acetylcodeine and
cannabinoids, especially ll-nor-delta-9-tetrahydrocannabinolic acid) in urine specimens is the decisive
cause of definitive or temporary discharge from the treatment according to the individual status of patient
and all case consequencies.
Methods: A total of 3464 urine specimens randomly collected from 85 patients admitted to programme ( 70
males, 15 females, aged 19 to 43) over an 8-year (1996-2003 ) period were screened for illicit drug use,
especially for opiates and amphetamines. The screening analyses were carried out by immunochemical
methods (EMIT II) and full-automatic HPLC-UV procedure ( REMEDi HS Drug Profiling System ). The
confirmations were performed by GC-MS (Magnum MAT Finnigan). A total of 25600 tests were done.
Extraction procedures before GC-MS acquisition were carried out by solid phase extraction devices with
reagents containing ethyl acetate, acetone, methylene chloride, 0.01 M acetic acid, methanol and
ammonium hydroxide. Bond Elute CertifY II columns were used for the extraction of amphetamines and
opiates after enzymatic hydrolysis with p- glucuronidase at 60°C for 3 hours. Positive samples for cannabis
afterdeconjugation with lIN potassium hydroxide were extracted on SPEC CI8 AR columns.
Amphetamines and opiates were detected simultaneously in one analysis in the form of
pentafluoropropionyl derivatives (PFPA reagent).Cannabinoids were derivatized with BSTFA + TMCS
(99+1) mixture. Samples for evidence of psilocine abuse were extracted on SPEC MPI mixed disc and
derivatized with acetic anhydride in pyridine in the ratio of 3:1 (LOD IOng/mL). The chromatographic·
separations were achieved on a DB5ms fused-silica capillary column (30m x 0.25mm x 0,25J.lm film
thickness) using helium as carrier gas at lml/min flow rate.
Results: It was found that the commonest illicit drug detected in this programme was cannabis ( 20%)
followed by opiates (9.9 % ) and amphetamines (9 %). Other classes of illicit drugs (cocaine, LSD and
psilocine) were not detected.
Conclusions: Specimens tested positive for opiates and amphetamines showed decreasing tendency during
the whole period of the detoxification programme but specimens tested positive for cannabinoids were
stable over time. It seems to be problem concerning the number of positives because positive results for
cannabis caused temporary discharge from treatment. In addition to this problem we have to admit that GC­
MS such as Magnum does not able to offer sufficient analytical sensitivity for LSD analysis. A cut-off
value of LSD immunochemical assay is 1 ng/ml but LOD for our GC-MS procedure was 25 ng/ml after
silylation with BSTFA + TMCS, 99 + 1). However, methylamphetamine and heroin users mostly prevailed.
Therefore LSD did not belong to main drugs of abuse in this controlled group of abusers. Positive results
for LSD above a cut-off value were not obtained. Nevertheless in spite of these facts the analytical data
derived from this survey give relative satisfaction and demonstrate the high level of effectiveness of this
manner of drugs of abuse therapy.
Keywords: drugs of abuse, substitution therapy, detoxification programme
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