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Fast and Highly Selective LC-MS/MS Screening for THC and 16 Other Abused Drugs and Metabolites in Human Hair to Monitor Patients for Drug Abuse

Koster, Remco A. BSc*; Alffenaar, Jan-Willem C. PhD, PharmD*; Greijdanus, Ben BSc*; VanDerNagel, Joanneke E. L. MD†,‡; Uges, Donald R. A. PhD, PharmD*

doi: 10.1097/FTD.0b013e3182a377e8
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Background: To facilitate the monitoring of drug abuse by patients, a method was developed and validated for the analysis of amphetamine, methamphetamine, 3,4-methylenedioxymethamphetamine, methylenedioxyamphetamine, methylenedioxyethylamphetamine, methylphenidate, cocaine, benzoylecgonine, morphine, codeine, heroin, 6-monoacteylmorphine, methadone, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP), delta-9-tetrahydrocannabinol (THC), nicotine, and cotinine in human hair.

Methods: The hair preparation method contains a 3-step wash procedure with dichloromethane followed by a simultaneous hair pulverization and extraction procedure with disposable metal balls. The developed liquid chromatography tandem mass spectrometry method uses a single injection to detect and confirm all 17 abused drugs, including THC, within 4.8 minutes.

Results: Nicotine was validated with a linear range of 800–25,000 pg/mg hair, and all other substances were validated with a linear range of 30.0–2500 pg/mg hair. For inaccuracy and imprecision, the overall bias did not exceed −8.2% and the overall coefficient of variation did not exceed 17.7%. Autosampler stability was proven for 48 hours at 10°C for all substances. Analytical cutoff concentrations were defined for each substance at the lowest validated inaccuracy and imprecision concentration with a bias and coefficient of variation within 15% and qualifier/quantifier ratios within 20% of the set ratio. The analytical cutoff concentrations were 200 pg/mg for codeine and 80.0 pg/mg for 6-MAM, heroin, EDDP, and THC. The analytical cutoff concentration for nicotine was 800 pg/mg and for all other validated substances 30.0 pg/mg. This method was successfully applied to analyze hair samples from patients who were monitored for drug abuse. Hair samples of 47 subjects (segmented into 129 samples) showed 3,4-methylenedioxymethamphetamine, methylphenidate, cocaine, benzoylecgonine, codeine, methadone, EDDP, THC, nicotine, and cotinine above the analytical cutoff.

Conclusions: The method was fully validated, including the validation of the qualifier/quantifier ratios. The analysis of real hair samples proved the efficacy of the developed method for monitoring drug abuse. The results obtained by this method provide the physician or health-care professional with extensive information about actual drug abuse or relapse and can be used for patient-specific therapy.

Supplemental Digital Content is Available in the Text.

*Laboratory for Clinical and Forensic Toxicology and Drugs Analysis, Department of Hospital and Clinical Pharmacy, University of Groningen, University Medical Center Groningen;

SumID-Project, Zorgontwikkeling, Tactus Addiction Medicine, Deventer; and

ACSW-Nijmegen Institute for Scientist-Practitioners in Addiction, Radboud University, Nijmegen, The Netherlands.

Correspondence: Remco A. Koster, BSc, Laboratory for Clinical and Forensic Toxicology and Drugs Analysis, Department of Hospital and Clinical Pharmacy, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands (e-mail: r.koster@umcg.nl).

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.drug-monitoring.com).

The authors declare no funding or conflict of interest.

Received April 01, 2012

Accepted July 03, 2013

© 2014 by Lippincott Williams & Wilkins