Immunochemical detection of drugs used for the management of heroin dependence and other opioids

摘要

In France in 2007, between 12000 and 15 000 patients were treated by methadone and more than 80000 by buprenorphine. A rapid detection of these two compounds has to be available for the monitoring of these patients, or in forensic cases since these compounds are found in more than 8% of the deceases. Many studies were published on the different marketed tests. All these tests were validated in urine, but many of them, notably ELISA tests, were also validated in whole blood, serum, plasma, oral fluid or hair. The used cut-offs were in the range 5-300 ng/mL for methadone and 0.5-5 ng/mL for buprenorphine depending on the tests and the matrix. In hair, the proposed cut-offs were 200 pg/mg for methadone and 10 pg/mg for buprenorphine. The cross-reactivity of EDDP, the main metabolite of methadone, is very low, but some tests used a specific antibody for this metabolite. The cross-reactivity of norbuprenor-phine, the main metabolite of buprenorphine, is in the range 1-100%. False-positives for methadone were attributable to metabolites of verapamil, some neuroleptics, diphenydramine and doxylamine and to tramadol and dihydrocodeine for buprenorphine tests. More recently, immunotests have been developped for the screening of opioid drugs that are not detected by usual opiate immunoassay, like dextropropoxyphene, oxycodone and fentanyl. These tests may be very interesting in some cases.