r; Substance Abuse and Montal Hoalth :1'.!.!Mt(~!
Transcript of r; Substance Abuse and Montal Hoalth :1'.!.!Mt(~!
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...r; Substance Abuse and Montal Hoalth SoNloos Administration
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Drug Metabolites and Hair Testing
Robert M. White, Sr., Ph.D., DABCC, F-ABFT
Rockville, Maryland
March 20, 2017
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Urine Drug/Drug Metabolite Testing
• Current urine drug testing under the DHHS Mandatory Guidelines allows testing for Cannabinoids, Cocaine Metabolite, Amphetamines, Opiates, and PCP and Specimen Validity Testing or SVT.
• Numerous other drugs and drug metabolites.
• Whether a parent drug and/or a metabolite is present, a urine positive shows use.
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Urine Specimen - Filtered Blood
By Madhero88 - Own
workReferenceshere, CC BY 3.0,
https://commons.wikimedia.org/w/index.p
hp?curid=9665603
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Hair Drug Testing
• Hair, as harvested for testing, was removed from completely outside the body.
• Currently, most testing for drugs of abuse in hair is performed by targeting parent drugs except for the major metabolite of Δ9-tetrahydrocannabinol (“THC”), 11-nor-Δ9-tetrahydrocannabinol-9-carboxylic acid or THCA (Carboxy-THC, THCCOOH).
• Major Issue: External contamination by drugs.
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Hair Drug Testing (continued)
• Potential remedy to show actual use as opposed to simple exposure:
– A common metabolite that is NOT 1) a separately marketed drug or 2) a manufacturing impurity or 3) a chemical decomposition product or 4) the product of an in vitro chemical reaction on the hair.
• Unacceptable candidate marker to show cocaine use:
– Benzoylecgonine.
• Potentially good candidate marker for codeine:
– Norcodeine to indicate the use of codeine. 6
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Incorporation & Metabolism
Reprinted for presentation with permission from Saunders-Elsevier. 7
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Metabolites in Hair
• By incorporation of the formed metabolite into hair.
– Lipophilicity or lipid solubility (melanin affinity).
– Basicity.
• By parent drug metabolism in the hair.
– Convert the parent drug to the desired metabolite by enzymes in the papilla or hair shaft.
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THC
• Commonly, THCA in hair is tested to show use of parent THC.
• Glucuronide: Pichini et al., FSI, 2015.
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Cocaine
• Numerous impurities in illicit and pharmaceutical cocaine.
• Multiple metabolites of cocaine have been identified.
• Possible metabolite set to demonstrate use of parent cocaine:
ortho, meta & para-Hydroxycocaines
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4-Hydroxy- or
para-Hydroxymethamphetamine
Amphetamines
• Possible metabolite set to demonstrate use of methamphetamine/amphetamine would be the hydroxyamphetamines.
→ CYP2D6
Methamphetamine
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Amphetamines (continued)
• ortho-, meta- and para- (or 2-, 3-, and 4-) Hydroxymethamphetamines themselves may be produced by the action of oxidizing agents on methamphetamine deposited on hair.
• Glucuronide or sulfate conjugates of the hydroxy amphetamines to show use of the parent drugs.
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Amphetamines (continued)
• Possible metabolite set to demonstrate use of MDMA/MDA:
CYP2D6, 3A4, 1A2, 2B6
→
3,4-Dihydroxymethamphetamine MDMA ↓ COMT
↓ CYP2D6
4-Hydroxy-3-methoxymethamphetamineMDA
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Phencyclidine (PCP)
• Possible metabolite to demonstrate use of parent drug:
– trans-PCPdiol (Nakahara et al., JAT, 1997).
• Hydroxyphencyclidines may be produced by the action of oxidizing agents on PCP deposited on hair. 14
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Codeine & Morphine
• Possible metabolites to demonstrate use of either parent drug:
– Norcodeine (Codeine; CYP3A4).
– Normorphine (Morphine; CYP3A4).
– Glucuronide conjugates of either drug (UGT).
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Hydrocodone & Hydromorphone
• Possible metabolites to demonstrate use of either parent drug:
– Glucuronide conjugates (UGT).
– nor Metabolites (CYP3A4).
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Oxycodone & Oxymorphone
• Possible metabolites to demonstrate use of either parent drug:
– nor Metabolites (CYP3A4).
– Glucuronide conjugates (UGT).
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Metabolites in Hair to Show Use of a Parent Drug
• Choices for metabolites to demonstrate that a drug or drug class was used by a donor currently exist.
• Drug metabolites exist in hair as the result of complex processes that probably include a combination of incorporation and metabolism in hair/hair bulb.
• Drug metabolism may be limited in a small number of cases due to polymorphism and other enzyme inactivation.
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Potential Studies
• Incidence of enzymatic oxidation failures.
– e.g. Demethylation of opioids or hydroxylation of amphetamines.
• Incidence of demethylenation (MDMA & MDA).
• Oxidation of surface drug contamination using a broader range of potential hair products.
• White, FSR, 2017.
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A lot remains to be accomplished.
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