Oral Fluid Samples

Amethod wasdeveloped using liquid chromatography linked to atmospheric pressure ionization-tandem mass spectrometry (LC-MS-MS) for the measurement of the opiates, morphine, codeine, 6-monoacetylmorphine (6-MAM), acetylcodeine (AC), and heroin in oralfluid collected from patients attending a substance abuse clinic. Of the513oralfluid samples tested, 297 showed detectable concentrations of1 or more of the opiates and their respective percentage incidence being morphine (97%), codeine (82%), 6-MAM (77%), acetylcodeine (55%), and heroin (45%). Ahigh percentage ofthese opiate-positive samples (40%) haddetectable concentrations ofallopiates tested. Significant correlations (p < 0.0001) werefound between AC and 6-MAM (r =0.95), heroin and6·MAM (r =0.81), and heroin andAC (r = 0.84). Although noneof the subjects in this study werebeing treated with prescription heroin, nine showed detectable concentrations ofheroin with nodetectable AC. The mean concentration of heroin in these lattersamples was very low compared with samples showing detectable AC (24 vs, 2571 pg/t), Several studies have reported the usefulness of measuring AC in urine fordetection of illicit heroin abuse. This study demonstrates that the same marker canalsobeapplied to oral fluid. The additional measurement of heroin inoralfluid isof limited usein monitoring subjects attending a substance abuse clinic.