Sectional hair testing. Judicial and clinical applications

Modern sophisticated analytical tools have enabled toxicologists to investigate hair specimens for the presence of drugs. Although great sensitivity and specificity in hair analysis have been already achieved, some concerns about bias due to hair color, lack of reference materials, and dose versus concentration relationship make the quantitative data sometimes debatable. The most commonly held opinion in this field nowadays indicates that hair analysis has sufficient scientific validity. Experts should always be aware and take into account limitations of hair analysis results and its evaluation. Unresolved scientific issues, however, should not obstruct the admissibility of strongly positive test results. Recent applications of hair testing include forensic investigations, epidemiological studies, gestational drug exposure, legal issues, clinical drug monitoring, and historical research. In this paper, the use of sectional hair tests to assess exposure to drugs of abuse (evaluation of toxicomania) and to assess compliance with carbamazepine, phenytoin and valproic acid therapy regime is presented. We conclude that hair drug versus time profiles give strong evidence that confirm chronic abuse, the diagnosis of drugs of abuse poisoning, and the state of addiction (toxicomania). Additionally, they may be used as a marker of the dosage history and the compliance of patients under long-term treatment with carbamazepine and phenytoin.

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Hair testing for 3-fluorofentanyl, furanylfentanyl, methoxyacetylfentanyl, carfentanil, acetylfentanyl and fentanyl by LC–MS/MS after unintentional overdose

Forensic Toxicology ◽

10.1007/s11419-019-00502-0 ◽

2019 ◽

Vol 38 (1) ◽

pp. 277-286 ◽

Cited By ~ 4

Author(s):

Islam Amine Larabi ◽

Marie Martin ◽

Nicolas Fabresse ◽

Isabelle Etting ◽

Yve Edel ◽

...

Keyword(s):

Drugs Of Abuse ◽

Hair Analysis ◽

Methadone Treatment ◽

Time Frame ◽

Repetitive Exposure ◽

Hair Samples ◽

Liquid Chromatography Tandem Mass ◽

Exposure Pattern ◽

Hair Testing ◽

Urine Testing

Abstract Purpose To demonstrate the usefulness of hair testing to determine exposure pattern to fentanyls. Methods A 43-year-old male was found unconscious with respiratory depression 15 min after snorting 3 mg of a powder labeled as butyrylfentanyl. He was discharged from hospital within 2 days without blood or urine testing. Two locks of hair were sampled 1 month (M1 A: 0–2 cm (overdose time frame); B: 2–4 cm; C: 4–6 cm) and 1 year (Y1: A: 0–2 cm; B: 2–4 cm) later to monitor his exposure to drugs of abuse by liquid chromatography–tandem mass spectrometry after liquid-liquid extraction. Results Hair analysis at M1 showed a repetitive exposure to 3-fluorofentanyl (A/B/C: 150/80/60 pg/mg) with higher concentration in segment A reflecting the overdose period. The non-detection of butyrylfentanyl was consistent with the analysis of the recovered powder identified as 3-fluorofentanyl. Furanylfentanyl (40/20/15 pg/mg) and fentanyl (37/25/3 pg/mg) were also detected in hair. The second hair analysis at Y1 showed the use of three new fentanyls, with probably repetitive exposures to methoxyacetylfentanyl (A/B: 500/600 pg/mg), and single or few exposures to carfentanil (2.5/3 pg/mg) and acetyl fentanyl (1/1 pg/mg). A decreasing exposure to 3-fluorofentanyl (25/80 pg/mg), and increasing consumption of furanylfentanyl (310/500 pg/mg) and fentanyl (620/760 pg/mg) were also observed despite methadone treatment initiation. The patient claimed not consuming three out of the six detected fentanyls. Conclusions We report single or repetitive exposure to several fentanyls using hair testing. To our knowledge, this is the first demonstration of 3-fluorofentanyl and methoxyacetylfentanyl in hair samples collected from an authentic abuser.

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Hair as a Biological Indicator of Drug Use, Drug Abuse or Chronic Exposure to Environmental Toxicants

International Journal of Toxicology ◽

10.1080/10915810600683028 ◽

2006 ◽

Vol 25 (3) ◽

pp. 143-163 ◽

Cited By ~ 103

Author(s):

Vassiliki A. Boumba ◽

Kallirroe S. Ziavrou ◽

Theodore Vougiouklakis

Keyword(s):

Drug Use ◽

Chronic Exposure ◽

Drug Testing ◽

Drugs Of Abuse ◽

Hair Analysis ◽

Clinical Chemistry ◽

Biological Indicator ◽

Environmental Toxicants ◽

Hair Samples ◽

Hair Testing

In recent years hair has become a fundamental biological specimen, alternative to the usual samples blood and urine, for drug testing in the fields of forensic toxicology, clinical toxicology and clinical chemistry. Moreover, hair-testing is now extensively used in workplace testing, as well as, on legal cases, historical research etc. This article reviews methodological and practical issues related to the application of hair as a biological indicator of drug use/abuse or of chronic exposure to environmental toxicants. Hair structure and the mechanisms of drug incorporation into it are commented. The usual preparation and extraction methods as well as the analytical techniques of hair samples are presented and commented on. The outcomes of hair analysis have been reviewed for the following categories: drugs of abuse (opiates, cocaine and related, amphetamines, cannabinoids), benzodiazepines, prescribed drugs, pesticides and organic pollutants, doping agents and other drugs or substances. Finally, the specific purpose of the hair testing is discussed along with the interpretation of hair analysis results regarding the limitations of the applied procedures.

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Technical Issues Concerning Hair Analysis for Drugs of Abuse

PsycEXTRA Dataset ◽

10.1037/e495752006-013 ◽

1995 ◽

Author(s):

Martha R. Harkey

Keyword(s):

Drugs Of Abuse ◽

Hair Analysis ◽

Technical Issues

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Hair Testing and Maternal Drug Exposure

Family Practice News ◽

10.1016/s0300-7073(05)71760-6 ◽

2005 ◽

Vol 35 (18) ◽

pp. 45

Author(s):

GIDEON KOREN

Keyword(s):

Drug Exposure ◽

Hair Testing

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The Potential for Bias in Hair Testing for Drugs of Abuse

Drug Testing in Hair ◽

10.1201/9781003068884-4 ◽

2020 ◽

pp. 69-93

Author(s):

Edward J. Cone ◽

Robert E. Joseph

Keyword(s):

Drugs Of Abuse ◽

Hair Testing

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HAIR ANALYSIS FOR DRUGS OF ABUSE. PLAUSIBILITY OF INTERPRETATION

Biomedical Papers ◽

10.5507/bp.2005.026 ◽

2005 ◽

Vol 149 (2) ◽

pp. 199-207 ◽

Cited By ~ 32

Author(s):

Marie Balikova

Keyword(s):

Drugs Of Abuse ◽

Hair Analysis

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Neuroendocrinology of Stress and Addiction

10.1093/acrefore/9780190264086.013.252 ◽

2021 ◽

Author(s):

Steven Kinsey ◽

Olivia Vanegas ◽

Kristen Trexler ◽

Floyd Steele ◽

Matthew Eckard

Keyword(s):

Stress Response ◽

Psychotropic Drugs ◽

Drug Exposure ◽

Drugs Of Abuse ◽

Drug Withdrawal ◽

Host Organism ◽

Repeated Use ◽

Drug Abstinence ◽

Withdrawal Syndromes ◽

Development Of Tolerance

The stress response evolved as a series of neural and endocrine mechanisms that protect the host organism from threats to homeostasis. Repeated use of psychotropic drugs can lead to the development of tolerance (i.e., decreased drug activity at a given dose) and drug dependence, as indicated by withdrawal syndromes following drug abstinence. Drug withdrawal is often overtly stressful, although acute drug exposure may also represent a threat to homeostasis. This article explores the neuroendocrine effects of drugs of abuse and some of the ways in which stress and appetitive mechanisms interact.

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Influence of Drug Exposure on Vedolizumab-Induced Endoscopic Remission in Anti-Tumour Necrosis Factor [TNF] Naïve and Anti-TNF Exposed IBD Patients

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz151 ◽

2019 ◽

Vol 14 (3) ◽

pp. 332-341 ◽

Cited By ~ 7

Author(s):

Bram Verstockt ◽

Evelien Mertens ◽

Erwin Dreesen ◽

An Outtier ◽

Maja Noman ◽

...

Keyword(s):

Tumour Necrosis Factor ◽

Tumour Necrosis ◽

Drug Exposure ◽

Real Life ◽

Predictive Biomarkers ◽

Treatment Intensification ◽

Tertiary Referral Centre ◽

Long Term Treatment ◽

Endoscopic Remission ◽

Necrosis Factor

Abstract Background and Objectives Vedolizumab has demonstrated efficacy and safety in patients with Crohn's disease [CD] and ulcerative colitis [UC]. Endoscopic outcome data are limited, especially in anti-tumour necrosis factor [TNF] naïve patients. The present study compared endoscopic outcome in anti-TNF naïve and exposed patients, and explored if this was affected by drug exposure. Methods We retrospectively analysed all patients initiating vedolizumab at our tertiary referral centre since 2015. For UC, endoscopic improvement was defined as a Mayo endoscopic subscore ≤1 at week 14. For CD, endoscopic remission was defined as absence of ulcerations at week 22. Vedolizumab trough concentrations were measured at week 6, week 14 and during maintenance. Results A total of 336 patients were identified [53.3% CD], 20% of them being anti-TNF naïve. Endoscopic improvement was achieved by 56.1% of UC patients and endoscopic remission by 39.1% of CD patients. Endoscopic outcomes were significantly better in anti-TNF naïve vs exposed patients [all: 67.2% vs 42.0%, p = 0.0002; UC: 74.4% vs 50.0%, p = 0.02; CD: 57.1% vs 35.8%, p = 0.03]. Achievement of endoscopic end points significantly impacted long-term treatment continuation [p = 9.7 × 10−13]. A better endoscopic outcome was associated with significantly higher drug exposure in both CD and UC. Conclusions The results of this observational, single-centre real-life study suggest that vedolizumab may induce endoscopic remission in both CD and UC. Although anti-TNF naïve patients had a significantly better outcome, 42% of anti-TNF exposed patients still benefited endoscopically. A clear exposure–endoscopic response relationship exists, but not all patients will benefit from treatment intensification. Hence, predictive biomarkers remain necessary. Podcast This article has an associated podcast which can be accessed at https://academic.oup.com/ecco-jcc/pages/podcast

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