根据疾病控制中心,2021年,美国有超过107,000例药物过量死亡,其中超过8万人是由于阿片类药物造成的。最脆弱的人群之一是美国退伍军人。近25万名退伍军人患有与物质有关的疾病(SRD)。对于那些寻求治疗的人来说,丁丙诺啡用于帮助治疗阿片类药物使用障碍(OUD)。尿液分析目前用于监测丁丙诺啡的依从性以及检测治疗期间的非法药物使用。有时,如果患者试图产生丁丙诺啡尿液测试假阳性或掩盖非法药物,则会发生样品篡改,两者都可能影响治疗。为了解决这个问题,我们一直在开发一种即时(POC)分析仪,可以快速测量用于治疗的药物和患者唾液中的非法药物,最好是在physi-cian的办公室。两步分析仪采用(1)支持的液体萃取(SLE)从唾液中分离药物,以及(2)表面增强拉曼光谱(SERS)检测药物。使用原型SLE-SERS-POC分析仪以ng/mL的浓度定量丁丙诺啡,并在不到20分钟的时间内从20名SRD退伍军人收集的少于1mL的唾液中识别非法药物。它在20个样品中的19个中正确检测到丁丙诺啡(18个真阳性,1个真阴性和1个假阴性)。它还确定了患者样本中的其他10种药物:对乙酰氨基酚,安非他明,大麻二酚,cocathelee,可待因,布洛芬,甲基苯丙胺,美沙酮,尼古丁,和去丁丙诺啡.原型分析仪显示了测量治疗药物和药物使用复发的准确性证据。需要进一步研究和开发该系统。
According to the Center for Disease Control, there were more than 107,000 US drug overdose deaths in 2021, over 80,000 of which due to opioids. One of the more vulnerable populations is US military veterans. Nearly 250,000 military veterans suffer from substance-related disorders (SRD). For those seeking treatment, buprenorphine is prescribed to help treat opioid use disorder (OUD). Urinalysis is currently used to monitor buprenorphine adherence as well as to detect illicit drug use during treatment. Sometimes sample tampering occurs if patients seek to generate a false positive buprenorphine urine test or mask illicit drugs, both of which can compromise treatment. To address this problem, we have been developing a point-of-care (POC) analyzer that can rapidly measure both medications used for treatment and illicit drugs in patient saliva, ideally in the physi-cian\'s office. The two-step analyzer employs (1) supported liquid extraction (SLE) to isolate the drugs from the saliva and (2) surface-enhanced Raman spectroscopy (SERS) to detect the drugs. A prototype SLE-SERS-POC analyzer was used to quantify buprenorphine at ng/mL concentrations and identify illicit drugs in less than 1 mL of saliva collected from 20 SRD veterans in less than 20 min. It correctly detected buprenorphine in 19 of 20 samples (18 true positives, 1 true negative and 1 false negative). It also identified 10 other drugs in patient samples: acetaminophen, amphetamine, cannabidiol, cocaethylene, codeine, ibuprofen, methamphetamine, methadone, nicotine, and norbuprenorphine. The prototype analyzer shows evidence of accuracy in measuring treatment medications and relapse to drug use. Further study and development of the system is warranted.