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Lack of Detection of New Amphetamine-Like Drugs Using Conventional Urinary Immunoassays.
Ther Drug Monit 2018; 40(1):135-139TD

Abstract

BACKGROUND

The number of reports of serious adverse effects and intoxication after the use of the new drug 4-fluoroamphetamine (4-FA) increases. At the Emergency Department of the OLVG-Oost Hospital in Amsterdam, an on-site drug test, the Triage TOX Drug Screen, is available to assist in a rapid diagnosis. In less urgent cases, an EMIT II Plus immunoassay is used to determine semiquantitatively the presence of drugs of abuse (DOA). The antibodies in these immunoassays are designed to detect classic DOA and its urinary metabolites. Amphetamine-like drugs that may cause serious toxicity or impairment may not cross-react with the available immunoassay kits, and therefore may stay undetected. The question arises as to whether 4-FA and paramethoxymethamphetamine (PMMA) are detectable in the toxicological screening procedures commonly used for testing in urine.

METHODS

Synthetic urine was spiked with the drug under investigation to create spiking standards of 50, 100, 250, 500, 2500, and 5000 ng/mL. Urine drug screens were performed on the automated analyzer Biosite Triage MeterPro using the Triage TOX Drug Screen test and on a Siemens Drug Testing System Viva-E using the EMIT II Plus Ecstasy Assay and the EMIT II Plus Amphetamines Assay.

RESULTS

In this concentration range, the EMIT II Plus did not screen positive for PMMA, but there was some cross-reactivity for PMMA on the EMIT II Plus Ecstasy assay. The Triage TOX Drug Screen did test positive for PMMA at a concentration of 2500 ng/mL. The EMIT II Plus Amphetamines did test positive for 4-FA at a concentration of 5000 ng/mL, whereas the Ecstasy [3,4-methylenedioxymethamphetamine (MDMA)] assay only showed low cross-reactivity for 4-FA. The Triage TOX Drug Screen did not test positive for 4-FA.

CONCLUSIONS

The available immunoassays lack sensitivity to detect 4-FA and PMMA in lower urine concentrations. Awareness of the fact that novel DOA may lead to false-negative urinary drug tests is of great importance.

Authors+Show Affiliations

Department of Pharmacy, University of Groningen, Groningen. Department of Pharmacy, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.Department of Pharmacy, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29194289

Citation

Begeman, Anja, and Eric J F. Franssen. "Lack of Detection of New Amphetamine-Like Drugs Using Conventional Urinary Immunoassays." Therapeutic Drug Monitoring, vol. 40, no. 1, 2018, pp. 135-139.
Begeman A, Franssen EJF. Lack of Detection of New Amphetamine-Like Drugs Using Conventional Urinary Immunoassays. Ther Drug Monit. 2018;40(1):135-139.
Begeman, A., & Franssen, E. J. F. (2018). Lack of Detection of New Amphetamine-Like Drugs Using Conventional Urinary Immunoassays. Therapeutic Drug Monitoring, 40(1), pp. 135-139. doi:10.1097/FTD.0000000000000475.
Begeman A, Franssen EJF. Lack of Detection of New Amphetamine-Like Drugs Using Conventional Urinary Immunoassays. Ther Drug Monit. 2018;40(1):135-139. PubMed PMID: 29194289.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Lack of Detection of New Amphetamine-Like Drugs Using Conventional Urinary Immunoassays. AU - Begeman,Anja, AU - Franssen,Eric J F, PY - 2017/12/2/pubmed PY - 2018/11/10/medline PY - 2017/12/2/entrez SP - 135 EP - 139 JF - Therapeutic drug monitoring JO - Ther Drug Monit VL - 40 IS - 1 N2 - BACKGROUND: The number of reports of serious adverse effects and intoxication after the use of the new drug 4-fluoroamphetamine (4-FA) increases. At the Emergency Department of the OLVG-Oost Hospital in Amsterdam, an on-site drug test, the Triage TOX Drug Screen, is available to assist in a rapid diagnosis. In less urgent cases, an EMIT II Plus immunoassay is used to determine semiquantitatively the presence of drugs of abuse (DOA). The antibodies in these immunoassays are designed to detect classic DOA and its urinary metabolites. Amphetamine-like drugs that may cause serious toxicity or impairment may not cross-react with the available immunoassay kits, and therefore may stay undetected. The question arises as to whether 4-FA and paramethoxymethamphetamine (PMMA) are detectable in the toxicological screening procedures commonly used for testing in urine. METHODS: Synthetic urine was spiked with the drug under investigation to create spiking standards of 50, 100, 250, 500, 2500, and 5000 ng/mL. Urine drug screens were performed on the automated analyzer Biosite Triage MeterPro using the Triage TOX Drug Screen test and on a Siemens Drug Testing System Viva-E using the EMIT II Plus Ecstasy Assay and the EMIT II Plus Amphetamines Assay. RESULTS: In this concentration range, the EMIT II Plus did not screen positive for PMMA, but there was some cross-reactivity for PMMA on the EMIT II Plus Ecstasy assay. The Triage TOX Drug Screen did test positive for PMMA at a concentration of 2500 ng/mL. The EMIT II Plus Amphetamines did test positive for 4-FA at a concentration of 5000 ng/mL, whereas the Ecstasy [3,4-methylenedioxymethamphetamine (MDMA)] assay only showed low cross-reactivity for 4-FA. The Triage TOX Drug Screen did not test positive for 4-FA. CONCLUSIONS: The available immunoassays lack sensitivity to detect 4-FA and PMMA in lower urine concentrations. Awareness of the fact that novel DOA may lead to false-negative urinary drug tests is of great importance. SN - 1536-3694 UR - https://www.unboundmedicine.com/medline/citation/29194289/Lack_of_Detection_of_New_Amphetamine_Like_Drugs_Using_Conventional_Urinary_Immunoassays_ L2 - http://Insights.ovid.com/pubmed?pmid=29194289 DB - PRIME DP - Unbound Medicine ER -