title: Methadone disposition in oral fluid during pharmacotherapy for opioid-dependence.
abstract: BACKGROUND
  Oral fluid testing is widely used for detecting drug exposure, but data describing methadone and metabolites in oral fluid during pharmacotherapy for opioid-dependence are relatively limited.
  
  
  METHODS
  414 oral fluid specimens from 16 opioid-dependent pregnant women receiving daily methadone were analyzed for methadone, 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP), and methadol by liquid chromatography-mass spectrometry.
  
  
  RESULTS
  All oral fluid specimens contained methadone greater than 1 ng/mL; 88% were positive for EDDP and 12% for methadol. Over 95% of oral fluid specimens exceeded the 20 ng/mL methadone cutoff set by the European Driving Under the Influence of Drugs, Alcohol and Medicines (DRUID) study. Methadone and EDDP oral fluid concentrations were highly variable within and between participants, did not predict methadone dose, but were negatively correlated with pH.
  
  
  CONCLUSIONS
  Methadone was readily identified in oral fluid at concentrations greater than 20 ng/mL following daily 30-110 mg/day methadone pharmacotherapy. As no specimens contained only EDDP or methadol, there was no advantage to including these analytes for identification of methadone exposure. As nearly all oral fluid specimens from methadone-maintained patients exceeded the DRUID guideline, the 20 ng/mL cutoff appears to be sensitive enough to detect daily methadone exposure; however, additional indicators of behavioral and/or motor impairment would be necessary to provide evidence of driving impairment.
authors.affiliation: Chemistry and Drug Metabolism, National Institute on Drug Abuse, National Institutes of Health, 251 Bayview Blvd, Suite 200, Room 05A721, Baltimore, MD 21224, USA. teresa.r.gray@gmail.com
authors.forename: Teresa R
authors.initials: TR
authors.lastname: Gray
authors.forename: Riet
authors.initials: R
authors.lastname: Dams
authors.forename: Robin E
authors.initials: RE
authors.lastname: Choo
authors.forename: Hendree E
authors.initials: HE
authors.lastname: Jones
authors.forename: Marilyn A
authors.initials: MA
authors.lastname: Huestis
mesh_terms: D002853:Chromatography, Liquid; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D013058:Mass Spectrometry; D008691:Methadone / Q000032:analysis* / Q000627:therapeutic use; D008692:Methadyl Acetate / Q000032:analysis; D009294:Narcotics / Q000032:analysis* / Q000627:therapeutic use; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D011247:Pregnancy; D011759:Pyrrolidines / Q000032:analysis; D012463:Saliva / Q000737:chemistry*
chemical_list: D009294:Narcotics; D011759:Pyrrolidines; D008692:Methadyl Acetate; D008691:Methadone; C010724:2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine