title: Plasma level monitoring of the major metabolites of diacetylmorphine (heroin) by the "chasing the dragon" route in severe heroin addicts.
abstract: The objective of the present study was to verify if severe physical health problems frequently encountered in heroin addicts and the concomitant use of alcohol and legal or illegal drugs other than heroin influenced the pharmacokinetics of the major metabolites of heroin. We conducted a 90 minutes follow-up of the plasma concentrations of the pharmaceutical heroin, named diacetylmorphine (DAM), in patients recruited in a DAM assisted treatment centre. TADAM (Traitement Assisté par DiAcétylMorphine) aimed to compare the efficacy of heroin-assisted treatment (HAT) compared with methadone maintenance treatment (MMT) for heroin users considered as treatment resistant patients and who have severe physical and mental health problems. Eleven patients were recruited. Blood samples were collected at baseline and 15, 45 and 90 minutes after DAM administration. All patients received DAM by the "chasing the dragon" route. Plasma samples were analyzed by a previously described ultra-high pressure liquid chromatography coupled to tandem mass spectrometry (UHPLC/MS-MS) method. A principal component analysis (PCA) was performed and 8 metabolite concentrations ratios were calculated to evaluate the influence of various factors (DAM dose, patient pathologies, concomitant use of medications, methadone, street heroin, alcohol and cocaine) on heroin metabolite pharmacokinetics. It seemed to be not affected by the DAM dose, patient pathologies and the concomitant use of medications, methadone, street heroin and alcohol. Cocaine use was the only parameter which showed differences in heroin pharmacokinetics.
authors.affiliation: Laboratory of Clinical, Forensic, Environmental and Industrial Toxicology, CHU, Liège. nathalie.dubois@chu.ulg.ac.be
authors.forename: N
authors.initials: N
authors.lastname: Dubois
authors.affiliation: Department of Psychiatry, CHU, Liège.
authors.forename: I
authors.initials: I
authors.lastname: Demaret
authors.affiliation: Department of Psychiatry, CHU, Liège.
authors.forename: M
authors.initials: M
authors.lastname: Ansseau
authors.affiliation: Laboratory of Analytical Chemistry, Department of Pharmacy, University of Liège.
authors.forename: E
authors.initials: E
authors.lastname: Rozet
authors.affiliation: Laboratory of Analytical Chemistry, Department of Pharmacy, University of Liège.
authors.forename: Ph
authors.initials: P
authors.lastname: Hubert
authors.affiliation: Laboratory of Clinical, Forensic, Environmental and Industrial Toxicology, CHU, Liège.
authors.forename: C
authors.initials: C
authors.lastname: Charlier
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000097:blood; D002851:Chromatography, High Pressure Liquid; D019970:Cocaine-Related Disorders / Q000097:blood; D003932:Heroin / Q000378:metabolism* / Q000493:pharmacokinetics; D006556:Heroin Dependence / Q000097:blood* / Q000188:drug therapy; D006801:Humans; D013287:Illicit Drugs / Q000097:blood; D008691:Methadone / Q000627:therapeutic use; D008875:Middle Aged; D009294:Narcotics / Q000627:therapeutic use; D058850:Opiate Substitution Treatment; D025341:Principal Component Analysis; D053719:Tandem Mass Spectrometry
chemical_list: D013287:Illicit Drugs; D009294:Narcotics; D003932:Heroin; D008691:Methadone