title: New psychoactive substances as part of polydrug abuse within opioid maintenance treatment revealed by comprehensive high-resolution mass spectrometric urine drug screening.
abstract: OBJECTIVE
  At present, polydrug abuse comprises, besides traditional illicit drugs, new psychoactive substances (NPS) and non-prescribed psychotropic medicines (N-PPM). Polydrug abuse was comprehensively evaluated among opioid-dependent patients undergoing opioid maintenance treatment (OMT).
  
  
  METHODS
  Two hundred consecutively collected urine samples from 82 OMT patients (52 male) treated with methadone or buprenorphine-naloxone medication were studied using a liquid chromatography/time-of-flight mass spectrometry screening method. The method enables simultaneous detection of hundreds of abused substances covering the traditional drugs of abuse and many NPS as well as N-PPM.
  
  
  RESULTS
  Ninety-two (45.8%) samples were positive for the abused substances. Benzodiazepines (29.0%), amphetamines (19.5%), cannabinoids (17.0%), NPS (13.0%), N-PPM (9.0%), and opioids (9.0%) were detected in different combinations. The simultaneous occurrence of up to three groups of abused substances was common (40.0%), and in one sample, all six groups were found. The stimulant NPS alpha-pyrrolidinovalerophenone was found in 10.0% and the sedative N-PPM pregabalin in 4.0% of the samples. The patients were seldom aware of what particular NPS they had abused.
  
  
  CONCLUSIONS
  A widespread occurrence of abused substances beyond the ordinary was revealed. Identifying these patients is essential as polydrug abuse is a safety risk to the patient and may cause attrition from OMT.
authors.affiliation: Department of Psychiatry, University of Helsinki, Helsinki, Finland.
authors.forename: Pertti
authors.initials: P
authors.lastname: Heikman
authors.affiliation: Department of Forensic Medicine, University of Helsinki, Helsinki, Finland.
authors.forename: Mira
authors.initials: M
authors.lastname: Sundström
authors.affiliation: Department of Forensic Medicine, University of Helsinki, Helsinki, Finland.
authors.forename: Anna
authors.initials: A
authors.lastname: Pelander
authors.affiliation: Department of Forensic Medicine, University of Helsinki, Helsinki, Finland.
authors.forename: Ilkka
authors.initials: I
authors.lastname: Ojanperä
mesh_terms: D000328:Adult; D000069479:Buprenorphine, Naloxone Drug Combination / Q000008:administration & dosage; D002853:Chromatography, Liquid / Q000379:methods; D005260:Female; D006801:Humans; D013287:Illicit Drugs; D008297:Male; D013058:Mass Spectrometry / Q000379:methods*; D008691:Methadone / Q000008:administration & dosage; D008875:Middle Aged; D058850:Opiate Substitution Treatment; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D011619:Psychotropic Drugs / Q000008:administration & dosage / Q000009:adverse effects; D012189:Retrospective Studies; D015813:Substance Abuse Detection / Q000379:methods*; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000069479:Buprenorphine, Naloxone Drug Combination; D013287:Illicit Drugs; D011619:Psychotropic Drugs; D008691:Methadone
keywords: high-resolution mass spectrometry; new psychoactive substances; opioid maintenance treatment; polydrug abuse; α-PVP