ABSTRACT
BACKGROUND: The abuse of synthetic cannabinoids (SCs) as presumed legal alternative to cannabis poses a great risk to public health. For economic reasons many laboratories use immunoassays (IAs) to screen for these substances in urine. However, the structural diversity and high potency of these designer drugs places high demands on IAs regarding cross-reactivity of the antibodies used and detection limits. METHODS: Two retrospective studies were carried out in order to evaluate the capability of two homogenous enzyme IAs for the detection of currently prevalent SCs in authentic urine samples. Urine samples were analyzed utilizing a 'JWH-018' kit and a 'UR-144' kit. The IA results were confirmed by an up-to-date liquid chromatography-electrospray ionization-tandem mass spectrometry (LC-ESI-MS/MS) screening method covering metabolites of 45 SCs. RESULTS: The first study (n=549) showed an 8% prevalence of SCs use (LC-MS/MS analysis) among inpatients of forensic-psychiatric clinics, whereas all samples were tested negative by the IAs. In a second study (n=200) the combined application of both IAs led to a sensitivity of 2% and a diagnostic accuracy of 51% when applying the recommended IA cut-offs. Overall, 10 different currently prevalent SCs were detected in this population. The results can be explained by an insufficient cross-reactivity of the antibodies towards current SCs in combination with relatively high detection limits of the IAs. CONCLUSIONS: In light of the presented study data it is strongly recommended not to rely on the evaluated IA tests for SCs in clinical or forensic settings. For IA kits of other providers similar results can be expected.
Subject(s)
Cannabinoids/urine , Immunoassay , Substance Abuse Detection , Cannabinoids/chemistry , Cannabinoids/metabolism , Humans , Retrospective Studies , Spectrometry, Mass, Electrospray Ionization , Tandem Mass SpectrometryABSTRACT
AIMS: Compulsory admissions according to section sign 64 German penal code are rising. There is also a dramatic increase in dropout-rates with regard to coercive therapeutic interventions in forensic facilities specialized in the treatment of offenders addicted to drugs or alcohol. METHODS: By means of two case histories dilemmas of expert opinion and coercive treatment of offenders addicted to drugs or alcohol are illustrated. RESULTS AND CONCLUSIONS: Consideration of current results in addiction research should be an obligatory element of expert opinion and coercive treatment programmes in forensic facilities to provide for sufficient quality standards. Even when strict quality criteria are considered failures in placement of offenders with drug or alcohol addiction can not be ruled out. Besides scientific criteria a variety of other factors may influence the decision to coercive drug addiction therapy in a forensic facility e. g. jurisdiction or even tactical statements of the offender.
