Pharmacopsychiatry 2024; 57(02): 88
DOI: 10.1055/s-0044-1779562
Abstracts │ XVth Symposium of the Task Force Therapeutic Drug Monitoring of the AGNP
Lecture Abstracts

Therapeutic Drug Monitoring (TDM) in addiction medicine from the laboratory perspective

J. Neumann
1   Abteilung Drogen-/Medikamentenanalytik, MVZ Medizinische Labore Dessau Kassel GmbH, Dessau, Germany
M. Böttcher
1   Abteilung Drogen-/Medikamentenanalytik, MVZ Medizinische Labore Dessau Kassel GmbH, Dessau, Germany
› Author Affiliations

The request of “standard TDM” to aid in dosing of substitution drugs in maintenance therapy is rare. Mostly adherence assessment especially in patients with take-home privilege is needed. The laboratory is asked for support if the clinician suspects that the patient: 1. pauses from substitution, 2. spikes substitute into a drug-free “friend-sample”, 3. reduces dose, 4. increases dose with illegal substitute, 5. is not in steady state or underdosed or 6. is injecting substitute. These points show different significance for the different substitution drugs:

A) Methadone or Polamidone: dose reduction or increase (3., 4.) or enantioselective metabolism (5.) can be disclosed with chiral LC-MS/MS analysis of D- and L-Methadone in plasma. Injection of Methadone can be spotted by the detection of lactose or sucrose in urine (6.). Drug of abuse negative urine must contain 2-ethylene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP) (2).

B) Buprenorphine: patients on Buprenorphine sometimes discontinue the intake of their dose (1., 5.) to prepare for a Heroin relapse. This can be assumed if the metabolic ratio of Buprenorphine/Norbuprenorphine in urine is falling below the reference range. A higher ratio is indicating a new intake or dose increase of the substitute (4, 5.). Urine must contain Buprenorphine, Norbuprenorphine and the corresponding glucuronides (2). TDM (3., 4.) of Buvidal patients can be challenging due to low concentrations.

C) Morphine: contamination of Substitol with Codeine and formation of the minor Morphine metabolite Hydromorphone makes the interpretation of drug test results difficult.

Publication History

Article published online:
12 March 2024

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