Urine has been the preferred matrix for monitoring heroin and methadone adherence due to its large detection window. Drawbacks such as privacy concerns and adulteration however require other matrices. The study aims to determine if oral fluid and exhaled breath are suitable alternatives for heroin and methadone monitoring and to assess the detection time in exhaled breath. Forty-three participants, all on methadone and heroin-assisted treatment, were studied. Participants were monitored after the first and right before the second dosage of heroin. At both time points, oral fluid and exhaled breath samples were collected with urine at the second time point. All samples were screened for opiates, methadone and other drugs using immunoassay and LC–MS-MS. At the second time point, 98% of oral fluid samples and all exhaled breath samples tested positive for 6-monoacetylmorphine (6-MAM). Regarding morphine detection, the findings were reversed (100% in oral fluid, 98% in exhaled breath). Methadone-related results were 100% positive across all matrices, as expected. Notable is the detection of the heroin marker acetylcodeine in oral fluid and exhaled breath samples, which resulted in relatively low negative predictive value (average 54.6%). Oral fluid and exhaled breath are suitable alternatives for heroin and methadone maintenance monitoring. Clinicians should consider ease of collection, adulteration risk, costs, turn-around time and the substance of interest while choosing a matrix. In addition, even in cases when medicinal heroin is used, medical professionals should be aware of the presence of acetylcodeine in these alternate matrices.

中文翻译：

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在慢性海洛因使用障碍患者的美沙酮维持治疗计划中使用呼吸或口腔液作为基质进行依从性监测：问题和结果解释

由于其较大的检测窗口，尿液已成为监测海洛因和美沙酮依从性的首选基质。然而，隐私问题和掺假等缺点需要其他矩阵。该研究旨在确定口腔液和呼出气是否适合替代海洛因和美沙酮监测，并评估呼出气的检测时间。对 43 名参与者进行了研究，他们全部接受美沙酮和海洛因辅助治疗。在第一次服用海洛因之后和第二次服用海洛因之前对参与者进行监测。在两个时间点，在第二个时间点收集口腔液和呼出气样本以及尿液。使用免疫分析和 LC-MS-MS 对所有样品进行阿片类药物、美沙酮和其他药物的筛查。在第二个时间点，98% 的口腔液样本和所有呼出气样本的 6-单乙酰吗啡 (6-MAM) 检测呈阳性。关于吗啡检测，结果相反（口腔液中 100%，呼出气中 98%）。正如预期的那样，所有基质中美沙酮相关结果均为 100% 阳性。值得注意的是，在口腔液和呼出气样本中检测到了海洛因标记物乙酰可待因，导致阴性预测值相对较低（平均 54.6%）。口腔液和呼出气是海洛因和美沙酮维持监测的合适替代方案。临床医生在选择基质时应考虑收集的难易程度、掺假风险、成本、周转时间和感兴趣的物质。此外，即使在使用药用海洛因的情况下，医疗专业人员也应该意识到这些替代基质中乙酰可待因的存在。