Published: Journal of Analytical Toxicology, ISSN 0146-4760, Volume 30, Issue 6, July/August 2006, pp.390-394

TECHNICAL NOTE: Screening for Illicit Heroin Use in Patients in a Heroin-Assisted Treatment Program
Elisabeth J. Rook[1], Alwin D.R Huitema[1], Wim van den Brink[2,3], Michel J.X. Hillebrand[1], Jan M. van Ree[2,4], and Jos H. Beijnen[1,5]
[1]Slotervaart Hospital, Department of Pharmacy and Pharmacology, Amsterdam, The Netherlands;
[2]Central Committee on the Treatment of Heroin Addicts, Utrecht, The Netherlands;
[3]Department of Psychiatry, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands;
[4]Rudolf Magnus Institute of Neuroscience, Department of Pharmacology and Anatomy, University Medical Centre Utrecht, Utrecht, The Netherlands; and
[5]Utrecht University, Faculty of Pharmaceutical Sciences, Utrecht, The Netherlands

The aim of this study was to investigate the use of illicit heroin among patients in a heroin-assisted treatment program. In this program, pharmaceutical-grade heroin was administered to heroin-addicted patients. Monitoring of illicit heroin use was considered important for the evaluation of this treatment program. Acetylcodeine and codeine, common adulterants of “street” heroin, were used as markers for illicit heroin. A liquid chromatography method with tandem mass spectrometric detection (LC–MS–MS) was developed, for quantitative analysis of heroin and methadone, their metabolites, and the simultaneous detection of acetylcodeine. One-hundred patients in a heroin-assisted treatment program were screened for acetylcodeine in plasma. Furthermore, patients were interviewed about illicit heroin use, and they were tested for alcohol and cocaine use. In plasma samples of 16% of the patients, acetylcodeine was detected. Overall agreement between self-report and plasma samples was 95% (kappa: 0.81). Patients who tested positive for acetylcodeine had visited the outpatients’ clinics significantly less frequently than the patients who tested negative. Alcohol and cocaine use was more common in patients who tested positive for acetylcodeine. Illicit heroin use was observed in a limited percentage of patients. Overall agreement between self-report and markers of illicit heroin use was good.

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