Opioid kullanım bozukluğunda idrar ve tükürük numunelerinde yasaklı madde analizlerinin karşılaştırılması

Abstract

Various drugs are used in the treatment of opioid use disorder (OUD). In the diagnosis and treatment of this group of patients, laboratory analyzes are required in order to detect the drugs used in the treatment as well as opioid substances in patient samples such as urine, blood and saliva. In this thesis, it is aimed to develop LC-MS/MS methods as a panel that will perform the quantitative analysis of drugs used in the treatment of OUD, their metabolites and commonly abused illicit substances in the opioid group in urine and saliva samples. A total of 26 substances, including 16 opioid group, 3 cocaine group, 5 amphetamine group and 2 gabapentenoids, which are thought to be useful in the diagnosis and treatment follow-up of OUD, were included in the study. Analysis methods of these substances (6-MAM, BEG, buprenorphine, cocaethylene, cocaine, codeine, dihydrocodeine, EDDP, ethylmorphine, gabapentin, heroin, MBDB, MDA, MDEA, MDMA, methadone, methamphetamine, morphine, naloxane, naltrexone, norbuprenorphine, norcodeine, normorphine, oxycodone, pregabalin and tramadol), in urine and saliva samples by LC-MS/MS were developed. Substance analyzes were performed in urine and saliva samples of 76 patients with the methods whose validations were completed. LC-MS/MS results of urine samples were found to be compatible with opiate, ecstasy and amphetamine results studied by immunological method. In addition, it was determined that the drugs used in the treatment of the patients and their metabolites did not interact with the immunoassay used in opiate measurement. It was thought that the measurement of naltrexone levels of the urine and salivary LC-MS/MS methods we developed in our study would contribute to preventing the risk of relapse of the patients. As a result of the analyzes made with the methods we developed, it was concluded that the minimalized panels, which included 14 substances detected for urine samples and 11 substances detected for saliva samples, would be beneficial in the diagnosis and treatment of OUD.