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Beigebrauchdetektion in der Substitutionstherapie

Speichelproben versus Urinscreening
  • Johannes SteinEmail author
  • Max Geraedts
Originalien und Übersichten

Zusammenfassung

Hintergrund

Die Gesundheit von Substitutionstherapiepatienten wird durch die Einnahme weiterer Drogen gefährdet. Daher verlangt die Bundesärztekammer den Nachweis therapiegetreuer Substituteinnahme. Testart und Überprüfungsfrequenz sind vom Arzt zu wählen. In der Routineversorgung wurde untersucht, ob ein Beikonsumnachweis in Speichelproben machbar und aufgrund niedrigerer Nachweisgrenzen und minimierter Manipulationsmöglichkeiten dem Urinscreening überlegen ist.

Methode

Die Urin- und Speichelproben eines zufällig ausgewählten Drittels von insgesamt 361 Patienten, welche sich in der Behandlung von 4 Praxen der suchtmedizinischen Grundversorgung einer westdeutschen Großstadt befanden, wurden untersucht. Die Detektionsraten in den Urin- und Speichelproben wurden bivariat verglichen. Zudem wurden der Beikonsum von Patientensubgruppen und die Patienten- und Personalpräferenzen hinsichtlich der Beikonsumkontrollen erfasst.

Ergebnisse

Bei 29 Patienten war die doppelte Probenentnahme wegen zu geringen Materials oder Verweigerung nicht möglich. In 117 gepaarten Urin- und Speichelproben fanden sich in den Urinproben neben den Substituten 155, in den Speichelproben 82 weitere Substanzen. Die größten Unterschiede bestanden bei THC mit 50 (42,7 %) positiven Urin- und 3 (2,6 %) positiven Speichelproben (p < 0,0001) sowie bei Benzodiazepinen mit 41 (35 %) positiven Urin- sowie 28 (23,9 %) positiven Speichelproben (p < 0,0001). Insgesamt waren 75,2 % der Urinproben beikonsumpositiv. Patienten und Mitarbeiter präferierten keine Kontrollart eindeutig.

Schlussfolgerung

Beikonsumkontrollen durch Speichelproben sind in der Routineversorgung zwar generell machbar, den Urinkontrollen jedoch unterlegen.

Schlüsselwörter

Substitutionsbehandlung Methadon Beikonsum Urinprobe Speicheltest 

Substance abuse detection in substitution therapy

Oral fluid versus urine screening

Abstract

Background

A patient’s health in an opioid maintenance program is potentially endangered due to concurrent consumption of drugs. Therefore, the German Medical Association requests evidence of compliant substitute intake while type and frequency of drug screening is chosen by the physician. This study comparatively assessed the feasibility and potential advantage of oral fluid drug testing versus urine screening in day-to-day practice.

Methods

Urine and oral fluid-samples of a randomly chosen third of a total of 361 patients, treated in four different practices in a major German city, were tested. The detection rates were compared bivariate and the illicit substance intake of subgroups were analysed. Additionally, patients’ and employees’ satisfaction with the test procedures were assessed.

Results

A total of 117 paired urine and oral fluid samples were considered for this study. A dual sample collection was not obtainable with 29 patients due to insufficient sample volume or refusal. Other than methadone or buprenorphine, 155 substances were found in urine samples, whereas only 82 other substances were detected in oral fluids. Significant differences existed within substance groups with THC being positive in 50 (42.7%) urine samples and only three (2.6%) positive oral fluid samples (p < 0.0001) and with benzodiazepines with 41 (35%) positive urine and 28 (23.9%) positive oral fluid samples (p < 0.0001), respectively. In total 75.2% of the urine samples were positive for concurrent drug consumption. Employees and patients did not prefer one test type over the other.

Conclusion

The confirmation of concurrent drug intake in maintenance setting is generally possible by the use of oral fluid, but inferior to urine screening.

Keywords

Treatment setting Methadone Drug abuse Urine screening Saliva 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

J. Stein und M. Geraedts geben an, dass kein Interessenkonflikt besteht.

Die Probenuntersuchungen wurden im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki in der aktuellen, überarbeiteten Fassung von 2013 durchgeführt.

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Copyright information

© Springer-Verlag GmbH Deutschland 2017

Authors and Affiliations

  1. 1.Institut für GesundheitssystemforschungUniversität Witten/HerdeckeWittenDeutschland
  2. 2.Institut für Versorgungsforschung und Klinische EpidemiologiePhilipps-Universität MarburgMarburgDeutschland

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