parenteral (intravenous or intramuscular injection) administration. Te side effects of the drug include
nausea, sedation, respiratory depression, constipation, excessive sweating and cardiovascular effects. Users will oſten develop a tolerance to the nausea and respiratory effects but the tolerance to constipation generally does not develop as fully. Te potential for dependency is routinely demonstrated by drug withdrawal of administration of an opioid antagonist. Te overall abuse potential is similar to that of morphine. In recent years, the drug has been
increasingly prescribed for the treatment of moderate to severe pain. Prescriptions for the drug increased 727 percent from 1997 until 2004 and workplace positives in the Quest Diagnostics Drug Testing Index™ increased 208 percent during this time period. Because the drug is commonly ad- ministered on an outpatient basis, patients are typically unmonitored. Tis brought about an increasing rate of adverse events with the drug. Rising concerns regarding the safety in prescribing the drug, prompt- ed the DEA to request that manufacturers voluntarily restrict the distribution of the large (40 mg) dose to authorized opioid addiction treatment programs and hospi- tals only. Tis did not substantially reduce the number of prescriptions issued for use in pain management. In 2009, an estimated 4.4 million prescriptions for the drug were dispensed in the United States. According to the CDC, the drug was involved with 31.4% of opioid pain reliever fatalities making its overdose death rate significantly higher than that for other opioid pain relievers for either multidrug or single-drug deaths. Te rate of overdose deaths from the drug in 2009 was 5.5 times that of the 1999 rate. Te widespread use of the drug in pill form can significantly influence the use of the drug by others than those for whom the drug was prescribed and who may not use the drug correctly. Te drug
www.datia.org
is frequently encountered in emergency departments, rising from 36,806 incidents in 2004 to 63,031 visits in 2009. Laboratory testing for the drug is a well
established technology and available in most commercial and hospital laboratories. Urinary concentrations of the parent drug are usually not monitored but the presence of the drug and metabolites are used as an indicator of patient compliance in some maintenance programs. Numerous reports of analysis of the drug in blood and plasma have helped assess toxicities and develop pharmacokinetic data. Tere have been studies done in regards to the monitoring of this drug in hair samples as an atempt to ensure long-term compliance with treat- ment regimens. However, the usefulness of this type of testing is oſten outstripped by its cost and lack of widespread commercial availability. Tere is also recurring interest in the measurement of the drug in oral fluid as a means of assessing patient compliance. Testing for this drug is oſten performed
using an immunoassay technique or some type of chromatographic analysis—such as gas chromatography (GC) or liquid chromatography (LC)—and, when required, mass spectrometry for confirma- tion. More sensitive techniques like gas chromatography-mass spectrometry (GC/ MS) or tandem mass spectrometry (GC/ MS/MS or LC/MS/MS) are oſten used for the identification and quantification of the drug and its metabolites in hair or oral fluid, due to the very low concentrations of this drug and metabolite and limited sample sizes in these matrices. As the use of this compound increases
for treatment of opioid addiction, pain relief and as an occasional antitussive, its abuse potential is starting to show. Cur- rently it is a Schedule II drug in the United States, indicating accepted medical use, but with a high potential for abuse. While DOT rules permit the MRO to verify a drug test result as negative when the labo- ratory reports a positive result for certain
datia focus 55
prescribed Schedule I and II controlled substances, this exception does not apply to the drug. Currently the mystery drug goes by
several names, but its original title was a combination of the Latin words for pain and end. Dolor (pain) and Fin (end) gave rise to Dolophine. It’s been marketed under the names Symoron, Amidone and Heptadon. What is it? Its common name is Metha-
done. ❚
Randy Clouette is a Forensic Toxicology Laboratory Direc- tor at Quest Diagnostics. His efforts and expertise focus on hair and steroid testing in the Lenexa, Kansas workplace
drugs of abuse testing laboratory.
Randy has worked in the field of analytical toxi- cology since 1983. He earned his undergradu- ate degree from West Texas State University and his Masters Degree in Forensic Science from the University of Birmingham in Alabama. He is certified by the National Registry of Certified Chemists and is board-certified by the Forensic Toxicology Certification Board.
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