代谢产物在检测阿片类物质滥用中的研究进展

目的对近年来检测阿片类物质滥用的代谢产物进行综述,为加强阿片类物质的管理、确证滥用导致的死亡等提供依据,也可以用于区别滥用和正常摄入。方法通过大量检索检测阿片类物质滥用的代谢产物相关资料,总结归纳阿片类物质体内代谢过程、常用代谢产物检测的优缺点及应用。结果海洛因、含可待因的药物和罂粟类物质等均能代谢生成吗啡,导致假阳性结果。目前尚未有明确统一的金标准用于准确判断阿片类物质的滥用,滥用确证时除了检测常用的代谢产物指标6-单乙酰吗啡和吗啡外,乙酰可待因、可待因、吗啡与可待因浓度比值、蒂巴因与罂粟碱及那可汀的代谢物也可附加检测。结论在确证阿片类物质滥用时,需谨慎判断代谢产物检测结果的可靠性,并详细询问被检测者近期的服药史。

Research Progress on the Metabolites in Detecting the Abuse of Opiates

OBJECTIVE To review the metabolites in detecting the abuse of opiates in recent years, and to provide evidence for the management of opiates abuse and the confirmation of death by illicit opiates abuse, and also to distinguish between illicit abuse and normal intake. METHODS Through a large number of materials on the metabolites in detecting the abuse of opiates, the metabolic process in vivo of opiates, the advantages and disadvantages of commonly used metabolites in detecting the opiates abuse and their application were reviewed to summarize. RESULTS Heroin, drugs containing codeine, poppy substances and so on were metabolized to morphine, resulting in false positive results. There was currently no clear and uniform gold standard that can be used to accurately determine the abuse of opioids. In addition to the commonly used metabolites 6-monoacetylmorphine and morphine, acetylcodeine, codeine, concentration ratios of morphine to codeine, metabolites of thebaine, papaverine and narcotine could also be tested in the confirmation. CONCLUSION When confirming illicit opiates abuse, it is necessary to carefully judge the reliability of the test results of metabolites, and ask the testee about his recent medication history in detail.