The only absolute proof of heroin use is the presence of 6-Monoacetyl
morphine (6-MAM) in the urine or blood. (Of course, you if you detect
heroin, that is absolute proof, too, but because of the very short half
life of heroin, this is unlikely.) Opiate immunoassays won't be able to
distinguish 6-MAM from the other opiates. Morphine, itself a main
metabolite of heroin, will give you positive opiate result, regardless
of where it is coming from.
You may want to consider using TLC (ToxiLab) to detect 6MAM, but it's
analytical sensitivity is not optimal for this kind of use. The best
option is GC/MS, but this is not going to give you a TAT of 6 hours or
less.
You may want to discuss these issues with your A&E. They may not know
that there are technical limits to their request.
Geza
Geza Bodor, MD
DHMC Pathology
Denver, CO
> -----Original Message-----
> From: Helen Verrill [mailto:[log in to unmask]]
> Sent: Thursday, August 15, 2002 9:43 AM
> To: [log in to unmask]
> Subject: A&E heroin
>
>
> We have been approached by our A&E department for advice on
> how to 'detect' heroin. Many patients self discharge if their
> treatment takes longer than they expect or are admitted and
> they are heroin addicts. A&E want to prescribe methadone to
> patients who are admitted and would otherwise self discharge.
> Their proposal is 'state heroin addiction' plus a positive
> opiate test - they would prescribe methadone, but if an
> opiate test was negative they would wait for symptoms before
> prescribing. They would like about a six hour turn-around.
> We are dubious about this approach, we don't want to become
> known as an easy touch for methadone scripts and don't want
> to prescribe to someone not taking heroin. Are there any NPT
> devices which would help us solve this? Would an automated
> immunoassay help?
>
> Any experiences of how to solve this problem would be
> gratefully received.
>
> Helen Verrill
> Principal Biochemist
> North Tees and Hartlepool NHS Trust
>
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