Analisis De Toxicos En Pelo

Int J Legal Med (2009) 123:363–369
DOI 10.1007/s00414-008-0272-0

ORIGINAL ARTICLE

Cocaine and opiate concentrations in hair from subjects
in a heroin maintenance program in comparison
to a methadone substituted group
Frank Musshoff & Katrin Lachenmeier &
Dirk Lichtermann & Burkhard Madea

Received: 18 February 2008 / Accepted: 26 June 2008 / Published online: 26 July 2008
#Springer-Verlag 2008

Abstract One month before (T-1) and 12 months after (T12)
controlled i.v. administration of pharmaceutical heroin–HCl
(10–100 mg/day) in the context of a heroin maintenance
program (HMP), concentrations of opiates and cocaine as well
as its metabolites were determined in head hair (n =46) using
a validated gas chromatographic–mass spectrometric method.
In addition, a patientcollective of a methadone maintenance
program (MMP, daily doses 15–260 mg) was examined (n =
35). The incidence of additional cocaine consumption decreased in both groups during the study period (T-1 to T12):
in HMP from 64.6% to 45.8% and in MMP from 71.4% to
60.0%. A significant reduction of cocaine consumption was
defined as an at least 30% reduction of analyte concentrations in hair (Δc>30%). Accordingly, in HMP, a decrease
in 45.8% of initially (T-1) cocaine-positive patients was
determined; in MMP, the reduction was 48.6%. In 22.9% of
HMP and 37.1% of MMP, an increase of cocaine concentrations was detected. Codeine and acetylcodeine were found
in 50.0% and 43.5% (T-1) and 13.0% and 10.9% (T12) of
the samples of the HMP, as well as in 45.7% and 25.7%
(T-1) and 17.1% and5.7% (T12) in MMP, respectively. The
missing of acetylcodeine, in particular at T-1, questions its

Electronic supplementary material The online version of this article
(doi:10.1007/s00414-008-0272-0) contains supplementary material,
which is available to authorized users.
F. Musshoff (*) : K. Lachenmeier : B. Madea
Institute of Forensic Medicine, University of Bonn,
Stiftsplatz 12,
53111Bonn, Germany
e-mail: f.musshoff@uni-bonn.de
D. Lichtermann
Department of Psychiatry, University of Bonn,
Sigmund-Freud-Str. 25,
53105 Bonn, Germany

applicability as a characteristic marker of a preceding consumption of illicit heroin in hair analysis.
Keywords Heroin maintenance program . Hair analysis .
Opiates . Acetylcodeine . GC/MS

Introduction
For drugs of abuse, hair analysiscomplements blood and urine
analyses by providing long-term information on an individual’s drug use and is routinely applied in clinical and forensic
toxicology [1–5]. Several groups have analysed opiates and
cocaine in hair to prove illicit consumption of heroin and cocaine using immunoassay methodologies [6–10] and especially using gas chromatographic–mass spectrometric (GC/MS)
procedures[11–17]. In the present study, a validated GC/MS
method was used for determination of cocaine (COC), the
cocaine metabolites benzoylecgonine (BE) and cocaethylene
(CE) and of heroin (HER), 6-monoacetylmorphine (MAM),
morphine (MOR), codeine (COD), acetylcodeine (AC) in hair
samples of patients taking part in a heroin maintenance program (HMP). A basic requirement in such a substitution program isthat participants do not use any other illicit drugs,
particularly non-prescription heroin. HER intake can be
checked by detection of the parent drug itself together with
MAM, the major metabolite found in hair, and MOR.
Various preparation techniques have been developed to
analyse hair specimens for opiates, such as organic solvent
incubation [12, 13, 17–24], enzymatic hydrolysis [11, 16]and acid [14, 25–27] or alkaline hydrolysis [28]. For the
current study, alkaline hydrolysis has to be avoided because
of the possible hydrolysis of HER and MAM to MOR.
Methanol extraction reveals best results and is the only
procedure that has been proposed to identify HER in hair

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[29, 30]. For this reason, a procedure with methanolic...