Scientists Detect Drug Use By Testing One’s Breath
Djuan Rugs
Breath analysis not only holds great potential for the development of new non-invasive diagnostic methods, but also for the identification and follow up of drug levels in breath. This is of interest for both, forensic and medical science. On the one hand, the detection of drugs of abuse in exhaled breath-similar to the well-known breath alcohol tests-would be highly desirable as an alternative to blood or urine analysis in situations such as police controls for drugged driving. The non-invasive detection of drugs and their metabolites is thus of great interest in forensic science, especially since marijuana is becoming legalized in certain parts of the US and the EU. The detection and monitoring of medical drugs in exhaled breath without the need of drawing blood samples on the other hand, is of high relevance in the clinical environment. This could facilitate a more precise medication and enable therapy control without any burden to the patient. Furthermore, it could be a step towards personalized medicine. This review gives an overview of the current state of drug detection in breath, including both volatile and non-volatile substances. The review is divided into two sections. The first section deals with qualitative detection of drugs (drugs of abuse), while the second is related to quantitative drug detection (medical drugs). Chances and limitations are discussed for both aspects. The detection of the intravenous anesthetic propofol is presented as a detailed example that demonstrates the potential, requirements, pitfalls and limitations of therapeutic drug monitoring by means of breath analysis.
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Chakrabarty and Cirrito said the breath test could be modified to simultaneously detect other viruses, including influenza and respiratory syncytial virus (RSV). They also believe they can develop a biodetector for any newly emerging pathogen within two weeks of receiving samples of it.
The researchers also found that the breath test successfully detected several different strains of SARS-CoV-2, including the original strain and the omicron variant, and their clinical studies are measuring active strains in the St. Louis area.
To date, nightlife event attendees have mainly been interviewed about their drug use using face-to-face surveys or written questionnaires. However, a large proportion of drug users do not self-report drug use (i.e., underreporting), which has been revealed using biological testing3,5,9,27. Several biological specimens such as hair31,32, blood8, urine8, and, more commonly, oral fluid3,5,8,9,10 have been sampled among nightlife attendees to test drug use. Hair samples are not suitable for assessing recent drug use, given that the detection window is between several days to months or years after drug use and will vary across individuals due to different hair lengths. Moreover, not all participants were willing to provide a hair sample. Blood sampling requires certain equipment and training to be performed safely, and because of its invasiveness, it might be even less accepted by participants. Similarly, sampling urine requires toilet facilities and is unfeasible in nightlife settings. Several studies have shown that oral fluid sampling can be used to assess the prevalence of drug use among nightlife attendees and is superior to self-reporting3,5,9. Oral fluid samples in these studies were analyzed using mass spectrometry, a highly sensitive and specific method to analyze drug use off-site. For example, among Swedish attendees of a two-day electronic dance music (EDM) event on a cruise ship, 10% tested positive for illicit drugs, but only 4% had reported recent drug use5. Similarly, among Norwegian festival goers, 11% tested positive for illicit drugs, but only 6% had reported drug use9. Furthermore, matching self-report and drug testing results among club goers in the San Francisco Bay area revealed moderate agreement between the two measures3. In addition, an on-site immunological quick screening test of oral fluid samples has also been conducted among Australian club goers, demonstrating that 9% had reported drug use, and 20% tested positive27. Although oral fluid sampling is a non-invasive method, which seems to be in good agreement with the results obtained from blood sampling8, in some participants, sampling can be time-consuming, often due to a dry mouth, which can be induced by some drugs or medications5. More recently, studies have demonstrated that breath sampling can be used to detect a variety of illicit drugs and medications33,34,35; however, to our knowledge, this has not been tested in nightlife settings.
We aimed to investigate the feasibility of testing a large number of nightlife attendees for the recent use of illicit drugs by using a device that enables the quick and easy sampling of aerosol particles in exhaled breath34. More specifically, we tested whether breath sampling is well-accepted and if drug testing is superior to self-reporting for estimating the prevalence of recent drug use. Furthermore, we aimed to investigate the validity of self-reporting regarding the recent use of various substances by matching drug testing results at an individual level. We were also interested in comparing drug use prevalence, as well as the extent of underreporting between genders and the alcohol levels between people who tested positive and negative for drug use.
Of the 1659 persons who were invited to anonymously participate in the study, 436 refused, and 1223 agreed, leaving a response rate of 73.7%. Those who refused participation had been informed about the study's aim to investigate alcohol and drug use but had not yet been informed about drug testing. All participants agreed to alcohol breath testing, but breath samples for drug testing were not collected from 19 participants (1.6%). Of these, 12 participants dropped out when they were asked to complete a self-reported questionnaire on illicit drug use. Thus, these 12 participants dropped out before they were asked to conduct breath sampling. Only seven participants (0.6%) actively refused breath sampling. In general, the use of the device was well accepted, and most participants found the sampling procedure easy and fast (between 2 and 4 min, including instructions). Some participants started to exhale with much force or very slowly, in which case they were reminded to exhale normally. In particular, highly intoxicated participants sometimes had difficulties following the instructions.
Breath sampling was accepted well and could easily be collected from a large number of participants in different nightlife settings. The analysis of breath samples could detect the use of 19 different substances, most commonly cocaine, amphetamine, MDMA (ecstasy), and cannabis. Drug testing revealed that 13.0% of participants had used illicit drugs recently, in comparison to 4.3% who had self-reported recent drug use. There was little to no match between the results obtained by drug testing and self-reporting for each drug, and drug testing revealed that the most commonly used drugs were underreported. The analytical detection of a substance is considered reliable, as it follows forensic standards.
There was no to minimal agreement between drug test results and self-reports, which is in line with a study on cruise-ship5. In addition, no agreement was found for amphetamine and minimal agreement was found for MDMA and cocaine, which is in line with previous studies that found moderate agreement at best3,9. Although cannabis was the most commonly self-reported drug, the mismatch between the drug test and self-reported use was the largest for this substance. Nevertheless, THC was only detected among those who did not self-report recent use, indicating underreporting. Among participants who self-reported use during the last 48 h, none tested positive, which is most likely explained by the relatively short detection window of up to 6 h36,37. However, a comparative study revealed that concentrations of THC declined more rapidly in the oral fluid samples than in the breath samples of the same individuals during the 6 h of cannabis smoking that were measured37, indicating that the oral fluid sample is not a better alternative to the breath sample for the detection of cannabis use. Furthermore, a recent study has shown that the window of detection of THC in breath samples is similar to the window of impairment38.
Similar to previous studies that linked hazardous alcohol consumption with drug use4,5,9,10,41, the present study showed that BAC levels were higher among those who tested positive for illicit drugs. Therefore, there is a need for preventive interventions that target drug use and hazardous drinking in nightlife settings. Examples of such interventions are the multicomponent programs 'Clubs against Drugs' and 'Responsible Beverage Service.' These programs were associated with a number of positive outcomes such as increased refusal rates of drug-intoxicated guests to enter licensed premises or alcohol-intoxicated or underaged guests to serve alcohol, reduced observed drug use prevalence among guests, and reduced police-reported violence42,43,44,45,46,47,48. Based on the present results, future programs should focus on addressing both alcohol and drug use together and detect drug use early among women.
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