Enhancing addiction care: Benefits of urinary screening with LC-HRMS (liquid chromatography-high resolution mass spectrometry) for psychoactive substances and drugs

Introduction

Immunoassay (IA) is currently used at Nantes University Hospital to perform urine drug screening in the inpatient addiction unit. Given its numerous limitations, we aimed to assess the overall benefit of the Liquid-Chromatography-High-Resolution-Mass Spectrometry (LC-HRMS), and to identify the profiles of patients for whom its use provided a clinical benefit.

Methods

All adult patients admitted to this unit between January and September 2023 were systematically included. A part of the urine sample routinely collected on admission was retained for subsequent analysis by LC-HRMS. For each active molecule, the analytical performance of LC-HRMS compared with IA was evaluated by biologists. Then unit's physicians assessed for each patient whether the new data provided by LC-HRMS would have had an impact on their management. A multivariate analysis was carried out to identify the profiles of these patients.

Results

154 patients were included with 293 non-prescribed molecules and 434 prescribed drugs. For 2/3 of all molecules, LC-HRMS performed better than IA. Most of these molecules were not detectable by IA but some were not detected even though they belonged to the panel of detectable substances. Physicians considered that the new results provided by LC-HRMS would have had an impact on the management of 1/4 of patients. A history of opiate abuse/dependence was associated with a clinical benefit of LC-HRMS in the multivariate analysis.

Conclusion

These results confirm the benefit of LC-HRMS for urine drug screening in inpatient addiction units for patients with multiple substance use, especially those with a history of opioid use.