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Saliva and Drugs of Abuse

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Salivary Bioscience

Abstract

The drug overdose epidemic resulted in approximately 630,000 deaths from 1999 to 2016 according to the Center for Disease Control and Prevention (CDC). In 2015, 52,404 drug overdose deaths occurred in the USA in which 63.1% involved an opioid; whereas in 2016, there were 63,632 drug overdose deaths reported, opioids accounted for 66.4% of them. On average, 115 Americans die every day from an opioid overdose. National Institute of Drug Abuse (NIDA) confirmed this data by reporting that drug-related deaths have more than doubled since 2000. There are more deaths, oral and systemic complications and disabilities from substance use than from any other preventable health condition. Today, one in four deaths is attributable to alcohol, tobacco, and illicit or prescription drug use. NIDA 5 pertains to the five drugs of abuse, which should be tested in relation to a drug-free workplace, by the National Institute on Drug Abuse. The NIDA 5 drugs that need to be tested are Cannabinoids (hashish, marijuana, THC or tetrahydrocannabinol), phencyclidine (PCP), opiates (opium, codeine, heroin, and morphine), amphetamines (methamphetamine), and cocaine (benzoylecognine, cocaethylene).

Saliva or oral fluid has become increasingly area of focus for, detection, recognition, and diagnosis of potential drug abuse in the workplace, clinical toxicology, and driving under the influence of drugs (DUID). This is due to multiple factors such as simplicity and rapidity of collection and storage, cost-effectiveness, noninvasiveness, and low biohazard considerations, no need for specialized collection by medical personnel, and the possibility of second sample collection for laboratory confirmation. As only unbound or free drugs are excreted into the oral fluid, there is evidence that oral fluid drug concentrations correlate with free drug plasma levels; thus, oral fluid can reflect a recent drug use. Limitations associated with oral fluid testing may include the difficulty in collecting a proper volume, possible oral cavity contamination after drug administration, and dry mouth following the drug use. Due to several advantages of oral fluid testing, quite recently this matrix has been introduced in place of blood or urine testing.

Oral fluid application in detection of drugs of abuse is reviewed in this chapter regarding five main categories of illicit drugs (cannabinoids, opioids, cocaine, amphetamine, and benzodiazepines). Relevant scientific and evidence-based publications from 2000 to 2018 were identified, reviewed, and will be presented in the chapter. The efficacy of the main saliva collection kits (Intercept, StatSure, Quantisal, and Oral-Eze, Draeger cassette) and different saliva assessment methods (Liquid chromatography–tandem mass spectrometry, SPE 2D-GCMS assay, Direct ELISA, Surface-enhanced Raman spectroscopy, Smartphone, (UCNPs)-Based paper device, Headspace solid-phase microextraction and gas chromatography–mass spectrometry, Radioimmunoassay, Triage kit, Aptasensor, Point of collection testing devices (POCT)) pertaining to drugs of abuse will be discussed. Validity of saliva/oral fluid in comparison to urine and blood-based testing will also be mentioned.

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Authors and Affiliations

  1. Division of Periodontology, Diagnostic Sciences & Dental Hygiene, Herman Ostrow School of Dentistry of University of Southern California, Los Angeles, CA, USA

    Mahvash Navazesh

  2. Division of Biomedical Sciences, Herman Ostrow School of Dentistry of University of Southern California, Los Angeles, CA, USA

    Azadeh Ahmadieh

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  1. Mahvash Navazesh
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  2. Azadeh Ahmadieh
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Correspondence to Mahvash Navazesh .

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  1. Institute for Interdisciplinary Salivary Bioscience Research, University of California at Irvine, Irvine, CA, USA

    Douglas A. Granger

  2. Institute for Interdisciplinary Salivary Bioscience Research, University of California at Irvine, Irvine, CA, USA

    Marcus K. Taylor

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Navazesh, M., Ahmadieh, A. (2020). Saliva and Drugs of Abuse. In: Granger, D., Taylor, M. (eds) Salivary Bioscience. Springer, Cham. https://doi.org/10.1007/978-3-030-35784-9_16

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