Article

Potential Misclassification of a Case of SIDS: Maternal and Neonatal Hair Analysis for Cocaine and Heroin

07/2009; 2(2):91-93. DOI: 10.3109/14767059309017233

ABSTRACT Verification of illicit drug use by the mother during pregnancy is crucial when an attempt is made to correlate such exposure with fetal outcome. However, maternal report has been shown to be very inaccurate, and urine and blood testing for illicit drugs are positive only during the few days after their use [1]. Meconium testing is a very sensitive tool to detect in utero exposure to drugs; however, it has to be performed during the first days of life [2]. We have recently reported the sensitivity and specificity of hair analysis for intrauterine cocaine exposure; accumulation of cocaine in the hair is maintained for the life of neonatal hair [3]. We describe a case in which analysis of maternal and neonatal hair yielded important information about drug history, which was not elicited from the mother.

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    ABSTRACT: Drug self-reports are often unreliable and standard blood and urine tests detect only recent cocaine use. Since cocaine is deposited in hair, we have applied a radioimmunoassay to hair extract to detect past cocaine use. Hair from 16 adult users was positive for benzoylecgonine, in the presence of negative findings from urine screening tests. Benzoylecgonine in admitted heavy users averaged 8775 ng/g of hair (range, 640 to 29,089 ng/g of hair), whereas in occasional users it averaged 624 ng/g of hair (range, 32 to 1210 ng/g of hair). Benzoylecgonine was not detected in hair of 21 adults who reported no use of cocaine ever and whose urine samples were negative for the metabolite. Neonatal hair from seven infants whose mothers were known cocaine users averaged 5430 ng of benzoylecgonine per gram of hair (range, 200 to 27500 ng/g of hair). Hair from two infants 2.5 and 3.5 months of age averaged 6050 ng of benzoylecgonine per gram of hair. However, values were negative for infants 1 year and older, corresponding to loss of fetal hair in the few months after birth. Because studies reporting reproductive risks of cocaine compare exposed and nonexposed groups, validation of drug-free status of control subjects is extremely important. Hair analysis may remedy the disadvantages of currently used methods and may identify intrauterine exposure to cocaine in babies when a maternal drug history is not available or of doubtful truthfulness.
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