Morphine and Cocaine elixir

Assessment of drugs of abuse in biological fluids requires thorough knowledge of stability of the drugs under various conditions, including sample collection, handling, transportation, and analysis, to ensure accurate interpretation of results. This systematic review provides an overview of the literature on the pre-analytical stability of selected clinically relevant drugs of abuse in urine. A systematic search of the PubMed and Embase databases was conducted in October 2020 and February 2024. The search strategy encompassed over 20 drugs and their relevant metabolites tested in urine, focusing on studies that examined the stability of opioids, amphetamine-like drugs (including ephedrine, cocaine and cathinone), and cannabis using mass spectrometry. A total of 2688 records were identified, and 71 studies met the inclusion criteria. These studies evaluated storage conditions including room temperature, refrigeration, freezing, and deep freezing, as well as the effects of freeze-thaw cycles. Most drugs demonstrated stability for months when refrigerated or frozen, and deep freezing and freeze-thaw cycles generally had minimal impact on stability. However, storage at room temperature showed limited stability, with cathinone, cannabis, morphine, codeine, and cocaine being particularly prone to degradation under different conditions. This review offers valuable insights into the storage stability of a wide range of drugs of abuse in urine, serving as a practical resource for healthcare professionals and others working with these substances in laboratory settings.

Abstract licence: CC BY-NC

Treatment-resistant depression (TRD) presents a complex clinical challenge, particularly when comorbid with substance use disorders (SUDs) or other compulsive behaviors. With up to a third of major depressive disorder (MDD) patients failing to respond to standard antidepressant therapies, there is growing interest in interventions such as esketamine, a glutamatergic N-methyl-D-aspartate (NMDA) receptor antagonist approved for TRD in 2019, as an intranasal therapy. While esketamine has demonstrated efficacy in alleviating depressive symptoms of TRD, emerging data also point towards its potential in addressing compulsive and addictive behaviors, particularly in patients whose depression and SUDs are deeply intertwined. This review aims to evaluate and synthesize the current literature on the use of esketamine in treating not only TRD, but specifically its application in patients suffering from comorbid substance use and addiction-related behaviors. We aim to clarify the therapeutic mechanisms, examine both human and animal data, and identify whether esketamine offers a dual-modality treatment approach that concurrently reduces depressive symptoms and addictive tendencies. Across peer-reviewed studies, including randomized control trials, cohort analyses, systematic reviews, and preclinical investigations, findings suggest that esketamine may reduce drug-seeking behavior, attenuate cravings, and improve outcomes when combined with behavioral interventions (such as mindfulness-based therapy). In rodent models, esketamine significantly inhibited cocaine-seeking after various abstinence conditions, and clinical data point to its potential role in treating alcohol misuse. In conclusion, esketamine holds potential as a dual-action therapeutic in patients with TRD and comorbid addiction; however, further large-scale studies are needed to explore its therapeutic magnitude, duration of benefit, safety, and effects on substance use-related outcomes.

Abstract licence: CC BY