Observations on the effects of buprenorphine and methadone on illicit drug use.

Objective: To determine if the agonistic effects of buprenorphine and methadone affect drug use.

Method: Quantitative examination of urine drug concentrations of patients treated with buprenorphine and methadone.

Results: Patients on buprenorphine had less opioid and methamphetamine drug use than those on methadone.

Monitoring buprenorphine in patients on medication-assisted treatment.

Background: Buprenorphine is used for medication-assisted treatment of opioid dependence.

Purpose: Monitoring of medication adherence involves testing of urine or oral fluid for the drug or its metabolite.

Methods: Quantitative results using liquid chromatography tandem mass spectrometer testing defined the excretion pattern of the drug and its metabolites.

Observations of Deception in Urine Drug Testing.

Objective: Determining deception in urine drug testing. Some of the patients undergoing urine drug tests have not taken the prescribed drug and attempt to deceive the laboratory test by placing the parent drug in the collection cup.

Methods: One of the ways to determine if this is occurring is to monitor the major metabolite of the drug.

Estimates of Drug Metabolism Using Drug Excretion Concentrations.

We propose that quantitative urine drug concentrations from LC-MS/MS measurements can be used to estimate zero and first order pharmacokinetics of the drugs oxycodone, hydrocodone, buprenorphine, methadone, and fentanyl. We observed the ratio of metabolite to parent drug could be used for this estimate. As the amount of observed parent drug increased, the metabolic ratio decreased, indicating a shift from first order to zero order metabolism.

Primary cutaneous mucormycosis of the lower extremity in a male patient with diabetes.

Introduction: Mucormycosis is a rare but serious angioinvasive fungal infection that can affect the cutaneous system. Primary cutaneous mucormycosis is caused by direct inoculation and is most prevalent in immunocompromised hosts, particularly those with diabetes. A high index of suspicion is necessary for this condition in patients with rapid and deep extension of necrosis despite aggressive surgical intervention.