Non-mineralized dental biofilm (plaque) has potential as a novel alternative matrix in forensic toxicology to prove drug use. The incorporation of illicit and medicinal drugs in dental plaque could take place through direct contact after oral or nasal intake, which can lead to high drug levels in the oral cavity, or indirectly via the secretion of drug-containing saliva, e.g., after intravenous application. Therefore, plaque samples from patients in opioid replacement therapy (ORT) and postmortem plaque samples were analyzed and the drug concentrations were compared. The study comprised 26 plaque samples from ORT patients with different daily doses, which were analyzed for methadone, morphine and their respective metabolites. Plaque samples were taken directly before the oral administration of the regular daily dose. Seventeen postmortem plaque samples were analyzed, either from cases of lethal drug intoxications or after pain therapy with morphine. Plaque analysis was performed using liquid chromatography-tandem mass spectrometry after liquid extraction with acetonitrile. Plaque concentrations in ORT for methadone and its metabolite 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP) ranged from 42 to approximately 49,000 pg/mg (median 1,300 pg/mg) and from below 10 to 610 pg/mg (median 31 pg/mg), respectively. Morphine plaque concentrations in ORT ranged from 120 to 480 pg/mg (median 400 pg/mg). In lethal intoxication cases, plaque concentrations were generally at least one order of magnitude higher than those in the study groups with therapeutic substance use. These data will help to interpret drug findings in plaque. Furthermore, the EDDP/methadone concentration ratio in plaque was lower after oral intake with contamination of the oral cavity (e.g., syrup) compared to cases with suspected intravenous application of methadone. Therefore, the EDDP/methadone concentration ratio could therefore indicate the drug administration route.

中文翻译：

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阿片类药物替代疗法和死后病例中美沙酮、吗啡及其代谢物的牙菌斑浓度

非矿化牙科生物膜（牙菌斑）有可能成为法医毒理学中证明药物使用的新型替代基质。牙菌斑中的违禁药物和药用药物可以通过口腔或鼻腔摄入后的直接接触发生，这可能导致口腔中的药物浓度升高，或间接通过含药物唾液的分泌，例如静脉注射后. 因此，对阿片类药物替代疗法 (ORT) 患者的斑块样本和死后斑块样本进​​行了分析，并比较了药物浓度。该研究包括来自 ORT 患者每日不同剂量的 26 个斑块样本，用于分析美沙酮、吗啡及其各自的代谢物。在口服常规每日剂量之前直接采集斑块样品。对 17 个死后斑块样本进​​行了分析，这些样本来自致命药物中毒病例或吗啡疼痛治疗后的病例。在用乙腈进行液体萃取后，使用液相色谱-串联质谱进行噬菌斑分析。ORT 中美沙酮及其代谢物 2-亚乙基-1,5-二甲基-3,3-二苯基吡咯烷 (EDDP) 的斑块浓度范围为 42 至约 49,000 pg/mg（中值 1,300 pg/mg）和低于 10 至 610 pg /mg（中位数 31 pg/mg），分别。ORT 中的吗啡斑块浓度范围为 120 至 480 pg/mg（中位数 400 pg/mg）。在致死性中毒病例中，斑块浓度通常比使用治疗物质的研究组高出至少一个数量级。这些数据将有助于解释斑块中的药物发现。此外，与疑似静脉注射美沙酮的病例相比，经口摄入口腔污染（如糖浆）后斑块中的 EDDP/美沙酮浓度比较低。因此，EDDP/美沙酮浓度比可以指示给药途径。