New psychoactive substances as part of polydrug abuse within opioid maintenance treatment revealed by comprehensive high-resolution mass spectrometric urine drug screening

Objective At present, polydrug abuse comprises, besides traditional illicit drugs, new psychoactive substances (NPS) and non‐prescribed psychotropic medicines (N‐PPM). Polydrug abuse was comprehensively evaluated among opioid‐dependent patients undergoing opioid maintenance treatment (OMT). Methods Two hundred consecutively collected urine samples from 82 OMT patients (52 male) treated with methadone or buprenorphine‐naloxone medication were studied using a liquid chromatography/time‐of‐flight mass spectrometry screening method. The method enables simultaneous detection of hundreds of abused substances covering the traditional drugs of abuse and many NPS as well as N‐PPM. Results Ninety‐two (45.8%) samples were positive for the abused substances. Benzodiazepines (29.0%), amphetamines (19.5%), cannabinoids (17.0%), NPS (13.0%), N‐PPM (9.0%), and opioids (9.0%) were detected in different combinations. The simultaneous occurrence of up to three groups of abused substances was common (40.0%), and in one sample, all six groups were found. The stimulant NPS alpha‐pyrrolidinovalerophenone was found in 10.0% and the sedative N‐PPM pregabalin in 4.0% of the samples. The patients were seldom aware of what particular NPS they had abused. Conclusions A widespread occurrence of abused substances beyond the ordinary was revealed. Identifying these patients is essential as polydrug abuse is a safety risk to the patient and may cause attrition from OMT. Copyright © 2016 John Wiley & Sons, Ltd.