Is there a better way to monitor abstinence among substance abusers awaiting transplantation?

Abstract

Conventional biomarkers are poor measures of ongoing abstinence. Due to short and variable windows of detection, the chances that an active substance user will be detected during the 6-month waiting period depend on the testing method and the drug. Herein we discuss hair testing as an alternative matrix for monitoring abstinence. Issues and obstacles related to adoption of a more uniform testing protocol are identified. Hair testing is a powerful matrix with the capacity to detect drugs for up to 90 days. Seemingly a logical choice for use in situations in which continuous abstinence is required, it mostly has been employed in Europe with forensic populations such as alcoholics seeking drivers license reinstatement. Only two studies have been conducted in transplant patients. In both, hair testing detected more active users than other modalities. Use of conventional biomarkers results in variable rates of drug detection, raising questions about fairness of the selection process. Hair analysis significantly increases detection rates. Programs adopting hair analysis should be prepared for more patients to be disqualified during the 6-month waiting period, but those testing negative at baseline could, theoretically, proceed with transplantation sooner. Selection of more optimal candidates also could improve outcomes.