PubMed · 4099911
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D Patey. 1971-01-30. Pilonidal sinus: a postscript.. https://doi.org/10.1016/s0140-6736(71)90991-3
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When examining concentration relationships of doses it must be taken into account that hair growth is irregular. Hair growing from the shaved skin after a single dose of a certain drug cannot possibly contain the same concentration as hair after the same dose that has not been cut over a long period. Concentrations can even change during the hair growth in cases where the hair had been cut a couple of months before the hair sample was taken. The variations in the expected concentrations can exceed 20%. On the other hand, the evaluation of a hair tuft which has grown after the last drug consumption may be important in forensic cases where the hair which has grown earlier is not available. This may lead to misinterpretations at low concentrations. Expected concentrations are calculated assuming a telogen part of 10%.
Hair analysis and urinalysis are complementary tests for establishing drug use. Hair analysis provides long-term information, from months to years, concerning both the severity and pattern of drug use. In contrast to this, urinalysis can indicate only drug use, and then generally only that which has occurred within the last 2-3 days. Field studies have demonstrated that hair analysis is considerably more effective than urinalysis at identifying drug users. This difference is due to the wider surveillance window of hair analysis and to the susceptibility of urinalysis to evasive maneuvers. The main concerns with urinalysis are endogenous evidentiary false positives caused by passive drug exposure, e.g., ingestion of poppy seed. This problem arises from the hypersensitivity of the urine test, i.e. the need to use low cut-off levels in order to compensate for the temporary recording of drug use. This problem does not occur with hair analysis since its wide window of detection and permanent record of drug use ensure that the detection efficiency of the test is not compromised by the use of more effective cut-off levels guarding against passive endogenous drug exposure. On the other hand, exogenous evidentiary false positives due to external contamination of hair by drugs present in the environment (e.g., smoke) are the main concern of hair analysis. This problem, however, can be effectively avoided by washing the hair specimen, by kinetic analyses of the wash data, and by measurement of metabolites. The possibility of bias due to race and/or hair color is avoided by the exclusion of melanin from the analysis of hair. The safety and effectiveness of hair testing has been established by extensive field studies with over 400,000 specimens.
Hair analysis has been presented by some authors as a possible tool of investigation for estimating patients' compliance to long-term therapies. This paper summarises the different publications that have been devoted to this topic and highlights the available statistically data presented to support this proposition. Qualitative results of such determinations may be of some interest but due to the enormous interindividual variations of quantitative data, the idea of using hair analysis to ascertain whether a patient has taken his treatment exactly as prescribed, clearly appears to be inapplicable.