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Schackmuth M, Kerrigan S. Temperature and pH-dependent stability of fentanyl analogs: Degradation pathways and potential biomarkers. J Forensic Sci 2024. [PMID: 38997947 DOI: 10.1111/1556-4029.15578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/07/2024] [Accepted: 06/25/2024] [Indexed: 07/14/2024]
Abstract
The collection, storage, and transport of samples prior to and during analysis is of utmost importance, especially for highly potent analogs that may not be present in high concentrations and are susceptible to pH or thermally mediated degradation. An accelerated stability study was performed on 17 fentanyl analogs (fentalogs) over a wide range of pH (2-10) and temperature (20-60°C) conditions over 24 h. Dilute aqueous systems were used to investigate temperature and pH-dependent kinetics using liquid chromatography-tandem mass spectrometry (LC-MS/MS). Liquid chromatography-quadrupole/time-of-flight-mass spectrometry (LC-Q/TOF-MS) was used for structural elucidation of degradants. With the exception of remifentanil, all fentalogs evaluated were stable at pH 6 or lower. Fentalogs were generally unstable in strongly alkaline environments and at elevated temperatures. Remifentanil was the least stable drug and N-dealkylated fentalogs were the most stable. Fentanyl degraded to acetylfentanyl, norfentanyl, fentanyl N-oxide, and 1-phenethylpyridinium salt (1-PEP). A total of 26 unique breakdown products were observed for 15 of the fentanyl derivatives studied. Common degradation pathways involved N-dealkylation, oxidation of the piperidine nitrogen, and β-elimination of N-phenylpropanamide followed by oxidation/dehydration of the piperidine ring. Ester and amide hydrolysis, demethylation at the propanamide, and O-demethylation were observed for selected fentalogs only. The potential for analyte loss should be considered during the pre-analytical phase (i.e., shipping and transport) where environmental conditions may not be controlled, as well as during the analysis itself.
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Affiliation(s)
- Madison Schackmuth
- Department of Forensic Science, Sam Houston State University, Huntsville, Texas, USA
| | - Sarah Kerrigan
- Department of Forensic Science, Sam Houston State University, Huntsville, Texas, USA
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2
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Li Z, Li Z, Xu Q, Zhao L, Li B, Liu W, Shi Y. Acoustic ejection tandem mass spectrometry for high-throughput screening of phencyclidine-type substances in urine, including authentic cases. Anal Chim Acta 2024; 1312:342751. [PMID: 38834265 DOI: 10.1016/j.aca.2024.342751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/02/2024] [Accepted: 05/20/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND The abuse of the Phencyclidine-type substances, especially ketamine is a serious problem worldwide, and retrospective analysis are important for both the analysis and the identification of forms of drug abuse. The current major analytical methods, while all excellent in terms of accuracy, are time- and reagent-consuming. This depletion is made even more unfortunate by the fact that a large number of samples are negative in retrospective analyses. It is clear that a set of methods that can be analyzed both accurately and quickly need to be developed and applied to the screening and analysis of large quantities of samples. RESULTS We described a urine test based on acoustic ejection mass spectrometry, which allows precise injection at very low volumes and near 1 ejection s-1 and data acquisition. The confidence in identification was increased by the characterization of the abundance ratio of the two pairs of ions. Urine samples could be diluted with water and loaded into a 384-well plate for sampling without complicated sample preparation. The sample in the transparent 384-well plate was pre-scanned by the laser, and then 20 nL droplets were ejected into the ion source for targeted analysis of 2 ion transitions per droplet totaling 9 targeted analytes in the sequence of acquisition methods. It took 90 min to screen 250 samples in this approach, yielding 10 ng mL-1 detection limits. Positive samples were further analyzed by UHPLC-MS/MS for confirmation and quantification of up to 36 analytes. SIGNIFICANCE This was the first fast screening method for phencyclidine-type substances based on acoustic ejection mass spectrometry, which greatly reduces the analytical time, and can accomplish in 1.5 h what UHPLC-MS/MS needs 3 days to complete. And the samples can be analyzed without complicated sample preparation, and also can obtain good detectability. It was applied to a short-term retrospective analysis in Shanghai, and its accuracy was also extremely high.
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Affiliation(s)
- Ziyi Li
- Department of Forensic Toxicology, Academy of Forensic Science, Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Science Platform, Key Laboratory of Forensic Sciences, Ministry of Justice, Shanghai, 200063, PR China; School of Pharmacy, China Pharmaceutical University, Nanjing, 211198, PR China
| | - Zehong Li
- Department of Forensic Toxicology, Academy of Forensic Science, Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Science Platform, Key Laboratory of Forensic Sciences, Ministry of Justice, Shanghai, 200063, PR China; School of Pharmacy, China Pharmaceutical University, Nanjing, 211198, PR China
| | - Qing Xu
- Department of Forensic Toxicology, Academy of Forensic Science, Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Science Platform, Key Laboratory of Forensic Sciences, Ministry of Justice, Shanghai, 200063, PR China; School of Pharmacy, China Pharmaceutical University, Nanjing, 211198, PR China
| | - Liuqing Zhao
- SCIEX Analytical Instrument Trading Co., Ltd, Shanghai, 200335, PR China
| | - Bo Li
- School of Pharmacy, China Pharmaceutical University, Nanjing, 211198, PR China
| | - Wei Liu
- Department of Forensic Toxicology, Academy of Forensic Science, Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Science Platform, Key Laboratory of Forensic Sciences, Ministry of Justice, Shanghai, 200063, PR China
| | - Yan Shi
- Department of Forensic Toxicology, Academy of Forensic Science, Shanghai Key Laboratory of Forensic Medicine, Shanghai Forensic Science Platform, Key Laboratory of Forensic Sciences, Ministry of Justice, Shanghai, 200063, PR China.
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3
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Rosendo LM, Rosado T, Zandonai T, Rincon K, Peiró AM, Barroso M, Gallardo E. Opioid Monitoring in Clinical Settings: Strategies and Implications of Tailored Approaches for Therapy. Int J Mol Sci 2024; 25:5925. [PMID: 38892112 PMCID: PMC11173075 DOI: 10.3390/ijms25115925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 05/25/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
This review emphasises the importance of opioid monitoring in clinical practice and advocates for a personalised approach based on pharmacogenetics. Beyond effectively managing pain, meticulous oversight is required to address concerns about side effects, specially due to opioid-crisis-related abuse and dependence. Various monitoring techniques, along with pharmacogenetic considerations, are critical for personalising treatment and optimising pain relief while reducing misuse and addiction risks. Future perspectives reveal both opportunities and challenges, with advances in analytical technologies holding promise for increasing monitoring efficiency. The integration of pharmacogenetics has the potential to transform pain management by allowing for a precise prediction of drug responses. Nevertheless, challenges such as prominent pharmacogenetic testing and guideline standardisation persist. Collaborative efforts are critical for transforming scientific advances into tangible improvements in patient care. Standardised protocols and interdisciplinary collaboration are required to ensure consistent and evidence-based opioid monitoring. Future research should look into the long-term effects of opioid therapy, as well as the impact of genetic factors on individual responses, to help guide personalised treatment plans and reduce adverse events. Lastly, embracing innovation and collaboration can improve the standard of care in chronic pain management by striking a balance between pain relief and patient safety.
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Affiliation(s)
- Luana M. Rosendo
- Centro de Investigação em Ciências da Saúde, Universidade da Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal;
- Laboratório de Fármaco-Toxicologia, UBIMedical, Universidade da Beira Interior, EM506, 6200-000 Covilhã, Portugal
| | - Tiago Rosado
- Centro de Investigação em Ciências da Saúde, Universidade da Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal;
- Laboratório de Fármaco-Toxicologia, UBIMedical, Universidade da Beira Interior, EM506, 6200-000 Covilhã, Portugal
- Centro Académico Clínico das Beiras (CACB), Grupo de Problemas Relacionados com Toxicofilias, 6200-000 Covilhã, Portugal
| | - Thomas Zandonai
- Pharmacogenetic Unit, Clinical Pharmacology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Dr. Balmis General University Hospital, 03010 Alicante, Spain; (T.Z.); (K.R.); (A.M.P.)
- Addiction Science Lab, Department of Psychology and Cognitive Science, University of Trento, 38060 Trento, Italy
- Department of Pharmacology, Paediatrics and Organic Chemistry, Miguel Hernandez University of Elche, 03550 Alicante, Spain
| | - Karem Rincon
- Pharmacogenetic Unit, Clinical Pharmacology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Dr. Balmis General University Hospital, 03010 Alicante, Spain; (T.Z.); (K.R.); (A.M.P.)
- Clinical Pharmacology Unit, Department of Health of Alicante, University General Hospital Dr. Balmis, 03010 Alicante, Spain
| | - Ana M. Peiró
- Pharmacogenetic Unit, Clinical Pharmacology Department, Alicante Institute for Health and Biomedical Research (ISABIAL), Dr. Balmis General University Hospital, 03010 Alicante, Spain; (T.Z.); (K.R.); (A.M.P.)
- Department of Pharmacology, Paediatrics and Organic Chemistry, Miguel Hernandez University of Elche, 03550 Alicante, Spain
- Clinical Pharmacology Unit, Department of Health of Alicante, University General Hospital Dr. Balmis, 03010 Alicante, Spain
| | - Mário Barroso
- Serviço de Química e Toxicologia Forenses, Instituto Nacional de Medicina Legal e Ciências Forenses-Delegação do Sul, 1169-201 Lisboa, Portugal;
| | - Eugenia Gallardo
- Centro de Investigação em Ciências da Saúde, Universidade da Beira Interior (CICS-UBI), 6200-506 Covilhã, Portugal;
- Laboratório de Fármaco-Toxicologia, UBIMedical, Universidade da Beira Interior, EM506, 6200-000 Covilhã, Portugal
- Centro Académico Clínico das Beiras (CACB), Grupo de Problemas Relacionados com Toxicofilias, 6200-000 Covilhã, Portugal
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4
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Nazdrajić E, Rickert DA, Pawliszyn J. Rapid Analysis of Fentanyl and Fentanyl Analogues from Whole Blood Using SPME Coupled to the Microfluidic Open Interface. Anal Chem 2024; 96:821-827. [PMID: 38158586 DOI: 10.1021/acs.analchem.3c04354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Fentanyl and its analogues are potent opioids that pose a significant threat to society. Over the last several years, considerable focus has been on the concerning trend of increasing fentanyl usage among drug users. Fentanyl analogues are mainly synthesized to evade analytical detection or increase their potency; thus, very low concentrations are sufficient to achieve a therapeutic effect. In an effort to help combat the synthetic opioid epidemic, developing targeted mass spectrometric methods for quantifying fentanyl and its analogues at ultralow concentrations is incredibly important. Most methods used to analyze fentanyl and its analogues from whole blood require manual sample preparation protocols (solid-phase extraction or liquid-liquid extraction), followed by chromatographic separation and mass spectrometric detection. The main disadvantages of these methods are the tedious sample preparation workflows, resulting in lengthy analysis times. To mitigate these issues, we present a targeted method capable of analyzing 96 samples containing fentanyl, several fentanyl analogues, and a common fentanyl (analogue) precursor simultaneously in 2.4 min per sample. This is possible by using a high-throughput solid phase microextraction workflow on the Concept96 autosampler followed by manual coupling of solid-phase microextraction fibers to the microfluidic open interface for tandem mass spectrometry analysis. Our quantitative method is capable of extremely sensitive analysis, with limits of quantification ranging from 0.002 to 0.031 ng mL-1 and linearity ranging from 0.010 to 25.0 ng mL-1. The method shows very good reproducibility (1-18%), accuracy (81-100%) of calibration and validation points, and good interday reproducibility (6-15%).
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Affiliation(s)
- Emir Nazdrajić
- Department of Chemistry, University of Waterloo, Waterloo N2L 3G1, ON, Canada
| | - Daniel A Rickert
- Department of Chemistry, University of Waterloo, Waterloo N2L 3G1, ON, Canada
| | - Janusz Pawliszyn
- Department of Chemistry, University of Waterloo, Waterloo N2L 3G1, ON, Canada
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5
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Palmquist KB, Truver MT, Shoff EN, Krotulski AJ, Swortwood MJ. Review of analytical methods for screening and quantification of fentanyl analogs and novel synthetic opioids in biological specimens. J Forensic Sci 2023; 68:1643-1661. [PMID: 37221651 DOI: 10.1111/1556-4029.15282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/24/2023] [Accepted: 05/05/2023] [Indexed: 05/25/2023]
Abstract
Fentanyl, fentanyl analogs, and other novel synthetic opioids (NSO), including nitazene analogs, prevail in forensic toxicology casework. Analytical methods for identifying these drugs in biological specimens need to be robust, sensitive, and specific. Isomers, new analogs, and slight differences in structural modifications necessitate the use of high-resolution mass spectrometry (HRMS), especially as a non-targeted screening method designed to detect newly emerging drugs. Traditional forensic toxicology workflows, such as immunoassay and gas chromatography mass spectrometry (GC-MS), are generally not sensitive enough for detection of NSOs due to observed low (sub-μg/L) concentrations. For this review, the authors tabulated, reviewed, and summarized analytical methods from 2010-2022 for screening and quantification of fentanyl analogs and other NSOs in biological specimens using a variety of different instruments and sample preparation approaches. Limits of detection or quantification for 105 methods were included and compared to published standards and guidelines for suggested scope and sensitivity in forensic toxicology casework. Methods were summarized by instrument for screening and quantitative methods for fentanyl analogs and for nitazenes and other NSO. Toxicological testing for fentanyl analogs and NSOs is increasingly and most commonly being conducted using a variety of liquid chromatography mass spectrometry (LC-MS)-based techniques. Most of the recent analytical methods reviewed exhibited limits of detection well below 1 μg/L to detect low concentrations of increasingly potent drugs. In addition, it was observed that most newly developed methods are now using smaller sample volumes which is achievable due to the sensitivity increase gained by new technology and new instrumentation.
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Affiliation(s)
| | - Michael T Truver
- Forensic Toxicology Laboratory, Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Elisa N Shoff
- Miami-Dade Medical Examiner Department, Miami, Florida, USA
| | - Alex J Krotulski
- Center for Forensic Science Research and Education, Fredric Rieders Family Foundation, Willow Grove, Pennsylvania, USA
| | - Madeleine J Swortwood
- Department of Forensic Science, Sam Houston State University, Huntsville, Texas, USA
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Mercier B, Scala-Bertola J, Pape E, Kolodziej A, Gibaja V, Bisch M, Jouzeau JY, Gambier N. Online SPE UPLC-MS/MS method for the simultaneous determination of 33 psychoactive drugs from swab-collected human oral fluid samples. Anal Bioanal Chem 2022; 414:4203-4215. [PMID: 35451622 DOI: 10.1007/s00216-022-04073-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/30/2022] [Accepted: 04/06/2022] [Indexed: 11/01/2022]
Abstract
Oral fluid is easy and safe to collect and allows the detection of drugs of abuse after local exposure by oral, smoked, and/or inhaled intake, or systemic exposure. A routine online solid-phase extraction UPLC-MS/MS method was developed for the simultaneous determination of 33 psychoactive drugs in oral fluid. The selected drugs were fourteen fentanyl analogs and nineteen other abused psychoactive compounds, including classical narcotics, which were analyzed in a run of 10 min. Limits of detection and of quantification ranged from 0.02 to 1 ng/mL and from 0.02 to 5 ng/mL depending on the analyte, respectively. Matrix effect was in the range - 17 to + 15.7% for all analytes having a deuterated analog. Accuracy ranged from 82.7 to 113.4% and precision CV was at worst of 18.6%. Carryover was below 0.8% for all analytes. Recovery from FLOQSwabs™ showed high variability between analytes with THC, D2FF, 4-ANPP, ocfentanil, and valerylfentanyl being recovered below 40%. A stability study performed over 2 weeks on collecting devices loaded with artificial oral fluid showed huge variation between analytes with morphine, BZE, and norfentanyl being the more stable. Storage at 4 °C allowed drug detection for 1 week except for THC and remifentanil. The method was successfully applied to the detection of abused psychoactive compounds in oral fluid samples from 6 patients admitted to an addiction department.
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Affiliation(s)
- Benoit Mercier
- Département de Pharmacologie Clinique et Toxicologie, Université de Lorraine, CHRU-Nancy, 54500, Vandœuvre, France
| | - Julien Scala-Bertola
- Département de Pharmacologie Clinique et Toxicologie, Université de Lorraine, CHRU-Nancy, 54500, Vandœuvre, France
- Université de Lorraine, CNRS, IMoPA, 54505, Vandœuvre, France
| | - Elise Pape
- Département de Pharmacologie Clinique et Toxicologie, Université de Lorraine, CHRU-Nancy, 54500, Vandœuvre, France
- Université de Lorraine, CNRS, IMoPA, 54505, Vandœuvre, France
| | - Allan Kolodziej
- Département de Pharmacologie Clinique et Toxicologie, Université de Lorraine, CHRU-Nancy, 54500, Vandœuvre, France
| | - Valérie Gibaja
- Département de Pharmacologie Clinique et Toxicologie, Université de Lorraine, CHRU-Nancy, 54500, Vandœuvre, France
| | - Michael Bisch
- Centre Psychothérapique de Nancy, Département d'Addictologie, Pôle Hospitalo-Universitaire du Grand Nancy, 54520, Laxou, France
| | - Jean-Yves Jouzeau
- Département de Pharmacologie Clinique et Toxicologie, Université de Lorraine, CHRU-Nancy, 54500, Vandœuvre, France
- Université de Lorraine, CNRS, IMoPA, 54505, Vandœuvre, France
| | - Nicolas Gambier
- Département de Pharmacologie Clinique et Toxicologie, Université de Lorraine, CHRU-Nancy, 54500, Vandœuvre, France.
- Université de Lorraine, CNRS, IMoPA, 54505, Vandœuvre, France.
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7
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Zhang S, Hua Z, Yao W, Lü T, Zhang D, Zhao Q, Li J, Zhao H. Preparation of bamboo-derived magnetic biochar for solid-phase microextraction of fentanyls from urine. J Sep Sci 2022; 45:1766-1773. [PMID: 35261155 DOI: 10.1002/jssc.202200049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 11/11/2022]
Abstract
In this study, a biochar-based magnetic solid-phase microextraction method, coupled with liquid chromatography-mass spectrometry (LC/MS), was developed for analyzing fentanyl analogs from urine sample. Magnetic biochar was fabricated through an one-step pyrolysis carbonization and magnetization process, followed by an alkali treatment. In order to achieve desired extraction efficiency, feed stocks (wood and bamboo) and different pyrolysis temperatures (300-700 °C) were optimized. The magnetic bamboo biochar pyrolyzed at 400°C was found to have the greatest potential for extraction of fentanyls, with enrichment factors ranging from 58.9 to 93.7, presumably due to H-bonding and π- π interactions between biochar and fentanyls. Various extraction parameters, such as type and volume of desorption solvent, pH, extraction time were optimized, respectively, to achieve the highest extraction efficiency for the target fentanyls. Under optimized conditions, the developed method was found to have detection limits of 3.1-9.4 ng/L, a linear range of 0.05-10 μg/L, good precisions (1.9-9.4% for intra-batch, 2.9-9.9% for inter-batch), and satisfactory recoveries (82.0-111.3%). The developed method by using magnetic bamboo biochar as adsorbent exhibited to be an efficient and promising pretreatment procedure and could potentially be applied for drug analysis in biological samples. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Suling Zhang
- College of Materials & Environmental Engineering, Hangzhou Dianzi University, Hangzhou, 310018, China
| | - Ziluo Hua
- College of Materials & Environmental Engineering, Hangzhou Dianzi University, Hangzhou, 310018, China
| | - Weixuan Yao
- Key Laboratory of Drug Prevention and Control Technology of Zhejiang Province, Department of Criminal Science and Technology, Zhejiang Police College, Hangzhou, 310053, China
| | - Ting Lü
- College of Materials & Environmental Engineering, Hangzhou Dianzi University, Hangzhou, 310018, China
| | - Dong Zhang
- College of Materials & Environmental Engineering, Hangzhou Dianzi University, Hangzhou, 310018, China
| | - Qingwei Zhao
- Department of Pharmacy, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Jianhong Li
- School of Environmental and Chemical Engineering, Foshan University, Foshan, Guangdong, 528011, China
| | - Hongting Zhao
- School of Environmental and Chemical Engineering, Foshan University, Foshan, Guangdong, 528011, China
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Delaney SR, Tacker DH, Snozek CLH. The North American opioid epidemic: opportunities and challenges for clinical laboratories. Crit Rev Clin Lab Sci 2022; 59:309-331. [PMID: 35166639 DOI: 10.1080/10408363.2022.2037122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Since 1999, the opioid epidemic in North America has resulted in over 1 million deaths, and it continues to escalate despite numerous efforts in various arenas to combat the upward trend. Clinical laboratories provide drug testing to support practices such as emergency medicine, substance use disorder treatment, and pain management; increasingly, these laboratories are collaborating in novel partnerships including drug-checking services (DCS) and multidisciplinary treatment teams. This review examines drug testing related to management of licit and illicit opioid use, new technologies and test strategies employed by clinical laboratories, barriers hindering laboratory response to the opioid epidemic, and areas for improvement and standardization within drug testing. Literature search terms included combinations of "opioid," "opiate," "fentanyl," "laboratory," "epidemic," "crisis," "mass spectrometry," "immunoassay," "drug screen," "drug test," "guidelines," plus review of PubMed "similar articles" and references within publications. While immunoassay (IA) and point-of-care (POC) test options for synthetic opioids are increasingly available, mass spectrometry (MS) platforms offer the greatest flexibility and sensitivity for detecting novel, potent opioids. Previously reserved as a second-tier application in most drug test algorithms, MS assays are gaining a larger role in initial screening for specific patients and DCS. However, there are substantial differences among laboratories in terms of updating test menus, algorithms, and technologies to meet changing clinical needs. While some clinical laboratories lack the resources and expertise to implement MS, many are also slow to adopt available IA and POC tests for newer opioids such as fentanyl. MS-based testing also presents challenges, including gaps in available guidance for assay validation and ongoing performance assessment that contribute to a dramatic lack of standardization among laboratories. We identify opportunities for improvement in laboratory operations, reporting, and interpretation of drug test results, including laboratorian and provider education and laboratory-focused guidelines. We also highlight the need for collaboration with providers, assay and instrument manufacturers, and national organizations to increase the effectiveness of clinical laboratory and provider efforts in preventing morbidity and mortality associated with opioid use and misuse.
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Affiliation(s)
- Sarah R Delaney
- Department of Laboratory Medicine, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Department of Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Danyel H Tacker
- Department of Pathology, Anatomy, and Laboratory Medicine, West Virginia University School of Medicine, Morgantown, WV, USA
| | - Christine L H Snozek
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Phoenix, AZ, USA
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Specka M, Kuhlmann T, Bonnet U, Sawazki J, Schaaf L, Kühnhold S, Steinert R, Grigoleit T, Eich H, Zeiske B, Niedersteberg A, Steiner K, Schifano F, Scherbaum N. Novel Synthetic Opioids (NSO) Use in Opioid Dependents Entering Detoxification Treatment. Front Psychiatry 2022; 13:868346. [PMID: 35722574 PMCID: PMC9198264 DOI: 10.3389/fpsyt.2022.868346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Over the last decade, the use of New/Novel Synthetic Opioids (NSO) has emerged as an increasing problem, and especially so in the USA. However, only little is known about the prevalence and history of NSO use in European heroin dependents. METHOD A cross-sectional multicenter study, carried out with the means of both standardized interviews and urine toxicology enhanced screening, in a sample of opioid addicted patients referred for an in-patient detoxification treatment. RESULTS Sample size included here n = 256 patients; prior to admission, 63.7% were prescribed with an opioid maintenance treatment. Lifetime use of heroin and opioid analgesics was reported by 99.2 and 30.4%, respectively. Lifetime NSO/fentanyl use was reported by 8.7% (n = 22); a regular use was reported by 1.6% (n = 4), and ingestion over the 30 days prior to admission by 0.8% (n = 2). Most typically, patients had started with a regular consumption of heroin, followed by maintenance opioids; opioid analgesics; and by NSO. Self-reported data were corroborated by the toxicology screenings carried out; no evidence was here identified for the presence of heroin being contaminated by fentanyl/derivatives. DISCUSSION NSO and also opioid analgesics did not play a relevant role in the development and the course of opioid/opioid use disorders in German patients referred for an inpatient detoxification treatment.
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Affiliation(s)
- Michael Specka
- Department of Addictive Behaviour and Addiction Medicine, LVR Hospital Essen, Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - Thomas Kuhlmann
- Psychosomatic Hospital Bergisch Gladbach, Bergisch Gladbach, Germany
| | - Udo Bonnet
- Castrop-Rauxel Evangelic Hospital, Castrop-Rauxel, Germany
| | - Jürgen Sawazki
- Landschaftsverband Rheinland (LVR) Hospital Viersen, Viersen, Germany
| | - Luzia Schaaf
- Landschaftsverband Rheinland (LVR) Hospital Viersen, Viersen, Germany
| | - Stefan Kühnhold
- Landschaftsverband Westfalen-Lippe (LWL) Hospital Lippstadt and Warstein, Warstein, Germany
| | - Renate Steinert
- Landschaftsverband Westfalen-Lippe (LWL) Hospital Münster, Münster, Germany
| | - Torsten Grigoleit
- Landschaftsverband Rheinland (LVR) Hospital Langenfeld, Langenfeld, Germany
| | | | | | | | - Katharina Steiner
- Department of Addictive Behaviour and Addiction Medicine, LVR Hospital Essen, Medical Faculty, University Duisburg-Essen, Essen, Germany
| | - Fabrizio Schifano
- Psychopharmacology, Drug Misuse, and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Norbert Scherbaum
- Department of Addictive Behaviour and Addiction Medicine, LVR Hospital Essen, Medical Faculty, University Duisburg-Essen, Essen, Germany
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10
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Palmquist KB, Swortwood MJ. Long-Term Stability of 13 Fentanyl Analogs in Blood. J Anal Toxicol 2021; 45:870-877. [PMID: 34008837 DOI: 10.1093/jat/bkab051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/26/2021] [Accepted: 05/18/2021] [Indexed: 12/18/2022] Open
Abstract
Fentanyl analogs continue to play a major role in proliferating the opioid epidemic in the United States. With high rates of overdose deaths, forensic laboratories experience backlogs, which may lead to false negative results due to drug instability. To address this issue, a quantitative method was validated for fentanyl analogs (3-methylfentanyl, 4-ANPP, 4-fluoro-isobutyrylfentanyl (4-FIBF), acetylfentanyl, acrylfentanyl, butyrylfentanyl, carfentanil, cyclopropylfentanyl, fentanyl, furanylfentanyl, methoxyacetylfentanyl, p-fluorofentanyl, and valerylfentanyl) in blood using liquid chromatography-quadrupole-time-of-flight mass spectrometry (LC-QTOF-MS) and used to assess long-term stability under various temperature conditions (-20°C, 4°C, ~25°C, and 35°C) for 9 months. Authentic specimens were also analyzed 6 months apart for applicability to postmortem blood. Method validation resulted in calibration ranges of 1-100 ng/mL and limits of detection (LOD) of 0.5 ng/mL. Precision and bias were acceptable (within ±7.2%CV and ±15.2%, respectively). Matrix effects exhibited ion enhancement for all analytes, except carfentanil and 4-ANPP in low quality control (>25%). For long-term stability, fentanyl analogs (except acrylfentanyl) remained stable under room temperature and refrigerated conditions at low and high concentrations (81.3-112.5% target) for 9 months. While most fentanyl analogs remained stable frozen, degradation was observed after 2 weeks (4 freeze/thaw cycles). At elevated temperatures, most analytes were stable for 1 week (74.2-112.6% target). Acrylfentanyl was unstable after 24h under elevated (70% loss) and room temperatures (53-60% loss), 48-72h refrigerated (28-40% loss), and 4 weeks frozen (22% loss). In authentic bloods (n=7), initial furanylfentanyl (FuF) and 4-ANPP concentrations were 1.1-3.6 and 1.4-6.4 ng/mL, respectively. Percent loss of FuF and 4-ANPP over 6 months were 16.3-37.4% and 0.2-26.8%, respectively. Samples suspected to contain fentanyl analogs are recommended to be stored refrigerated or frozen with limited freeze/thaw cycles. Due to instability, in the event of an acrylfentanyl overdose, samples should be analyzed immediately or stored frozen with analysis within 1 month.
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Affiliation(s)
| | - Madeleine J Swortwood
- Department of Forensic Science, College of Criminal Justice, Sam Houston State University, 1003 Bowers Blvd, Huntsville, TX 77341, USA
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