1
|
Garneau B, Roy C, Motard J, Desharnais B, Bouchard C, Mireault P. Atypical postmortem redistribution in chronic methadone consumers. J Anal Toxicol 2024; 48:343-349. [PMID: 38491986 DOI: 10.1093/jat/bkae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 02/09/2024] [Accepted: 02/26/2024] [Indexed: 03/18/2024] Open
Abstract
Available literature demonstrates that methadone is prone to moderate postmortem redistribution, but subject to high interindividual variability in the central to peripheral blood concentration ratios (C/P). In this case series, 10 cases of chronic methadone users displaying C/P < 1 (range 0.26-0.82) are described. Femoral, cardiac and ante-mortem blood concentrations of methadone and its metabolite 2-ethylidene-1,5-dimethyl-3,3-diphenylpyrrolidine (EDDP) are reported for all cases, as well as sex, age, case history, results of the pathological investigation, other toxicological findings and cause and manner of death. EDDP blood concentrations, similar in both central and peripheral blood, as well as antemortem blood concentration results in Case 4, demonstrate that this atypical C/P < 1 finding is attributable to postmortem changes and not analytical or pre-analytical artifacts. Case 4 is a particularly instructive example, with femoral blood concentration (966 ng/mL) approximately twice as high as cardiac blood (499 ng/mL) and ante-mortem blood (418 ng/mL, collected 38 min prior to death)-clearly demonstrating that cardiac blood methadone concentration is more representative of the antemortem blood concentration in this case. In Case 4 and four others, toxicological interpretation based on femoral blood concentration alone would have been misleading. Based on these results and evidence from the literature, it is hypothesized that methadone bioaccumulates in the tissues of chronic users and redistributes from thigh tissues into femoral blood, increasing the concentration postmortem. This case series highlights how femoral blood is not always preserved from postmortem changes and that the analysis of multiple blood sources is necessary to avoid a misleading toxicological interpretation-particularly for cases of chronic methadone users.
Collapse
Affiliation(s)
- Béatrice Garneau
- Department of Toxicology, Laboratoire de sciences judiciaires et de médecine légale, 1701 Parthenais St., Montréal, Québec H2K 3S7, Canada
| | - Cynthia Roy
- Department of Toxicology, Laboratoire de sciences judiciaires et de médecine légale, 1701 Parthenais St., Montréal, Québec H2K 3S7, Canada
| | - Julie Motard
- Department of Toxicology, Laboratoire de sciences judiciaires et de médecine légale, 1701 Parthenais St., Montréal, Québec H2K 3S7, Canada
| | - Brigitte Desharnais
- Department of Toxicology, Laboratoire de sciences judiciaires et de médecine légale, 1701 Parthenais St., Montréal, Québec H2K 3S7, Canada
- Department of Environmental and Occupational Health, Université de Montréal School of Public Health, PO Box 6128, Station Centre-ville, Montréal, Québec H3C 3J7, Canada
| | - Corinne Bouchard
- Department of Toxicology, Laboratoire de sciences judiciaires et de médecine légale, 1701 Parthenais St., Montréal, Québec H2K 3S7, Canada
| | - Pascal Mireault
- Department of Toxicology, Laboratoire de sciences judiciaires et de médecine légale, 1701 Parthenais St., Montréal, Québec H2K 3S7, Canada
| |
Collapse
|
2
|
Mantinieks D, Di Rago M, Drummer OH, Glowacki L, Schumann J, Gerostamoulos D. Quantitative analysis of tetrahydrocannabinol isomers and other toxicologically relevant drugs in blood. Drug Test Anal 2023. [PMID: 38158877 DOI: 10.1002/dta.3632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/09/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024]
Abstract
A multi-analyte liquid chromatography-tandem mass spectrometry (LC-MS/MS) method is described, involving the separation of delta-9-tetrahydrocannabinol (delta-9-THC) and delta-8-THC in addition to other commonly encountered drugs and metabolites. Briefly, sample preparation involved an alkaline liquid-liquid extraction (methyl tert-butyl ether) of blood (100 μl). The solvent layer was transferred, evaporated to dryness, reconstituted, and samples then separated on an Agilent Poroshell 120 EC-C18 100 Å (50 mm × 3.0 mm, 2.7 μm) analytical column using a multi-step gradient elution of 50 mM ammonium formate in water (pH 3.5) and 0.1% formic acid in methanol over 14 min. A SCIEX Triple Quad 6500+ system operating in scheduled multiple reaction monitoring and positive electrospray ionization was used for detection. There were no interferences, and matrix effects were generally acceptable (±20% of neat response). Linearity was achieved within the calibration range, including methylamphetamine (MA) (10-1000 ng/ml), 3,4-methylenedioxy-N-methylamphetamine (MDMA) (10-1,000 ng/ml), cocaine (10-1000 ng/ml), and two THC isomers (1-100 ng/ml). Accuracies of MA, MDMA, cocaine, and two THC isomers were 3.6 to 8.9%, -1.2 to 4%, -5.3 to 5.8%, and -11 to 14%, respectively; while precision estimates of the same were 1.6 to 5.4%, 1.7 to 5.3%, 1.2 to 4.5%, and 2 to 10%, respectively. Autosampler stability and dilution integrity were within acceptable limits, and no carryover was detected at the limit of detection. This validated LC-MS/MS method made the routine identification of both delta-9-THC and delta-8-THC in blood possible.
Collapse
Affiliation(s)
- Dylan Mantinieks
- Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, Southbank, Victoria, Australia
- Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia
| | - Matthew Di Rago
- Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, Southbank, Victoria, Australia
- Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia
| | - Olaf H Drummer
- Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, Southbank, Victoria, Australia
- Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia
| | - Linda Glowacki
- Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia
| | - Jennifer Schumann
- Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, Southbank, Victoria, Australia
- Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia
| | - Dimitri Gerostamoulos
- Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, Southbank, Victoria, Australia
- Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia
| |
Collapse
|