Quantification of Classic, Prescription and Synthetic Opioids in Hair by LC-MS-MS

Detection of fentanyl, synthetic opioids, and ketamine in hair specimens from purposive samples of American and Italian populations

With the current crisis related to the diffusion of fentanyl and other novel opioids in several countries and populations, new and effective approaches are needed to better elucidate the phenomenon. In this context, hair testing offers a unique perspective in the investigation of drug consumption, producing useful information in terms of exposure to psychoactive substances. In this research, we applied targeted ultra-high performance liquid chromatography tandem mass spectrometry (UHPLC-MS/MS) analytical methods to detect novel synthetic and prescription opioids and other common controlled psychoactive drugs in the keratin matrix. A total of 120 hair samples were analyzed from the United States (US) and Italy, segmented when longer than 6 cm, and then analyzed. In the 60 samples (83 segments in total) analyzed from a purposive sample of data collected in the US, fentanyl was detected in 14 cases (16.9%), with no detection of nitazens or brorphine. We also detected fentanyl metabolites, despropionyl-p-fluorofentanyl, and prescription opioids. In the 60 samples collected in Italy (91 segments in total), ketamine was the most prevalent compound detected (in 41 cases; 45.1%), with ketamine demonstrating a strong correlation with detection of amphetamines and MDMA, likely due to co-use of these substances in recreational contexts. Several common drugs were also detected but no exposure to fentanyl or its analogs were detected. Results of this retrospective exploration of drug use add to increasing evidence that hair testing can serve as a useful adjunct to epidemiology studies that seek to determine biologically confirmed use and exposure in high-risk populations.

A Novel UHPLC-MS/MS Method for the Quantification of Seven Opioids in Different Human Tissues

BACKGROUND

Opioids are considered the cornerstone of pain management: they show good efficacy as a first-line therapy for moderate to severe cancer pain. Since pharmacokinetic/pharmacodynamic information about the tissue-specific effect and toxicity of opioids is still scarce, their quantification in post-mortem autoptic specimens could give interesting insights.

METHODS

We describe an ultra-high-performance liquid chromatography coupled with tandem mass spectrometry method for the simultaneous quantification of methadone, morphine, oxycodone, hydrocodone, oxymorphone, hydromorphone and fentanyl in several tissues: liver, brain, kidney, abdominal adipose tissue, lung and blood plasma. The presented method has been applied on 28 autoptic samples from different organs obtained from four deceased PLWH who used opioids for palliative care during terminal disease.

RESULTS

Sample preparation was based on tissue weighing, disruption, sonication with drug extraction medium and a protein precipitation protocol. The extracts were then dried, reconstituted and injected onto the LX50 QSight 220 (Perkin Elmer, Milan, Italy) system. Separation was obtained by a 7 min gradient run at 40 °C with a Kinetex Biphenyl 2.6 µm, 2.1 × 100 mm. Concerning the analyzed samples, higher opioids concentrations were observed in tissues than in plasma. Particularly, O-MOR and O-COD showed higher concentrations in kidney and liver than other tissues (>15-20 times greater) and blood plasma (>100 times greater).

CONCLUSIONS

Results in terms of linearity, accuracy, precision, recovery and matrix effect fitted the recommendations of FDA and EMA guidelines, and the sensitivity was high enough to allow successful application on human autoptic specimens from an ethically approved clinical study, confirming its eligibility for post-mortem pharmacological/toxicological studies.

A New Multi-Analyte LC-MS-MS Screening Method for the Detection of 120 NPSs and 49 Drugs in Hair

Liquid chromatography coupled with mass spectrometry (LC-MS) has been increasingly used for screening purposes in forensic toxicology. High versatility and low time/resource consumption are the main advantages of this technology. Numerous multi-analyte methods have been validated in order to face the analytical challenge of new psychoactive substances (NPSs). However, forensic toxicologists must focus the attention also on "classical" NPSs and medicines, such as benzodiazepines (BDZs) and prescription opioids. In this paper, a new method for the simultaneous detection of 169 substances (120 NPSs and 49 other drugs) in hair by LC-MS-MS is described. After the decontamination of hair samples with dichloromethane, a 20-mg aliquot of the sample was mixed with 1 mL of methanol (MeOH; 0.1% of formic acid) and then sonicated at room temperature for 2 h. The mixture was then dried under nitrogen stream and reconstituted with 100 µL of MeOH. LC separation was achieved with a 100-mm-long C18 column in 35 min, and mass acquisition was performed in dynamic multiple reaction monitoring mode and in positive ionization. The analysis results were very sensitive, with the limit of quantification ranging from 0.07 to 10.0 pg/mg. Accuracy and precision were always within the acceptable criteria. Matrix effect and recovery rate ranges were from -21.3 to + 21.9% and from 75.0 to 99.3%, respectively. The new method was successfully applied in a preliminary study on the prevalence of NPSs, BDZs and other substances in case of driving license issuance. In 14% of cases, BDZs/antidepressants (mainly trazodone, diazepam/nordiazepam and flunitrazepam) were found. Codeine, ketamine, methylone and mephedrone were also detected.

Evaluation of Pretreatment and Extraction Parameters for the Analysis of Fentanyl in Hair Using Statistical Design of Experiments (DoE)

Optimal methods for hair analysis are often debated. Previous work in this laboratory demonstrated that the statistical technique known as Design of Experiments (DoE) is useful for such optimization. DoE evaluates both the individual roles and the combinatorial associations among multiple independent variables (i.e., hair pretreatment parameters) and a dependent variable (i.e., drug recovery from hair). In this study, hair externally contaminated with fentanyl underwent decontamination with combinations of parameters based on a 24 fractional factorial block design DoE matrix. The parameters of interest included aqueous wash solvent (1% SDS or water), organic wash solvent (dichloromethane or methanol), number of consecutive washes (one or three), sequence of washes (aqueous first or organic first), and wash time (30 s or 30 min). The optimal method for decontaminating fentanyl from the hair surface was found to be one 30-min wash with dichloromethane followed by one 30-min wash with water. Pretreatment parameters were optimized with a 23 full factorial DoE matrix using authentic hair reference material (HRM), which consisted of pooled drug user hair diluted to a known concentration of fentanyl with drug-free hair. The factors of interest were extraction solvent/sample weight ratio (12.5 or 25 µL/mg), hair particle size (pulverized or 1 mm segments), and extraction time (2 or 24 h). The most effective pretreatment method for fentanyl consisted of pulverizing the hair prior to a 2-h extraction in a 25 µL/mg extraction solvent volume/sample weight ratio. Finally, using the optimized pretreatment methods, fentanyl containing authentic HRM was extracted using aqueous base, solvent, and enzymatic hair extraction methods, where it was determined that the aqueous base technique was most effective for recovery of fentanyl. These experiments further demonstrate the value of DoE and authentic HRM in method development for forensic hair analysis.