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Yu J, Diekhans K, Tsang A, Rodda LN. Fluorofentanyl and novel synthetic opioids in accidental overdose deaths. J Anal Toxicol 2024; 48:573-581. [PMID: 39087259 DOI: 10.1093/jat/bkae062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 07/08/2024] [Accepted: 07/31/2024] [Indexed: 08/02/2024] Open
Abstract
One of the quickest-growing subclasses of novel psychoactive substances is novel synthetic opioids (NSOs), which are categorized as fentanyl analogs (fentalogs) or nonfentanyl opioids that bind to the mu-opioid receptor. Increased detections of NSOs have been observed in the USA. However, limited information on their prevalence outside of the East Coast is available. This study details the prevalence of NSOs, specifically fluorofentanyl, in the biological and drug paraphernalia specimens of accidental overdose deaths in San Francisco in 2022. A recently developed and validated liquid chromatography with tandem mass spectrometry method was utilized for the analysis of >250 NSOs. Out of the 649 accidental overdose deaths in 2022, 617 cases were available for blood analysis, with at least 1 NSO detected in 48 cases (7.8%). Fentalogs were detected in all 48 cases, with fluorofentanyl being detected in 40 cases. In postmortem femoral blood, estimated concentrations of fluorofentanyl ranged from 0.1 to 8.9 ng/mL, and 0.05 to 85 ng/mL in urine. Polysubstance use with NSO was seen with fentanyl (89.6%), methamphetamine (70.8%), cocaine (33.3%), and heroin (18.8%). NSOs, mainly fluorofentanyl, were observed in matched drug paraphernalia. This report documents the migration of fluorofentanyl to the West Coast, specifically California.
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Affiliation(s)
- Jihau Yu
- Office of the Chief Medical Examiner, San Francisco, CA 94124, United States
| | - Katie Diekhans
- Office of the Chief Medical Examiner, San Francisco, CA 94124, United States
| | - Anson Tsang
- Office of the Chief Medical Examiner, San Francisco, CA 94124, United States
| | - Luke N Rodda
- Office of the Chief Medical Examiner, San Francisco, CA 94124, United States
- Department of Laboratory Medicine, University of California, San Francisco, CA 94143, United States
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2
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Jørgenrud B, McQuade T, Maria MH, Nilsson G, Berg T. Buffer-free high pH mobile phase LC-MS/MS for determination of the alcohol biomarker phosphatidylethanol 16:0/18:1 and 20 drugs and metabolites in whole blood. Talanta 2024; 282:126964. [PMID: 39366246 DOI: 10.1016/j.talanta.2024.126964] [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: 06/26/2024] [Revised: 09/10/2024] [Accepted: 09/25/2024] [Indexed: 10/06/2024]
Abstract
BACKGROUND Acidic mobile phases are commonly used in reversed phase liquid chromatography tandem mass spectrometry (LC-MS/MS) bioanalysis. However, increased sensitivity, improved peak symmetry, and increased retention, especially for basic hydrophilic drugs have been observed using basic mobile phases. In our previous acidic mobile phase LC-MS/MS method we needed two injections (0.4 and 2.0 μL) of each sample for this task, which is inefficient. The aim of this study was to investigate if basic mobile phase LC-MS/MS could be used to determine phosphatidylethanol 16:0/18:1 and 20 other drugs and metabolites with satisfactory sensitivity in one single run. METHODS Whole blood was prepared by 96-well supported-liquid extraction using heptane/ethyl acetate/2-propanol (16:64:20, v:v:v). Chromatographic separation was achieved on an Acquity BEH C18 column (50 × 2.1 mm I.D.), using a mobile phase with 0.025 % ammonia, pH 10.7 (Solvent A) and methanol (Solvent B). All compounds had isotope-labelled internal standards. RESULTS The method was fully validated. Recovery was between 63 and 91 % for 20 compounds and 10 % for benzoylecgonine. Matrix effects were low, except for ion enhancement of buprenorphine and ion suppression for THC. However, internal standards compensated for these effects. Inter-assay precision and accuracy were < ± 20 % for all compounds at five tested concentrations, except for methamphetamine at the highest concentration. CONCLUSION An LC-MS/MS method for simultaneous determination of PEth 16:0/18:1 and 20 drugs and metabolites in whole blood were for the first time developed and validated. Retention of PEth 16:0/18:1 was, in contrast to the other 20 compounds, largely affected by mobile phase buffer concentration. The buffer free basic mobile phase ensured that phosphatidylethanol 16:0/18:1 eluted before most of the unwanted phospholipids.
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Affiliation(s)
- Benedicte Jørgenrud
- Section of Forensic Research, Department of Forensic Sciences, Division of Laboratory Medicine, Oslo University Hospital, P.O. Box 4950 Nydalen, N-0424, Oslo, Norway.
| | - Tao McQuade
- Section of Forensic Research, Department of Forensic Sciences, Division of Laboratory Medicine, Oslo University Hospital, P.O. Box 4950 Nydalen, N-0424, Oslo, Norway
| | - Marisa H Maria
- Centro de Química Estrutural, Institute of Molecular Sciences, Departamento de Química e Bioquímica, Faculdade de Ciências, Universidade de Lisboa, 1749 -016, Lisboa, Portugal
| | - Galina Nilsson
- Section of Forensic Research, Department of Forensic Sciences, Division of Laboratory Medicine, Oslo University Hospital, P.O. Box 4950 Nydalen, N-0424, Oslo, Norway
| | - Thomas Berg
- Section of Forensic Research, Department of Forensic Sciences, Division of Laboratory Medicine, Oslo University Hospital, P.O. Box 4950 Nydalen, N-0424, Oslo, Norway.
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3
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Tsang A, Rodda LN. Assessment of postmortem urine fentanyl detection by autopsy dipstick testing in accidental overdose deaths. J Anal Toxicol 2024:bkae072. [PMID: 39230968 DOI: 10.1093/jat/bkae072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Revised: 08/08/2024] [Accepted: 08/15/2024] [Indexed: 09/06/2024] Open
Abstract
Accidental overdose cases continue to rise due to the opioid epidemic in the USA, namely, the widespread availability and use of fentanyl. Medical examiners and coroners across the country have been subsequently burdened, and with limited resources, some seek alternative triaging processes to identify overdoses. Point-of-care urine dipstick testing at autopsy is one such idea that may be used in various ways to instigate or negate the need for an autopsy or regular forensic toxicology laboratory testing. This study investigated the frequency and estimated quantitative fentanyl and norfentanyl concentrations in the postmortem urine of fentanyl-related accidental overdose deaths, as well as the effectiveness of commercially available point-of-care urine dipstick tests based on such concentrations. A total of 1550 fentanyl-related accidental overdose cases, where both the postmortem peripheral femoral blood and urine were tested, were reviewed. Of these, using sensitive liquid chromatography-tandem mass spectrometry (LC-MS-MS) laboratory testing, 82 cases (5%) had a positive fentanyl or norfentanyl detection in the blood, while fentanyl or norfentanyl remained undetected in the urine. Furthermore, a comparison of commercially available urine dipstick test cut-offs and authentic casework with estimated urine concentrations revealed that at a fentanyl/norfentanyl cut-off level of 5 ng/mL, 19% of these fentanyl-related accidental overdoses would result in a false negative, 24% at 10 ng/mL, 25% at 20 ng/mL, 51% at 50 ng/mL, and 61% at 100 ng/mL. The study found that the use of urine dipstick tests, as a decision-maker for the initiation of further comprehensive routine toxicology laboratory testing, or to support cause and manner of death determination, leads to both false-positive and false-negative predictions in fentanyl accidental overdoses.
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Affiliation(s)
- Anson Tsang
- Office of the Chief Medical Examiner, 1 Newhall Street, San Francisco, CA 94124, United States
| | - Luke N Rodda
- Office of the Chief Medical Examiner, 1 Newhall Street, San Francisco, CA 94124, United States
- Department of Laboratory Medicine, University of California, 185 Berry Street, San Francisco, CA 94107, United States
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Świątek S, Czyrski A. Analytical Methods for Determining Psychoactive Substances in Various Matrices: A Review. Crit Rev Anal Chem 2024:1-27. [PMID: 39155524 DOI: 10.1080/10408347.2024.2388123] [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: 08/20/2024]
Abstract
Psychoactive substances pose significant challenges and dangers to society due to their impact on perception, mood, and behavior, leading to health and life disturbances. The consumption of these substances is largely influenced by their legal status, cultural norms, and religious beliefs. Continuous development and chemical modifications of psychoactive substances complicate their control, detection, and determination in the human body. This paper addresses the terminological distinctions between psychoactive and psychotropic substances and drugs. It provides a comprehensive review of analytical methods used to identify and quantify 25 psychoactive substances in various biological matrices, including blood, urine, saliva, hair, and nails. The analysis categorizes these substances into four primary groups: stimulants, neuroleptics, depressants, and hallucinogens. The study specifically focuses on chromatographic and spectrophotometric methods, as well as other novel analytical techniques. Methodology includes a review of scientific articles containing validation studies of these methods and innovative approaches to psychoactive substance determination. Articles were sourced from the PubMed database, with most research originating from the twenty first century. The paper discusses the limits of detection and quantitation for each method, along with current trends and challenges in the analytical determination of evolving psychoactive substances.
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Affiliation(s)
- Szymon Świątek
- Department of Physical Pharmacy and Pharmacokinetics, Poznań University of Medical Sciences, Poznań, Poland
- Doctoral School of Natural Sciences, Faculty of Geographical and Geological Sciences, Adam Mickiewicz University in Poznań, Poznań, Poland
| | - Andrzej Czyrski
- Department of Physical Pharmacy and Pharmacokinetics, Poznań University of Medical Sciences, Poznań, Poland
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Dos Santos BP, Birk L, Schwarz P, Sebben VC, Sgaravatti ÂM, de Gouveia GC, Silva Petry AU, de Menezes FP, Gonzaga AP, Schlickmann PF, Arbo MD, de Oliveira TF, Eller S. A validated dilute-and-shoot LC-MS-MS urine screening for the analysis of 95 illicit drugs and medicines: Insights from clinical and forensic Brazilian cases. J Anal Toxicol 2024; 48:314-331. [PMID: 38334744 DOI: 10.1093/jat/bkae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/16/2023] [Accepted: 02/05/2024] [Indexed: 02/10/2024] Open
Abstract
Urine toxicological analysis is a relevant tool in both clinical and forensic scenarios, enabling the diagnosis of acute poisonings, elucidation of deaths, verification of substance use in the workplace and identification of drug-facilitated crimes. For these analyses, the dilute-and-shoot technique associated with liquid chromatography coupled with tandem mass spectrometry (LC-MS-MS) is a promising alternative since it has demonstrated satisfactory results and broad applicability. This study developed and validated a comprehensive LC-MS-MS screening method to analyze 95 illicit drugs and medicines in urine samples and application to clinical and forensic Brazilian cases. The dilute-and-shoot protocol was defined through multivariate optimization studies and was set using 100 µL of sample and 300 µL of solvent. The total chromatographic run time was 7.5 min. The method was validated following the recommendations of the ANSI/ASB Standard 036 Guideline. The lower limits of quantification varied from 20 to 100 ng/mL. Within-run and between-run precision coefficient of variations% were <20%, and bias was within ± 20%. Only 4 of the 95 analytes presented significant ionization suppression or enhancement (>25%). As proof of applicability, 839 urine samples from in vivo and postmortem cases were analyzed. In total, 90.9% of the analyzed samples were positive for at least one substance, and 78 of the 95 analytes were detected. The most prevalent substances were lidocaine (40.2%), acetaminophen (38.0%) and benzoylecgonine (31.5%). The developed method proved to be an efficient and simplified alternative for analyzing 95 therapeutic and illicit drugs in urine samples. Additionally, the results obtained from sample analysis are essential for understanding the profile of Brazilian substance use, serving as a valuable database for the promotion of health and safety public policies.
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Affiliation(s)
- Bruno Pereira Dos Santos
- Graduate Program in Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS 90050-170, Brazil
- Faculty of Pharmacy, Federal University of Rio Grande do Sul, Porto Alegre, RS 90010-150, Brazil
| | - Letícia Birk
- Graduate Program in Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS 90050-170, Brazil
| | - Patrícia Schwarz
- Graduate Program in Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS 90050-170, Brazil
| | | | - Ângela Malysz Sgaravatti
- Graduate Program in Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS 90050-170, Brazil
- General Institute of Expertise of Rio Grande do Sul, Porto Alegre, RS 90230-010, Brazil
| | - Giovanna Cristiano de Gouveia
- Graduate Program in Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS 90050-170, Brazil
| | - Adriana Ubirajara Silva Petry
- Graduate Program in Pathology, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS 90050-170, Brazil
- Division of Postmortem Inspection, Associação Hospitalar Vila Nova, Porto Alegre, RS 91750-040, Brazil
| | - Francisco Paz de Menezes
- Division of Postmortem Inspection, Associação Hospitalar Vila Nova, Porto Alegre, RS 91750-040, Brazil
| | - Alexsandro Pinto Gonzaga
- Division of Postmortem Inspection, Associação Hospitalar Vila Nova, Porto Alegre, RS 91750-040, Brazil
| | - Paula Flores Schlickmann
- Division of Postmortem Inspection, Associação Hospitalar Vila Nova, Porto Alegre, RS 91750-040, Brazil
| | - Marcelo Dutra Arbo
- Faculty of Pharmacy, Federal University of Rio Grande do Sul, Porto Alegre, RS 90010-150, Brazil
| | - Tiago Franco de Oliveira
- Graduate Program in Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS 90050-170, Brazil
| | - Sarah Eller
- Graduate Program in Health Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS 90050-170, Brazil
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Diekhans K, Yu J, Farley M, Rodda LN. Analysis of over 250 novel synthetic opioids and xylazine by LC-MS-MS in blood and urine. J Anal Toxicol 2024:bkae009. [PMID: 38459917 DOI: 10.1093/jat/bkae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/21/2023] [Accepted: 02/15/2024] [Indexed: 03/11/2024] Open
Abstract
Novel Synthetic Opioids (NSO) are frequently found in postmortem (PM) and human performance (HP) forensic toxicology casework, resulting in impairment and fatal overdoses. Developing a broad NSO method benefits public health, as it can be used to identify trends in potent opioid use to develop risk management programs. This project aimed to design a comprehensive, rapid and routine method for the selective analysis of over 250 novel synthetic opioids in blood and urine. This method rapidly extracted 150 µL of blood or urine via protein precipitation followed by size-exclusion filtration, evaporation and reconstitution. Separation and data acquisition were achieved on a 12 min LC-MS-MS method using an F5 column. Data processing was expedited with a custom built-in query created in-house that automated processing and enhanced quality assurance. Validation according to ASB/ANSI Standard 036 was performed and applicability of the method was assessed using proficiency test and authentic casework samples. Assessed in blood and urine qualitatively were 261 unique analytes including fentanyl analogs (fentalogs), nitazenes and other miscellaneous synthetic opioids. As 59 isomeric target analytes were placed into groups due to co-elution, there were 202 distinct acquired targets or target - groups. To demonstrate applicability, 27 proficiency test blood samples received over an approximate 4-year period were analyzed with 126 expected results assessed comprising 25 unique target analytes. Additionally, 617 fatal accidental overdoses within San Francisco in 2022 were retroactively analyzed by this method with almost 10% of cases containing a new NSO substance(s). Such trends and NSO substances were previously unknown in this community.
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Affiliation(s)
- Katie Diekhans
- Office of the Chief Medical Examiner, 1 Newhall Street, San Francisco, CA, United States
| | - Jihau Yu
- Office of the Chief Medical Examiner, 1 Newhall Street, San Francisco, CA, United States
| | - Megan Farley
- Office of the Chief Medical Examiner, 1 Newhall Street, San Francisco, CA, United States
| | - Luke N Rodda
- Office of the Chief Medical Examiner, 1 Newhall Street, San Francisco, CA, United States
- Laboratory Medicine, University of California, San Francisco, San Fransisco, CA, United States
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Goryński K, Sobczak Ł, Kołodziej D. Developing and Evaluating the Greenness of a Reliable, All-in-One Thin-Film Microextraction Protocol for Determining Fentanyl, Methadone, and Zolpidem in Plasma, Urine, and Oral Fluid. Molecules 2024; 29:335. [PMID: 38257248 PMCID: PMC10818652 DOI: 10.3390/molecules29020335] [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: 11/23/2023] [Revised: 12/26/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
This paper proposes an all-in-one microextraction-based protocol capable of determining and quantifying fentanyl, methadone, and zolpidem in plasma, urine, and saliva at concentrations below those required by international regulatory organizations. A homemade thin-film microextraction device featuring an octyl-cyanopropyl stationary phase was coupled with LC-MS/MS. The proposed method was developed and validated according to FDA criteria, providing extraction efficiency values ranging from 26.7% to 76.2% with no significant matrix effects (2.6% to 15.5% signal suppression). The developed protocol provided low limits of quantification (mostly equal to 1 ng mL-1) and good reproducibility (intra- and inter-day RSDs of less than 9.6% and 12.0%, respectively) and accuracy (89% to 104% of the test concentration). An assessment of the protocol's environmental impact indicated that attention must be devoted to eliminating the use of toxic reagents and developing its capability for in situ sampling and in-field analysis using portable instruments. The proposed TFME-based protocol provides clinical laboratories with a versatile, one-step tool that enables the simultaneous monitoring of fentanyl, methadone, and zolpidem using the most popular biological matrices.
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Affiliation(s)
- Krzysztof Goryński
- Faculty of Chemical Technology and Engineering, Bydgoszcz University of Science and Technology, Seminaryjna 3, 85-326 Bydgoszcz, Poland
| | - Łukasz Sobczak
- Faculty of Pharmacy, Nicolaus Copernicus University in Toruń, Jurasza 2, 85-089 Bydgoszcz, Poland
| | - Dominika Kołodziej
- Faculty of Pharmacy, Nicolaus Copernicus University in Toruń, Jurasza 2, 85-089 Bydgoszcz, Poland
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Rodrigo Valero AM, Jorge OQ, Serrano BB, Tejedor SA. Optimization of a rapid method for screening drugs in blood by liquid chromatography tandem mass spectrometry. ADVANCES IN LABORATORY MEDICINE 2023; 4:365-371. [PMID: 38106497 PMCID: PMC10724859 DOI: 10.1515/almed-2023-0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 09/13/2023] [Indexed: 12/19/2023]
Abstract
Objectives In the recent years, liquid chromatography with tandem mass spectrometry has gained popularity in laboratories. This technique has a higher specificity, detects different analytes from a single specimen, measures analytes in distinct matrices, and substantially reduce analytical interference, with respect to immunoassay. The processing and preparation of biological samples are crucial in chromatography. Interferences in blood testing are usually caused by the presence of phospholipids and proteins. The main objective of this study was to improve analytical processes for drug screening by LC-MS/MS using a novel blood sample preparation method based on protein precipitation and removal of phospholipids. Methods An evaluation was performed of a new method for the preparation of blood samples based on protein precipitation and removal of phospholipids by LC-Q-q-LIT. Results Limit of detection, limit of quantification and measurement range were determined for 56 molecules. The results of 11 cases were compared with those obtained using standard blood collection methods and instruments. Conclusions The novel blood preparation and testing method based on LC-Q-q-LIT, a more sensitive technique, has demonstrated to yield comparable results to traditional methods. In addition, this new technique reduces turnaround time and costs.
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Affiliation(s)
- Alba M. Rodrigo Valero
- Departamento Madrid, Servicio de Química, Instituto Nacional de Toxicología y Ciencias Forenses (INTCF), Madrid, Spain
| | - Oscar Quintela Jorge
- Departamento Madrid, Servicio de Química, Instituto Nacional de Toxicología y Ciencias Forenses (INTCF), Madrid, Spain
| | - Begoña Bravo Serrano
- Departamento Madrid, Servicio de Química, Instituto Nacional de Toxicología y Ciencias Forenses (INTCF), Madrid, Spain
| | - Sara Ayuso Tejedor
- Departamento Madrid, Servicio de Química, Instituto Nacional de Toxicología y Ciencias Forenses (INTCF), Madrid, Spain
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9
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Rodrigo Valero AM, Quintela Jorge O, Bravo Serrano B, Ayuso Tejedor S. Optimización de un método de cribado rápido de fármacos en sangre mediante la técnica de cromatografía de líquidos acoplada a espectrometría de masas. ADVANCES IN LABORATORY MEDICINE 2023; 4:372-378. [PMID: 38106500 PMCID: PMC10724858 DOI: 10.1515/almed-2023-0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 09/13/2023] [Indexed: 12/19/2023]
Abstract
Objetivos La cromatografía líquida acoplada a la espectrometría de masas ha ganado en popularidad en los laboratorios en los últimos años debido a una mayor especificidad de la técnica, la posibilidad de determinar múltiples analitos en una sola inyección de la muestra, la medición de analitos en una variedad de matrices diferentes y a una drástica reducción de las interferencias analíticas en comparación con el inmunoensayo. El tratamiento y preparación de las muestras biológicas es un proceso esencial cuando éstas han de ser analizadas mediante sistemas cromatográficos. Los principales interferentes en el análisis de las muestras de sangre son los fosfolípidos y las proteínas. El objetivo principal de este estudio es mejorar la sistemática analítica toxicológica en el cribado general de fármacos mediante la técnica LC-MS/MS a través de un nuevo método de preparación de muestras en sangre basado en la precipitación de proteínas y eliminación de fosfolípidos. Métodos Se ha evaluado el nuevo método de preparación de muestras en sangre basado en la precipitación de proteínas y eliminación de fosfolípidos mediante la tecnología LC-Q-q-LIT. Resultados Se ha determinado el límite de detección, el límite de cuantificación y rango de medición para las 56 moléculas seleccionadas y se han comparado los resultados de once casos con las extracciones e instrumentación tradicionales. Conclusiones La metodología propuesta de preparación de muestras en sangre y análisis mediante técnicas más sensibles como LC-Q-q-LIT ha resultado comparable a la metodología tradicional en cuanto a resultados y, ofreciendo, además, una reducción de tiempo y coste.
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Affiliation(s)
- Alba M. Rodrigo Valero
- Departamento Madrid, Servicio de Química, Instituto Nacional de Toxicología y Ciencias Forenses (INTCF), Las Rozas, Madrid, España
| | - Oscar Quintela Jorge
- Departamento Madrid, Servicio de Química, Instituto Nacional de Toxicología y Ciencias Forenses (INTCF), Las Rozas, Madrid, España
| | - Begoña Bravo Serrano
- Departamento Madrid, Servicio de Química, Instituto Nacional de Toxicología y Ciencias Forenses (INTCF), Las Rozas, Madrid, España
| | - Sara Ayuso Tejedor
- Departamento Madrid, Servicio de Química, Instituto Nacional de Toxicología y Ciencias Forenses (INTCF), Las Rozas, Madrid, España
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10
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Ayala J, Kerrigan S. Comprehensive toxicological screening of common drugs of abuse, new psychoactive substances and cannabinoids in blood using supported liquid extraction and liquid chromatography-quadrupole time-of-flight mass spectrometry. J Anal Toxicol 2023; 47:656-667. [PMID: 37702353 DOI: 10.1093/jat/bkad069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 09/03/2023] [Accepted: 09/06/2023] [Indexed: 09/14/2023] Open
Abstract
Immunoassay (IA) is currently the most widely used technique for toxicological screening in drug-impaired driving investigations. However, practical limitations in the scope of testing, and the emergence of new psychoactive substances (NPSs), have highlighted the need for alternative approaches, particularly mass spectrometry-based screening. High-resolution mass spectrometry broadens the scope of testing to include NPSs and increases analyte specificity compared to IA. In addition, it provides a platform with increased flexibility and adaptability to incorporate emerging drugs of interest due to the transient drug market. In this study, a comprehensive screening procedure was developed to identify >200 drugs of interest, including cannabinoids and NPSs in whole blood. Supported liquid extraction and liquid chromatography-quadrupole time-of-flight mass spectrometry using All Ions data acquisition were used. The method was validated in accordance with published recommendations, and all compounds of interest were identified at recommended cutoffs for driving under the influence of drug investigations. Cannabinoids, including 11-nor-9-carboxy-∆9-tetrahydrocannabinol, fentanyl analogs, buprenorphine, novel synthetic opioids and synthetic cannabinoids, were identified at low- to sub-nanogram/milliliter concentrations in whole blood using both positive and negative electrospray ionization acquisition methods.
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Affiliation(s)
- Jessica Ayala
- Department of Forensic Science, Sam Houston State University, 1003 Bowers Blvd., Huntsville, TX 77340, United States
| | - Sarah Kerrigan
- Department of Forensic Science, Sam Houston State University, 1003 Bowers Blvd., Huntsville, TX 77340, United States
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11
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Citti C, Laganà A, Capriotti AL, Montone CM, Cannazza G. Kratom: The analytical challenge of an emerging herbal drug. J Chromatogr A 2023; 1703:464094. [PMID: 37262932 DOI: 10.1016/j.chroma.2023.464094] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 05/19/2023] [Accepted: 05/20/2023] [Indexed: 06/03/2023]
Abstract
Mitragyna speciosa or kratom is emerging worldwide as a "legal" herbal drug of abuse. An increasing number of papers is appearing in the scientific literature regarding its pharmacological profile and the analysis of its chemical constituents, mainly represented by alkaloids. However, its detection and identification are not straightforward as the plant material is not particularly distinctive. Hyphenated techniques are generally preferred for the identification and quantification of these compounds, especially the main purported psychoactive substances, mitragynine (MG) and 7-hydroxymitragynine (7-OH-MG), in raw and commercial products. Considering the vast popularity of this recreational drug and the growing concern about its safety, the analysis of alkaloids in biological specimens is also of great importance for forensic and toxicological laboratories. The review addresses the analytical aspects of kratom spanning the extraction techniques used to isolate the alkaloids, the qualitative and quantitative analytical methods and the strategies for the distinction of the naturally occurring isomers.
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Affiliation(s)
- Cinzia Citti
- Institute of Nanotechnology - CNR NANOTEC, Campus Ecotekne, Via Monteroni, Lecce 73100, Italy.
| | - Aldo Laganà
- Department of Chemistry, Sapienza University of Rome, Piazzale Aldo Moro 5, Rome 00185, Italy
| | - Anna Laura Capriotti
- Department of Chemistry, Sapienza University of Rome, Piazzale Aldo Moro 5, Rome 00185, Italy
| | - Carmela Maria Montone
- Department of Chemistry, Sapienza University of Rome, Piazzale Aldo Moro 5, Rome 00185, Italy
| | - Giuseppe Cannazza
- Department of Life Sciences, University of Modena and Reggio Emilia, Via Campi 103, Modena 41125, Italy.
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Al Bahri AA, Hamnett HJ. Etizolam and Its Major Metabolites: A Short Review. J Anal Toxicol 2023; 47:216-226. [PMID: 36477341 DOI: 10.1093/jat/bkac096] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/16/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
Etizolam is a benzodiazepine (BZD). Etizolam is structurally different from BZDs as a thiophene replaces the benzene ring and a triazole ring is fused to the diazepine ring, but etizolam's pharmacological profile is similar. Etizolam has been used to treat anxiety and panic disorders, to reduce depressive and somatization symptoms and to induce muscle relaxation. Etizolam is used recreationally due to its reinforcing and sedative effects. Etizolam is available in tablet or powder form or administered on blotter paper that can be placed on the tongue for oral absorption. Etizolam metabolizes into two major metabolites: α-hydroxyetizolam and 8-hydroxyetizolam, and all three compounds can be detected in different biological specimens using various common analytical techniques such as immunoassay, chromatography and mass spectrometry. Etizolam is a controlled drug in many countries around the globe but is approved for medical use in some countries, such as Japan, South Korea and Italy. This work is a collation and review of available literature on etizolam to help improve the fundamental understanding of its toxicology, outline best analytical practice, and aid interpretation of toxicology results.
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Affiliation(s)
- Abdul Aziz Al Bahri
- Forensic Toxicologist Specialist, Forensic Science Laboratory, PO Box 446, Muscat, 113, Oman
| | - Hilary J Hamnett
- Associate Professor in Forensic Science, School of Chemistry, University of Lincoln, Green Lane, Lincoln, Lincolnshire, LN6 7DL, UK
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Barone R, Giorgetti A, Cardella R, Rossi F, Garagnani M, Pascali JP, Mohamed S, Fais P, Pelletti G. Development and validation of a fast UPLC-MS/MS screening method for the detection of 68 psychoactive drugs and metabolites in whole blood and application to post-mortem cases. J Pharm Biomed Anal 2023; 228:115315. [PMID: 36889130 DOI: 10.1016/j.jpba.2023.115315] [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: 01/11/2023] [Revised: 02/22/2023] [Accepted: 02/22/2023] [Indexed: 02/27/2023]
Abstract
We report a rapid and sensitive LC-MS/MS method that allows the simultaneous detection of 68 commonly prescribed antidepressants, benzodiazepines, neuroleptics, and metabolites in whole blood with a small sample volume after a rapid protein precipitation. The method was also tested on post-mortem blood from 85 forensic autopsies. Three sets of commercial serum calibrators containing a mix of prescription drugs of increasing concentration were spiked with red blood cells (RBC) to obtain 6 calibrators (3 "serum calibrators" and 3 "blood calibrators"). Curves obtained from serum calibrators and from blood calibrators were compared using a Spearman correlation test and by analyzing slopes and intercepts, to assess if the points from six calibrators could be plotted together in a single calibration model. The validation plan included interference studies, calibration model, carry-over, bias, within-run and between-run precision, limit of detection (LOD), limit of quantification (LOQ), matrix effect and dilution integrity. Four deuterated Internal Standards (Nordiazepam-D5, Citalopram-D6, Ketamine-D4 and Amphetamine-D5) and two different dilutions were assessed. Analyses were performed using an Acquity UPLC® System coupled with triple quadrupole detector Xevo TQD®. The degree of agreement with a previously validated method was calculated on whole blood samples of 85 post-mortem cases, by performing a Spearman correlation test with a Bland-Altman plot. Percentage error between the two methods was evaluated. Slopes and intercepts of curves obtained from serum calibrators and from blood calibrators showed a good correlation, and the calibration model was built plotting all points together. No interferences were found. The calibration curve appeared to provide a better fit of the data using an unweighted linear model. Negligible carry-over was observed, and very good linearity, precision, bias, matrix effect and dilution integrity were achieved. The LOD and the LOQ were at the lower limits of the therapeutic range for the tested drugs. In a series of 85 forensic cases, 11 antidepressants, 11 benzodiazepines and 8 neuroleptics were detected. For all analytes, a very good agreement between the new method and the validated method was demonstrated. The innovation of our method consists in the use of commercial calibrators, readily available to most forensic toxicology laboratories, for the validation of a fast, inexpensive, wide-panel LC-MS/MS method that can be used as a reliable and accurate screening for psychotropic drug in postmortem samples. As observed in the implementation on real cases, this method could be profitably applied in forensic cases.
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Affiliation(s)
- Rossella Barone
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126 Bologna, Italy
| | - Arianna Giorgetti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126 Bologna, Italy
| | - Rachele Cardella
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126 Bologna, Italy
| | - Francesca Rossi
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126 Bologna, Italy
| | - Marco Garagnani
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126 Bologna, Italy
| | - Jennifer Paola Pascali
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Via Falloppio 50, 35121 Padova, Italy
| | - Susan Mohamed
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126 Bologna, Italy
| | - Paolo Fais
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126 Bologna, Italy.
| | - Guido Pelletti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Via Irnerio 49, 40126 Bologna, Italy
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