Quantitative determination of methamphetamine in oral fluid by liquid-liquid extraction and gas chromatography/mass spectrometry

An Overview of Advances in the Chromatography of Drugs Impurity Profiling

A systematic literature survey published in several journals of pharmaceutical chemistry and of chromatography used to analyze impurities for most of the drugs that have been reviewed. This article covers the period from 2016 to 2020, in which almost of chromatographic techniques have been used for drug impurity analysis. These chromatography techniques are important in the analysis and description of drug impurities. Moreover, some recent developments in forced impurity profiling have been discussed, such as buffer solutions, mobile phase, columns, elution modes, and detectors are highlighted in drugs used for the study. This primarily focuses on thorough updating of different analytical methods which include hyphenated techniques for detecting and quantifying impurity and degradation levels in various pharmaceutical matrices.

Quantification of amphetamine and derivatives in oral fluid by dispersive liquid-liquid microextraction and liquid chromatography-tandem mass spectrometry

The abuse of stimulants such as amphetamine, methamphetamine, ecstasy (MDMA), and their analogues (MDEA and MDA) has been increasing considerably worldwide since 2009. In this work, an analytical method using dispersive liquid-liquid microextraction (DLLME) to determine amphetamine and derivatives in oral fluid samples by liquid chromatography-tandem mass spectrometry (LC-MS/MS) was developed and validated. Linearity was achieved between 20 to 5000 ng/mL (r>0.992, 1/x² weighted linear regression), with a limit of quantification (LOQ) of 20 ng/mL. Imprecision (%relative standard deviation) and bias (%) were not higher than 9.1 and -12.3%, respectively. The matrix effect was lower than 14.6%, with no carryover observed up to 5000 ng/mL and no interference with 10 different oral fluid matrix sources and against 14 pharmaceuticals and other common drugs of abuse. MDMA, MDA, and MDEA in processed samples were stable up to 24 h at autosampler (10°C); and amphetamine and methamphetamine up to 18 h. The developed method was successfully applied to authentic oral fluid analyses (n = 140). The proposed method is an example of the Green Analytical Toxicology, since it reduces both the amount of solvent required in samples preparation and the quantity of solvents and reagents used in analytical-instrumental stage, as well as requires a minimal sample volume, being a cheaper, quicker and more ecological alternative to conventional methods. Obtained results showed that DLLME extraction combined with LC-MS/MS is a fast and simple method to quantify amphetamine derivatives in oral fluid samples.

Trends in Poly Drug Use-associated Deaths based on Confirmed Analytical Toxicology Results in Tehran, Iran, in 2011-2016

BACKGROUND

Poly drug use is a public health threat causing morbidity and mortality all over the world. Combined use of licit and illicit drugs is among the possible causes of death. In this retrospective analytical study, we evaluated forensic toxicology analysis results from 2011 to 2016 in Tehran province, Iran.

METHODS

All deaths related to poly drug use and referred to the Legal Medicine Organization, Tehran during the 6-year study period were evaluated. Postmortem samples were analyzed to detect alcohols, and prescription and illicit drugs using headspace gas chromatography (HSGC), high performance liquid chromatography (HPLC), and gas chromatography/mass spectrometry (GC/MS) in a forensic toxicology laboratory. Manner of death, demographic characteristics, and different drug categories in postmortem samples were analyzed.

FINDINGS

A total of 1388 poly drug use-associated deaths were investigated during the 6-year study period. Overall, victims were mostly young men of 20-40 years of age (56.8%). The male to female ratio was 7:16. Methadone (n = 660; 47.6%) and amphetamine type stimulants (ATS) (n = 657; 47.3%) were in the highest category for poly drug use-associated deaths. Moreover, in some cases, opium (n = 458; 32.9%), tramadol (n = 389; 28.0%), and tricyclic antidepressants (n = 151; 10.9%) had been used with other drugs.

CONCLUSION

The present study provides information about poly drug use-associated deaths in Tehran and highlights the major role of substance abuse in death.

An alarming rise in the prevalence of deaths with methamphetamine involved in Tehran, Iran 2011-2018

Methamphetamine is one of the most commonly abused illicit drugs in Iran. Despite this fact, there has been relatively little research on methamphetamine-associated deaths in Iran. The present study aimed to investigate the cause of death in methamphetamine positive cases based on forensic toxicology findings In this data base descriptive study, individuals with methamphetamine-associated deaths that were referred to the Legal Medicine Organization, Tehran, Iran (2011-2018) were assessed. Deaths including those from natural causes, toxicity, accident and suicides with positive forensic toxicology analyses for methamphetamine and its metabolite amphetamine in postmortem samples were investigated. All cases were examined to determine trends in methamphetamine-associated deaths, and in the manner and causes of deaths. During the eight year study there were 1389 methamphetamine-associated deaths. The mean age was 37.47±10.87 years, with a male/female ratio of 12.36:10. The methamphetamine-associated death rate increased significantly during the study period (2.05 vs. 21.93 per 10⁶ Tehran province populations). The most common cause of death was cardiac arrest due to stimulant abuse with supportive histologic findings of acute myocardial infarction, myocardial fiber hypertrophy, aortic dissection and perivascular fibrosis (25%). Opioids (methadone, tramadol and morphine), tricyclic antidepressants and benzodiazepines were frequently present in postmortem samples of study cases. Methamphetamine-associated deaths significantly contribute to illicit drug-associated deaths in Tehran and represent a substantial clinical and public health problem.

Whether drug detection in urine and oral fluid is similar? A systematic review

Urine has been a biological matrix of choice for drug screening, but recent advances in technology and the introduction of commercial oral fluid assays have effectively established oral fluid as a viable alternative matrix. This systematic review aimed to evaluate the sensitivity of oral fluid in detecting some illicit drugs compared to urine, and to compare the initial and final detection times of these drugs in both fluids. The electronic search in MEDLINE, Cochrane Library, Scopus, and Web of Science was carried out covering studies published from January 2003 and June 2019, in order to find all valid studies that detected drugs in oral fluid and urine in the same patient. Studies about illicit drugs, such as tetrahydrocannabinol, cocaine, amphetamines and illicit opioids, with fluids collection at the same day, controlled drug administration during the study, reported administration interval and time of collection were favored. Out of 2598 studies identified by electronic search, 7 studies were selected for qualitative analysis. Five were clinical trials and 2 were crossover trials. In total, 74 patients aged 20-52 years underwent a diagnostic examination (4 studies with tetrahydrocannabinol, 1 with methamphetamine, and 2 with cocaine) after drug administration. Illicit drug detection in oral fluid is similar to urine but oral fluid has a strong potential for the immediate detection of recent marijuana use compared to urine. In relation to cocaine and methamphetamine, the largest drugs detection window is obtained through urine analysis. Oral fluids cannot replace urine for most of the purposes of drug testing.

Forensic Toxicology Perspectives of Methadone-associated Deaths in Tehran, Iran, a 7-year Overview

Methadone has a long history of pain relief and successful substitute for maintenance treatment in heroin and narcotic addiction. The aim of the study was to assess the trends of methadone-associated deaths in Tehran, Iran, in 2009-2015, from a forensic toxicology point of view. All methadone-associated deaths during this 7-year study period were evaluated according to demographic parameters and forensic toxicology analysis results. Results showed that 1274 cases of methadone-associated deaths were investigated during the study period. The incidence rate of methadone-associated deaths had risen 7.7 times in 2015 in comparison with 2009 (p < 0.05). The majority of cases were men (90.35%), aged from 20 to 40 years. About 80% of cases had shown positive results for other drugs and poisons in combination with methadone. Methamphetamine and tramadol were the most drugs detected in post-mortem samples. Death rates among methadone users in Tehran, Iran, increased year by year during 2009-2015. These findings raise the attention to the concomitant use of drugs with the need for changes in regulation and regulatory policy to restrict access and use of controlled drugs.

Discrimination Between Drug Abuse and Medical Therapy: Case report of a tranylcypromine overdose-related fatality

Tranylcypromine is an effective antidepressant from the class of monoamine oxidase inhibitors and is structurally related to amphetamine. However, reports differ regarding the potential metabolism of tranylcypromine to amphetamine and methamphetamine within the human body. We report a 25-year-old woman with severe depression who died due to a fatal tranylcypromine overdose in 2016. She had been prescribed tranylcypromine one day previously and had no history of previous suicide attempts or substance abuse. The body was transferred to a forensic medicine department in Tehran, Iran for the autopsy. A urine sample was positive for tranylcypromine, amphetamine and methamphetamine using gas chromatography/mass spectrometry after derivatisation with heptafluorobutyric acid. As amphetamines were present in the urine sample, it was assumed that the tranylcypromine had been converted to amphetamines metabolically. As such, it is possible that the legitimate use of certain prescription drugs may complicate the interpretation of test results for illegal drugs.

Discrimination Between Drug Abuse and Medical Therapy: Case report of a tranylcypromine overdose-related fatality

Tranylcypromine is an effective antidepressant from the class of monoamine oxidase inhibitors and is structurally related to amphetamine. However, reports differ regarding the potential metabolism of tranylcypromine to amphetamine and methamphetamine within the human body. We report a 25-year-old woman with severe depression who died due to a fatal tranylcypromine overdose in 2016. She had been prescribed tranylcypromine one day previously and had no history of previous suicide attempts or substance abuse. The body was transferred to a forensic medicine department in Tehran, Iran for the autopsy. A urine sample was positive for tranylcypromine, amphetamine and methamphetamine using gas chromatography/mass spectrometry after derivatisation with heptafluorobutyric acid. As amphetamines were present in the urine sample, it was assumed that the tranylcypromine had been converted to amphetamines metabolically. As such, it is possible that the legitimate use of certain prescription drugs may complicate the interpretation of test results for illegal drugs.

Forensic toxicology analysis of self-poisoning suicidal deaths in Tehran, Iran; trends between 2011-2015

Background

Suicide ranks among the top ten causes of death in all age groups all over the world. There are many methods for committing suicide including self-poisoning, firearm and hanging. The aim of the present study was to provide an overview of self-poisoning related suicidal deaths with special focus on forensic toxicology analysis results in Tehran, Iran from 2011 to 2015.

Methods

All suspicious cases with the the history of self-poisoning were investigated to define the cause and manner of death under the supervision of forensic medicine practitioners. Postmortem samples were analysed in forensic toxicology laboratory to confirm the presence of drugs in cadaver of suicidal cases. Drugs and poisons were analysed using thin layer chromatography, high performance liquid chromatography, gas chromatography/mass spectrometry, headspace gas chromatography and gas chromatography equipped with nitrogen phosphorus detector. Demographic data were collected from autopsy reports of all cases with confirmed self-poisoning suicidal cause of death.

Results

Results showed that 674 cases of self-poisoning deaths were investigated during a five-year study period, of which 68.55% were male. The most often used suicide method was self-poisoning in young population. Phosphine gas liberated from aluminum phosphide tablets was the most toxic substance detected in postmortem samples (619 cases) followed by opioids, methamphetamine, organophosphates, cyanide and strychnine.

Conclusion

In conclusion self-poisoning suicidal death was predominant in young male population in Tehran, Iran. It seems that free access to suicide means such as drugs and poisons should be restricted by national and health authorities.

Trial registration

Not applicable.

Histopathological study of cardiac lesions in methamphetamine poisoning-related deaths

BACKGROUND

Methamphetamine abuse is a worldwide health concern. Methamphetamine causes health hazards in many vital organs. It can cause damage to cardiac tissue via catecholamines release. Methamphetamine related deaths are becoming one of the most important problems in Iran. The purpose of the present study was to determine cardiac pathology in methamphetamine poisoning-related deaths.

METHODS

The study included 100 cases of methamphetamine poisoning-related deaths and 100 cases as control group. Toxicology analysis of liver, gastric content, bile, urine, blood and vitreous humor were conducted to detect drugs, poisons and alcohols using thin layer chromatography, gas chromatography/mass spectrometry, and high performance liquid chromatography. Positive toxicology analysis results except for amphetamine and methamphetamine were excluded from the study in order to omit interfering factors. The most striking features of cardiac damage were observed by light microscopy.

RESULTS

Methamphetamine and amphetamine were detected in either urine or gastric content samples. In all of the cases methamphetamine toxicity was determined to be a direct cause of death by forensic medicine practitioner. Cardiovascular pathology was noted in 68% of studied cases. The most common histopathologic features were myocardial fiber hypertrophy, mild, moderate to severe atherosclerosis and focal degeneration/necrosis.

CONCLUSION

The results of the present study indicate that cardiotoxicity is one of the major contributing factors in methamphetamine poisoning related deaths. Overall, the current study highlights the fact that cardiotoxic effects of methamphetamine can explain increasing reports of heart failure and consequently death in young abusers.

TRIAL REGISTRATION

Not applicable. Histopathological study of cardiac lesions in methamphetamine poisoning-related deaths.