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Maruejouls C, Ameline A, Gheddar L, Mazoyer C, Teston K, Aknouche F, Kintz P. First evidence in an oversea French department of the deadly risk of protonitazene use: about 5 post mortem cases. Int J Legal Med 2024:10.1007/s00414-024-03309-w. [PMID: 39168895 DOI: 10.1007/s00414-024-03309-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 08/07/2024] [Indexed: 08/23/2024]
Abstract
Protonitazene is a synthetic benzoimidazole opioid of the nitazenes class, developed in the 1950s as an effective analgesic, but never released in the market due to severe side effects and major risk of dependence. The laboratory was involved in the determination of the cause of death for 5 subjects deceased in a French department of the Indian Ocean. The 5 victims were male, aged between 20 and 35 years. The first 2 victims were found dead in their prison cell and the 3 other victims were found dead in a squat. Therefore, we have developed and validated a specific procedure to identify and quantify the drug in post mortem specimens using LC-MS/MS. The procedure involves extraction of 0.5 mL fluid at pH 9.5 with a mixture of organic solvents in presence of 20 ng fentanyl-d5 used as internal standard. Linearity of the method was verified from 0.1 to 20 ng/mL in both whole blood and urine (r2 = 0.9983 and 0.9993, respectively). The limit of detection was estimated at 0.05 ng/mL in each matrix. Protonitazene was identified at < LOQ to 0.8 ng/mL, 0.4 to 2.9 ng/mL and 3.0 to 8.0 ng/mL in femoral blood, urine and bile, respectively. Post mortem concentrations were very low, which is consistent with reported high toxicity of protonitazene. As nitazenes represent a growing threat to public health in various parts of the world, this method seems to be a good response to the challenges posed by the identification of this class of substances.
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Affiliation(s)
| | - Alice Ameline
- Institut de médecine légale, 11 rue Humann, Strasbourg, 67000, France
| | - Laurie Gheddar
- Institut de médecine légale, 11 rue Humann, Strasbourg, 67000, France
| | - Cédric Mazoyer
- Laboratoire SYNLAB Réunion, 19 ter rue Balbolia, Saint-Paul, 97460, France
| | - Kati Teston
- Laboratoire SYNLAB Réunion, 19 ter rue Balbolia, Saint-Paul, 97460, France
| | - Frédéric Aknouche
- Laboratoire SYNLAB Réunion, 19 ter rue Balbolia, Saint-Paul, 97460, France
| | - Pascal Kintz
- Institut de médecine légale, 11 rue Humann, Strasbourg, 67000, France.
- X-Pertise Consulting, 42 rue Principale, Mittelhausbergen, 67206, France.
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Di Trana A, Di Giorgi A, Carlier J, Serra F, Busardò FP, Pichini S. "Tranq-dope": The first fatal intoxication due to xylazine-adulterated heroin in Italy. Clin Chim Acta 2024; 561:119826. [PMID: 38909977 DOI: 10.1016/j.cca.2024.119826] [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: 05/02/2024] [Revised: 06/14/2024] [Accepted: 06/19/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND AND AIMS The number of xylazine-involved overdose deaths tremendously increased from 2019 onwards in the US. This is due to the "tranq-dope" trend consisting in mixing opioids with the sedative to reduce drug manufacturing costs and enhance their effects. In this study, we report the first fatality involving xylazine-adulterated heroin in the EU. MATERIALS AND METHODS The subject was a 33-year-old Caucasian male with a documented history of drug abuse who was found dead in a public area with puncture marks at the elbow. Peripheral blood and urine were collected at the autopsy and analyzed by liquid chromatography-high-resolution tandem mass spectrometry (LC-HRMS/MS) after protein precipitation. RESULTS 6-Monoacetylmorphine, total/free morphine, and codeine blood concentrations of 20.3, 236/105, and 38.3 ng/mL, respectively, indicated recent heroin consumption. Methadone blood concentration was below 10 ng/mL. Alprazolam, nordiazepam, and flurazepam blood concentrations were 23.9, 61.4, and 55.0 ng/mL, respectively. Benzoylecgonine blood concentration was below 5 ng/mL. Xylazine blood and urine concentrations were 105 and 72.6 ng/mL, respectively. CONCLUSION The combination of central nervous system depressants, i.e., opioids, benzodiazepines, and xylazine, was the principal cause of death by cardiorespiratory failure. The case was promptly reported to the UE Early Warning System on drugs.
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Affiliation(s)
- Annagiulia Di Trana
- National Centre on Addiction and Doping, National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy
| | - Alessandro Di Giorgi
- Section of Legal Medicine, Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Via Tronto 10/a, 60126 Ancona, Italy
| | - Jeremy Carlier
- Section of Legal Medicine, Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Via Tronto 10/a, 60126 Ancona, Italy.
| | - Francesco Serra
- Section of Legal Medicine, Department of Prevention, Sassari Hospital, via Rizzeddu 21/B, 07100 Sassari, Italy
| | - Francesco Paolo Busardò
- Section of Legal Medicine, Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Via Tronto 10/a, 60126 Ancona, Italy
| | - Simona Pichini
- National Centre on Addiction and Doping, National Institute of Health, Viale Regina Elena 299, 00161 Rome, Italy
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Ververi C, Galletto M, Massano M, Alladio E, Vincenti M, Salomone A. Method development for the quantification of nine nitazene analogs and brorphine in Dried Blood Spots utilizing liquid chromatography - tandem mass spectrometry. J Pharm Biomed Anal 2024; 241:115975. [PMID: 38280237 DOI: 10.1016/j.jpba.2024.115975] [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: 10/29/2023] [Revised: 12/31/2023] [Accepted: 01/08/2024] [Indexed: 01/29/2024]
Abstract
The detection of nitazenes in biological fluids is increasingly needed as they are repeatedly reported in intoxication and overdose cases. A simple method for the quantification of low levels of nine nitazene analogs and brorphine in Dried Blood Spots (DBS) was developed and validated. 10 μL of spiked whole blood is deposited on a Capitainer®B card and allowed to dry. The spot is punched out, and extracted with 500 μL methanol:acetonitrile (3:1 v/v) added with 1.5 μL of fentanyl-D5 as the internal standard. After stirring, sonication, and centrifugation of the vial, the solvent is dried under nitrogen, the extract is reconstituted in 30 μL methanol, and 1 μL is injected into a UHPLC-MS/MS instrument. The method validation showed linear calibration in the 1-50 ng/mL range, LOD values ranging between 0.3 ng/mL (isotonitazene) and 0.5 ng/mL (brorphine), average CV% and bias% within 15 % and 10 % for all compounds, respectively. The matrix effect due to blood and filter paper components was within 85-115 % while recovery was between 15-20 %. Stability tests against time and temperature showed no significant variations for storage periods up to 28 days. Room temperature proved to represent the best samples storage conditions. UHPLC-MS/MS proved capable to reliably identify all target analytes at low concentration even in small specimen volumes, as those obtained from DBS cards, which in turn confirmed to be effective and sustainable micro-sampling devices. This procedure improves the efficiency of toxicological testing and provides an innovative approach for the identification of the nitazene class of illicit compounds.
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Affiliation(s)
| | | | - Marta Massano
- Department of Chemistry, University of Turin, Turin, Italy
| | | | - Marco Vincenti
- Department of Chemistry, University of Turin, Turin, Italy; Centro Regionale Antidoping, Orbassano, Turin, Italy
| | - Alberto Salomone
- Department of Chemistry, University of Turin, Turin, Italy; Centro Regionale Antidoping, Orbassano, Turin, Italy
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Brunetti P, Berardinelli D, Giorgetti A, Schwelm HM, Haschimi B, Pelotti S, Busardò FP, Auwärter V. Human metabolism and basic pharmacokinetic evaluation of AP-238: A recently emerged acylpiperazine opioid. Drug Test Anal 2024; 16:221-235. [PMID: 37376716 DOI: 10.1002/dta.3535] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 06/12/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023]
Abstract
As a consequence of recently implemented legal restrictions on fentanyl analogs, a new generation of acylpiperazine opioids appeared on the illicit drug market. AP-238 was the latest opioid in this series to be notified by the European Early Warning System in 2020 and was involved in an increasing number of acute intoxications. AP-238 metabolism was investigated to provide useful markers of consumption. For the tentative identification of the main phase I metabolites, a pooled human liver microsome assay was performed. Further, four whole blood and two urine samples collected during post-mortem examinations and samples from a controlled oral self-administration study were screened for anticipated metabolites. In total, 12 AP-238 phase I metabolites were identified through liquid chromatography-quadrupole time-of-flight mass spectrometry in the in vitro assay. All of these were confirmed in vivo, and additionally, 15 phase I and five phase II metabolites were detected in the human urine samples, adding up to a total of 32 metabolites. Most of these metabolites were also detected in the blood samples, although mostly with lower abundances. The main in vivo metabolites were built by hydroxylation combined with further metabolic reactions such as O-methylation or N-deacylation. The controlled oral self-administration allowed us to confirm the usefulness of these metabolites as proof of intake in abstinence control. The detection of metabolites is often crucial to documenting consumption, especially when small traces of the parent drug can be found in real samples. The in vitro assay proved to be suitable for the prediction of valid biomarkers of novel synthetic opioid intake.
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Affiliation(s)
- Pietro Brunetti
- Unit of Forensic Toxicology, Section of Legal Medicine, Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
- Institute of Forensic Medicine, Forensic Toxicology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Diletta Berardinelli
- Unit of Forensic Toxicology, Section of Legal Medicine, Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
- Institute of Forensic Medicine, Forensic Toxicology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Arianna Giorgetti
- Institute of Forensic Medicine, Forensic Toxicology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
- Unit of Legal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Hannes Max Schwelm
- Institute of Forensic Medicine, Forensic Toxicology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
- Hermann Staudinger Graduate School, University of Freiburg, Freiburg, Germany
| | - Belal Haschimi
- Institute of Forensic Medicine, Forensic Toxicology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
- Hermann Staudinger Graduate School, University of Freiburg, Freiburg, Germany
| | - Susi Pelotti
- Unit of Legal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Francesco Paolo Busardò
- Unit of Forensic Toxicology, Section of Legal Medicine, Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Volker Auwärter
- Institute of Forensic Medicine, Forensic Toxicology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
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Di Trana A, Montana A, Lo Faro AF, Busardò FP, Pichini S. Molecular Insights of New Psychoactive Substances (NPS) 2.0. Int J Mol Sci 2023; 24:17492. [PMID: 38139320 PMCID: PMC10743891 DOI: 10.3390/ijms242417492] [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: 11/18/2023] [Revised: 11/24/2023] [Accepted: 12/01/2023] [Indexed: 12/24/2023] Open
Abstract
The New Psychoactive Substances (NPS) phenomenon represents an ever-changing global issue, with a number of new molecules entering the illicit market every year in response to international banning laws [...].
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Affiliation(s)
- Annagiulia Di Trana
- National Centre on Addiction and Doping, National Institute of Health, 00161 Rome, Italy;
| | - Angelo Montana
- Department of Biomedical Science and Public Health, University Politecnica delle Marche, 60121 Ancona, Italy; (A.M.); (A.F.L.F.)
| | - Alfredo Fabrizio Lo Faro
- Department of Biomedical Science and Public Health, University Politecnica delle Marche, 60121 Ancona, Italy; (A.M.); (A.F.L.F.)
| | - Francesco Paolo Busardò
- Department of Biomedical Science and Public Health, University Politecnica delle Marche, 60121 Ancona, Italy; (A.M.); (A.F.L.F.)
| | - Simona Pichini
- National Centre on Addiction and Doping, National Institute of Health, 00161 Rome, Italy;
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Di Trana A, La Maida N, Froldi R, Scendoni R, Busardò FP, Pichini S. The new synthetic benzimidazole opioid etonitazepipne: an emerging fatal harm and a challenge for laboratory medicine. Clin Chem Lab Med 2023; 61:e200-e202. [PMID: 37067537 DOI: 10.1515/cclm-2023-0186] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/31/2023] [Indexed: 04/18/2023]
Affiliation(s)
- Annagiulia Di Trana
- National Centre on Addiction and Doping, Istituto Superiore di Sanità Rome, Italy
| | - Nunzia La Maida
- National Centre on Addiction and Doping, Istituto Superiore di Sanità Rome, Italy
| | - Rino Froldi
- Institute of Legal Medicine, Department of Law, University of Macerata, Macerata, Italy
| | - Roberto Scendoni
- Institute of Legal Medicine, Department of Law, University of Macerata, Macerata, Italy
| | - Francesco Paolo Busardò
- Department of Excellence of Biomedical Science and Public Health, University "Politecnica delle Marche" of Ancona, Ancona, Italy
| | - Simona Pichini
- National Centre on Addiction and Doping, Istituto Superiore di Sanità Rome, Italy
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Resnik KN, Babb KN, Bekenstein LW, Moeller FG, Peace MR, Alves EA. Case report: Identification of AP-238 and 2-fluorodeschloroketamine in internet available powder samples sold as bucinnazine. Forensic Sci Int 2023; 348:111732. [PMID: 37216788 DOI: 10.1016/j.forsciint.2023.111732] [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: 01/27/2023] [Revised: 05/08/2023] [Accepted: 05/16/2023] [Indexed: 05/24/2023]
Abstract
Novel synthetic opioids (NSOs) are a class of opioid agonists that include analogs of fentanyl and structurally distinct non-fentanyl compounds normally used as standalone products, heroin adulterants, or constituents of counterfeit pain pills. Most NSOs are not currently scheduled in the U.S., are predominantly illegally synthesized, and sold on the Darknet. Among them, the cinnamylpiperazine derivatives such as bucinnazine (AP-237), AP-238, and 2-methyl-AP-237 and the arylcyclohexylamine derivatives, analogs of ketamine, such as 2-fluoro-deschloroketamine (2 F-DCK) have appeared in several monitoring systems. Two white powders purchased on the internet as bucinnazine were first analyzed with polarized light microscopy followed by direct analysis in real time-mass spectrometry (DART-MS) and gas chromatography-mass spectrometry (GC-MS). Both powders were white crystals with no other significant microscopic properties. The DART-MS analysis showed the presence of 2-fluorodeschloroketamine in powder #1, and AP-238 in powder #2. Identification was confirmed by GC-MS. The purity of each substance was 78.0% for powder #1, and 88.9% for powder #2, respectively. The toxicological risk associated with the misuse of NSOs still needs further study. The absence of bucinnazine and the presence of different active compounds in internet purchased samples raises public health and safety concerns.
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Affiliation(s)
- Karissa N Resnik
- Special Forensic Toxicology Drug Testing Laboratory, Division of Forensic Toxicology, Armed forces Medical Examiner System, Dover, DE, United States; Department of Forensic Science, Virginia Commonwealth University, Richmond, VA, United States
| | - Kala N Babb
- Department of Forensic Science, Virginia Commonwealth University, Richmond, VA, United States
| | - Lori W Bekenstein
- University Student Health Services, Virginia Commonwealth University, Richmond, VA, United States
| | - F Gerard Moeller
- Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, United States
| | - Michelle R Peace
- Department of Forensic Science, Virginia Commonwealth University, Richmond, VA, United States
| | - Emanuele Amorim Alves
- Department of Forensic Science, Virginia Commonwealth University, Richmond, VA, United States; National School of Public Health Sérgio Arouca, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
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Molecular Insights and Clinical Outcomes of Drugs of Abuse Adulteration: New Trends and New Psychoactive Substances. Int J Mol Sci 2022; 23:ijms232314619. [PMID: 36498947 PMCID: PMC9739917 DOI: 10.3390/ijms232314619] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/18/2022] [Accepted: 11/21/2022] [Indexed: 11/24/2022] Open
Abstract
Adulteration is a well-known practice of drug manufacturers at different stages of drug production. The intentional addition of active ingredients to adulterate the primary drug may enhance or mask pharmacological effects or may produce more potent drugs to increase the number of available doses and the dealer's profit. Adulterants found in different drugs change over time in response to different factors. A systematic literature search in PubMed and Scopus databases and official international organizations' websites according to PRISMA guidelines was performed. A total of 724 studies were initially screened, with 145 articles from PubMed and 462 from Scopus excluded according to the criteria described in the Method Section. The remaining 117 records were further assessed for eligibility to exclude articles without sufficient data. Finally, 79 studies were classified as "non-biological" (n = 35) or "biological" (n = 35 case reports; n = 9 case series) according to the samples investigated. Although the seized samples analyses revealed the presence of well-established adulterants such as levamisole for cocaine or paracetamol/acetaminophen for heroin, the reported data disclosed new adulteration practices, such as the use of NPS as cutting agents for classic drugs of abuse and other NPS. For example, heroin adulterated with synthetic cannabinoids or cocaine adulterated with fentanyl/fentalogues raised particular concern. Notably, adulterants play a role in some adverse effects commonly associated with the primary drug, such as levamisole-adulterated cocaine that may induce vasculitis via an autoimmune process. It is essential to constantly monitor adulterants due to their changing availability that may threaten drug consumers' health.
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