1
|
Derne AS, Pape E, Jouzeau JY, Kolodziej A, Gambier N, Scala-Bertola J. Immunological detection of hexahydrocannabinol (HHC) in oral fluid. Drug Test Anal 2024; 16:638-640. [PMID: 37916294 DOI: 10.1002/dta.3595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/11/2023] [Accepted: 10/17/2023] [Indexed: 11/03/2023]
Affiliation(s)
- Anne-Sophie Derne
- Université de Lorraine, CHRU-Nancy, Service de Pharmacologie Clinique et Toxicologie, Nancy, France
| | - Elise Pape
- Université de Lorraine, CHRU-Nancy, Service de Pharmacologie Clinique et Toxicologie, Nancy, France
- Université de Lorraine, CNRS, IMoPA, Nancy, France
| | - Jean-Yves Jouzeau
- Université de Lorraine, CHRU-Nancy, Service de Pharmacologie Clinique et Toxicologie, Nancy, France
- Université de Lorraine, CNRS, IMoPA, Nancy, France
| | - Allan Kolodziej
- Université de Lorraine, CHRU-Nancy, Service de Pharmacologie Clinique et Toxicologie, Nancy, France
| | - Nicolas Gambier
- Université de Lorraine, CHRU-Nancy, Service de Pharmacologie Clinique et Toxicologie, Nancy, France
- Université de Lorraine, CNRS, IMoPA, Nancy, France
| | - Julien Scala-Bertola
- Université de Lorraine, CHRU-Nancy, Service de Pharmacologie Clinique et Toxicologie, Nancy, France
- Université de Lorraine, CNRS, IMoPA, Nancy, France
| |
Collapse
|
2
|
Pigaiani N, Musile G, Scott KS, Dye DW, Ausania F, Davis GG, Bortolotti F. Post-mortem formation of ethanol: Is 1-propanol a reliable marker? A proof-of-concept study using an in vitro putrefactive environment setup. J Forensic Sci 2024; 69:974-985. [PMID: 38317608 DOI: 10.1111/1556-4029.15479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/06/2024] [Accepted: 01/23/2024] [Indexed: 02/07/2024]
Abstract
Ethanol is the psychoactive substance identified most frequently in post-mortem specimens. Unfortunately, interpreting post-mortem ethanol concentrations can be difficult because of post-mortem alcohol redistribution and the possibility of post-mortem alcohol neogenesis. Indeed, in the time interval between death and sample collection, the decedent may be exposed to non-controlled environments for an extended period, promoting microbial colonization. Many authors report that in the presence of carbohydrates and other biomolecules, various species of bacteria, yeast, and fungi can synthesize ethanol and other volatile substances in vitro and in vivo. The aim of this study was to study the impact of several variables on microbial ethanol production as well as develop a mathematical model that could estimate the microbial-produced ethanol in correlation with the most significant consensual produced higher alcohol, 1-propanol. An experimental setup was developed using human blood samples and cadaveric fragments incubated under strictly anaerobic conditions to produce a novel substrate, "cadaveric putrefactive blood" mimicking post-mortem corpse conditions. The samples were analyzed daily for ethanol and 1-propanol using an HS-GC-FID validated method. The formation of ethanol was evaluated considering different parameters such as putrefactive stage, blood glucose concentration, storage temperature, and storage time. Statistical analysis was performed using the Mann-Whitney non-parametric test and simple linear regression. The results indicate that the early putrefactive stage, high blood glucose concentration, high temperature, and time of incubation increase microbial ethanol production. In addition, the developed mathematical equation confirms the feasibility of using 1-propanol as a marker of post-mortem ethanol production.
Collapse
Affiliation(s)
- Nicola Pigaiani
- Unit of Forensic Medicine, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
- Division of Forensics, Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Giacomo Musile
- Unit of Forensic Medicine, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Karen S Scott
- Division of Laboratory Medicine, Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Daniel W Dye
- Division of Forensics, Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Francesco Ausania
- Unit of Forensic Medicine, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Gregory G Davis
- Division of Forensics, Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Federica Bortolotti
- Unit of Forensic Medicine, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| |
Collapse
|
3
|
Bierly JJ, Chan-Hosokawa A. Gabapentin in drugged driving investigations. J Forensic Sci 2024; 69:986-992. [PMID: 38402540 DOI: 10.1111/1556-4029.15500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/12/2024] [Accepted: 02/14/2024] [Indexed: 02/26/2024]
Abstract
The increasing use and misuse of gabapentin pose a major risk to public health and traffic safety. Gabapentin has been approved by the Food and Drug Administration (FDA) since 1993 for adjunctive therapy in the treatment of epilepsy and neuralgia but is increasingly being prescribed for numerous off-label uses including insomnia, anxiety, depression, and migraine. Reported side effects include blurred vision, drowsiness, and loss of coordination. Driving behaviors such as exiting the lane of travel and crashes have been reported in connection to drugged driving investigations concerning gabapentin. To further assist with the toxicological interpretation of gabapentin in driving under the influence of drugs (DUID) scenarios, a review of approximately 108,000 gabapentin-positive DUID cases was conducted. Of those, 858 cases met inclusion criteria and underwent additional evaluation. Blood specimens were screened via enzyme-linked immunosorbent assay (ELISA) and confirmed by liquid chromatography tandem mass spectrometry (LC-MS/MS) for quantitation of gabapentin. This review found an overall DUID gabapentin positivity of 7.9% between January 2020 and December 2022; 17 states from various geographical regions had at least one positive gabapentin DUID case. Observations in six driving and human performance cases where gabapentin was the only drug reported were consistent with the known adverse effects of the medication. Half of the case histories reviewed involved crashes where the driver was determined to be at fault. Additionally, 94% of the cases in this review involved gabapentin in combination with other drugs. The most prevalent drug combinations were opioids and gabapentin present in 64% of cases.
Collapse
|
4
|
Höfert L, Becker S, Dreßler J, Baumann S. Quantification of (9R)- and (9S)-hexahydrocannabinol (HHC) via GC-MS in serum/plasma samples from drivers suspected of cannabis consumption and immunological detection of HHC and related substances in serum, urine, and saliva. Drug Test Anal 2024; 16:489-497. [PMID: 37652872 DOI: 10.1002/dta.3570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 09/02/2023]
Abstract
The semisynthetic cannabinoid hexahydrocannabinol (HHC) is currently getting a lot of media attention because the legal status in many countries is not clearly specified. In this study, a GC-MS method for the quantification of Δ9-tetrahydrocannabinol (THC), 11-hydroxy-Δ9-tetrahydrocannabinol (11-OH-THC), and 11-nor-9-carboxy-Δ9-tetrahydrocannabinol (THC-COOH) was extended to (9R)- and (9S)-HHC. The applicability was proven by serum/plasma samples from drivers suspected of cannabis consumption. Limit of detection (LOD) and lower limit of quantification (LLOQ) were 0.15 and 0.25 ng/mL, respectively. Within-run imprecision was <6.5% and between-run imprecision was <10.0%. Inter-injection stability, processed sample stability (3 days), freeze-thaw stability (three cycles), and storage stability (1 week room temperature; 1 month 4°C, -20°C) could be proven. Both HHC diastereomers could be detected in 17 (5.3%) out of 321 analyzed samples from traffic controls in Western Saxony. The mean ratio between (9R)- and (9S)-HHC was 1.99 (CV = 14.6%). Quantification resulted in concentrations between
Collapse
Affiliation(s)
- Lisa Höfert
- Institute of Legal Medicine, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Susen Becker
- Institute of Legal Medicine, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Jan Dreßler
- Institute of Legal Medicine, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Sven Baumann
- Institute of Legal Medicine, Medical Faculty, University of Leipzig, Leipzig, Germany
| |
Collapse
|
5
|
Norman C, Deventer MH, Dremann O, Reid R, Van Uytfanghe K, Guillou C, Vinckier IMJ, Nic Daéid N, Krotulski A, Stove CP. In vitro cannabinoid receptor activity, metabolism, and detection in seized samples of CH-PIATA, a new indole-3-acetamide synthetic cannabinoid. Drug Test Anal 2024; 16:380-391. [PMID: 37491777 DOI: 10.1002/dta.3555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/27/2023]
Abstract
The rapidly evolving synthetic cannabinoid receptor agonist (SCRA) market poses significant challenges for forensic scientists. Since the enactment of a generic ban in China, a variety of new compounds have emerged capable of evading the legislation by carrying new structural features. One recent example of a SCRA with new linker and head moieties is CH-PIATA (CH-PIACA, CHX-PIATA, CHX-PIACA). CH-PIATA bears an additional methylene spacer in the linker moiety between the indole core and the traditional carbonyl component of the linker. This study describes detections in 2022 of this new SCRA in the United States, Belgium, and Scottish prisons. CH-PIATA was detected once in a seized powder by Belgian customs and 12 times in Scottish prisons in infused papers or resin. The metabolites of CH-PIATA were investigated via in vitro human liver microsome (HLM) incubations and eight metabolites were identified, dominated by oxidative biotransformations. A blood sample from the United States was confirmed to contain a mixture of SCRAs including CH-PIATA via presence of the parent and at least five of the metabolites identified from HLM incubations. Furthermore, this paper evaluates the intrinsic in vitro cannabinoid 1 and 2 (CB1 and CB2) receptor activation potential of CH-PIATA reference material and the powder seized by Belgian customs by means of β-arrestin 2 recruitment assays. Both the reference and the seized powder showed a weak activity at both CB receptors with signs of antagonism found. Based on these results, the expected harm potential of this newly emerging substance remains limited.
Collapse
Affiliation(s)
- Caitlyn Norman
- Leverhulme Research Centre for Forensic Science, School of Science and Engineering, University of Dundee, Dundee, UK
| | - Marie H Deventer
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Olivia Dremann
- College of Arts and Sciences, Arcadia University, Glenside, Pennsylvania, USA
| | - Robert Reid
- Leverhulme Research Centre for Forensic Science, School of Science and Engineering, University of Dundee, Dundee, UK
| | - Katleen Van Uytfanghe
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Claude Guillou
- European Commission, Joint Research Centre (JRC), Ispra, Italy
| | | | - Niamh Nic Daéid
- Leverhulme Research Centre for Forensic Science, School of Science and Engineering, University of Dundee, Dundee, UK
| | - Alex Krotulski
- Center for Forensic Science Research and Education, Frederic Rieders Family Foundation, Willow Grove, Pennsylvania, USA
| | - Christophe P Stove
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| |
Collapse
|
6
|
Dinis P, Franco J, Margalho C. α-Pyrrolidinohexanophenone (α-PHP) and α-Pyrrolidinoisohexanophenone (α-PiHP): A Review. Life (Basel) 2024; 14:429. [PMID: 38672701 PMCID: PMC11051472 DOI: 10.3390/life14040429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 03/20/2024] [Accepted: 03/20/2024] [Indexed: 04/28/2024] Open
Abstract
New Psychoactive Substances are currently a serious and growing problem affecting public health worldwide. By 2022, 1184 of these substances had been identified over a period of 16 years. Within these, α-pyrrolidinohexanophenone (α-PHP) and α-pyrrolidinoisohexanophenone (α-PiHP) have emerged, two synthetic cathinones from the pyrovalerone derivates subgroup that are positional isomers of each other. Alpha-PHP appeared on the Japanese illicit drug market in 2014 and, two years later, α-PiHP was identified for the first time in China. They were placed in schedule II on the list of Psychotropic Substances under International Control in 2020 and in March 2023, respectively. Both cathinones have no therapeutic potential for medical use and therefore are abused for recreational habits, which can lead to fatalities. The most frequent adverse effects reported are cardiac, psychiatric, and neurologic, and fatal intoxications have already been described. In Portugal, their consumption and consequent seizures are more prevalent on the archipelagos, which has been aggravating the health situation. In conclusion, these types of substances are a challenge for forensic toxicology since they are easily synthesized, modified, and placed on the market. Therefore, more studies to develop analytical methods to detect them and more comprehensive legislation should be applied. Thus, this review aimed to address the legislative, physicochemical, toxicological, and analytical aspects of both substances.
Collapse
Affiliation(s)
| | | | - Cláudia Margalho
- Laboratory of Forensic Chemistry and Toxicology, National Institute of Legal Medicine and Forensic Sciences, I.P.—Centre Branch, Pólo das Ciências da Saúde (Pólo III)—Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal; (P.D.); (J.F.)
| |
Collapse
|
7
|
Wiedfeld C, Skopp G, Musshoff F. Single hair analysis for gamma-hydroxybutyric acid-Method optimization, validation, and application. Drug Test Anal 2024. [PMID: 38517060 DOI: 10.1002/dta.3683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/23/2024] [Accepted: 03/05/2024] [Indexed: 03/23/2024]
Abstract
As gamma-hydroxybutyric acid (GHB) underlies fast metabolization, its determination from hair may presumably offer a detection window superior to that of body fluids. Due to the wide range of endogenous concentration levels, the evidence of an exogenous ingestion is challenging. As already shown for other drugs, the temporal resolution obtained by applying single hair microanalysis provides further information. Therefore, a method for the extraction and quantification of GHB in 2-mm hair segments (seg) was optimized and validated (limit of detection [LOD]: 2.5 pg/seg, lower limit of quantification [LLOQ]: 5 pg/seg), and five single hairs were examined, each for three non-users and for three (alleged) users. A major challenge was the choice of appropriate extraction tubes without remains of GHB. In two samples from non-users, GHB could not or could only be detected in trace amounts. In the third sample, concentrations between the LOD and 31.1 pg/seg (mean: 9.5, median: 8.4; each pg/seg) were detected with decreasing values towards the tips. In two samples of persons with assumed GHB intake, maximum concentrations of 6.8 and 30.7 pg/seg were measured, but no significant concentration peaks indicating a single ingestion could be observed. The third sample showed concentrations of 7.6-55.2 pg/seg (mean: 28.8, median: 29.6; each pg/seg). In this case, the obtained profiles showing at least two reproducible concentration maxima between 20 and 40 mm point to an ingestion of GHB. The concentration profiles from single hairs were reproducible in each case, reflecting the concentration course of routine 1-cm segmental analysis. These are the first results published on GHB testing in segmented single hairs, and the results must be verified further.
Collapse
Affiliation(s)
| | - Gisela Skopp
- Forensic Toxicological Center (FTC) Munich, Munich, Germany
| | - Frank Musshoff
- Forensic Toxicological Center (FTC) Munich, Munich, Germany
| |
Collapse
|
8
|
Höfert L, Baumann S, Dreßler J, Becker S. Does the Quantification of Δ9-Tetrahydrocannabinolic Acid A in Serum/Plasma Provide Any Additional Information About Consumption Pattern from Drivers Under the Influence of Cannabis? Cannabis Cannabinoid Res 2024. [PMID: 38512708 DOI: 10.1089/can.2023.0172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024] Open
Abstract
Introduction: Δ9-tetrahydrocannabinolic acid A (THCA-A) is one of the main ingredients of cannabis plants and is converted to the psychoactive substance Δ9-tetrahydrocannabinol (THC) by decarboxylation during heating above ∼90°C. During the consumption of cannabis, a varying proportion of THCA-A is absorbed into the body. Therefore, the quantification of THCA-A in serum/plasma might provide additional information on consumption behavior in driving under the influence of cannabis cases. Materials and Methods: In this study, an already established gas-chromatography mass-spectrometry (GC-MS) method for the quantification of THC, 11-OH-THC, and THC-COOH in serum and plasma samples was extended to include THCA-A. This validated method was then applied to 1228 routinely achieved serum/plasma samples from drivers suspected of cannabis consumption in Western Saxony. Two different grouping systems for chronic/occasional consumption, one system for acute/subacute consumption, Huestis formulas, and the cannabis influence factor (CIF) were used for evaluation. Results: Method validation showed appropriate results for forensic toxicological routine analysis. Limit of detection and lower limit of quantification (LLOQ) for THCA-A were 0.3 and 1.0 ng/mL, respectively. Reproducibility was <11% and accuracy ranged between 104% and 107%. THCA-A was stable in native samples at least for 2 weeks at room temperature or 4°C as well as 1 month at -20°C. Freeze-thaw stability for three cycles and processed sample stability over 3 days was proven. A total of 865 cases with a THC concentration above the German analytical cutoff of 1 ng/mL as well as the analytical LLOQs of 0.9 and 2.5 ng/mL for 11-OH-THC and THC-COOH, respectively, were included in further statistical analysis. In 407 (47.1%) of these samples, THCA-A was quantifiable. Different statistical analyses indicated a correlation between THCA-A and THC concentrations in cases of chronic and acute consumption. In addition, an increase of chronic and acute cases with increasing THCA-A concentrations was observed. However, no correlation between THCA-A and CIF was found. Discussion: These data show that THCA-A might be an additional indicative marker to provide information about consumption frequency and acuteness. Additional studies with known consumption frequencies and times are required to verify these findings.
Collapse
Affiliation(s)
- Lisa Höfert
- Department Forensic Toxicology, Faculty of Medicine, Institute of Forensic Medicine, Leipzig University, Leipzig, Germany
| | - Sven Baumann
- Department Forensic Toxicology, Faculty of Medicine, Institute of Forensic Medicine, Leipzig University, Leipzig, Germany
| | - Jan Dreßler
- Department Forensic Toxicology, Faculty of Medicine, Institute of Forensic Medicine, Leipzig University, Leipzig, Germany
| | - Susen Becker
- Department Forensic Toxicology, Faculty of Medicine, Institute of Forensic Medicine, Leipzig University, Leipzig, Germany
| |
Collapse
|
9
|
Boscolo-Berto R. Challenges and future trends of forensic toxicology to keep a cut above the rest. ADV CLIN EXP MED 2024; 33:0-0. [PMID: 38515257 DOI: 10.17219/acem/185730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 03/06/2024] [Indexed: 03/23/2024]
Abstract
Forensic toxicology faces several challenges in research and daily practice, including new drugs and futuristic technologies requiring innovative testing methods and continuous education and training of professionals. One of the most pressing issues in recent years is the emergence of novel psychoactive substances, often created by modifying the chemical structure of existing drugs to produce compounds with similar effects that are not yet regulated and lack standardized references. To overcome this challenge, forensic toxicologists have employed a range of analytical methods, including qualitative and quantitative analysis using highly sensitive technologies such as liquid chromatography-mass spectrometry (LC-MS) and gas chromatography-mass spectrometry (GC-MS), which are the most reliable and accurate methods for detecting drugs in biological samples. Liquid chromatography coupled with tandem mass spectrometry (LC-MS-MS) is becoming the gold standard for detecting controlled substances, their derivatives and metabolites. Despite advancements in testing methods, challenges persist in forensic toxicology. As such, the field must invest in research and development to improve testing methods, utilize cutting-edge technologies, increase funding for training programs, and promote multidisciplinary interactions.
Collapse
Affiliation(s)
- Rafael Boscolo-Berto
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Italy
| |
Collapse
|
10
|
Mocanu C, Woodall KL, Solbeck P. Prevalence and blood concentrations of benzodiazepines and opioids in opioid-positive death investigations in Ontario, Canada, from 2017 to 2021. J Forensic Sci 2024; 69:607-617. [PMID: 38282130 DOI: 10.1111/1556-4029.15463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/04/2024] [Accepted: 01/11/2024] [Indexed: 01/30/2024]
Abstract
The aim of this study was to investigate the incidence of benzodiazepines in opioid-positive death investigations, including trends in frequency and combination of drugs, as well as demographic data and blood concentrations, where available. Additionally, naloxone concentrations in polysubstance compared to opioid-only cases were analyzed. This was a retrospective study that consisted of all post-mortem toxicology cases in Ontario, Canada, from January 01, 2017, to December 31, 2021, with an opioid finding in any analyzed autopsy specimen. There were 11,033 death investigations identified. The overall rate of benzodiazepine co-involvement was 54.5%. Males accounted for the majority of cases (71%), and the most affected age group was 30- to 39-year-olds. The most frequently detected opioid was fentanyl and the most frequently detected benzodiazepine was etizolam, which was also the most frequently observed opioid/benzodiazepine combination. Findings related to differences in concentrations of opioids when naloxone was also present were mostly non-significant, except for methadone. The rate of benzodiazepine detection with opioids grew faster than opioid detections overall, potentially due to the increasingly toxic drug supply. Detection of novel psychoactive drugs fluctuated more unpredictably than opioids and benzodiazepines associated with clinical use. These findings can help inform policy decisions by public health agencies in exploring harm reduction efforts, for example, education and drug-checking services.
Collapse
Affiliation(s)
- Cora Mocanu
- University of Toronto, Toronto, Ontario, Canada
| | - Karen L Woodall
- University of Toronto Mississauga, Mississauga, Ontario, Canada
| | - Patricia Solbeck
- Quality Assurance Unit, Centre of Forensic Sciences, Toronto, Ontario, Canada
| |
Collapse
|
11
|
Gomonit MM, Skillman B, Swortwood MJ. Quantification of psilocin in human whole blood using liquid chromatography-tandem mass spectrometry (LC-MS/MS). J Forensic Sci 2024; 69:678-687. [PMID: 38140718 DOI: 10.1111/1556-4029.15454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/13/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023]
Abstract
There has been burgeoning interest in psilocybin-use for the treatment of various neurological and neurodegenerative diseases. Psilocybin is mistakenly perceived as the principal pharmacologically active compound due to its high concentrations found in magic mushrooms; however, it is the prodrug of psilocin. Despite the expanding body of clinical research seeking to understand the pharmacodynamic/pharmacokinetic properties of psilocin, and its role in inducing dramatic changes to cognitive function, there has not been a corresponding increase in the development of sensitive analytical methods that can quantify psilocin in different biological fluids. Existing analytical methods have been developed using plasma, serum, and urine as the matrix of choice, but with the unknown blood-to-plasma ratio of psilocin, any pharmacokinetic conclusions drawn solely on plasma data may be misleading. Thus, the main objective of this study is to develop the first analytical method that utilizes SPE and LC-MS/MS to quantify psilocin in human whole blood. The SPE procedure yielded a high recovery efficiency (≥89%) with minimal matrix effects. The method was validated according to ANSI/ASB 036 guidelines. Linearity was between 0.7-200 ng/mL and encompassed previously reported ranges found in plasma/serum. Bias, within- and between-run precision for all quality controls met ANSI/ASB 036 acceptability criteria. Endogenous/exogenous interferences and carryover were negligible. Psilocin stability was assessed at 4°C over 48 h and was considered stable. Although a proof-of-concept study will need to be performed to characterize the method, this analytical workflow was able to detect and quantify psilocin in human whole blood at low limits of quantification.
Collapse
Affiliation(s)
- Munchelou M Gomonit
- Department of Forensic Science, College of Criminal Justice, Sam Houston State University, Huntsville, Texas, USA
| | - Britni Skillman
- Department of Forensic Science, College of Criminal Justice, Sam Houston State University, Huntsville, Texas, USA
| | - Madeleine J Swortwood
- Department of Forensic Science, College of Criminal Justice, Sam Houston State University, Huntsville, Texas, USA
- Robson Forensic, Denver, Colorado, USA
| |
Collapse
|
12
|
Usman M, Baig Y, Nardiello D, Quinto M. How new nanotechnologies are changing the opioid analysis scenery? A comparison with classical analytical methods. Forensic Sci Res 2024; 9:owae001. [PMID: 38560581 PMCID: PMC10981550 DOI: 10.1093/fsr/owae001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 01/02/2024] [Indexed: 04/04/2024] Open
Abstract
Opioids such as heroin, fentanyl, raw opium, and morphine have become a serious threat to the world population in the recent past, due to their increasing use and abuse. The detection of these drugs in biological samples is usually carried out by spectroscopic and/or chromatographic techniques, but the need for quick, sensitive, selective, and low-cost new analytical tools has pushed the development of new methods based on selective nanosensors, able to meet these requirements. Modern sensors, which utilize "next-generation" technologies like nanotechnology, have revolutionized drug detection methods, due to easiness of use, their low cost, and their high sensitivity and reliability, allowing the detection of opioids at trace levels in raw, pharmaceutical, and biological samples (e.g. blood, urine, saliva, and other biological fluids). The peculiar characteristics of these sensors not only have allowed on-site analyses (in the field, at the crime scene, etc.) but also they are nowadays replacing the gold standard analytical methods in the laboratory, even if a proper method validation is still required. This paper reviews advances in the field of nanotechnology and nanosensors for the detection of commonly abused opioids both prescribed (i.e. codeine and morphine) and illegal narcotics (i.e. heroin and fentanyl analogues).
Collapse
Affiliation(s)
- Muhammad Usman
- Narcotic Unit, Punjab Forensic Science Agency, Home Department, Government of The Punjab, Lahore-54000, Pakistan
- Department of Sciences of Agriculture, Food, Natural Resources and Engineering (DAFNE), University of Foggia, I-71122 Foggia, Italy
| | - Yawar Baig
- Narcotic Unit, Punjab Forensic Science Agency, Home Department, Government of The Punjab, Lahore-54000, Pakistan
| | - Donatella Nardiello
- Department of Sciences of Agriculture, Food, Natural Resources and Engineering (DAFNE), University of Foggia, I-71122 Foggia, Italy
| | - Maurizio Quinto
- Department of Sciences of Agriculture, Food, Natural Resources and Engineering (DAFNE), University of Foggia, I-71122 Foggia, Italy
| |
Collapse
|
13
|
Giorgetti A, Pascali JP, Pelletti G, Garagnani M, Roffi R, Grech M, Fais P. Optimizing screening cutoffs for drugs of abuse in hair using immunoassay for forensic applications. ADV CLIN EXP MED 2024; 34:0-0. [PMID: 38411387 DOI: 10.17219/acem/183124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/25/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND In forensic toxicology, positive immunoassay (IA) test results do not hold forensic validity and need to be confirmed with mass spectrometry (MS). On the other hand, a negative result is a strong indication that the drug and/or the drug metabolites are not present in the sample and that confirmatory analyses are not necessary. Consequently, a negative IA result must have forensic validity since it can be admitted in court during a trial. OBJECTIVES Screening cutoffs for the analysis of hair samples using immunoassays (IAs) were retrospectively optimized based on the Society of Hair Testing (SoHT) confirmation cutoffs and the utility of the test for forensic applications was discussed. MATERIAL AND METHODS Hair samples taken from 150 patients with a history of drug addiction were analyzed with ILab 650, Werfen (Milan, Italy) using DRI® reagents. Confirmatory analyses were subsequently performed using the ACQUITY UPLC® System, Waters Corporation (Milford, USA). Screening cutoffs were retrospectively optimized using receiver operating characteristic (ROC) analysis. RESULTS A total of 162 single positive results were obtained for confirmatory analysis (10 for amphetamines/methamphetamines, 11 for MDMA, 37 for cocaine, 40 for THC, 33 for methadone, and 31 for opiates). The optimized screening cutoffs were 0.27 IA ng/mg for amphetamines, 0.51 IA ng/mg for MDMA, 0.59 IA ng/mg for cocaine, 0.14 IA ng/mg for cannabinoids, 0.63 IA ng/mg for methadone, and 0.26 IA ng/mg for opiates. An area under the curve (AUC) greater than 0.95 was obtained with very high sensitivity and specificity for all drugs. CONCLUSIONS The presented screening method proved to be a useful technique on hair samples for the classes of drugs most commonly found in Italy and Europe and can be applied to forensic analysis.
Collapse
Affiliation(s)
- Arianna Giorgetti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Italy
| | - Jennifer P Pascali
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Italy
| | - Guido Pelletti
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Italy
| | - Marco Garagnani
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Italy
| | - Raffaella Roffi
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Italy
| | | | - Paolo Fais
- Department of Medical and Surgical Sciences, Unit of Legal Medicine, University of Bologna, Italy
| |
Collapse
|
14
|
Šoša I. Quetiapine-Related Deaths: In Search of a Surrogate Endpoint. Toxics 2024; 12:37. [PMID: 38250993 PMCID: PMC10819769 DOI: 10.3390/toxics12010037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/30/2023] [Accepted: 01/01/2024] [Indexed: 01/23/2024]
Abstract
Quetiapine is a second-generation antipsychotic drug available for two and half decades. Due to increased misuse, prescription outside the approved indications, and availability on the black market, it is being encountered in medicolegal autopsies more frequently. For instance, it has been linked to increased mortality rates, most likely due to its adverse effects on the cardiovascular system. Its pharmacokinetic features and significant postmortem redistribution challenge traditional sampling in forensic toxicology. Therefore, a systematic literature review was performed, inclusive of PubMed, the Web of Science-core collection, and the Scopus databases; articles were screened for the terms "quetiapine", "death", and "autopsy" to reevaluate each matrix used as a surrogate endpoint in the forensic toxicology of quetiapine-related deaths. Ultimately, this review considers the results of five studies that were well presented (more than two matrices, data available for all analyses, for instance). The highest quetiapine concentrations were usually measured in the liver tissue. As interpreted by their authors, the results of the considered studies showed a strong correlation between some matrices, but, unfortunately, the studies presented models with poor goodness of fit. The distribution of quetiapine in distinct body compartments/tissues showed no statistically significant relationship with the length of the postmortem interval. Furthermore, this study did not confirm the anecdotal correlation of peripheral blood concentrations with skeletal muscle concentrations. Otherwise, there was no consistency regarding selecting an endpoint for analysis.
Collapse
Affiliation(s)
- Ivan Šoša
- Department of Anatomy, Faculty of Medicine, University of Rijeka, 51000 Rijeka, Croatia
| |
Collapse
|
15
|
Shi T, Shea JL. A case of fatal overdose involving both hydromorphone and kratom. J Forensic Sci 2024; 69:355-358. [PMID: 37753815 DOI: 10.1111/1556-4029.15394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/13/2023] [Accepted: 09/18/2023] [Indexed: 09/28/2023]
Abstract
Kratom is a plant originating in Southeast Asia that has been used for its dose-dependent stimulant and opioid effects. The main active compound in kratom is mitragynine, an alkaloid with affinity for the mu-opioid receptor. Toxicity and fatalities related to kratom use have increased substantially in recent years. In this case report, we describe a 44-year-old man who was found deceased in bed. The only significant finding at autopsy was abdominal distension with >4 L of ascites. Toxicology testing was performed on femoral blood which showed 79 ng/mL of hydromorphone, 560 ng/mL of mitragynine, and 240 ng/mL of olanzapine. In addition, creatinine and urea in vitreous humor were significantly elevated, consistent with renal impairment. Death was attributed to hydromorphone toxicity with mitragynine being a contributing factor.
Collapse
Affiliation(s)
- Thomas Shi
- Department of Laboratory Medicine, Dr. Everett Chalmers Hospital, Horizon Health Network, Fredericton, New Brunswick, Canada
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jennifer L Shea
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Laboratory Medicine, Saint John Regional Hospital, Horizon Health Network, Saint John, New Brunswick, Canada
| |
Collapse
|
16
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
17
|
Durand L, O'Kane A, Tierney J, Cronly M, Bennett KE, Kavanagh Y, Keenan E, Cousins G. Gabapentinoids in Ireland 2010 to 2020: An observational study of trends in gabapentinoid prescribing, law enforcement drug seizures and postmortem toxicology. Br J Clin Pharmacol 2023. [PMID: 38072974 DOI: 10.1111/bcp.15984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/02/2023] [Accepted: 11/29/2023] [Indexed: 01/04/2024] Open
Abstract
AIMS We explored trends in gabapentinoid prescribing, drug seizures and postmortem toxicology using a national pharmacy claims database, law enforcement drug seizures data and a population-based postmortem toxicology database. METHODS Gabapentinoid prescribing rates per 100 000 eligible population (2010-2020), annual number of drug seizures involving gabapentinoids (2012-2020) and gabapentinoid detection (positive) rates per 100 postmortem toxicology case (2013-2020) were calculated. Negative binomial regression models were used to evaluate longitudinal trends for gabapentin and pregabalin separately. RESULTS Gabapentin (adjusted rate ratio [RR] 1.06, 95% confidence interval [CI] 1.05-1.06, P < .001) and pregabalin (adjusted RR 1.08, 95% CI 1.08-1.09, P < .001) prescribing increased annually, with higher rates of pregabalin (vs. gabapentin) observed every year. Drug seizures involving pregabalin also increased over time (RR 1.54 95% CI 1.25-1.90, P < .0001). Of the 26 317 postmortem toxicology cases, 0.92% tested positive for gabapentin, and 6.37% for pregabalin. Detection rates increased for both gabapentin (RR 1.28, 95% CI 1.11-1.48, P < .001) and pregabalin (RR 1.13, 95% CI 1.11-1.48, P < .001) between 2013 and 2020. A total of 1901 cases (7.2%) tested positive for heroin/methadone; this sub-group had a higher detection rate for pregabalin (n = 528, 27.8%) and gabapentin (n = 41, 2.2%) over the study period, with a high burden of codetections for pregabalin with benzodiazepines (peaking at 37.3% in 2018), and pregabalin with prescription opioids (peaking at 28.9% in 2020). CONCLUSION This study raises concerns regarding the wide availability of pregabalin in Ireland, including a growing illicit supply, and the potential for serious harm arising from poly drug use involving pregabalin among people who use heroin or methadone.
Collapse
Affiliation(s)
- Louise Durand
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
| | - Aoife O'Kane
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
| | - Julie Tierney
- Human Toxicology, The State Laboratory, Kildare, Ireland
| | - Mark Cronly
- Human Toxicology, The State Laboratory, Kildare, Ireland
| | - Kathleen E Bennett
- Data Science Centre, School of Population Health, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
| | - Yvonne Kavanagh
- Chemical Analysis Discipline, Forensic Science Ireland, Dublin, Ireland
| | - Eamon Keenan
- National Social Inclusion Office, Health Service Executive, Dublin, Ireland
| | - Gráinne Cousins
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
| |
Collapse
|
18
|
Norman C, Webling K, Kyslychenko O, Reid R, Krotulski AJ, Farrell R, Deventer MH, Liu H, Connolly MJ, Guillou C, Vinckier IMJ, Logan BK, NicDaéid N, McKenzie C, Stove CP, Gréen H. Detection in seized samples, analytical characterization, and in vitro metabolism of the newly emerged 5-bromo-indazole-3-carboxamide synthetic cannabinoid receptor agonists. Drug Test Anal 2023. [PMID: 38037247 DOI: 10.1002/dta.3609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/03/2023] [Accepted: 11/05/2023] [Indexed: 12/02/2023]
Abstract
Synthetic cannabinoid receptor agonists (SCRAs) are a diverse class of new psychoactive substances (NPS) and new structural scaffolds have emerged on the recreational drug market since the enactment of Chinese SCRA analog controls in 2021. This study reports the first SCRAs to be detected with a bromide at the 5 position (5'Br) on the phenyl ring of the indazole core and without a tail moiety. ADB-5'Br-INACA (ADMB-5'Br-INACA) and MDMB-5'Br-INACA were detected in seized samples from Scottish prisons, Belgian customs, and US forensic casework. The brominated analog with a tail moiety, ADB-5'Br-BUTINACA (ADMB-5'Br-BUTINACA), was also detected in Scottish prisons and US forensic casework. The metabolites of these compounds and the predicted compound MDMB-5'Br-BUTINACA were identified through incubation with primary human hepatocytes to aid in their toxicological identification. The bromide on the indazole remains intact on metabolites, allowing these compounds to be easily distinguished in toxicological samples from their non-brominated analogs. Glucuronidation was more common for tail-less analogs than their butyl tail-containing counterparts. Forensic toxicologists are advised to update their analytical methods with the characteristic ions for these compounds, as well as their anticipated urinary markers: amide hydrolysis and monoOH at tert-butyl metabolites (after β-glucuronidase treatment) for ADB-5'Br-INACA; monoOH at tert-butyl and amide hydrolysis metabolites for ADB-5'Br-BUTINACA; and ester hydrolysis metabolites with additional metabolites for MDMB-5'Br-INACA and MDMB-5'Br-BUTINACA. Toxicologists should remain vigilant to the emergence of new SCRAs with halogenation of the indazole core and tail-less analogs, which have already started to emerge.
Collapse
Affiliation(s)
- Caitlyn Norman
- Leverhulme Research Centre for Forensic Science, School of Science and Engineering, University of Dundee, Dundee, UK
| | - Kristin Webling
- Department of Biomedical and Clinical Science, Division of Clinical Chemistry and Pharmacology, Linköping University, Linköping, Sweden
| | - Oleksandra Kyslychenko
- Department of Biomedical and Clinical Science, Division of Clinical Chemistry and Pharmacology, Linköping University, Linköping, Sweden
| | - Robert Reid
- Leverhulme Research Centre for Forensic Science, School of Science and Engineering, University of Dundee, Dundee, UK
| | - Alex J Krotulski
- Center for Forensic Science Research and Education, Fredric Rieders Family Foundation, Willow Grove, Pennsylvania, USA
| | - Ryan Farrell
- Indianapolis-Marion County Forensic Services Agency, Indianapolis, Indiana, USA
| | - Marie H Deventer
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | | | | | - Claude Guillou
- European Commission, Joint Research Centre, Directorate F-Health, Consumers and Reference Materials, Ispra, Italy
| | | | - Barry K Logan
- Center for Forensic Science Research and Education, Fredric Rieders Family Foundation, Willow Grove, Pennsylvania, USA
- Toxicology Department, NMS Labs, Horsham, Pennsylvania, USA
| | - Niamh NicDaéid
- Leverhulme Research Centre for Forensic Science, School of Science and Engineering, University of Dundee, Dundee, UK
| | - Craig McKenzie
- Leverhulme Research Centre for Forensic Science, School of Science and Engineering, University of Dundee, Dundee, UK
- Chiron AS, Trondheim, Norway
| | - Christophe P Stove
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Henrik Gréen
- Department of Biomedical and Clinical Science, Division of Clinical Chemistry and Pharmacology, Linköping University, Linköping, Sweden
- Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden
| |
Collapse
|
19
|
Potoukian RB, Gonyea J, Shoff EN, Hime GW, Moore DM. Prevalence of xylazine in overdose cases: An analysis of Miami-Dade County medical examiner case data. J Forensic Sci 2023; 68:2205-2210. [PMID: 37658657 DOI: 10.1111/1556-4029.15375] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/21/2023] [Accepted: 08/23/2023] [Indexed: 09/03/2023]
Abstract
Xylazine sedative, muscle relaxant, and analgesic used in a veterinary setting. Although xylazine was never approved for therapeutic use in humans, it has become popular in the street drug market as a cutting or bulking agent in the fentanyl and heroin supply. Recently, there has been a significant increase in the detection of xylazine in postmortem forensic toxicology casework. Xylazine can be identified during routine toxicology screening utilizing instrumentation such as gas chromatography-mass spectrometry and liquid chromatography-mass spectrometry. Using the Miami-Dade Medical Examiner's LIMS system, all cases received between 2015 and 2022 in which xylazine was reported were reviewed. The cases studied include accidental drug overdose deaths in Miami-Dade County as well as Collier County (Naples), Florida. In total, there are 170 cases; the majority are accidental polydrug overdoses involving White males between the ages of 25 and 44 years old. Of the 170 cases, 37% listed xylazine as the cause of death. 13% of cases contained only xylazine and fentanyl while the remaining 87% of deaths were attributed to polydrug toxicity involving two or more substances. The prevalence of xylazine can be attributed to its increasing popularity rather than an increase in caseload. In 2019, xylazine was present in only 4% of all accidental fentanyl overdoses. By 2021, this percentage has increased sixfold, with xylazine present in 24% of all accidental fentanyl overdoses. Despite a decrease in fentanyl overdoses in 2022, the percentage of xylazine detection remained the same.
Collapse
Affiliation(s)
- Rocio B Potoukian
- Miami-Dade Medical Examiner Department, Toxicology Laboratory, Miami, Florida, USA
| | - Jennifer Gonyea
- Miami-Dade Medical Examiner Department, Toxicology Laboratory, Miami, Florida, USA
| | - Elisa N Shoff
- Miami-Dade Medical Examiner Department, Toxicology Laboratory, Miami, Florida, USA
| | - George W Hime
- Miami-Dade Medical Examiner Department, Toxicology Laboratory, Miami, Florida, USA
| | - Diane M Moore
- Miami-Dade Medical Examiner Department, Toxicology Laboratory, Miami, Florida, USA
| |
Collapse
|
20
|
Liu CM, Jia W, Song CH, Qian ZH, Hua ZD, Chen YM. Qualitative and Quantitative Analysis of Five Indoles or Indazole Amide Synthetic Cannabinoids in Suspected E-Cigarette Oil by GC-MS. Fa Yi Xue Za Zhi 2023; 39:457-464. [PMID: 38006265 DOI: 10.12116/j.issn.1004-5619.2022.320101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
OBJECTIVES To establish the GC-MS qualitative and quantitative analysis methods for the synthetic cannabinoids, its main matrix and additives in suspicious electronic cigarette (e-cigarette) oil samples. METHODS The e-cigarette oil samples were analyzed by GC-MS after diluted with methanol. Synthetic cannabinoids, its main matrix and additives in e-cigarette oil samples were qualitatively analyzed by the characteristic fragment ions and retention time. The synthetic cannabinoids were quantitatively analyzed by using the selective ion monitoring mode. RESULTS The linear range of each compound in GC-MS quantitative method was 0.025-1 mg/mL, the matrix recovery rate was 94%-103%, the intra-day precision relative standard deviations (RSD) was less than 2.5%, and inter-day precision RSD was less than 4.0%. Five indoles or indazole amide synthetic cannabinoids were detected in 25 e-cigarette samples. The main matrixes of e-cigarette samples were propylene glycol and glycerol. Additives such as N,2,3-trimethyl-2-isopropyl butanamide (WS-23), glycerol triacetate and nicotine were detected in some samples. The content range of synthetic cannabinoids in 25 e-cigarette samples was 0.05%-2.74%. CONCLUSIONS The GC-MS method for synthesizing cannabinoid, matrix and additive in e-cigarette oil samples has good selectivity, high resolution, low detection limit, and can be used for simultaneous qualitative and quantitative analysis of multiple components; The explored fragment ion fragmentation mechanism of the electron bombardment ion source of indole or indoxamide compounds helps to identify such substances or other compounds with similar structures in cases.
Collapse
Affiliation(s)
- Cui-Mei Liu
- Key Laboratory of Drug Monitoring and Control, Drug Intelligence and Forensic Center, Ministry of Public Security, Beijing 100193, China
| | - Wei Jia
- Key Laboratory of Drug Monitoring and Control, Drug Intelligence and Forensic Center, Ministry of Public Security, Beijing 100193, China
| | - Chun-Hui Song
- School of Pharmacy, China Pharmaceutical University, Nanjing 210009, China
| | - Zhen-Hua Qian
- Key Laboratory of Drug Monitoring and Control, Drug Intelligence and Forensic Center, Ministry of Public Security, Beijing 100193, China
| | - Zhen-Dong Hua
- Key Laboratory of Drug Monitoring and Control, Drug Intelligence and Forensic Center, Ministry of Public Security, Beijing 100193, China
| | - Yue-Meng Chen
- Drug Control Detachment of Guiyang Public Security Bureau, Guiyang 550081, China
| |
Collapse
|
21
|
Zhai WY, Wu LN, Yang S, Shen BH, Shi Y. Detection and Analysis of Blood Dexmedetomidine in Drug-Facilitated Cases. Fa Yi Xue Za Zhi 2023; 39:452-456. [PMID: 38006264 DOI: 10.12116/j.issn.1004-5619.2022.320306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
OBJECTIVES To establish a simple and rapid qualitative and quantitative detection method of dexmedetomidine in blood. METHODS Blood was separated on the Allure PFP Propyl liquid chromatography column with isocratic elution after it was precipitated by acetonitrile and filtered. Qualitative and quantitative analysis of dexmedetomidine was performed using positive ion scan mode and multi-reaction monitoring mode. RESULTS The limit of detection of dexmedetomidine in blood was 0.2 ng/mL and the limit of quantification was 0.5 ng/mL. The linearity of the method was good in the range of 0.5-1 000 ng/mL, and the correlation coefficient was greater than 0.99. The accuracy of the method was 90.34%-112.67% and the extraction recovery was 50.05%-91.08%, with no significant matrix effect. CONCLUSIONS This method is simple, selective and suitable for the qualitative and quantitative analysis of dexmedetomidine in blood, which can provide a reference for drug-facilitated cases involving dexmedetomidine.
Collapse
Affiliation(s)
- Wen-Ya Zhai
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Ministry of Justice, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai 200063, China
- School of Forensic Medicine, Xi'an Jiaotong University, Xi'an 710061, China
| | - Li-Na Wu
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Ministry of Justice, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai 200063, China
| | - Shuo Yang
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Ministry of Justice, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai 200063, China
| | - Bao-Hua Shen
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Ministry of Justice, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai 200063, China
| | - Yan Shi
- Shanghai Key Laboratory of Forensic Medicine, Key Laboratory of Forensic Science, Ministry of Justice, Shanghai Forensic Service Platform, Academy of Forensic Science, Shanghai 200063, China
| |
Collapse
|
22
|
Simas MV, Olaniyan PO, Hati S, Davis GA, Anspach G, Goodpaster JV, Manicke NE, Sardar R. Superhydrophobic Surface Modification of Polymer Microneedles Enables Fabrication of Multimodal Surface-Enhanced Raman Spectroscopy and Mass Spectrometry Substrates for Synthetic Drug Detection in Blood Plasma. ACS Appl Mater Interfaces 2023; 15:46681-46696. [PMID: 37769194 DOI: 10.1021/acsami.3c10174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Microneedles are widely used substrates for various chemical and biological sensing applications utilizing surface-enhanced Raman spectroscopy (SERS), which is indeed a highly sensitive and specific analytical approach. This article reports the fabrication of a nanoparticle (NP)-decorated microneedle substrate that is both a SERS substrate and a substrate-supported electrospray ionization (ssESI) mass spectrometry (MS) sample ionization platform. Polymeric ligand-functionalized gold nanorods (Au NRs) are adsorbed onto superhydrophobic surface-modified polydimethylsiloxane (PDMS) microneedles through the control of various interfacial interactions. We show that the chain length of the polymer ligands dictates the NR adsorption process. Importantly, assembling Au NRs onto the micrometer-diameter needle tips allows the formation of highly concentrated electromagnetic hot spots, which provide the SERS enhancement factor as high as 1.0 × 106. The micrometer-sized area of the microneedle top and high electromagnetic field enhancement of our system can be loosely compared with tip-enhanced Raman spectroscopy, where the apex of a plasmonic NP-functionalized sharp probe produces high-intensity plasmonic hot spots. Utilizing our NR-decorated microneedle substrates, the synthetic drugs fentanyl and alprazolam are analyzed with a subpicomolar limit of detection. Further analysis of drug-molecule interactions on the NR surface utilizing the Langmuir adsorption model suggests that the higher polarizability of fentanyl allows for a stronger interaction with hydrophilic polymer layers on the NR surface. We further demonstrate the translational aspect of the microneedle substrate for both SERS- and ssESI-MS-based detection of these two potent drugs in 10 drug-of-abuse (DOA) patient plasma samples with minimal preanalysis sample preparation steps. Chemometric analysis for the SERS-based detection shows a very good classification between fentanyl, alprazolam, or a mixture thereof in our selected 10 samples. Most importantly, ssESI-MS analysis also successfully identifies fentanyl or alprazolam in these same 10 DOA plasma samples. We believe that our multimodal detection approach presented herein is a highly versatile detection technology that can be applicable to the detection of any analyte type without performing any complicated sample preparation.
Collapse
Affiliation(s)
- M Vitoria Simas
- Department of Chemistry and Chemical Biology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana 46202, United States
| | - Philomena O Olaniyan
- Department of Chemistry and Chemical Biology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana 46202, United States
| | - Sumon Hati
- Department of Chemistry and Chemical Biology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana 46202, United States
| | - Gregory A Davis
- Department of Chemistry and Chemical Biology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana 46202, United States
| | - Gavin Anspach
- Department of Chemistry and Chemical Biology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana 46202, United States
| | - John V Goodpaster
- Department of Chemistry and Chemical Biology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana 46202, United States
| | - Nicholas E Manicke
- Department of Chemistry and Chemical Biology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana 46202, United States
| | - Rajesh Sardar
- Department of Chemistry and Chemical Biology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana 46202, United States
| |
Collapse
|
23
|
Cittadini F, De Giovanni N, Aulino G, Lentini G, Vetrugno G, Strano-Rossi S, Covino M. Blood alcohol concentration and road accidents: Underestimation due to time of the arrival to the emergency department (ED) or delay in blood sampling. A 4-Year Retrospective Study in Rome. Med Sci Law 2023; 63:292-297. [PMID: 36740934 DOI: 10.1177/00258024231154219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Alcohol is a significant public health issue, according to the World Health Organization. Our study aims to analyze the correlation between blood alcohol concentrations (BACs) of drivers, their demographic features, and the possible underestimation of BACs due to the time elapsed between hospital admission and blood sampling. Methods: This study includes patients evaluated for BAC levels in the emergency department (ED) of Fondazione Policlinico Universitario A. Gemelli IRCCS from January 2013 to December 2016. BAC levels were compared in patients involved in road crashes according to age group, sex, and time of the accident. The delays in blood sampling and BAC measurement in the ED were recorded for each patient. The time between the accident and access to the hospital in most cases was unknown. Results: A total of 398 patients were included in the analysis, 107 of them had BACs more than 0.05 g/L., and 86 of these individuals had BAC levels more than 0.5 g/L. Road accident patients had higher rates of positive BAC readings at night and on weekends. A significant delay in blood sampling for BAC determination was observed. Discussion: This study demonstrates a critical bias due to the arrival time at the ED and the delay in blood sampling that inevitably influences and underestimates the BAC, resulting in possible false negative results (BAC values below the cutoff). Zero tolerance or a retrospective BAC calculation could mitigate this bias. It is necessary to implement preventive strategies to reduce instances of driving under the influence (DUI) of alcohol.
Collapse
Affiliation(s)
- Francesca Cittadini
- Department of Health Surveillance and Bioethics, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome, Rome, Italy
| | - Nadia De Giovanni
- Department of Health Surveillance and Bioethics, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome, Rome, Italy
| | - Giovanni Aulino
- Department of Health Surveillance and Bioethics, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome, Rome, Italy
| | | | - Giuseppe Vetrugno
- Department of Health Surveillance and Bioethics, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome, Rome, Italy
| | - Sabina Strano-Rossi
- Department of Health Surveillance and Bioethics, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore Rome, Rome, Italy
| | - Marcello Covino
- Emergency Medicine Department, Fondazione Policlinico Universitario Agostino Gemelli-IRCCS, Università Cattolica del Sacro Cuore di Roma, Rome, Italy
| |
Collapse
|
24
|
Harruff RC, Yarid NA, Barbour WL, Martin YH. Medical examiner response to the drug overdose epidemic in King County Washington: "Real-time" surveillance, data science, and applied forensic epidemiology. J Forensic Sci 2023; 68:1632-1642. [PMID: 37417312 DOI: 10.1111/1556-4029.15329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/16/2023] [Accepted: 06/27/2023] [Indexed: 07/08/2023]
Abstract
As the overdose epidemic overwhelmed medicolegal death investigation offices and toxicology laboratories, the King County Medical Examiner's Office responded with "real-time" fatal overdose surveillance to expedite death certification and information dissemination through assembling a team including a dedicated medicolegal death investigator, an information coordinator, and student interns. In-house testing of blood, urine, and drug evidence from scenes was performed using equipment and supplies purchased for surveillance. Collaboration with state laboratories allowed validation. Applied forensic epidemiology accelerated data dissemination. From 2010 to 2022, the epidemic claimed 5815 lives in King County; the last 4 years accounted for 47% of those deaths. After initiating the surveillance project, in-house testing was performed on blood from 2836 decedents, urine from 2807, and 4238 drug evidence items from 1775 death scenes. Time to complete death certificates decreased from weeks to months to hours to days. Overdose-specific information was distributed weekly to a network of law enforcement and public health agencies. As the surveillance project tracked the epidemic, fentanyl and methamphetamine became dominant and were associated with other indicators of social deterioration. In 2022, fentanyl was involved in 68% of 1021 overdose deaths. Homeless deaths increased sixfold; in 2022, 67% of 311 homeless deaths were due to overdose; fentanyl was involved in 49% and methamphetamine in 44%. Homicides increased 250%; in 2021, methamphetamine was positive in 35% of 149 homicides. The results are relevant to the value of rapid surveillance, its impact on standard operations, selection of cases requiring autopsy, and collaboration with other agencies in overdose prevention.
Collapse
Affiliation(s)
| | - Nicole A Yarid
- King County Medical Examiner's Office, Seattle, Washington, USA
| | | | - Yang H Martin
- King County Medical Examiner's Office, Seattle, Washington, USA
| |
Collapse
|
25
|
Ellefsen KN, Smith CR, Taylor EA, Hall BJ. Emergence of fentanyl-related deaths in Travis County, Texas and surrounding areas: A retrospective review of postmortem fentanyl-related drug toxicities from 2020 to 2022. J Forensic Sci 2023; 68:1662-1674. [PMID: 37194396 DOI: 10.1111/1556-4029.15283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/27/2023] [Accepted: 05/05/2023] [Indexed: 05/18/2023]
Abstract
The opioid epidemic has affected the United States (US) for decades with fentanyl and its analogs accounting for a recent surge in morbidity and mortality. Currently, there is a relative lack of information characterizing fentanyl-related fatalities specifically in the Southern US. A retrospective study was conducted to examine all postmortem fentanyl-related drug toxicities in Travis County, Texas, encompassing Austin (one of the fastest-growing cities in the US), from 2020 to 2022. Fentanyl contributed to 2.6% and 12.2% of deaths submitted for toxicology between 2020 and 2022, respectively, representing a 375% increase in fentanyl-related deaths over this 3-year period (n = 517). Fentanyl-related fatalities primarily occurred in males in their mid-30s. Fentanyl and norfentanyl concentrations ranged from 0.58 to 320 ng/mL and 0.53 to 140 ng/mL with mean (median) concentrations of 17.2 ± 25.0 (11.0) and 5.6 ± 10.9 (2.9) ng/mL, respectively. Polydrug use was present in 88% of cases, with methamphetamine (or other amphetamines) (25%), benzodiazepines (21%), and cocaine (17%) representing the most frequently identified concurrent substances. Co-positivity rates of various drugs and drug classes widely varied over time. Scene investigations reported illicit powder(s) (n = 141) and/or illicit pill(s) (n = 154) in 48% (n = 247) of fentanyl-related deaths. Illicit oxycodone (44%, n = 67) and illicit "Xanax" (38%, n = 59) pills were frequently reported on scene; however, toxicology only identified oxycodone and alprazolam in 2 and 24 of these cases, respectively. The results of this study provide a better understanding of the fentanyl epidemic in this region creating an opportunity to promote increased awareness, shift focus to harm reduction, and aid in minimizing public health risks.
Collapse
Affiliation(s)
| | | | | | - Brad J Hall
- Travis County Medical Examiner, Austin, Texas, USA
| |
Collapse
|
26
|
Palmquist KB, Truver MT, Shoff EN, Krotulski AJ, Swortwood MJ. Review of analytical methods for screening and quantification of fentanyl analogs and novel synthetic opioids in biological specimens. J Forensic Sci 2023; 68:1643-1661. [PMID: 37221651 DOI: 10.1111/1556-4029.15282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/24/2023] [Accepted: 05/05/2023] [Indexed: 05/25/2023]
Abstract
Fentanyl, fentanyl analogs, and other novel synthetic opioids (NSO), including nitazene analogs, prevail in forensic toxicology casework. Analytical methods for identifying these drugs in biological specimens need to be robust, sensitive, and specific. Isomers, new analogs, and slight differences in structural modifications necessitate the use of high-resolution mass spectrometry (HRMS), especially as a non-targeted screening method designed to detect newly emerging drugs. Traditional forensic toxicology workflows, such as immunoassay and gas chromatography mass spectrometry (GC-MS), are generally not sensitive enough for detection of NSOs due to observed low (sub-μg/L) concentrations. For this review, the authors tabulated, reviewed, and summarized analytical methods from 2010-2022 for screening and quantification of fentanyl analogs and other NSOs in biological specimens using a variety of different instruments and sample preparation approaches. Limits of detection or quantification for 105 methods were included and compared to published standards and guidelines for suggested scope and sensitivity in forensic toxicology casework. Methods were summarized by instrument for screening and quantitative methods for fentanyl analogs and for nitazenes and other NSO. Toxicological testing for fentanyl analogs and NSOs is increasingly and most commonly being conducted using a variety of liquid chromatography mass spectrometry (LC-MS)-based techniques. Most of the recent analytical methods reviewed exhibited limits of detection well below 1 μg/L to detect low concentrations of increasingly potent drugs. In addition, it was observed that most newly developed methods are now using smaller sample volumes which is achievable due to the sensitivity increase gained by new technology and new instrumentation.
Collapse
Affiliation(s)
| | - Michael T Truver
- Forensic Toxicology Laboratory, Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Elisa N Shoff
- Miami-Dade Medical Examiner Department, Miami, Florida, USA
| | - Alex J Krotulski
- Center for Forensic Science Research and Education, Fredric Rieders Family Foundation, Willow Grove, Pennsylvania, USA
| | - Madeleine J Swortwood
- Department of Forensic Science, Sam Houston State University, Huntsville, Texas, USA
| |
Collapse
|
27
|
de Campos EG, de Almeida OGG, De Martinis ECP. The role of microorganisms in the biotransformation of psychoactive substances and its forensic relevance: a critical interdisciplinary review. Forensic Sci Res 2023; 8:173-184. [PMID: 38221972 PMCID: PMC10785599 DOI: 10.1093/fsr/owad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/24/2023] [Indexed: 01/16/2024] Open
Abstract
Microorganisms are widespread on the planet being able to adapt, persist, and grow in diverse environments, either rich in nutrient sources or under harsh conditions. The comprehension of the interaction between microorganisms and drugs is relevant for forensic toxicology and forensic chemistry, elucidating potential pathways of microbial metabolism and their implications. Considering the described scenario, this paper aims to provide a comprehensive and critical review of the state of the art of interactions amongst microorganisms and common drugs of abuse. Additionally, other drugs of forensic interest are briefly discussed. This paper outlines the importance of this area of investigation, covering the intersections between forensic microbiology, forensic chemistry, and forensic toxicology applied to drugs of abuse, and it also highlights research potentialities. Key points Microorganisms are widespread on the planet and grow in a myriad of environments.Microorganisms can often be found in matrices of forensic interest.Drugs can be metabolized or produced (e.g. ethanol) by microorganisms.
Collapse
Affiliation(s)
- Eduardo G de Campos
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
- Department of Chemistry and Fermentation Sciences, Appalachian State University, Boone, NC, USA
| | - Otávio G G de Almeida
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Elaine C P De Martinis
- Faculdade de Ciências Farmacêuticas de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| |
Collapse
|
28
|
Andersen FD, Steffensen SC, Vistisen ST, Pinilla E, Pedersen TM, Matchkov V, Simonsen U, Andersen CU. Combined effects of methadone and quetiapine on respiratory rate, haemodynamic variables, and temperature in conscious rats. Addict Biol 2023; 28:e13320. [PMID: 37644895 DOI: 10.1111/adb.13320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/18/2023] [Accepted: 07/20/2023] [Indexed: 08/31/2023]
Abstract
Fatal poisonings where both methadone and quetiapine are detected post-mortem occurs frequently in legal autopsy cases. It is unclear whether quetiapine increases the risk of fatal methadone poisoning or if it is merely detected due to widespread use. We hypothesized that methadone and quetiapine would have additive toxic effects on respiratory rate, blood pressure, and the QTc-interval. To investigate this hypothesis, we used telemetry implants for measurements of respiratory rate, haemodynamic variables, the velocity of blood pressure changes, temperature, and movement in conscious, freely moving male Wistar rats aged 12-13 weeks. The combined effects of three accumulative i.p. doses of methadone (2.5, 10, 15 mg/kg) and quetiapine (3, 10, 30 mg/kg) were compared to rats treated with the same doses of each drug alone, and a vehicle-treated group in a randomized investigator blinded study. No additive effects of quetiapine and methadone on respiratory rate, haemodynamic variables, or movement were observed. However, body temperature was significantly lower by approximately 1.5°C on average in the group treated with both methadone and quetiapine (15 + 30 mg/kg) compared to the other groups. This indicates a synergistic effect of quetiapine and methadone on thermoregulation, which may increase the risk of fatal poisoning. We suggest studying this finding further in human settings.
Collapse
Affiliation(s)
| | - Simon Comerma Steffensen
- Department of Biomedicine, Aarhus University, Denmark
- Department of Biomedical Sciences/AnimalPhysiology, Central University of Venezuela, Venezuela
| | | | | | | | | | - Ulf Simonsen
- Department of Biomedicine, Aarhus University, Denmark
| | - Charlotte Uggerhøj Andersen
- Department of Forensic Medicine, Aarhus University, Denmark
- Department of Biomedicine, Aarhus University, Denmark
- Department of Clinical Pharmacology, Aarhus University Hospital, Denmark
| |
Collapse
|
29
|
Davis GG, Fligner CL. The effects of the (fentanyl-fueled) drug overdose epidemic on medicolegal death investigation in the United States. J Forensic Sci 2023; 68:1626-1631. [PMID: 37306311 DOI: 10.1111/1556-4029.15304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/16/2023] [Accepted: 05/25/2023] [Indexed: 06/13/2023]
Abstract
The evolving opioid epidemic in the United States, fueled by illicit fentanyl, has greatly increased deaths from illicit drug use. These nonnatural deaths require formal death investigation. The National Association of Medical Examiners states in its Forensic Autopsy Performance Standards that autopsy remains a necessary component for proper investigation of suspected acute overdose deaths. If a death investigation office lacks adequate resources to investigate all deaths under its jurisdiction while meeting expected standards, then that office may be forced to consider altering its protocols for investigation by changing the types of deaths investigated or the extent of its investigations. Drug death investigations take longer to complete because novel illicit drugs and mixtures of drugs complicate toxicological analyses, prolonging a family's wait for completion of a death certificate and autopsy report. Public health agencies must also wait for results, but some agencies have developed mechanisms for rapid notification of preliminary results to allow timely deployment of public health resources. The increased deaths have strained the resources of medicolegal death investigation systems throughout the United States. Given the significant workforce shortage of forensic pathologists, newly trained forensic pathologists are too few to meet the demand. Nevertheless, forensic pathologists (and all pathologists) must make time to present their work and themselves to medical students and pathology trainees to encourage an understanding of the importance of quality medicolegal death investigation and autopsy pathology and to provide a model that can encourage interest in a career in forensic pathology.
Collapse
Affiliation(s)
- Gregory G Davis
- Forensic Division, Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Jefferson County, Alabama, Birmingham, Alabama, USA
| | - Corinne L Fligner
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington, USA
| |
Collapse
|
30
|
Harper CE, Mata DC, Lee D. The impact of fentanyl on DUIDs and traffic fatalities: Blood and oral fluid data. J Forensic Sci 2023; 68:1686-1697. [PMID: 37477181 DOI: 10.1111/1556-4029.15334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 07/22/2023]
Abstract
Fentanyl has emerged as the most prolific drug in the ongoing opioid epidemic and has greatly impacted traffic safety in recent years. This study aimed to evaluate fentanyl prevalence and concentrations in blood and oral fluid in driving under the influence of drugs (DUID) cases in three different regions (i.e., Alabama, Orange County, CA, and Houston, TX) from 2017 to 2022. Furthermore, traffic fatalities were evaluated for Alabama and Orange County, CA. Fentanyl positivity in DUID and traffic fatalities increased for most years in this study. In Alabama, the prevalence of fentanyl DUID cases increased 4-fold in 2022 compared to 2017. Orange County's increase from 2017 to 2022 was 14-fold. In Houston, the increase was approximately 2-fold from 2019 to 2022. The greatest increase for all laboratories coincided with the start of the COVID-19 pandemic. In 2022, the median fentanyl DUID blood concentrations were 4.7, 11, and 4.7 ng/mL in Alabama, Orange County, and Houston, respectively. Most fentanyl cases were polydrug cases (≥90%). Methamphetamine, THC, and alprazolam were the most frequently detected drugs in combination with fentanyl. Alabama has collected oral fluid and blood in DUID cases since 2018. The detection of fentanyl in oral fluid was comparable to blood. However, 59% and 8.7% of fentanyl-positive cases had concentrations of >20 ng/mL in oral fluid and blood, respectively. Therefore, oral fluid as an alternative or supplemental specimen to blood is an attractive approach for fentanyl in DUID cases. This study contributes to understanding recent fentanyl trends and their impact on traffic safety.
Collapse
Affiliation(s)
- Curt E Harper
- Alabama Department of Forensic Sciences, Hoover, Alabama, USA
| | - Dani C Mata
- Orange County Crime Laboratory, Santa Ana, California, USA
| | - Dayong Lee
- Houston Forensic Science Center, Houston, Texas, USA
| |
Collapse
|
31
|
Simon G, Kuzma M, Mayer M, Petrus K, Tóth D. Fatal Overdose with the Cannabinoid Receptor Agonists MDMB-4en-PINACA and 4F-ABUTINACA: A Case Report and Review of the Literature. Toxics 2023; 11:673. [PMID: 37624178 PMCID: PMC10458319 DOI: 10.3390/toxics11080673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023]
Abstract
A case of a 26-year-old male who died from consuming synthetic cannabinoid receptor agonists MDMB-4en-PINACA and 4F-ABUTINACA is reported. MDMB-4en-PINACA and 4F-ABUTINACA are potent synthetic cannabinoid receptor agonists (SCRAs). This is the first detailed reporting of MDMB-4-en-PINACA and 4F-ABUTINACA associated fatality, which can help the routine forensic work. The scientific literature on the symptoms associated with these substances are evaluated, along with the pharmacological properties and possible mechanism of death. A forensic autopsy was performed according to Recommendation No. R (99)3 of the Council of Europe on medico-legal autopsies. Histological samples were stained with hematoxylin and eosin (HE). Complement component C9 immunohistochemistry was applied to all heart samples. Toxicological analyses were carried out by supercritical fluid chromatography coupled with tandem mass spectrometry (SFC-MS/MS) and headspace gas chromatography with a flame ionization detector (HS-GC-FID). The literature was reviewed to identify reported cases of MDMB-4en-PINACA and 4F-ABUTINACA use. Autopsy findings included brain edema, internal congestion, petechial bleeding, pleural ecchymoses, and blood fluidity. Toxicological analyses determined 7.2 ng/mL of MDMB-4en-PINACA and 9.1 ng/mL of 4F-ABUTINACA in the peripheral blood. MDMB-4en-PINACA and 4F-ABUTINACA are strong, potentially lethal SCRA, and their exact effects and outcome are unpredictable.
Collapse
Affiliation(s)
- Gábor Simon
- Department of Forensic Medicine, Medical School, University of Pécs, Szigeti str. 12, H-7624 Pécs, Hungary; (M.K.); (M.M.); (K.P.); (D.T.)
| | - Mónika Kuzma
- Department of Forensic Medicine, Medical School, University of Pécs, Szigeti str. 12, H-7624 Pécs, Hungary; (M.K.); (M.M.); (K.P.); (D.T.)
| | - Mátyás Mayer
- Department of Forensic Medicine, Medical School, University of Pécs, Szigeti str. 12, H-7624 Pécs, Hungary; (M.K.); (M.M.); (K.P.); (D.T.)
- Department of Laboratory Medicine, Medical School, University of Pécs, Szigeti str. 12, H-7624 Pécs, Hungary
| | - Karola Petrus
- Department of Forensic Medicine, Medical School, University of Pécs, Szigeti str. 12, H-7624 Pécs, Hungary; (M.K.); (M.M.); (K.P.); (D.T.)
| | - Dénes Tóth
- Department of Forensic Medicine, Medical School, University of Pécs, Szigeti str. 12, H-7624 Pécs, Hungary; (M.K.); (M.M.); (K.P.); (D.T.)
| |
Collapse
|
32
|
Vernich F, Stefani L, Fiorelli D, Mineo F, Pallocci M, Treglia M, Marsella LT, Tittarelli R. Trends in Illicit Cannabis Potency based on the Analysis of Law Enforcement Seizures in the Southern Area of Rome. Toxics 2023; 11:648. [PMID: 37624154 PMCID: PMC10458633 DOI: 10.3390/toxics11080648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 07/13/2023] [Accepted: 07/25/2023] [Indexed: 08/26/2023]
Abstract
Cannabis remains the most illicitly produced and consumed substance worldwide, and the average trans-Δ9-tetrahydrocannabinol (THC) content in cannabis products (marijuana, hashish) has increased over time. This paper presents data about THC concentration in cannabis resin samples seized by law enforcement from 2015 to 2022 in the southern area of Rome (Italy). From 2015 to 2022, more than 1000 hashish samples were analyzed; the average THC content was 18.0% and dramatically increased from 13.7% (2015) to 27.1% (2022). The potency of THC in some samples characterized by unusual shape and color was higher than 24% and, in a few cases, higher than 40%. The age group most involved in seizures of cannabis resin concerned males aged between 15 and 36 years old. The spread of this phenomenon increases the risk of adverse health outcomes. Many observational studies compare the increased cannabis potency with the onset of psychosis, depression, anxiety and cannabis use disorders (CUDs), mainly in young adults. THC-potency monitoring provides data that can be helpful to create a network of communication and interaction between universities, and legislative and public health institutions to support education, awareness and surveillance related to cannabis abuse.
Collapse
Affiliation(s)
- Francesca Vernich
- Laboratory of Forensic Toxicology, Section of Legal and Forensic Medicine, Social Security and Forensic Toxicology, Department of Biomedicine and Prevention, Faculty of Medicine and Surgery, University of Rome “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy
| | - Lucrezia Stefani
- Laboratory of Forensic Toxicology, Section of Legal and Forensic Medicine, Social Security and Forensic Toxicology, Department of Biomedicine and Prevention, Faculty of Medicine and Surgery, University of Rome “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy
| | - Denise Fiorelli
- Laboratory of Forensic Toxicology, Section of Legal and Forensic Medicine, Social Security and Forensic Toxicology, Department of Biomedicine and Prevention, Faculty of Medicine and Surgery, University of Rome “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy
| | - Federico Mineo
- Laboratory of Forensic Toxicology, Section of Legal and Forensic Medicine, Social Security and Forensic Toxicology, Department of Biomedicine and Prevention, Faculty of Medicine and Surgery, University of Rome “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy
| | - Margherita Pallocci
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy
| | - Michele Treglia
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy
| | - Luigi Tonino Marsella
- Laboratory of Forensic Toxicology, Section of Legal and Forensic Medicine, Social Security and Forensic Toxicology, Department of Biomedicine and Prevention, Faculty of Medicine and Surgery, University of Rome “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy
| | - Roberta Tittarelli
- Laboratory of Forensic Toxicology, Section of Legal and Forensic Medicine, Social Security and Forensic Toxicology, Department of Biomedicine and Prevention, Faculty of Medicine and Surgery, University of Rome “Tor Vergata”, Via Montpellier 1, 00133 Rome, Italy
| |
Collapse
|
33
|
Musile G, Grazioli C, Fornasaro S, Dossi N, De Palo EF, Tagliaro F, Bortolotti F. Application of Paper-Based Microfluidic Analytical Devices (µPAD) in Forensic and Clinical Toxicology: A Review. Biosensors (Basel) 2023; 13:743. [PMID: 37504142 PMCID: PMC10377625 DOI: 10.3390/bios13070743] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/14/2023] [Accepted: 06/23/2023] [Indexed: 07/29/2023]
Abstract
The need for providing rapid and, possibly, on-the-spot analytical results in the case of intoxication has prompted researchers to develop rapid, sensitive, and cost-effective methods and analytical devices suitable for use in nonspecialized laboratories and at the point of need (PON). In recent years, the technology of paper-based microfluidic analytical devices (μPADs) has undergone rapid development and now provides a feasible, low-cost alternative to traditional rapid tests for detecting harmful compounds. In fact, µPADs have been developed to detect toxic molecules (arsenic, cyanide, ethanol, and nitrite), drugs, and drugs of abuse (benzodiazepines, cathinones, cocaine, fentanyl, ketamine, MDMA, morphine, synthetic cannabinoids, tetrahydrocannabinol, and xylazine), and also psychoactive substances used for drug-facilitated crimes (flunitrazepam, gamma-hydroxybutyric acid (GHB), ketamine, metamizole, midazolam, and scopolamine). The present report critically evaluates the recent developments in paper-based devices, particularly in detection methods, and how these new analytical tools have been tested in forensic and clinical toxicology, also including future perspectives on their application, such as multisensing paper-based devices, microfluidic paper-based separation, and wearable paper-based sensors.
Collapse
Affiliation(s)
- Giacomo Musile
- Unit of Forensic Medicine, Department of Diagnostics and Public Health, University of Verona, P.le Scuro 10, 37134 Verona, Italy
| | - Cristian Grazioli
- Department of Agrifood, Environmental and Animal Science, University of Udine, Via Cotonificio 108, 33100 Udine, Italy
| | - Stefano Fornasaro
- Department of Chemical and Pharmaceutical Sciences, University of Trieste, Via L. Giorgeri 1, 34127 Trieste, Italy
| | - Nicolò Dossi
- Department of Agrifood, Environmental and Animal Science, University of Udine, Via Cotonificio 108, 33100 Udine, Italy
| | - Elio Franco De Palo
- Unit of Forensic Medicine, Department of Diagnostics and Public Health, University of Verona, P.le Scuro 10, 37134 Verona, Italy
| | - Franco Tagliaro
- Unit of Forensic Medicine, Department of Diagnostics and Public Health, University of Verona, P.le Scuro 10, 37134 Verona, Italy
- Laboratory of Pharmacokinetics and Metabolomics Analysis, Institute of Translational Medicine and Biotechnology, I.M. Sechenov First Moscow State Medical University, Bolshaya Pirogovskaya Street, 119991 Moscow, Russia
| | - Federica Bortolotti
- Unit of Forensic Medicine, Department of Diagnostics and Public Health, University of Verona, P.le Scuro 10, 37134 Verona, Italy
| |
Collapse
|
34
|
Nakao KI, Kibayashi K. Detection of methamphetamine in mouse femurs exposed to high temperature. J Forensic Sci 2023; 68:1268-1276. [PMID: 37149745 DOI: 10.1111/1556-4029.15263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 05/08/2023]
Abstract
Bone samples are valuable for examining the cause of death and circumstance leading up to death when body fluids are not available for forensic toxicological analysis. Examined were heat-induced changes in methamphetamine and amphetamine concentrations in femurs removed from methamphetamine-injected mice to determine if the burned bones could be used for toxicology testing. The femurs were heated at 100°C, 300°C, or 500°C for 10 or 30 min. The tissue structure of the heated femurs was preserved at 100°C for 30 min but was destructed at higher temperatures. Methamphetamine and amphetamine were detected in femurs heated at 100°C for 10 min, 100°C for 30 min, and 300°C for 10 min (with methamphetamine and amphetamine concentrations ranging from 0.36 to 35 μg/g and 0.54 to 47 μg/g, respectively). Methamphetamine and amphetamine were detectable when heated above their decomposition temperature as a result of limited heat transfer do to protection provide by the femoral muscle. Thus, the bone could be a useful analytical sample in cases of burn-related deaths, where it is difficult to collect body fluids.
Collapse
Affiliation(s)
- Ken-Ichiro Nakao
- Department of Forensic Medicine, School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Kazuhiko Kibayashi
- Department of Forensic Medicine, School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
| |
Collapse
|
35
|
Teker C, Aslan R, İpekçi C, Tokdemir M, Akgür SA. Pregabalin Qualitative Detection in Turkish Forensic Cases Between 2017 to 2018. J Psychoactive Drugs 2023:1-7. [PMID: 37343948 DOI: 10.1080/02791072.2023.2226138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
Pregabalin (PGB) has been commonly subjected to diversion, from being a prescription drug to a recreational drug. In this study, pregabalin use (which is one of the substances subject to control in Turkey) and the concomitant use of other substances in cases admitted to the Izmir Forensic Medicine Institute was evaluated. Samples from 15,259 cases were screened, between June 2017 and December 2018, for the presence of PGB, and PGB positive cases were further analyzed. Of all cases screened, PGB was detected in 3.2% (n = 487). The mean age of PGB positive cases was 29.24 ± 10.34 years old (min: 14, max: 84), and 94% of them were male. Cannabis metabolite THC-COOH was the most common substance detected in the blood samples following PGB. Overall, 8 other substances were commonly used along with PGB. These substances were cannabis, morphine, hydromorphone, codeine, hydrocodone, heroin, paracetamol, and naproxen. Finally, we observed similar results in urine analysis. This research provides systematic data for PGB use in forensic cases in Turkey. The study findings indicate that PGB and multiple drug use increased over time, and providers should be particularly careful when prescribing PGB.
Collapse
Affiliation(s)
- Ceyda Teker
- The Ministry of Justice, Council of Forensic Medicine, İ̇zmir, Turkey
| | - Rukiye Aslan
- Toxicology and Pharmaceutical Science, Ege University Institute on Drug Abuse, Izmir, Turkey
| | - Cahit İpekçi
- The Ministry of Justice, Council of Forensic Medicine, İ̇zmir, Turkey
| | - Mehmet Tokdemir
- The Ministry of Justice, Council of Forensic Medicine, İ̇zmir, Turkey
- Department of Forensic Medicine, Izmir Katip Çelebi University, Izmir, Turkey
| | - Serap Annette Akgür
- Toxicology and Pharmaceutical Science, Ege University Institute on Drug Abuse, Izmir, Turkey
| |
Collapse
|
36
|
Currie Z, Kolodij S. In Vitro Production of Gamma-Hydroxybutyrate in Antemortem Blood Under Various Storage Conditions. J Anal Toxicol 2023:bkad039. [PMID: 37329304 DOI: 10.1093/jat/bkad039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/09/2023] [Accepted: 06/15/2023] [Indexed: 06/19/2023] Open
Abstract
Gamma-hydroxybutyrate (GHB) is an endogenous compound and central nervous system depressant drug used recreationally for its intoxicating effects. In a medico-legal context, the interpretation of blood GHB concentrations can be complicated by its endogenous nature and potential for formation during storage. In Canada, the per se limit for GHB in blood is 5 mg/L. Endogenous GHB concentrations in blood are typically well below 5 mg/L; however, there is a paucity of literature regarding the potential production of GHB in antemortem blood during storage. Changes in GHB concentrations were evaluated over the course of 306 days in preserved and unpreserved antemortem blood stored at 4°C and 21°C. Results were compared to 22 impaired driving cases in Ontario between 2019-2022 where GHB was detected in antemortem blood by toxicological analysis at the Centre of Forensic Sciences. Preservative was effective at minimizing GHB production (< 2.5 mg/L) regardless of storage temperature whereas significant in vitro production of GHB occurred in unpreserved antemortem blood. GHB production occurred rapidly in unpreserved blood stored at 21°C; a significant increase was detected after 5 days. The rate of GHB production in unpreserved blood stored at 4°C occurred more gradually but increased significantly by day 30 and reached a maximum concentration of 10 mg/L at 114 days. In unpreserved blood, GHB concentrations were significantly lower at 4°C compared to 21°C for the first 44 days; however, refrigeration had no significant effect then onward. Blood concentrations of GHB detected in the majority of impaired driving cases were markedly higher than the maximum concentration of 10 mg/L detected in the study; however, in 4 of the 22 cases, concentrations were below 10 mg/L. The results demonstrate that concentrations of GHB less than 10 mg/L in blood collected for the purposes of a drug impaired driving investigation should be carefully interpreted.
Collapse
Affiliation(s)
- Zachary Currie
- Toxicology Section, Centre of Forensic Sciences, 25 Morton Shulman Ave, M3M 0B1, Toronto, ON, Canada
| | - Stephanie Kolodij
- Toxicology Section, Centre of Forensic Sciences, 25 Morton Shulman Ave, M3M 0B1, Toronto, ON, Canada
| |
Collapse
|
37
|
Tumayhi M, Banji D, Khardali I, Banji OJF, Alshahrani S, Alqahtani SS, Muqri S, Abdullah A, Sherwani W, Attafi I. Amphetamine-Related Fatalities and Altered Brain Chemicals: A Preliminary Investigation Using the Comparative Toxicogenomic Database. Molecules 2023; 28:4787. [PMID: 37375342 DOI: 10.3390/molecules28124787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/04/2023] [Accepted: 06/11/2023] [Indexed: 06/29/2023] Open
Abstract
Amphetamine is a psychostimulant drug with a high risk of toxicity and death when misused. Abuse of amphetamines is associated with an altered organic profile, which includes omega fatty acids. Low omega fatty acid levels are linked to mental disorders. Using the Comparative Toxicogenomic Database (CTD), we investigated the chemical profile of the brain in amphetamine-related fatalities and the possibility of neurotoxicity. We classified amphetamine cases as low (0-0.5 g/mL), medium (>0.5 to 1.5 g/mL), and high (>1.5 g/mL), based on amphetamine levels in brain samples. All three groups shared 1-octadecene, 1-tridecene, 2,4-di-tert-butylphenol, arachidonic acid (AA), docosahexaenoic acid (DHA), eicosane, and oleylamide. We identified chemical-disease associations using the CTD tools and predicted an association between DHA, AA and curated conditions like autistic disorder, disorders related to cocaine, Alzheimer's disease, and cognitive dysfunction. An amphetamine challenge may cause neurotoxicity in the human brain due to a decrease in omega-3 fatty acids and an increase in oxidative products. Therefore, in cases of amphetamine toxicity, a supplement therapy may be needed to prevent omega-3 fatty acid deficiency.
Collapse
Affiliation(s)
- Murad Tumayhi
- Department of Pharmacology & Toxicology, College of Pharmacy, Jazan University, Jazan 45142, Saudi Arabia
| | - David Banji
- Department of Pharmacology & Toxicology, College of Pharmacy, Jazan University, Jazan 45142, Saudi Arabia
| | - Ibrahim Khardali
- Forensic Toxicology Services, Forensic Medical Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Otilia J F Banji
- Pharmacy Practice Research Unit, Department of Clinical Pharmacy, College of Pharmacy, Jazan University, Jazan 45142, Saudi Arabia
| | - Saeed Alshahrani
- Department of Pharmacology & Toxicology, College of Pharmacy, Jazan University, Jazan 45142, Saudi Arabia
| | - Saad S Alqahtani
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha 61421, Saudi Arabia
| | - Safiah Muqri
- Forensic Toxicology Services, Forensic Medical Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Amal Abdullah
- Forensic Toxicology Services, Forensic Medical Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Wedad Sherwani
- Forensic Toxicology Services, Forensic Medical Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Ibraheem Attafi
- Forensic Toxicology Services, Forensic Medical Center, Ministry of Health, Jazan 45142, Saudi Arabia
| |
Collapse
|
38
|
Qiao H, Shao L, Chen J, Jiang S, Su M, Liu P, Di B. Nail analysis for the assessment of caffeine abuse in Northwest China: A population-based study. J Forensic Sci 2023. [PMID: 37312428 DOI: 10.1111/1556-4029.15311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/31/2023] [Accepted: 06/02/2023] [Indexed: 06/15/2023]
Abstract
Caffeine is the most widely consumed psychoactive agent worldwide and has the potential for abuse, but studies monitoring caffeine abuse in China are scarce. This study aims to estimate the prevalence of caffeine abuse in northwest China and investigate the correlation between caffeine and other drugs in hair and nails using an ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). Fingernail clippings were collected from 376 participants in northwest China to detect caffeine and 13 other illicit psychoactive drugs and their metabolites. Paired hair and nail samples were collected from 39 participants to investigate the correlation between caffeine and other drugs in hair and nails. The samples were decontaminated, pulverized, and extracted by a high-throughput nail sample preparation method and analyzed by UPLC-MS/MS. The results showed a risk of caffeine abuse in northwest China, with concentrations ranging from 0.43 to 10.6 ng/mg for healthy volunteers, 0.49-246 ng/mg for caffeine abusers, and 0.25-363 ng/mg for drug addicts in community rehabilitation centers. Caffeine was detected together with other illicit psychoactive drugs and their metabolites. Furthermore, positive detection correlations were found between hair and nail samples. This study provides a current perspective on caffeine abuse in northwest China and demonstrates the practical use of UPLC-MS/MS for the simultaneous detection of caffeine and 13 illicit psychoactive drugs and their metabolites in hair and nails. The results highlight the potential of nails as a supplementary matrix when hair samples are unavailable and emphasize the need for handling caffeine carefully given its potential for abuse.
Collapse
Affiliation(s)
- Hongwei Qiao
- Key Laboratory of Drug Monitoring and Control, Drug Intelligence and Forensic Center, Ministry of Public Security, P. R. of China, Beijing, China
- China National Narcotics Control Commission - China Pharmaceutical University Joint Laboratory on Key Technologies of Narcotics Control, Nanjing, China
| | - Litao Shao
- China National Narcotics Control Commission - China Pharmaceutical University Joint Laboratory on Key Technologies of Narcotics Control, Nanjing, China
- School of Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Jie Chen
- Key Laboratory of Drug Monitoring and Control, Drug Intelligence and Forensic Center, Ministry of Public Security, P. R. of China, Beijing, China
- China National Narcotics Control Commission - China Pharmaceutical University Joint Laboratory on Key Technologies of Narcotics Control, Nanjing, China
| | - Shan Jiang
- China National Narcotics Control Commission - China Pharmaceutical University Joint Laboratory on Key Technologies of Narcotics Control, Nanjing, China
- School of Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Mengxiang Su
- China National Narcotics Control Commission - China Pharmaceutical University Joint Laboratory on Key Technologies of Narcotics Control, Nanjing, China
- School of Pharmacy, China Pharmaceutical University, Nanjing, China
| | - Peipei Liu
- Key Laboratory of Drug Monitoring and Control, Drug Intelligence and Forensic Center, Ministry of Public Security, P. R. of China, Beijing, China
- China National Narcotics Control Commission - China Pharmaceutical University Joint Laboratory on Key Technologies of Narcotics Control, Nanjing, China
| | - Bin Di
- China National Narcotics Control Commission - China Pharmaceutical University Joint Laboratory on Key Technologies of Narcotics Control, Nanjing, China
- School of Pharmacy, China Pharmaceutical University, Nanjing, China
| |
Collapse
|
39
|
Boudin C, Eysseric-Guérin H, Paysant F, Revet M, Stanke-Labesque F, Scolan V, Willeman T. Suicide with oral midazolam: post-mortem toxicological investigations using Ostro® plate and UPLC-MS/MS. J Anal Toxicol 2023:7193760. [PMID: 37300548 DOI: 10.1093/jat/bkad032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 06/05/2023] [Accepted: 06/09/2023] [Indexed: 06/12/2023] Open
Abstract
A middle-aged woman was found dead with multiple empty blisters of midazolam (DORMICUM®), equivalent to 450mg, near her body. The autopsy revealed that the cause of death was secondary to an asphyxia syndrome. Standard toxicological procedures identified midazolam only in blood, urine and gastric content. A quantitative analytical method for midazolam (MDZ) and 1-hydroxy-midazolam (1-OH-MDZ) was validated using protein precipitation, a phospholipid removal Ostro® plates and liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS). MDZ and 1-OH-MDZ were quantified in peripheral blood at 910 ng/mL and 534 ng/mL, respectively, and superior to 2000 ng/mL in urine. Reported to the body weight, the dose, which was lethal, was estimated to 6.7 mg/kg. The usual dose used in intensive care unit is 0.03-0.3 mg/kg. MDZ intoxication outside of hospital are rare given the restricted availably of this drug in France. Nevertheless, MDZ under oral form remains available in several countries. Toxic MDZ blood concentrations are described after intravenous administration for anesthesia and are not suited for oral intoxication. Based on the autopsy findings, police investigation and toxicology results, the cause of death was determined to be a self-inflicted oral MDZ acute intoxication, which is the first to be documented to the best of our knowledge. This fatal intoxication provides analytical data that could support subsequent toxicological result interpretation in similar forensic cases.
Collapse
Affiliation(s)
- Coralie Boudin
- Forensic Laboratory, University Grenoble Alpes, Grenoble, France
| | - Hélène Eysseric-Guérin
- Forensic Laboratory, University Grenoble Alpes, Grenoble, France
- Laboratory of Pharmacology, Pharmacogenetics and Toxicology, Grenoble University Hospital, Grenoble, France
| | - François Paysant
- Clinical Forensic Medicine Department, Grenoble University Hospital, Grenoble, France
| | - Melissa Revet
- Clinical Forensic Medicine Department, Grenoble University Hospital, Grenoble, France
| | - Françoise Stanke-Labesque
- Laboratory of Pharmacology, Pharmacogenetics and Toxicology, Grenoble University Hospital, Grenoble, France
- Grenoble Alpes University, HP2 Inserm U1300 Laboratory, Grenoble, France
| | - Virginie Scolan
- Clinical Forensic Medicine Department, Grenoble University Hospital, Grenoble, France
| | - Théo Willeman
- Laboratory of Pharmacology, Pharmacogenetics and Toxicology, Grenoble University Hospital, Grenoble, France
- Clinical Forensic Medicine Department, Grenoble University Hospital, Grenoble, France
| |
Collapse
|
40
|
Fischer V, Kamphausen T, Büttner A, Andresen-Streichert H. Fatal intoxication with 1,4-butanediol: Case report and comprehensive review of the literature. J Forensic Sci 2023. [PMID: 37277927 DOI: 10.1111/1556-4029.15294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 05/16/2023] [Accepted: 05/16/2023] [Indexed: 06/07/2023]
Abstract
A fatal case of 1,4-butanediol (1,4-BD) oral ingestion is reported here, in which a 51-year-old man was found dead in his bed. According to the police report, the deceased was a known drug user. A glass bottle labeled (and later confirmed to be) "Butandiol 1,4" (1,4-BD) was found in the kitchen. Furthermore, the deceased's friend stated that he consumed 1,4-BD on a regular basis. The autopsy and histological examination of postmortem parenchymatous organ specimens did not revealed a clear cause of death. Chemical-toxicological investigations revealed gammahydroxybutyrat (GHB) in body fluids and tissues in the following quantities: femoral blood 390 mg/L, heart blood 420 mg/L, cerebrospinal fluid 420 mg/L, vitreous humor 640 mg/L, urine 1600 mg/L, and head hair 26.7 ng/mg. In addition, 1,4-BD was qualitatively detected in the head hair, urine, stomach contents, and the bottle. No other substances, including alcohol, were detected at pharmacologically relevant concentrations. 1,4-BD is known as precursor substance that is converted in vivo into GHB. In the synoptic assessment of toxicological findings, the police investigations and having excluded other causes of death, a lethal GHB-intoxication following ingestion of 1,4-BD, can be assumed in this case. Fatal intoxications with 1,4-BD have seldom been reported due to a very rapid conversion to GHB and, among other things, non-specific symptoms after ingestion. This case report aims to give an overview to the published of fatal 1,4-BD-intoxications and to discuss the problems associated with detection of 1,4-BD in (postmortem) specimens.
Collapse
Affiliation(s)
- Victoria Fischer
- Institute of Legal Medicine, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Thomas Kamphausen
- Institute of Legal Medicine, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Andreas Büttner
- Institute of Forensic Medicine, University of Rostock, Rostock, Germany
| | | |
Collapse
|
41
|
Shaikhain G, Gaballah M, Alhazmi A, Khardali I, Hakami A, Oraiby M, Alharbi S, Tobaigi M, Ghalibi M, Fageeh M, Albeishy M, Attafi I. Fatalities Involving Khat in Jazan, Saudi Arabia, 2018 to 2021. Toxics 2023; 11:506. [PMID: 37368606 DOI: 10.3390/toxics11060506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023]
Abstract
Interpreting fatalities involving khat is challenging due to a lack of data on cathinone and cathine reference concentrations in postmortem tissues. This study investigated the autopsy findings and toxicological results of fatalities involving khat in Saudi Arabia's Jazan region from 1 January 2018 to 31 December 2021. All confirmed cathine and cathinone results in postmortem blood, urine, brain, liver, kidney, and stomach samples were recorded and analyzed. Autopsy findings and the manner and cause of death of the deceased were assessed. Saudi Arabia's Forensic Medicine Center investigated 651 fatality cases over four years. Thirty postmortem samples were positive for khat's active constituents, cathinone and cathine. The percentage of fatalities involving khat was 3% in 2018 and 2019 and increased from 4% in 2020 to 9% in 2021, when compared with all fatal cases. They were all males ranging in age from 23 to 45. Firearm injuries (10 cases), hanging (7 cases), road traffic accident (2 cases), head injury (2 cases), stab wounds (2 cases), poisoning (2 cases), unknown (2 cases), ischemic heart disease (1 case), brain tumor (1 case), and choking (1 case) were responsible for the deaths. In total, 57% of the postmortem samples tested positive for khat only, while 43% tested positive for khat with other drugs. Amphetamine is the drug most frequently involved. The average cathinone and cathine concentrations were 85 and 486 ng/mL in the blood, 69 and 682 ng/mL in the brain, 64 and 635 ng/mL in the liver, and 43 and 758 ng/mL in the kidneys, respectively. The 10th-90th percentiles of blood concentrations of cathinone and cathine were 18-218 ng/mL and 222-843 ng/mL, respectively. These findings show that 90% of fatalities involving khat had cathinone concentrations greater than 18 ng/mL and cathine concentrations greater than 222 ng/mL. According to the cause of death, homicide was the most common fatality involving khat alone (77%). More research is required, especially toxicological and autopsy findings, to determine the involvement of khat in crimes and fatalities. This study may help forensic scientists and toxicologists investigate fatalities involving khat.
Collapse
Affiliation(s)
- Ghassan Shaikhain
- Forensic Toxicology Services, Forensic Medical Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Mohammed Gaballah
- Forensic Medicine Services, Forensic Medical Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Ahmad Alhazmi
- Forensic Medicine Services, Forensic Medical Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Ibrahim Khardali
- Forensic Toxicology Services, Forensic Medical Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Ahmad Hakami
- Forensic Medicine Services, Forensic Medical Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Magbool Oraiby
- Forensic Toxicology Services, Forensic Medical Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Sultan Alharbi
- Forensic Toxicology Services, Forensic Medical Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Mohammad Tobaigi
- Forensic Medicine Services, Forensic Medical Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Mohammed Ghalibi
- Forensic Medicine Services, Forensic Medical Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Mohsen Fageeh
- Forensic Toxicology Services, Forensic Medical Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Mohammed Albeishy
- Forensic Toxicology Services, Forensic Medical Center, Ministry of Health, Jazan 45142, Saudi Arabia
| | - Ibraheem Attafi
- Forensic Toxicology Services, Forensic Medical Center, Ministry of Health, Jazan 45142, Saudi Arabia
| |
Collapse
|
42
|
Lin J, Yun K, Sun Q, Xiang P, Wu L, Yang S, Dun J, Fu S, Chen H. How to sample a seizure plant: the role of the visualization spatial distribution analysis of Lophophora williamsii as an example. Forensic Sci Res 2023; 8:140-151. [PMID: 37621449 PMCID: PMC10445667 DOI: 10.1093/fsr/owad014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/16/2023] [Indexed: 08/26/2023] Open
Abstract
Natural compounds in plants are often unevenly distributed, and determining the best sampling locations to obtain the most representative results is technically challenging. Matrix-assisted laser desorption/ionization mass spectrometry imaging (MALDI-MSI) can provide the basis for formulating sampling guideline. For a succulent plant sample, ensuring the authenticity and in situ nature of the spatial distribution analysis results during MSI analysis also needs to be thoroughly considered. In this study, we developed a well-established and reliable MALDI-MSI method based on preservation methods, slice conditions, auxiliary matrices, and MALDI parameters to detect and visualize the spatial distribution of mescaline in situ in Lophophora williamsii. The MALDI-MSI results were validated using liquid chromatography-tandem mass spectrometry. Low-temperature storage at -80°C and drying of "bookmarks" were the appropriate storage methods for succulent plant samples and their flower samples, and cutting into 40 μm thick sections at -20°C using gelatin as the embedding medium is the appropriate sectioning method. The use of DCTB (trans-2-[3-(4-tert-butylphenyl)-2-methyl-2-propenylidene]malononitrile) as an auxiliary matrix and a laser intensity of 45 are favourable MALDI parameter conditions for mescaline analysis. The region of interest semi-quantitative analysis revealed that mescaline is concentrated in the epidermal tissues of L. williamsii as well as in the meristematic tissues of the crown. The study findings not only help to provide a basis for determining the best sampling locations for mescaline in L. williamsii, but they also provide a reference for the optimization of storage and preparation conditions for raw plant organs before MALDI detection. Key Points An accurate in situ MSI method for fresh water-rich succulent plants was obtained based on multi-parameter comparative experiments.Spatial imaging analysis of mescaline in Lophophora williamsii was performed using the above method.Based on the above results and previous results, a sampling proposal for forensic medicine practice is tentatively proposed.
Collapse
Affiliation(s)
- Jiaman Lin
- School of Forensic Medicine, Shanxi Medical University, Key Laboratory of Forensic Medicine in Shanxi Province, Key Laboratory of Forensic Toxicology of Ministry of Public Security, Jinzhong, China
- Department of Forensic Toxicology, Shanghai Key Laboratory of Forensic Medicine, Academy of Forensic Science, Shanghai, China
| | - Keming Yun
- School of Forensic Medicine, Shanxi Medical University, Key Laboratory of Forensic Medicine in Shanxi Province, Key Laboratory of Forensic Toxicology of Ministry of Public Security, Jinzhong, China
| | - Qiran Sun
- Department of Forensic Toxicology, Shanghai Key Laboratory of Forensic Medicine, Academy of Forensic Science, Shanghai, China
| | - Ping Xiang
- Department of Forensic Toxicology, Shanghai Key Laboratory of Forensic Medicine, Academy of Forensic Science, Shanghai, China
| | - Lina Wu
- School of Forensic Medicine, Shanxi Medical University, Key Laboratory of Forensic Medicine in Shanxi Province, Key Laboratory of Forensic Toxicology of Ministry of Public Security, Jinzhong, China
- Department of Forensic Toxicology, Shanghai Key Laboratory of Forensic Medicine, Academy of Forensic Science, Shanghai, China
| | - Shuo Yang
- Department of Forensic Toxicology, Shanghai Key Laboratory of Forensic Medicine, Academy of Forensic Science, Shanghai, China
| | | | - Shanlin Fu
- School of Forensic Medicine, Shanxi Medical University, Key Laboratory of Forensic Medicine in Shanxi Province, Key Laboratory of Forensic Toxicology of Ministry of Public Security, Jinzhong, China
| | - Hang Chen
- Department of Forensic Toxicology, Shanghai Key Laboratory of Forensic Medicine, Academy of Forensic Science, Shanghai, China
| |
Collapse
|
43
|
Takei S, Kinoshita H, Jamal M, Kumihashi M, Yamashita T, Tanaka E, Kawahara S, Abe H, Tsutsui K, Kimura S. Case report: Fatal poisoning caused by additive effects of two barbiturates. Front Pharmacol 2023; 14:1196565. [PMID: 37292155 PMCID: PMC10244534 DOI: 10.3389/fphar.2023.1196565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 05/09/2023] [Indexed: 06/10/2023] Open
Abstract
A case of fatal poisoning involving multiple psychotropic drugs is presented. Quantitative toxicological analysis showed femoral blood concentrations of pentobarbital, phenobarbital, duloxetine, acetaminophen and tramadol were 10.39, 22.57, 0.22, 0.61 and 0.22 μg/ml, respectively. We concluded that the death was due to the additive effects of two barbiturates. As both pentobarbital and phenobarbital act on gamma-aminobutyric acid (GABA) receptors, central nervous system activity was suppressed, causing respiratory depression. Additive pharmacological effects should be considered in cases of massive ingestion of multiple drugs.
Collapse
Affiliation(s)
- Sella Takei
- Departments of Forensic Medicine, Faculty of Medicine, Kagawa University, Takamatsu, Japan
| | - Hiroshi Kinoshita
- Departments of Forensic Medicine, Faculty of Medicine, Kagawa University, Takamatsu, Japan
| | - Mostofa Jamal
- Departments of Forensic Medicine, Faculty of Medicine, Kagawa University, Takamatsu, Japan
| | - Mitsuru Kumihashi
- Departments of Forensic Medicine, Faculty of Medicine, Kagawa University, Takamatsu, Japan
| | - Tadayoshi Yamashita
- Departments of Forensic Medicine, Faculty of Medicine, Kagawa University, Takamatsu, Japan
| | - Etsuko Tanaka
- Departments of Forensic Medicine, Faculty of Medicine, Kagawa University, Takamatsu, Japan
| | - Sachiko Kawahara
- Departments of Forensic Medicine, Faculty of Medicine, Kagawa University, Takamatsu, Japan
| | | | - Kunihiko Tsutsui
- Kagawa Prefectural University of Health Sciences, Takamatsu, Kagawa, Japan
| | - Shoji Kimura
- Departments of Forensic Medicine, Faculty of Medicine, Kagawa University, Takamatsu, Japan
| |
Collapse
|
44
|
Wachholz P, Celiński R, Bujak-Giżycka B, Skowronek R, Pawlas N. A fatal case of poisoning with a cathinone derivative: α-PiHP and its post-mortem distribution in body fluids and organ tissues. J Anal Toxicol 2023:7148126. [PMID: 37130049 PMCID: PMC10362950 DOI: 10.1093/jat/bkad026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/27/2023] [Accepted: 04/27/2023] [Indexed: 05/03/2023] Open
Abstract
New psychoactive substances (NPS) continue to appear on the drug market and alpha-pyrrolidinoisohexanophenone (α-PiHP) is one of the most popular cathinone derivatives. In this paper, we report a case of death caused by α-PiHP. Based on the toxicological results of the studied case along with autopsy, histopathological findings and crime-scene information, fatal intoxication with α-PiHP was accepted as the final cause of death. α-PiHP and its metabolite (OH-α-PiHP) were detected and quantified in all post-mortem materials (blood collected from the heart, the femoral vein and the dural venous sinuses, vitreous humour, cerebrospinal fluid, cerebral cortex, brainstem, cerebellum, bile, liver, kidney, heart, pancreas, spleen, thyroid gland, lung, adipose tissue, stomach and intestine). To date, this is the first case of determination of α-PiHP and its metabolite in post-mortem specimens. In our opinion, α-PiHP and its metabolite concentration database can be helpful in the interpretation of fatal cases.
Collapse
Affiliation(s)
- Paulina Wachholz
- Department of Pharmacology, Medical University of Silesia in Katowice, Faculty of Medical Sciences in Zabrze, 38 Jordana Street, 41-808 Zabrze, Poland
- Toxicology Laboratory ToxLab, 6 Kossutha Street, 40-844 Katowice, Poland
| | - Rafał Celiński
- Toxicology Laboratory ToxLab, 6 Kossutha Street, 40-844 Katowice, Poland
| | - Beata Bujak-Giżycka
- Department of Clinical Pharmacology, Faculty of Medicine, Jagiellonian University Medical College, 16 Grzegórzecka Street, 31-531 Kraków, Poland
| | - Rafał Skowronek
- Department of Forensic Medicine and Forensic Toxicology, Medical University of Silesia in Katowice, Faculty of Medical Sciences in Katowice, 18 Medyków Street, 40-752 Katowice, Poland
| | - Natalia Pawlas
- Department of Pharmacology, Medical University of Silesia in Katowice, Faculty of Medical Sciences in Zabrze, 38 Jordana Street, 41-808 Zabrze, Poland
| |
Collapse
|
45
|
Long W, Qu PF, Ma L, Wang R, Xi YM, Li YH, Nie SJ, Duan T, DU JL, Tang X, Zhao JF, Lei PP, Wang YB. Cytotoxicity of 4 Wild Mushrooms in a Case of Yunnan Sudden Unexplained Death. Fa Yi Xue Za Zhi 2023; 39:121-128. [PMID: 37277374 DOI: 10.12116/j.issn.1004-5619.2021.310802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To explore the cytotoxicity of four wild mushrooms involved in a case of Yunnan sudden unexplained death (YNSUD), to provide the experimental basis for prevention and treatment of YNSUD. METHODS Four kinds of wild mushrooms that were eaten by family members in this YNSUD incident were collected and identified by expert identification and gene sequencing. Raw extracts from four wild mushrooms were extracted by ultrasonic extraction to intervene HEK293 cells, and the mushrooms with obvious cytotoxicity were screened by Cell Counting Kit-8 (CCK-8). The selected wild mushrooms were prepared into three kinds of extracts, which were raw, boiled, and boiled followed by enzymolysis. HEK293 cells were intervened with these three extracts at different concentrations. The cytotoxicity was detected by CCK-8 combined with lactate dehydrogenase (LDH) Assay Kit, and the morphological changes of HEK293 cells were observed under an inverted phase contrast microscope. RESULTS Species identification indicated that the four wild mushrooms were Butyriboletus roseoflavus, Boletus edulis, Russula virescens and Amanita manginiana. Cytotoxicity was found only in Amanita manginiana. The raw extracts showed cytotoxicity at the mass concentration of 0.1 mg/mL, while the boiled extracts and the boiled followed by enzymolysis extracts showed obvious cytotoxicity at the mass concentration of 0.4 mg/mL and 0.7 mg/mL, respectively. In addition to the obvious decrease in the number of HEK293 cells, the number of synapses increased and the refraction of HEK293 cells was poor after the intervention of Amanita manginiana extracts. CONCLUSIONS The extracts of Amanita manginiana involved in this YNSUD case has obvious cytotoxicity, and some of its toxicity can be reduced by boiled and enzymolysis, but cannot be completely detoxicated. Therefore, the consumption of Amanita manginiana is potentially dangerous, and it may be one of the causes of the YNSUD.
Collapse
Affiliation(s)
- Wu Long
- College of Forensic Medicine, Kunming Medical University, Kunming 650500, China
| | - Peng-Fei Qu
- Department of Pathology, School of Basic Medicine, Peking University Health Science Center, Beijing 100191, China
| | - Lin Ma
- Yunnan Institute of Endemic Diseases Control and Prevention, Dali 671000, Yunnan Province, China
| | - Rui Wang
- College of Forensic Medicine, Kunming Medical University, Kunming 650500, China
| | - Yan-Mei Xi
- Yunnan Institute of Endemic Diseases Control and Prevention, Dali 671000, Yunnan Province, China
| | - Yu-Hua Li
- College of Forensic Medicine, Kunming Medical University, Kunming 650500, China
| | - Sheng-Jie Nie
- College of Forensic Medicine, Kunming Medical University, Kunming 650500, China
| | - Ting Duan
- College of Forensic Medicine, Kunming Medical University, Kunming 650500, China
| | - Jin-Liang DU
- College of Forensic Medicine, Kunming Medical University, Kunming 650500, China
| | - Xue Tang
- Yunnan Institute of Endemic Diseases Control and Prevention, Dali 671000, Yunnan Province, China
| | - Jing-Feng Zhao
- Key Laboratory of Medicinal Chemistry for Natural Resource, Ministry of Education, Yunnan Research and Development Center for Natural Products, School of Chemical Science and Technology, Yunnan University, Kunming 650500, China
| | - Pu-Ping Lei
- College of Forensic Medicine, Kunming Medical University, Kunming 650500, China
| | - Yue-Bing Wang
- Yunnan Institute of Endemic Diseases Control and Prevention, Dali 671000, Yunnan Province, China
| |
Collapse
|
46
|
Reinstadler V, Huber S, Lierheimer S, Boettcher M, Rüscher P, Tanzer M, Jenny K, Zoll A, Gruber W, Oberacher H. A fast and convenient sample preparation method for the analysis of cannabinoids in oral fluid. Biomed Chromatogr 2023:e5651. [PMID: 37057387 DOI: 10.1002/bmc.5651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 04/15/2023]
Abstract
Cannabis is the world's most used illegal drug. The main psychoactive component is ∆-9-tetrahydrocannabinol (THC). To aid identification of cannabis-impaired individuals, a simple but effective workflow for reliable quantification of THC and its metabolites in oral fluid samples collected with the Greiner Bio-One Saliva Collection System is presented. Sampling involves rinsing the oral cavity with an extraction solution containing a citrate buffer stimulating salivary flow. Sample processing targeted the cannabinoid fraction interacting with proteins and other insoluble constituents that can be separated by centrifugation. Approximately 50% of the total cannabinoid amount included in oral fluid were recovered from the obtained pellet by extraction with acetonitrile. Liquid chromatography-tandem mass spectrometry was used for cannabinoid quantification. Fitness of the developed workflow for application in forensic and clinical cannabis testing was demonstrated by assessing multiple performance parameters, including selectivity, linearity, limits of quantification (LOQs), accuracy, precision, matrix effects, extraction recoveries, process efficiencies, and stability. Furthermore, sensitivity and specificity of the developed oral fluid-based cannabis test was demonstrated by analysing 195 samples collected either from opioid addicts or persons suspected of driving under the influence of drugs. The accuracy of identifying a person with presence of THC in blood was found to be 97.9%.
Collapse
Affiliation(s)
- Vera Reinstadler
- Institute of Legal Medicine and Core Facility Metabolomics, Medical University of Innsbruck, Innsbruck, Austria
| | - Susanne Huber
- Institute of Legal Medicine and Core Facility Metabolomics, Medical University of Innsbruck, Innsbruck, Austria
| | | | | | | | | | - Kurt Jenny
- Landespolizeidirektion Vorarlberg, Bregenz, Austria
| | - Adolf Zoll
- Landespolizeidirektion Vorarlberg, Bregenz, Austria
| | | | - Herbert Oberacher
- Institute of Legal Medicine and Core Facility Metabolomics, Medical University of Innsbruck, Innsbruck, Austria
| |
Collapse
|
47
|
Buratti E, Cippitelli M, Mietti G, Scendoni R, Froldi R, Cerioni A, Cingolani M. Validation of an HPLC-HR/MS method for the determination and quantification of six drugs (morphine, codeine, methadone, alprazolam, clonazepam and quetiapine) in nails. J Anal Toxicol 2023; 47:488-493. [PMID: 37022151 DOI: 10.1093/jat/bkad022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/29/2023] [Accepted: 04/04/2023] [Indexed: 04/07/2023] Open
Abstract
Keratinized matrices, including nails, are among the most resistant matrices that can be analyzed in cases where remains are deeply decomposed and relatively non -invasive for living people. In order to exploit these new matrices in the search for exogenous substances, it is necessary to develop analytical technologies capable of achieving high levels of sensitivity. In this technical note, an easy method is presented for the simultaneous extraction and quantification of three narcotic substances (morphine, codeine, methadone), two benzodiazepines (BDZ) (clonazepam and alprazolam) and an antipsychotic (quetiapine) from nail matrix by analysis in Ultra High-Performance Liquid Chromatography at High Resolution Mass Spectrometry (HPLC/HR-MS). The method has been validated following the Standard Practices for Method Validation in Forensic Toxicology of the Scientific Working Group for Forensic Toxicology. Nail specimens from eight authentic postmortem cases and thirteen living donor samples were extracted and analyzed. Of the eight postmortem samples, five resulted positive for at least one of the three substances searched. Ten of the thirteen living donor specimens were positive for at least one of the targeted benzodiazepines or quetiapine.
Collapse
Affiliation(s)
- Erika Buratti
- Forensic Medicine Laboratory, Institute of Legal Medicine, University of Macerata Italy
| | - Marta Cippitelli
- Forensic Medicine Laboratory, Institute of Legal Medicine, University of Macerata Italy
| | - Gianmario Mietti
- Forensic Medicine Laboratory, Institute of Legal Medicine, University of Macerata Italy
| | - Roberto Scendoni
- Forensic Medicine Laboratory, Institute of Legal Medicine, University of Macerata Italy
| | - Rino Froldi
- Forensic Medicine Laboratory, Institute of Legal Medicine, University of Macerata Italy
| | - Alice Cerioni
- Forensic Medicine Laboratory, Institute of Legal Medicine, University of Macerata Italy
| | - Mariano Cingolani
- Forensic Medicine Laboratory, Institute of Legal Medicine, University of Macerata Italy
| |
Collapse
|
48
|
Arbouche N, Walch A, Raul JS, Kintz P. Intentional overdose of glargine insulin: Determination of the parent compound in postmortem blood by LC-HRMS. J Forensic Sci 2023; 68:1077-1083. [PMID: 36994942 DOI: 10.1111/1556-4029.15247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/17/2023] [Accepted: 03/21/2023] [Indexed: 03/31/2023]
Abstract
Insulin glargine is a long-acting insulin analog that is converted after enzymatic cleavage of the arginine pair of the β-chain into its main metabolite M1 (21A -Gly-insulin), which is responsible for the hypoglycemic activity. In all the overdose cases described in the literature, only M1 concentrations have been reported, whereas insulin glargine was always absent or below the limit of quantitation. In this study, we present a case of suicide of a young nurse by injection of insulin glargine in which the parent molecule was found at a toxic concentration in blood. The determination and the discrimination of insulin glargine from human insulin and other synthetic analogs in the blood specimen were performed by liquid chromatography coupled to high-resolution mass spectrometry (Waters XEVO G2-XS QToF) and extraction after precipitation in the presence of bovine insulin (internal standard), with a mixture of acetonitrile/methanol +1% formic acid followed by purification on solid phase extraction cartridges C18. Glargine insulin tested highly positive in the blood with a concentration of 1.06 mg/L. Due to the difficulty in obtaining a M1 pure standard, the metabolite could not be dosed. This unique presence of the parent molecule, reported for the first time, can be explained by inter-individual variability in the rate of conversion to metabolite. Intravenous injection versus subcutaneous injection can also explain the presence of insulin glargine. Finally, the dose injected may have been so high that saturation of the proteolytic enzymes responsible for conversion to M1 should have occurred.
Collapse
Affiliation(s)
- Nadia Arbouche
- Institut de Médecine Légale, 11 Rue Humann, Strasbourg, 67000, France
| | - Alexis Walch
- Institut de Médecine Légale, 11 Rue Humann, Strasbourg, 67000, France
| | | | - Pascal Kintz
- Institut de Médecine Légale, 11 Rue Humann, Strasbourg, 67000, France
- X-Pertise Consulting, 42 Rue Principale, Mittelhausbergen, 67206, France
| |
Collapse
|
49
|
Al-Asmari AI, Alharbi H, Al-Zahrani AE, Zughaibi TA. Heroin-Related Fatalities in Jeddah, Saudi Arabia, between 2008 and 2018. Toxics 2023; 11:248. [PMID: 36977013 PMCID: PMC10099738 DOI: 10.3390/toxics11030248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 02/20/2023] [Accepted: 02/27/2023] [Indexed: 06/18/2023]
Abstract
To date, epidemiological studies have not evaluated heroin-related deaths in the Middle East and North African regions, especially Saudi Arabia. All heroin-related postmortem cases reported at the Jeddah Poison Control Center (JPCC) over a 10-year period (21 January 2008 to 31 July 2018) were reviewed. In addition, liquid chromatography electrospray ionization tandem mass spectrometry (LC/ESI-MS/MS) was utilized to determine the 6-monoacetylmorphine (6-MAM), 6-acetylcodeine (6-AC), morphine (MOR), and codeine contents in unhydrolyzed postmortem specimens. Ninety-seven heroin-related deaths were assessed in this study, and they represented 2% of the total postmortem cases at the JPCC (median age, 38; 98% male). In the blood, urine, vitreous humor, and bile samples, the median morphine concentrations were 280 ng/mL, 1400 ng/mL, 90 ng/mL, and 2200 ng/mL, respectively; 6-MAM was detected in 60%, 100%, 99%, and 59% of the samples, respectively; and 6-AC was detected in 24%, 68%, 50%, and 30% of the samples, respectively. The highest number of deaths (33% of total cases) was observed in the 21-30 age group. In addition, 61% of cases were classified as "rapid deaths," while 24% were classified as "delayed deaths." The majority (76%) of deaths were accidental; 7% were from suicide; 5% were from homicide; and 11% were undetermined. This is the first epidemiological study to investigate heroin-related fatalities in Saudi Arabia and the Middle East and North African region. The rate of heroin-related deaths in Jeddah remained stable but increased slightly at the end of the study period. Most patients were heroin-dependent abusers and from the middle-aged group. The availability of urine, vitreous humor, and bile specimens provided valuable information regarding the opioids that were administered and the survival time following heroin injection.
Collapse
Affiliation(s)
- Ahmed I. Al-Asmari
- Laboratory Department, Ministry of Health, King Abdul-Aziz Hospital, Jeddah 21442, Saudi Arabia
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Hassan Alharbi
- Poison Control and Forensic Chemistry Center, Ministry of Health, Jeddah 21176, Saudi Arabia
| | | | - Torki A. Zughaibi
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| |
Collapse
|
50
|
Kosecki PA, Canonico E, Abbott L. Ethanol stability in unpreserved refrigerated antemortem blood. J Forensic Sci 2023; 68:682-687. [PMID: 36604777 DOI: 10.1111/1556-4029.15189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/09/2022] [Accepted: 12/20/2022] [Indexed: 01/07/2023]
Abstract
Ethanol stability in preserved antemortem blood has been widely studied since it is a common practice in cases involving suspected impaired driving to collect antemortem blood in evacuated blood tubes containing sodium fluoride. In some situations, antemortem blood is submitted to a forensic laboratory for ethanol analysis in evacuated blood tubes that contain only an anticoagulant. There has been limited research on ethanol stability in antemortem blood stored without a preservative. On two occasions, antemortem blood was collected from five ethanol-free individuals into 6-ml Vacutainer® tubes containing only 10.8 mg potassium EDTA. The blood tubes were spiked with ethanol to approximately either 0.08 or 0.15 g/dl. Dual-FID headspace gas chromatography was used to analyze 58 blood tubes, 29 from each session, for ethanol 1 day after sample collection and again after 1 year of refrigerated storage (~4°C). Statistically significant decreases in ethanol were detected at the 0.05 level of significance. Mean decreases in ethanol after 1 year of storage for the 0.08 and 0.15 g/dl samples were 0.013 and 0.010 g/dl, respectively. The mean ethanol decrease across all tubes was 0.012 g/dl. The range of decreases for the 58 blood tubes was 0.003-0.018 g/dl. The mean ethanol decreases measured in this unpreserved antemortem blood are comparable in magnitude to those previously observed in antemortem blood containing sodium fluoride after 1 year of refrigerated storage. Ethanol did not increase in the antemortem blood samples despite the absence of sodium fluoride.
Collapse
Affiliation(s)
| | - Erika Canonico
- Scottsdale Police Department Crime Laboratory, Scottsdale, Arizona, USA
| | - Lori Abbott
- Scottsdale Police Department Crime Laboratory, Scottsdale, Arizona, USA
| |
Collapse
|