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Five cases of unintentional exposure to BZO-4en-POXIZID among nightclub attendees in New York City. 纽约市夜总会参与者无意中接触bzo -4en- pozid5例
IF 2.5 3区 医学 Q1 Medicine Pub Date : 2024-01-31 DOI: 10.1093/jat/bkad086
Joseph J Palamar, Marta Massano, Alberto Salomone

A new class of synthetic cannabinoids called OXIZIDs has emerged in recent years. This class consists of compounds with oxindole cores and hydrazide/hydrazone linker moieties and has often been described as being designed to circumvent a Chinese class-wide ban that was effective as of 1 July 2021. However, through hair testing of nightclub attendees in New York City-a high-risk population for recreational drug use-we have evidence suggesting exposures to an OXIZID called BZO-4en-POXIZID (4en-pentyl MDA-19) prior to the effective ban. Through analysis of 6 cm segmented hair samples from attendees collected in 2021, we detected five cases of exposure. Specifically, we detected a cluster of three cases based on hair samples collected on 20 June 2021, and then two additional cases from samples collected on 16 July 2021. Four of these hair samples were long enough to analyze two 6 cm hair segments (representing approximately two 6-month timeframes) and three of four of these cases tested positive for repeated exposure (for an estimated exposure over 6 months prior to hair collection). All cases included young adult females reporting past-year cannabis use but all tested negative for tetrahydrocannabinol exposure. Three cases also reported past-year use of cocaine, ecstasy, and/or ketamine, and four cases tested positive for exposure to cocaine, 3,4-methylenedioxymethamphetamine (MDMA), 3,4-methylenedioxyamphetamine (MDA), methamphetamine and/or eutylone. These subjects were exposed to BZO-4en-POXIZID-likely as an adulterant in other drugs, and these cases are among the first documented cases which occurred approximately half a year before the Chinese legislative ban.

近年来出现了一类新的合成大麻素,称为OXIZIDs。这类化合物由含有氧吲哚核心和肼/腙连接基团的化合物组成,通常被描述为旨在规避自2021年7月1日起生效的中国全类禁令。然而,通过对纽约市夜总会参与者(娱乐性毒品使用的高风险人群)的头发测试,我们有证据表明,在有效禁令之前,接触过一种名为BZO-4en-POXIZID (4en-pentyl MDA-19)的OXIZID。通过分析2021年收集的与会者的6厘米分段头发样本,我们发现了5例暴露病例。具体来说,我们根据2021年6月20日收集的头发样本检测到三例病例,然后从2021年7月16日收集的样本中检测到另外两例病例。其中四个头发样本足够长,可以分析两个6厘米的头发片段(代表大约两个6个月的时间框架),其中四个病例中有三个因反复接触(收集头发前六个月的估计接触)而检测呈阳性。所有病例都包括报告过去一年吸食大麻的年轻成年女性,但四氢大麻酚暴露检测均为阴性。三例报告过去一年使用可卡因、摇头丸和/或氯胺酮,四例检测可卡因、MDMA、丙二醛、甲基苯丙胺和/或真替龙呈阳性。这些受试者暴露于bzo -4en- pozid,可能是其他药物中的掺杂物,这些病例是在中国立法禁止前大约半年发生的第一批有记录的病例。
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引用次数: 0
Evaluation of biochemical assays and optimization of LC-MS-MS analysis for the detection of synthetic urine. 生化分析的评价和LC-MS/MS分析检测合成尿液的优化。
IF 2.5 3区 医学 Q1 Medicine Pub Date : 2024-01-31 DOI: 10.1093/jat/bkad082
Laura Franke, Christian Fuczik, Michael Hubig, Frank T Peters, Dirk K Wissenbach

Ensuring specimen validity is an essential aspect of toxicological laboratories. In recent years, substituting authentic urine specimens for synthetic urine (SU) has become increasingly popular. Such SU products consist of components expected in normal urine and show physiological values for specific gravity and pH. Thus, standard specimen validity testing may fail in revealing adulteration by SU. The present study investigated three methods to distinguish authentic and SU specimens: enzymatic detection of uric acid, the commercially available Axiom Test True SU and liquid chromatography coupled with (tandem) mass spectrometry (LC-MS-MS) analysis of 10 endogenous biomolecules. Additionally, novel direct markers of SU were investigated. Two specimen sets were analyzed by each method. Specimen set A consisted of eight SU products purchased from the Austrian/German market and 43 urine specimens from volunteers of known authenticity, which underwent double-blind analysis. Specimen set B consisted of 137 real urine specimens submitted for drug testing, which were selected due to initial suspicious test results in adulteration testing and reanalyzed by all three methods. Uric acid and LC-MS-MS-based endogenous biomolecule testing showed 100% sensitivity and specificity for set A. The commercial test had 87.5% sensitivity and 97.7% specificity for set A. For set B, uric acid and LC-MS-MS analysis showed almost similar results, even if uric acid was missing one presumptive authentic urine specimen according to LC-MS-MS findings. Nearly half of the SU assignments for the commercial test were presumptive false positives. New SU markers were observed for SU products from the Austrian/German market. One specimen in set B had both an endogenous biomolecule pattern and SU markers suggesting urine dilution with SU. In conclusion, several analytes or methods should be used rather than one, and the most reliable results are achieved if both indirect and direct markers of urine substitution are analyzed.

确保标本的有效性是毒理学实验室的一个重要方面。近年来,用真实的尿液样本代替合成尿液变得越来越流行。这种合成尿液产品由正常尿液中预期的成分组成,并显示出比重和pH的生理值。因此,标准样本有效性测试可能无法揭示合成尿液的掺假。本研究调查了区分真实尿液和合成尿液样本的三种方法:尿酸的酶法检测、市售Axiom Test真实合成尿液和10种内源性生物分子的LC-MS/MS分析。此外,还研究了合成尿液的新的直接标志物。每种方法分析两个样本集。样本集A由8个从奥地利/德国市场购买的合成尿液产品和43个来自已知真实性志愿者的尿液样本组成,这些样本接受了双盲分析。样本组B由137份提交药物测试的真实尿液样本组成,这些样本是由于掺假测试中最初的可疑测试结果而选择的,并通过所有三种方法重新分析。基于尿酸和LC-MS/MS的内源性生物分子检测对A组显示出100%的敏感性和特异性。商业检测对A集的敏感性为87.5%,特异性为97.7%。对于B组,即使根据LC-MS/MS结果,尿酸缺少一个假定的真实尿液样本,尿酸和LC-MS分析也显示出几乎相似的结果。商业测试的合成尿液分配中,近一半是推定的假阳性。对于来自奥地利/德国市场的合成尿液产品,观察到了新的合成尿液标记物。B组中的一个样本同时具有内源性生物分子模式和合成尿液标志物,表明尿液被合成尿液稀释。总之,应该使用几种分析物或方法,而不是一种,如果同时分析尿液替代的间接和直接标志物,则可以获得最可靠的结果。
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引用次数: 0
Methoxetamine and its metabolites: Postmortem determination in body fluids of human cadaver. 甲氧基胺及其代谢物:人尸体体液中的死后测定。
IF 2.5 3区 医学 Q1 Medicine Pub Date : 2024-01-31 DOI: 10.1093/jat/bkad084
Miroslava Bursová, Tomáš Hložek, Miloš Sokol, Monika Židková, Radomír Čabala

We report the forensic case of a 42-year-old man, a known drug user, who died at home and whose body was only discovered 2 months later. Autopsy was performed on a corpse in the late postmortem stage where no apparent cause of death was found. A toxicological screening of biological materials (blood, urine and gastric content) using liquid chromatography with different types of mass detection (ion trap and high-resolution) revealed the presence of methoxetamine (MXE), a ketamine analog, and its metabolites. MXE and a number of its metabolites (e.g., O-desmethyl, N-desethyl, hydroxy, glucuronides and sulfates) were identified in urine. Based on the results, a method using liquid chromatography with tandem mass spectrometry was developed and validated for the determination of MXE concentration in biological materials. The following values of MXE concentration were found: blood-3.6 ng/mL, urine-70.5 ng/mL and gastric content-18.0 ng/mL. Given the absence of other drugs, medications and poisons, it can be inferred that despite relatively low blood concentrations, MXE contributed to the victim's death. The present case demonstrates that even after 2 months, MXE and its several metabolites can be detected and determined in the human cadaver at a relatively advanced stage of decomposition.

我们报告一名42岁男子的法医案件,他是一名已知的吸毒者,死于家中,他的尸体在2个月后才被发现。尸体解剖是在尸体后期进行的,没有发现明显的死亡原因。生物物质(血液、尿液和胃内容物)的毒理学筛选使用液相色谱和不同类型的质量检测(离子阱和高分辨率)发现存在甲氧基胺(MXE),一种氯胺酮类似物,及其代谢物。在尿中鉴定出甲氧基乙胺及其代谢产物(如o -去甲基、n -去乙基、羟基、-葡萄糖醛酸盐和硫酸盐)。在此基础上,建立了液相色谱-串联质谱(LC-MS/MS)测定生物材料中MXE浓度的方法,并进行了验证。甲氧基胺血药浓度为3.6 ng/mL,尿药浓度为70.5 ng/mL,胃药浓度为18.0 ng/mL。鉴于没有其他药物,药物和毒药,可以推断,尽管血液浓度相对较低,但甲氧基胺导致了受害者的死亡。本病例表明,即使在两个月后,甲氧基胺及其几种代谢物仍可在处于相对较晚期分解阶段的人体尸体中检测和确定。
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引用次数: 0
Correction to: Evaluation of biochemical assays and optimization of LC-MS-MS analysis for the detection of synthetic urine. 更正为评估生化测定和优化 LC-MS/MS 分析,以检测合成尿液。
IF 2.5 3区 医学 Q1 Medicine Pub Date : 2024-01-31 DOI: 10.1093/jat/bkad091
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引用次数: 0
Urine and hair drug test results associated with daily consumption of codeine-predominant poppy seed food products. 尿液和毛发药物测试结果与每日食用以可待因为主的罂粟种子食品有关。
IF 2.5 3区 医学 Q1 Medicine Pub Date : 2024-01-31 DOI: 10.1093/jat/bkad083
Gary M Reisfield, Scott A Teitelbaum, Joseph T Jones, Kent Mathias, Ben Lewis

This study examined the urine and hair opiate profiles associated with the daily consumption of presumptive codeine-predominant poppy seed food products. Ten participants consumed one of five food products at breakfast for 10 consecutive days. Baseline urine and hair samples were collected on Day 1. The urine samples were collected 4, 8 and 12 h following poppy seed consumption on Days 1 and 10, and the first morning void urine samples were collected on Days 2-10. A second hair specimen was collected on Day 20 ± 2. Urine drug test results: Three of the food products were associated with opiate-negative urine drug test results at all time points at a 300 ng/mL cut-off. Two of the food products were associated with opiate-positive drug test results at all non-baseline time points at a 300 ng/mL cut-off. Of these, all samples (n = 60) were codeine-positive, and 27 (45%) were morphine-positive. Codeine concentrations exceeded morphine concentrations in every sample and always by multiples. Thirty-nine of the 60 samples (65%) were codeine-positive at a 2,000 ng/mL cut-off, while none of these samples were morphine-positive at this cut-off. None of the 60 samples reached an opiate threshold of 15,000 ng/mL, although one participant produced a maximum codeine concentration of 13,161 ng/mL (13,854 ng/mg creatinine). There was no clear trend toward increasing urinary opiate concentrations over the course of the study. Hair drug test results: The hair samples of two participants produced quantifiable codeine (41 pg/mg and 51 pg/mg), but no sample reached a common reporting threshold of 200 pg/mg for codeine or morphine.

这项研究检查了尿液和头发的阿片类成分与假定的可待因为主的罂粟种子食品的日常消费有关。10名参与者在连续10天的早餐中食用五种食品中的一种。第1天采集基线尿液和毛发样本。分别于第1天和第10天食用罂粟籽后4、8和12 h采集尿样,第2-10天采集第一次晨空尿样。第20±2天采集第二次毛发标本。尿药检结果:三种食品在所有时间点的截断值为300纳克/毫升时与阿片类药物阴性尿药检结果相关。其中两种食品在所有非基线时间点的临界值为300纳克/毫升时均与阿片类药物检测结果呈阳性相关。所有样本(n = 60)均为可待因阳性,27例(45%)为吗啡阳性。每个样本的可待因浓度都超过吗啡浓度,而且总是超过吗啡数倍。60个样本中有39个(65%)在2000 ng/mL的临界值下呈可待因阳性,而这些样本中没有一个在这个临界值下呈吗啡阳性。60个样本中没有一个达到15,000 ng/mL的鸦片阈值,尽管一个参与者产生的最大可待因浓度为13,161 ng/mL (13,854 ng/mg肌酐)。在整个研究过程中,尿中阿片类药物浓度没有明显增加的趋势。头发药物测试结果:两名参与者的头发样本产生可量化的可待因(41 pg/mg和51 pg/mg),但没有样本达到可待因或吗啡200 pg/mg的常见报告阈值。
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引用次数: 0
Preanalytical factors influencing the results of ethanol analysis in postmortem specimens. 影响尸检标本乙醇分析结果的预分析因素。
IF 2.5 3区 医学 Q1 Medicine Pub Date : 2024-01-31 DOI: 10.1093/jat/bkad078
Maria L Olds, Alan W Jones

Excessive drinking and drunkenness are underlying factors in many fatal accidents, which make the quantitative determination of ethanol in postmortem (PM) specimens an essential part of all unnatural death investigations. The same analytical methods are used to determine ethanol in blood taken from living and deceased persons although the interpretation of the results is more complicated in medical examiner cases owing to various preanalytical factors. The biggest problem is that under anaerobic conditions ethanol can be produced naturally in decomposed bodies by microbial activity and fermentation of blood glucose. Ways are needed to differentiate antemortem ingestion of ethanol from PM synthesis. One approach involves the determination of ethanol in alternative specimens, such as bile, cerebrospinal fluid, vitreous humor and/or urine, and comparison of results with blood alcohol concentration (BAC). Another approach involves the analysis of various alcohol biomarkers, such as ethyl glucuronide, ethyl sulfate and/or phosphatidylethanol or the urinary metabolites of serotonin 5-hydroxytryptophol/5-hydroxyindoleacetic acid (5-HTOL/5-HIAA). If ethanol had been produced in the body by microbial activity, the blood samples should also contain other low-molecular volatiles, such as acetaldehyde, n-propanol and/or n-butanol. The inclusion of 1-2% w/v sodium or potassium fluoride, as an enzyme inhibitor, in all PM specimens is essential to diminish the risk of ethanol being generated after sampling, such as during shipment and storage prior to analysis. Furthermore, much might be gained if the analytical cut-off for reporting positive BAC was raised from 0.01 to 0.02 g% when PM blood is analyzed. During putrefaction low BACs are more often produced after death than high BACs. Therefore, when the cadaver is obviously decomposed, a pragmatic approach would be to subtract 0.05 g% from the mean analytical result. Any remaining BAC is expected to give a more reliable indication of whether alcohol had been consumed before death.

过量饮酒和醉酒是许多致命事故的潜在因素,这使得尸检(PM)样本中乙醇的定量测定成为所有非自然死亡调查的重要组成部分。同样的分析方法也用于测定从活人和死人身上采集的血液中的乙醇,尽管在法医案例中,由于各种预分析因素,对结果的解释更为复杂。最大的问题是,在厌氧条件下,乙醇可以通过微生物活动和血糖发酵在分解的身体中自然产生。需要有方法来区分死前(AM)摄入乙醇和PM合成。一种方法是测定替代标本中的乙醇,如胆汁、脑脊液(CSF)、玻璃体(VH)和/或尿液,并将结果与血液酒精浓度(BAC)进行比较。另一个涉及各种醇生物标志物的分析,如乙基葡糖苷酸(EtG)、硫酸乙酯(EtS)和/或磷脂酰乙醇(PEth)或5-羟色胺的尿代谢产物(5-HTOL/5-HIAA)。如果乙醇是通过微生物活动在体内产生的,血液样本还应含有其他低分子挥发物,如乙醛、正丙醇和/或正丁醇。在所有PM样品中加入1-2%w/v的氟化钠或氟化钾作为酶抑制剂,对于降低取样后产生乙醇的风险至关重要,例如在运输和分析前的储存过程中。此外,当分析PM血液时,如果报告阳性BAC的分析截止值从0.01 g%提高到0.02 g%,可能会有很多收获。低BAC比高BAC更经常在死亡后产生。因此,当尸体明显腐烂时,一种实用的方法是从平均分析结果中减去0.05 g%。任何剩余的BAC都有望更可靠地表明死亡前是否饮酒。
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引用次数: 0
Immunoassay testing for barbiturates using alternative matrices in postmortem tissues from cats and dogs. 在猫和狗的死后组织中使用替代基质进行巴比妥酸盐的免疫测定。
IF 2.5 3区 医学 Q1 Medicine Pub Date : 2024-01-31 DOI: 10.1093/jat/bkad087
Courtney Valerio, Megan C Romano, Rupam Sarma, Adam W Stern

The barbiturate drug pentobarbital is commonly used by veterinarians for the euthanasia of domestic animals. During the veterinary forensic autopsy, it is sometimes necessary to determine whether the animal was chemically euthanized with pentobarbital. The use of a human immunochromatographic test for barbiturate screening utilizing dog or cat urine has been previously validated; however, the use of alternative matrices for this purpose is yet to be explored when urine is not available. Postmortem heart, liver, spleen, skeletal muscle, blood and/or urine samples from 20 dogs and 26 cats with a reported chemical euthanasia status were processed using two different methods, bead homogenization and sonication, and screened for barbiturates using a human immunochromatographic test. There was 100% agreement of the immunochromatographic test results using the sonication method with the reported euthanasia status of both dogs and cats. Using the bead homogenization method, agreement with the reported euthanasia status was 93.3% and 96.7% for dogs and cats, respectively, due to invalid test results from four dog and two cat samples. A subset of liver samples (10 canine and 10 feline) was analyzed via gas chromatography-mass spectrometry, and there was 100% agreement between the immunochromatographic test results and gas chromatography-mass spectrometry results for both cats and dogs. Overall, our results support the use of a variety of alternative matrices for barbiturate screening in cats and dogs.

巴比妥类药物戊巴比妥通常被兽医用于家畜安乐死。在兽医法医解剖过程中,有时需要确定动物是否被戊巴比妥化学安乐死。利用狗或猫的尿液进行巴比妥酸盐筛选的人类免疫层析试验先前已得到验证;然而,在没有尿液的情况下,用于这一目的的替代基质的使用尚未探索。20只狗和26只猫的死后心脏、肝脏、脾脏、骨骼肌、血液和/或尿液样本被报告为化学安乐死状态,使用两种不同的方法进行处理,头均质和超声,并使用人类免疫层析测试筛选巴比妥酸盐。使用超声方法的免疫层析测试结果与报告的狗和猫的安乐死状态100%一致。由于4只狗和2只猫的检测结果无效,采用珠粒均质法,狗和猫的安乐死状态与报告的一致性分别为93.3%和96.7%。通过气相色谱-质谱(GC-MS)分析了一部分肝脏样本(10只犬和10只猫),猫和狗的免疫层析测试结果与GC-MS结果100%一致。总的来说,我们的结果支持在猫和狗中使用各种替代基质进行巴比妥酸盐筛选。
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引用次数: 0
Pharmacokinetics and Pharmacodynamics of Five Distinct Commercially Available Hemp-derived Topical Cannabidiol (CBD) Products 五种不同市售大麻衍生局部大麻二酚(CBD)产品的药代动力学和药效学研究
IF 2.5 3区 医学 Q1 Medicine Pub Date : 2024-01-09 DOI: 10.1093/jat/bkae001
C. Austin Zamarripa, Hayleigh E Tilton, Spencer Lin, Edward J Cone, Ruth E Winecker, Ronald R Flegel, David Kuntz, Melissa Beals, Martin Jaques, Michael Clark, Eric R Welsh, Lynn Wagner, Marcel O Bonn-Miller, Ryan Vandrey, Tory R Spindle
Products containing cannabidiol (CBD) have proliferated after the 2018 Farm Bill legalized hemp (cannabis with ≤0.3% delta-9-tetrahydrocannabinol, Δ9-THC). CBD-containing topical products have surged in popularity but controlled clinical studies on them are limited. This study characterized the effects of five commercially available hemp-derived high CBD/low Δ9-THC topical products. Healthy adults (N=46) received one of six study drugs: a CBD-containing cream (N =8), lotion (N =8), patch (N =7), balm (N=8), gel (N =6), or placebo (N=9; matched to an active formulation). The protocol included three phases conducted over 17 days: 1) an acute drug application laboratory session; 2) a 9-day outpatient phase with twice daily product application (visits occurred on Days 2, 3, 7, and 10); and 3) a 1-week washout phase. In each phase, whole blood, oral fluid, and urine specimens were collected and analyzed via liquid chromatography with tandem mass spectrometry (LC-MS/MS) for CBD, Δ9-THC, and primary metabolites of each and pharmacodynamic outcomes (subjective, cognitive/psychomotor, physiological effects) were assessed. Transdermal absorption of CBD was observed for three active products. On average, CBD/metabolite concentrations peaked after 7-10 days of product use and were highest for the lotion, which contained the most CBD and a permeation enhancer (vitamin E). Δ9-THC/metabolites were below the limit of detection in blood for all products and no urine samples tested “positive” for cannabis using current U.S. federal workplace drug testing criteria (immunoassay cutoff of 50ng/mL and confirmatory LC-MS/MS cutoff of 15ng/mL). Unexpectedly, nine participants (seven lotion, one patch, one gel) exhibited Δ9-THC oral fluid concentrations ≥ 2ng/mL (current U.S. federal workplace threshold for a “positive” test). Products did not produce discernable pharmacodynamic effects and were well-tolerated. This study provides important initial data on the acute/chronic effects of hemp-derived topical CBD products, but more research is needed given the diversity of products in this market.
2018 年《农业法案》将大麻(δ-9-四氢大麻酚≤0.3%的大麻)合法化后,含有大麻二酚(CBD)的产品激增。含 CBD 的外用产品大受欢迎,但对其进行的对照临床研究却很有限。本研究描述了五种市售大麻提取的高 CBD/ 低 Δ9-THC 外用产品的效果。健康成人(46 人)接受了六种研究药物中的一种:含 CBD 乳霜(8 人)、乳液(8 人)、贴片(7 人)、香膏(8 人)、凝胶(6 人)或安慰剂(9 人;与活性配方匹配)。实验方案包括三个阶段,历时 17 天:1)急性用药实验阶段;2)为期 9 天的门诊阶段,每天使用两次产品(第 2、3、7 和 10 天就诊);3)为期 1 周的冲洗阶段。在每个阶段,收集全血、口服液和尿液标本,通过液相色谱-串联质谱法(LC-MS/MS)分析 CBD、Δ9-THC 和每种物质的主要代谢物,并评估药效学结果(主观、认知/精神运动、生理效应)。观察了三种活性产品对 CBD 的透皮吸收情况。平均而言,CBD/代谢物浓度在使用产品 7-10 天后达到峰值,而含有最多 CBD 和渗透促进剂(维生素 E)的乳液的浓度最高。所有产品的Δ9-四氢大麻酚/代谢物浓度都低于血液中的检测限,按照美国联邦现行的工作场所药物检测标准(免疫测定临界值为 50ng/mL ,确证性 LC-MS/MS 临界值为 15ng/mL),没有尿样检测出大麻 "阳性"。出乎意料的是,9 名参与者(7 种乳液、1 种贴剂、1 种凝胶)口服液中的Δ9-四氢大麻酚浓度≥ 2ng/mL (目前美国联邦工作场所的 "阳性 "检测阈值)。产品未产生明显的药效学效应,且耐受性良好。这项研究为大麻衍生的局部 CBD 产品的急性/慢性效应提供了重要的初步数据,但鉴于该市场产品的多样性,还需要进行更多的研究。
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引用次数: 0
The Evolution of Fentanyl-Related Substances: Prevalence and Drug Concentrations in Postmortem Biological Specimens at the Miami-Dade Medical Examiner Department 芬太尼相关物质的演变:迈阿密-戴德法医部门死后生物标本中的流行率和药物浓度
IF 2.5 3区 医学 Q1 Medicine Pub Date : 2023-12-21 DOI: 10.1093/jat/bkad089
Jocelyn Martinez, Jennifer Gonyea, M. Elizabeth Zaney, Joseph Kahl, Diane M Moore
Since 2014, the Miami-Dade Medical Examiner Department (MDME) has observed a drastic increase in the number of fentanyl and fentanyl analog (fentanyl-related substances, FRS) fatalities since its introduction into the heroin and cocaine supply. Due to the prevalence of FRS in Miami-Dade County, the MDME toxicology laboratory began documenting each case in which fentanyl and/or a fentanyl analog was identified. Additional information monitored included demographics (age, race, and sex), other drugs identified, cause of death, and manner of death. From 2014 to 2022, the MDME toxicology laboratory analyzed a total of 1,989 cases that tested positive for FRS, of which 1,707 had detectable and/or quantifiable fentanyl concentrations in postmortem cases. The majority of the decedents were white males (62%), and the predominant age range was 25-34 years. The most prevalent manner of death was accident (93%) with the most common cause of death listed as acute combined drug toxicity of fentanyl in combination with other drugs (79%). Other drugs found in combination with fentanyl included heroin, cocaine (most prevalent), synthetic cathinones, and ethanol. Of all FRS cases, 9% (170 cases) involved fentanyl alone as a cause of death, while 2% (38 cases) included only fentanyl analogs. Fentanyl concentrations ranged from 1.0 to 1,646 ng/mL in peripheral blood, 1.2 to 449 ng/mL in central blood, 3.2 to 28 ng/mL in donor blood (obtained during tissue harvesting), 1.1 to 108 ng/mL in antemortem blood, 8.5 to 1130 ng/g in liver, and 2.0 to 471 ng/g in brain. Drug concentrations were also reported for an additional eight fentanyl analogs. Considering the prevalence, high potency, and constant evolution of FRS, it is important to continuously monitor trends and report drug concentrations in complex medical examiner casework in an effort to educate pathologists, law enforcement, and local governments.
自 2014 年以来,迈阿密-戴德法医部(MDME)观察到,自芬太尼和芬太尼类似物(芬太尼相关物质,FRS)进入海洛因和可卡因供应以来,芬太尼和芬太尼类似物的死亡人数急剧增加。由于 FRS 在迈阿密-戴德县很普遍,因此 MDME 毒理学实验室开始记录发现芬太尼和/或芬太尼类似物的每个案例。监测到的其他信息包括人口统计学特征(年龄、种族和性别)、鉴定出的其他毒品、死因和死亡方式。从 2014 年到 2022 年,MDME 毒理学实验室共分析了 1,989 例 FRS 检测呈阳性的病例,其中 1,707 例在死后病例中检测到和/或可量化的芬太尼浓度。死者大多为白人男性(62%),主要年龄段为 25-34 岁。最常见的死亡方式是意外事故(93%),最常见的死因是芬太尼与其他药物的急性合并药物中毒(79%)。与芬太尼同时发现的其他药物包括海洛因、可卡因(最常见)、合成卡西酮和乙醇。在所有急性呼吸系统综合征病例中,9%(170 例)的死因仅为芬太尼,2%(38 例)的死因仅为芬太尼类似物。芬太尼的浓度范围为:外周血 1.0 至 1,646 纳克/毫升,中心血 1.2 至 449 纳克/毫升,供体血 3.2 至 28 纳克/毫升(组织采集时获得),死前血 1.1 至 108 纳克/毫升,肝 8.5 至 1130 纳克/克,脑 2.0 至 471 纳克/克。还报告了另外八种芬太尼类似物的药物浓度。考虑到 FRS 的普遍性、高效力和不断演变,在复杂的法医案例工作中持续监控趋势和报告药物浓度以教育病理学家、执法部门和地方政府是非常重要的。
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引用次数: 0
High-throughput quantification of emerging "nitazene" benzimidazole opioid analogs by microextraction and UHPLC-MS-MS. 通过微萃取和超高效液相色谱-质谱-质谱联用技术高通量定量新出现的 "硝基苯 "苯并咪唑类阿片类似物。
IF 2.5 3区 医学 Q1 Medicine Pub Date : 2023-12-12 DOI: 10.1093/jat/bkad071
Maria Schüller, Ivana Lucic, Åse Marit Leere Øiestad, Stig Pedersen-Bjergaard, Elisabeth Leere Øiestad

Benzimidazole opioids, often referred to as nitazenes, represent a subgroup of new psychoactive substances with a recent increase in fatal overdoses in the USA and Europe. With a variety of analogs emerging on the illicit drug market, forensic laboratories are challenged to identify these potent drugs. We here present a simple quantitative approach for the determination of nine nitazene analogs, namely, clonitazene, etodesnitazene, etonitazene, etonitazepyne, flunitazene, isotonitazene, metodesnitazene, metonitazene and protonitazene in whole blood using liquid-phase microextraction and electromembrane extraction in a 96-well format and liquid chromatography-tandem mass spectrometry. Green and efficient sample preparation was accomplished by liquid-phase microextraction in a 96-well format and resulted in high extraction yields for all analytes (>81%). Here, blood diluted with buffer (1:1, %v) was extracted from a donor compartment across a thin organic liquid membrane and into an aqueous acceptor solution. The acceptor solution was collected and directly injected into the analysis platform. Chromatographic separation was accomplished with a biphenyl column, allowing for a baseline separation of the structural isomers isotonitazene and protonitazene before detection by multiple reaction monitoring. Validation was performed according to Scientific Working Group of Forensic Toxicology guidelines. The calibration range was from 0.5 to 50 nM (except for protonitazene and clonitazene from 0.1 nM) with good linearity and limits of detection down to 0.01 nM. An AGREEprep assessment was performed to evaluate sample preparation greenness, with a final score of 0.71. Nitazenes represent a current threat to public health, and analytical methods that cover a wide range of these analogs are limited. Here, the described method may assist in the detection of nitazenes in whole blood and prevent these substances from being missed in postmortem investigations.

苯并咪唑类阿片通常被称为硝氮烯类,是一类新型精神活性物质,最近在美国和欧洲因过量使用而致死的人数有所增加。由于非法药物市场上出现了各种类似物,法医实验室在识别这些强效药物方面面临挑战。我们在此介绍一种简单的定量方法,采用 96 孔液相微萃取、电膜萃取和液相色谱-串联质谱法测定全血中的九种硝氮类似物,即氯硝哒嗪、依托尼哒嗪、依托尼哒嗪、依托尼哒哌嗪、氟硝哒嗪、异托尼哒嗪、甲氧硝哒嗪、甲硝哒嗪和质子哒嗪。96 孔液相微萃取技术实现了绿色、高效的样品制备,所有分析物的萃取率都很高(大于 81%)。在这里,用缓冲液(1:1,%v)稀释的血液从供体室穿过薄薄的有机液体膜,被萃取到水性受体溶液中。收集受体溶液后直接注入分析平台。使用联苯色谱柱进行色谱分离,在通过多反应监测进行检测之前,可对结构异构体异烟肼和质子异烟肼进行基线分离。根据法医毒理学科学工作组指南进行了验证。校准范围为 0.5 至 50 nM(质子他嗪和氯硝他嗪的校准范围为 0.1 nM 除外),线性关系良好,检测限低至 0.01 nM。对样品制备的绿色性进行了 AGREEprep 评估,最终得分为 0.71。目前,硝氮类化合物对公众健康构成威胁,而涵盖这些类似物的多种分析方法却十分有限。在此,所述方法可帮助检测全血中的硝氮类物质,并防止在尸检中漏检这类物质。
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Journal of analytical toxicology
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