Qualitative identification of fentanyl and other synthetic opioids using ambient ionization high resolution time-of-flight mass spectrometry

The Centers for Disease Control and Prevention deemed the increase in overdose fatalities, due to the use of opioids, an “opioid epidemic” in the United States. Heroin, fentanyl, and other synthetic opioids are commonly abused and are contributing to the opioid epidemic. In 2016, the Drug Enforcement Administration temporarily placed three fentanyl analogs (beta-hydroxythiofentanyl, butyryl fentanyl, and furanyl fentanyl) under Schedule I due to their imminent threat to public health. These drugs elicit analgesic effects similar to heroin making them desirable drugs to abuse. Novel fentanyl analogs and designer opioids are expected to become more prominent in forensic casework in the near future as the opioid epidemic continues. These drugs can be seen in forensic seized drug and urine casework samples either alone or mixed with other drugs of abuse. It is therefore necessary to have an efficient methodology to identify these new compounds. Currently, gas chromatography-mass spectrometry (GC/MS) is used to identify drugs of abuse and is considered the “gold standard” in forensic casework. However, analysis times can often range from 15 to 60 minutes in length. Another drawback is the need for spectral library matching, which requires analytical reference materials for identification. Therefore, the identification of novel fentanyl analogs and designer drugs is limited until a reference material becomes available. In this study, direct sample analysis time-of-flight mass spectrometry (DSA-TOFMS) was evaluated to provide rapid identification of fentanyl and other synthetic opioids in seized drug and urine casework samples. DSA is a direct ambient ionization source, which requires no chromatography and minimal sample preparation. TOFMS is a high resolution mass spectrometer that uses collision-induced dissociation (CID) to produce precursor ion and characteristic fragmentation ions, which provide additional structural and molecular formula information, allowing for the identification of compounds without a reference material. The analytes explored in this study include: heroin, 6-monoacetylmorphine (6-MAM), morphine, fentanyl, norfentanyl, 4-anilino-N-phenethylpiperidine (4-ANPP), acetyl fentanyl, beta-hydroxythiofentanyl, butyryl fentanyl, furanyl fentanyl, valeryl fentanyl, AH-7921, U-47700, buprenorphine, norbuprenorphine, desomorphine, MT-45, W-15, and W-18. Direct sample analysis time-of flight mass spectrometry (DSA-TOFMS) is a novel instrumentation that could be utilized in the forensic sciences field to qualitatively identify illicit substances in casework samples. In this study, 19 compounds of interest containing heroin, fentanyl, fentanyl analogs, and other synthetic opioids were evaluated using DSA-TOFMS. DSA-TOFMS abbreviated the workload of the analysis and was utilized to provide precursor ion and characteristic fragmentation ions within an analysis time of 20 seconds. Certified reference standards were used to optimize instrumentation settings, to determine precursor ions and characteristic fragmentation ions, and to determine the limit of detection of the instrument. A carryover study determined there were no persisting ions present when entering the capillary inlet between runs. A repeatability study revealed the DSA-TOFMS repeated results within the acceptable criteria range of above 500 counts and within 10ppm error 93% (10ppm) and 83% (1ppm). Forensic seized drug casework samples were evaluated with DSA-TOFMS and qualitatively identified. Out of the 64 samples, 89% were qualitatively identified as heroin, 4% were qualitatively identified as fentanyl, 1% was qualitatively identified as heroin and fentanyl, 3% were qualitatively identified as acetyl fentanyl, and 3% were qualitatively identified as furanyl fentanyl. The casework samples containing furanyl fentanyl were considered “true unknown unknown samples,” as the Maine Health and Environmental Testing Laboratory gas chromatography-mass spectrometry library did not have a spectrum to use for the identification of these samples. Forensic urine casework samples were evaluated with DSA-TOFMS. Samples previously confirmed to contain compounds of interest were prepared using minimal sample preparation technique (filtered using 0.45 microns syringe filters and diluted (1:10) with LC/MS grade water). Analysis displayed the limitations of DSA-TOFMS as only twelve of the forty compounds of interest were present and only three of the twelve were within the acceptable criteria range. DSA-TOFMS is a fast and reliable technique with minimal sample preparation for forensic seized drug samples. However, the concentration in complex matrixes, such as urine and blood, were unable to be qualitatively identified using this sample preparation method by DSA-TOFMS

Home Manufacture of Drugs: An Online Investigation and a Toxicological Reality Check of Online Discussions on Drug Chemistry

Emerging trends in market dynamics and the use of new psychoactive substances are both a public health concern and a complex regulatory issue. One novel area of investigation is the availability of homemade opioids, amphetamines and dissociatives, and the potential fueling of interest in clandestine home manufacture of drugs via the Internet. We illustrate here how online communal folk pharmacology of homemade drugs on drug website forums may actually inform home manufacture practices or contribute to the reduction of harms associated with this practice. Discrepancies between online information around purification and making homemade drugs safer, and the synthesis of the same substances in a proper laboratory environment, exist. Moderation and shutdown of synthesis queries and discussions online are grounded in drug websites adhering to harm-reduction principles by facilitating discussions around purification of homemade drugs only. Drug discussion forums should consider reevaluating their policies on chemistry discussions in aiming to reach people who cannot or will not refrain from cooking their own drugs with credible information that may contribute to reductions in the harms associated with this practice. © 2017 Taylor & Francis Group, LL

Orally ingestion of krokodil in Spain: report of a case

El trastorno por uso de krokodil es una de las patologías adictivas con mayores repercusiones orgánicas, principalmente a nivel cutáneo, produciendo una grave y degenerativa necrosis del tejido sanguíneo y muscular. Se trata de un trastorno con escasa prevalencia en España, frente al elevado número de consumidores en otros países como Ucrania o Rusia, si bien se está produciendo una lenta aunque gradual expansión del consumo en países de la Unión Europea y del continente americano. El sencillo proceso de obtención de la sustancia desde la desomorfina, unido a la elevada disponibilidad y bajo coste, configura el proceso de autoabastecimiento de los consumidores. En este artículo revisamos un cuadro clínico, presentando el caso de un paciente que consume krokodil por vía oral.The krokodil use disorder is an addictive pathology with quite severe organic effects, especially at the skin level, that causes severe and degenerative necrosis of blood and muscle tissue. Though this disorder has a low prevalence in Spain, compared to the large number of consumers in other countries such as Ukraine or Russia, its consumption is slowly but gradually expanding in countries of the European Union and America. The simplicity of the process of obtaining the substance from desomorphine, together with its high availability and low cost, contribute toward consumers’ self-sufficiency. This article presents the case of a user of krokodil and reviews the clinical symptoms of oral ingestion.Publicación financiada por Fundación Hospital Provincial de Castellón, referencia CAF-16/017

A Scoping Review of Home Produced Heroin and Amphetamine Type Stimulant Substitutes: Implications for Prevention, Treatment and Policy

Several home-produced substances such as krokodil and boltushka are prevalent in many Eastern European countries. Anecdotal reports of its use have been circulating in Germany and Norway; however, this has not been confirmed. Its use has also been reported by the media in the USA, although only one confirmed report of its use exists. Home-produced drugs are associated with high levels of morbidity and a number of complex health issues such as the spread of blood borne viruses, gangrene, and internal organ damage. The high incidence of HIV rates amongst people who inject home-produced substances is a public health concern. The resulting physical health consequences of injecting these crude substances are very severe in comparison to heroin or amphetamine acquired in black markets. Due to this fact and the increased mortality associated with these substances, professionals in the area of prevention, treatment, and policy development need to be cognisant of the presentation, harms, and the dangers associated with home-produced substances globally. This scoping review aimed to examine existing literature on the subject of home-produced heroin and amphetamine-type stimulant substitutes. The review discussed the many implications such research may have in the areas of policy and practice. Data were gathered through the use of qualitative secondary resources such as journal articles, reports, reviews, case studies, and media reports. The home production of these substances relies on the utilisation of precursor drugs such as less potent stimulants, tranquillizers, analgesics, and sedatives or natural plant ingredients. The Internet underpins the facilitation of this practice as recipes, and diverted pharmaceutical sales are available widely online, and currently, ease of access to the Internet is evident worldwide. This review highlights the necessity of prevention, education, and also harm reduction related to home-produced drugs and also recommends consistent monitoring of online drug fora, online drug marketplaces, and unregulated pharmacies

World situation with regard to drug abuse. Report of the Secretariat.

Commission on Narcotic Drugs Fifty-fifth session Vienna, 12-16 March 2012 Item 6 (a) of the provisional agenda* Implementation of the Political Declaration and Plan of Action on International Cooperation towards an Integrated and Balanced Strategy to Counter the World Drug Problem: demand reduction and related measures. Summary: The present report summarizes the most current information available to the United Nations Office on Drugs and Crime on the illicit demand for drugs throughout the world and the promotion of rehabilitation- and reintegration-oriented strategies in response to drug use disorders and their consequences. It has been prepared pursuant to the international drug control conventions, as well as Commission on Narcotic Drugs resolutions 53/16 and 54/5. Compared with the estimates for 2008, there does not appear to have been a significant change in the prevalence and number of people using illicit drugs in 2009. Worldwide, it is estimated that between 3.4 and 6.2 per cent of people aged 15-64 years, or between 149 million and 272 million people, had used an illicit drug at least once in the preceding year. Global emerging trends are outlined in section I, which provides context with regard to drug use. Section II provides regional summaries. Section III provides an overview of efforts made by Member States to promote rehabilitationand reintegration-oriented strategies in response to drug use disorders and their consequences. Section IV includes conclusions and recommendations

From Drug War to Culture War: Russia’s Growing Role in the Global Drug Debate

No abstract available

World Drug Report 2014

The World Drug Report provides an annual overview of the major developments in drug markets for the various drug categories, ranging from production to trafficking, including development of new routes and modalities, as well as consumption. Chapter 1 of the World Drug Report 2014 provides a global overview of the latest developments with respect to opiates, cocaine, cannabis and amphetamines (including “ecstasy”) and the health impact of drug use. Chapter 2 zeroes in on the control of precursor chemicals used in the manufacture of illicit drugs