TY - JOUR
KW - Adolescent
KW - Analgesics, Opioid/analysis/urine
KW - Chromatography, Liquid
KW - Drug Contamination
KW - Drug Overdose/diagnosis/drug therapy/metabolism/urine
KW - drug test
KW - Emergency Service, Hospital
KW - Female
KW - Fentanyl
KW - Fentanyl/analysis/urine
KW - Heroin
KW - Heroin Dependence/diagnosis/drug therapy/metabolism/urine
KW - Humans
KW - Male
KW - Mass Spectrometry
KW - Naloxone/administration & dosage
KW - Narcotic Antagonists/administration & dosage
KW - Oral fluid
KW - Predictive Value of Tests
KW - Prospective Studies
KW - QTOF
KW - Reproducibility of Results
KW - Saliva/chemistry
KW - Substance Abuse Detection/methods
KW - Urinalysis
KW - Young Adult
AU - M. K. Griswold
AU - P. R. Chai
AU - A. J. Krotulski
AU - M. Friscia
AU - B. P. Chapman
AU - N. Varma
AU - E. W. Boyer
AU - B. K. Logan
AU - K. M. Babu
A1 - 
AB - INTRODUCTION: The adulteration of heroin with non-pharmaceutical fentanyl and other high-potency opioids is one of the factors contributing to striking increases in overdose deaths. To fully understand the magnitude of this problem, accurate detection methods for fentanyl and other novel opioid adulterant exposures are urgently required. The objective of this work was to compare the detection of fentanyl in oral fluid and urine specimens using liquid chromatography quadrupole time-of-flight mass spectrometry (LC-QTOF-MS) in a population of heroin users presenting to the Emergency Department after overdose. METHODS: This was a prospective observational study of adult Emergency Department patients who presented after a reported heroin overdose requiring naloxone administration. Participants provided paired oral fluid and urine specimens, which were prepared, extracted, and analyzed using a dual LC-QTOF-MS workflow for the identification of traditional and emerging drugs of abuse. Analytical instrumentation included SCIEX TripleTOF(R) 5600+ and Waters Xevo(R) G2-S QTOF systems. RESULTS: Thirty participants (N = 30) were enrolled during the study period. Twenty-nine participants had fentanyl detected in their urine, while 27 had fentanyl identified in their oral fluid (overall agreement 93.3%, positive percent agreement 93.1%). Cohen's Kappa (k) was calculated and demonstrated moderately, significant agreement (k = 0.47; p value 0.002) in fentanyl detection between oral fluid and urine using this LC-QTOF-MS methodology. Additional novel opioids and metabolites, including norfentanyl, acetylfentanyl, and U-47700, were detected during this study. CONCLUSION: In this study of individuals presenting to the ED after reported heroin overdose, a strikingly high proportion had a detectable fentanyl exposure. Using LC-QTOF-MS, the agreement between paired oral fluid and urine testing for fentanyl detection indicates a role for oral fluid testing in surveillance for nonpharmaceutical fentanyl. Additionally, the use of LC-QTOF-MS allowed for the detection of other clandestine opioids (acetylfentanyl and U-47700) in oral fluid.
BT - Journal of medical toxicology : official journal of the American College of Medical Toxicology
C5 - Opioids & Substance Use
CP - 4
CY - United States
DO - 10.1007/s13181-017-0632-6
IS - 4
JF - Journal of medical toxicology : official journal of the American College of Medical Toxicology
N2 - INTRODUCTION: The adulteration of heroin with non-pharmaceutical fentanyl and other high-potency opioids is one of the factors contributing to striking increases in overdose deaths. To fully understand the magnitude of this problem, accurate detection methods for fentanyl and other novel opioid adulterant exposures are urgently required. The objective of this work was to compare the detection of fentanyl in oral fluid and urine specimens using liquid chromatography quadrupole time-of-flight mass spectrometry (LC-QTOF-MS) in a population of heroin users presenting to the Emergency Department after overdose. METHODS: This was a prospective observational study of adult Emergency Department patients who presented after a reported heroin overdose requiring naloxone administration. Participants provided paired oral fluid and urine specimens, which were prepared, extracted, and analyzed using a dual LC-QTOF-MS workflow for the identification of traditional and emerging drugs of abuse. Analytical instrumentation included SCIEX TripleTOF(R) 5600+ and Waters Xevo(R) G2-S QTOF systems. RESULTS: Thirty participants (N = 30) were enrolled during the study period. Twenty-nine participants had fentanyl detected in their urine, while 27 had fentanyl identified in their oral fluid (overall agreement 93.3%, positive percent agreement 93.1%). Cohen's Kappa (k) was calculated and demonstrated moderately, significant agreement (k = 0.47; p value 0.002) in fentanyl detection between oral fluid and urine using this LC-QTOF-MS methodology. Additional novel opioids and metabolites, including norfentanyl, acetylfentanyl, and U-47700, were detected during this study. CONCLUSION: In this study of individuals presenting to the ED after reported heroin overdose, a strikingly high proportion had a detectable fentanyl exposure. Using LC-QTOF-MS, the agreement between paired oral fluid and urine testing for fentanyl detection indicates a role for oral fluid testing in surveillance for nonpharmaceutical fentanyl. Additionally, the use of LC-QTOF-MS allowed for the detection of other clandestine opioids (acetylfentanyl and U-47700) in oral fluid.
PP - United States
PY - 2017
SN - 1937-6995; 1556-9039
SP - 287
EP - 292
EP - 
T1 - A Novel Oral Fluid Assay (LC-QTOF-MS) for the Detection of Fentanyl and Clandestine Opioids in Oral Fluid After Reported Heroin Overdose
T2 - Journal of medical toxicology : official journal of the American College of Medical Toxicology
TI - A Novel Oral Fluid Assay (LC-QTOF-MS) for the Detection of Fentanyl and Clandestine Opioids in Oral Fluid After Reported Heroin Overdose
U1 - Opioids & Substance Use
U2 - 28971325
U3 - 10.1007/s13181-017-0632-6
VL - 13
VO - 1937-6995; 1556-9039
Y1 - 2017
ER -