Flualprazolam is a designer benzodiazepine and novel psychoactive substance (NPS) that is increasing in prevalence and appearing in forensic investigations. Flualprazolam was quantitatively confirmed in 197 blood samples from medicolegal death investigations and human performance cases reported between August 2019 and February 2020. Drug screening was performed using liquid chromatography–time-of-flight mass spectrometry (LC–TOF-MS) and quantitative confirmation was performed using liquid chromatography–tandem mass spectrometry (LC–MS-MS). A three-point standard addition protocol was implemented for quantitation in the absence of an available traditionally validated assay. In postmortem cases with quantitative results (n = 167), the mean (±SD) flualprazolam concentration was 20 (±63) ng/mL, the median concentration was 8.2 ng/mL, and the range of concentrations was 2.0 to 620 ng/mL. Four additional postmortem cases were reported positive (<2.0 ng/mL). In drug impaired driving cases (n = 22), the mean (±SD) flualprazolam concentration was 22 (±18) ng/mL, the median concentration was 14 ng/mL, and the range of concentrations was 4.4 to 68 ng/mL. The four remaining cases were of unknown circumstances. This report details the most extensive data set of flualprazolam intoxication cases reported to date. There was significant overlap in concentrations of flualprazolam between postmortem and DUID cases. Flualprazolam was commonly (83% of the time) found in combination with opioids (e.g. fentanyl). Toxicologists should consider quantitative flualprazolam results in the context of case history, observations, and/or other toxicological findings. Addition of flualprazolam to the scope of drug testing should be considered by all laboratories.

中文翻译：

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197份法医调查病例中的氟普唑仑血药浓度。

Flualprazolam是一种设计者苯二氮卓和新型精神活性物质（NPS），其患病率正在上升，并出现在法医调查中。在2019年8月至2020年2月之间从法医死亡调查和人类绩效报告的197个血液样本中定量确认了氟拉普兰。药物筛选使用液相色谱-飞行时间质谱（LC-TOF-MS）进行，定量确认为使用液相色谱-串联质谱（LC-MS-MS）进行。在没有可用的传统验证方法的情况下，实施了三点标准添加方案进行定量。在具有定量结果的死后病例中（n = 167），氟普拉唑仑的平均浓度（±SD）为20（±63）ng / mL，中位浓度为8.2 ng / mL，浓度范围为2.0至620 ng / mL。据报道还有四例死后阳性（<2.0 ng / mL）。在药物不良驾驶病例（n = 22）中，氟普拉唑仑的平均浓度（±SD）为22（±18）ng / mL，中位浓度为14 ng / mL，浓度范围为4.4至68 ng / mL 。其余四个案件情况不明。该报告详细介绍了迄今为止报道的氟普拉唑仑中毒病例的最广泛数据集。死后和DUID病例之间的氟吡唑仑浓度明显重叠。氟哌唑仑通常（83％的时间）与阿片类药物（例如芬太尼）联合使用。毒理学家应根据病史，观察结果和/或其他毒理学发现考虑定量的氟吡唑仑结果。