The proliferation of novel psychoactive substances (NPS) and the current opioid epidemic creates challenges for a toxicology laboratory. Methods capable of detecting and quantitating emerging compounds must be established despite limited information on toxicologically relevant concentrations. This paper will (i) describe how a publicly funded forensic laboratory reacted to the emergence of carfentanil as a public safety concern and (ii) contribute to the existing forensic literature by presenting a series of deaths involving carfentanil between July 2017 and June 2018. The Centre of Forensic Sciences is the primary provider of forensic toxicology testing in medicolegal death investigations in the province of Ontario. When carfentanil was first identified in the illicit drug supply, routine screening methods used by this laboratory were not sufficiently sensitive to detect the drug at concentrations expected in blood samples. Previously validated, multi-target liquid chromatography–tandem mass spectrometry (LC–MS-MS) quantitative methods already in use by the laboratory did show improved detectability for carfentanil. Thus, an existing LC–MS-MS method was adapted to include carfentanil, achieving improved sensitivity while also providing quantitation in suspected drug-related deaths. This approach had the added benefit that the LC–MS-MS method selected for modification was used in all death investigations requiring toxicology analysis in Ontario, thereby providing an opportunity for surveillance. Using this method, 4,953 cases were analyzed with carfentanil detected at a concentration greater than the limit of detection (0.05 ng/mL) in 160 decedents. Postmortem blood carfentanil concentrations ranged from less than 0.1 to 9.2 ng/mL. Of the 160 carfentanil-positive cases, 156 were classified as either mixed drug toxicity or carfentanil overdose. The approach described enabled this laboratory to efficiently implement a quantitative test for carfentanil in all death investigations, providing a useful template for modifying existing methods when a new psychoactive substance becomes available in the population.

中文翻译：

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法医毒理学实验室针对新兴 NPS 的战略决策：加拿大安大略省死亡调查中卡芬太尼的检测、定量和解释，2017 年 7 月至 2018 年 6 月

新型精神活性物质 (NPS) 的扩散和当前的阿片类药物流行给毒理学实验室带来了挑战。尽管毒理学相关浓度的信息有限，但必须建立能够检测和定量新兴化合物的方法。本文将 (i) 描述公共资助的法医实验室如何应对卡芬太尼作为公共安全问题的出现，以及 (ii) 通过介绍 2017 年 7 月至 2018 年 6 月期间涉及卡芬太尼的一系列死亡事件，为现有法医文献做出贡献。法医科学中心是安大略省法医死亡调查中法医毒理学测试的主要提供者。当卡芬太尼首次在非法药物供应中被发现时，该实验室使用的常规筛查方法不够灵敏，无法检测血液样本中预期浓度的药物。实验室已经使用的先前经过验证的多目标液相色谱-串联质谱 (LC-MS-MS) 定量方法确实显示出改善了卡芬太尼的可检测性。因此，现有的 LC-MS-MS 方法适用于包括卡芬太尼，从而提高了灵敏度，同时还提供了对疑似药物相关死亡的定量分析。这种方法的额外好处是，选择进行修改的 LC-MS-MS 方法被用于安大略省所有需要毒理学分析的死亡调查，从而提供了监测的机会。使用这种方法，对 4,953 例病例进行了分析，其中卡芬太尼的检测浓度高于检测限 (0. 05 ng/mL) 在 160 名死者中。死后血液中的卡芬太尼浓度范围从小于 0.1 到 9.2 ng/mL。在 160 例卡芬太尼阳性病例中，156 例被归类为混合药物毒性或卡芬太尼过量。所描述的方法使该实验室能够在所有死亡调查中有效地实施卡芬太尼的定量测试，为在人群中出现新的精神活性物质时修改现有方法提供有用的模板。