Sumandeep Rana, Ph.D.

The historical practice of brewing poppy tea for its opioid-like effects is reoccurring with modern-day substance users. We present four postmortem cases with toxicology results that serve as case studies for the potential hazards of poppy tea ingestion. There is limited information regarding the risks of this practice due to the variability of the morphine content of the opium exuded from the plant

An analytical method for the detection of 40 benzodiazepines, (±)-zopiclone, zaleplon and zolpidem in blood and urine by solid-phase extraction liquid chromatography–tandem mass spectrometry was developed and validated. Twenty-nine of 43 analytes were quantified in 0.5 mL whole blood for investigating postmortem, drug-facilitated sexual assault (DFSA) and driving under the influence of drugs cases

The endogenous presence of gamma-hydroxybutyric acid (GHB) complicates the interpretation of results in cases where an exogenous dosing is suspected. Due to GHB’s rapid metabolism and clearance following exogenous doses, hair has become a preferential matrix for confirmation of GHB exposure in drug-facilitated crimes. However, unlike blood and urine where an agreed-upon cut-off concentration for differentiation

Epilepsy is a common neurologic disease that requires treatment with one or more medications. Due to the polypharmaceutical treatments, potential side effects, and drug-drug interactions associated with these medications, therapeutic drug monitoring is important. Therapeutic drug monitoring is typically performed in blood due to established clinical ranges. While blood provides the benefit of determining

A 30-year-old woman presented to the emergency department 2 days after ingestion of 50 castor beans. Her symptoms on admission were vomiting, diarrhea, abdominal cramps, agitation and anxiety. Initial laboratory tests showed a slightly elevated C-reactive protein (CRP) and mild liver and kidney dysfunction The patient was transferred to the medium care unit of our hospital where she was observed for

Urine drug screening (UDS) assays can rapidly and sensitively detect drugs of abuse, but can also produce spurious results due to interfering substances. We previously developed an approach to identify interfering medications using electronic health record (EHR) data, but the approach was limited to UDS assays for which presumptive positives were confirmed using more specific methods. Here we adapted

The development of new sample preparation alternatives in analytical toxicology leading to quick, effective, automated and environmentally friendly procedures is growing in importance. One of these alternatives is the QuEChERS, originally developed for the analysis of pesticide residues, producing cleaner extracts than liquid-liquid extraction, and easier separation of aqueous and organic phases. However

The aim of the present study was to quantify a large number of analytes including opioids, stimulants, benzodiazepines, z-drugs, antidepressants and neuroleptics within a single sample workup followed by a single analytical measurement. Expected drug concentrations in hair are strongly substance-dependent. Therefore, three different calibration ranges were implemented: 0.5–600 pg/mg (group 1), 10–12

Mephedrone is a popular synthetic cathinone, known for its psychostimulant effects. At present, there is no data available on the pharmacokinetics of mephedrone and its metabolites in concurrently collected whole blood and plasma samples after a controlled intranasal administration to healthy volunteers. In this study, six healthy male volunteers nasally insufflated 100 mg of pure mephedrone hydrochloride

Baclofen (BLF) has been prescribed in the UK since 1972 for the alleviation of spasticity. However, evidence suggests BLF is also recreationally misused. It has been associated with ethanol, gamma-hydroxybutyric acid (GHB), pregabalin (PGL) and gabapentin (GBP) use/abuse and deaths have been reported. With current postmortem (PM) toxicological screening approaches, BLF is not routinely included in

This paper presents a rapid, sensitive and precise method developed and validated for the quantification of sufentanil in biological samples using ultra-performance liquid chromatography coupled with QqQ-MS-MS. Plasma samples were extracted with simple and fast liquid-liquid extraction (ethyl acetate, pH 9). Calibration curve showed linearity in the concentration range of 0.005–30 µg/L. The lower limit

Regarding ‘Evaluation of Oral Fluid as a Specimen for DUID’ by Veitenheimer and Wagner (2017; Journal of Analytical Toxicology, 41, 517–522), five (5) false positives are listed for THC in Table IV, but there should actually be zero (0). Therefore, the Results section (fourth paragraph) should read ‘The ELISA showed two FPs for amphetamine, while the DDS®2 showed one FP for cocaine and no FPs for THC’

The application of Quantitative Structure-Property Relationship (QSPR) to the prediction of reversed-phase liquid chromatography retention behavior of Synthetic Cannabinoids (SC), and its use in aiding the untargeted identification of unknown SC are described in this paper. 1D, 2D molecular descriptors and fingerprints of 105 SC were calculated with PaDEL-Descriptor, selected with Boruta algorithm

Despite LC-HR-MS2 enables untargeted acquisition, data processing in toxicological screenings is almost invariably performed in targeted mode. We developed a computational approach based on open source chemometrics software that, starting from a suspected Synthetic Cannabinoid determined formula, searches for isomers in different NPS web databases (NPSWD), predicts retention time (RT) and high-resolution

AB-FUBINACA M3 was reported to be a major metabolite of the drug, but its in vivo concentration in authentic human solid tissues has not been quantified yet. Another metabolite AB-FUBINACA M4 did not receive much attention previously and also has not been quantified yet in any authentic human specimens. The aims of this study are to establish a sensitive method for quantification of M3 and M4 in solid

Regarding ‘Evaluation of Oral Fluid as a Specimen for DUID’ by Veitenheimer and Wagner (2017; Journal of Analytical Toxicology, 41, 517–522), five (5) false positives are listed for THC in Table IV, but there should actually be zero (0). Therefore, the Results section (fourth paragraph) should read ‘The ELISA showed two FPs for amphetamine, while the DDS®2 showed one FP for cocaine and no FPs for THC’

Drugs of abuse and medication reconciliation testing can benefit from analysis methods capable of detecting a broader range of drug classes and analytes. Mass spectrometry analysis of a wide variety of commonly prescribed medications and over-the-counter drugs per sample also allows for application of a drug-drug-interaction (DDI) algorithm to detect adverse drug reactions (ADRs). In order to prevent

Deoxynivalenol (DON) is the most widely distributed trichothecene mycotoxin in grain-based foods and animal feed. Exposure to DON is widespread as it has been detected in food sources from around the world. The objective of this work was to develop a method to quantitate DON in biological matrices and apply it in a preliminary assessment of gestational and lactational transfer of DON following exposure

New psychoactive substances (NPS), especially synthetic cannabinoids (SC) remain a public health concern. Due to ethical reasons, systematic controlled human studies to elucidate their toxicodynamics and/or toxicokinetics are usually not possible. However, such knowledge is necessary, for example, for determination of screening targets and interpretation of clinical and forensic toxicological data

Haloperidol, butyrophenone derivative, is a typical antipsychotic drug used in the treatment of schizophrenia, manic phase of bipolar disorder, and acute psychomotor agitations. According to the recent guidelines for therapeutic drug monitoring, it is strongly recommended to measure plasma level during the therapy with haloperidol. The objective of this study was to develop and validate a simple liquid

Regarding ‘Evaluation of Oral Fluid as a Specimen for DUID’ by Veitenheimer and Wagner (2017; Journal of Analytical Toxicology, 41, 517–522), five (5) false positives are listed for THC in Table IV, but there should actually be zero (0). Therefore, the Results section (fourth paragraph) should read ‘The ELISA showed two FPs for amphetamine, while the DDS®2 showed one FP for cocaine and no FPs for THC’

Gabapentin was thought to have low abuse potential, but it is increasingly being abused by people with substance use disorder in an attempt to potentiate the euphoric effects from opioids and other CNS depressants. Additionally, infants co-exposed to gabapentin and opioids during pregnancy tend to exhibit prolonged and more severe neonatal abstinence syndrome. In this study, we describe positivity

Since the widespread diffusion of new psychoactive substances, forensic laboratories are often required to identify new drugs and their metabolites for which information or reference standards are lacking. We performed a study on N‐methyl‐2‐aminoindane (NM2AI) metabolism in silico and in vivo, in order to identify the main metabolites to be screened in the different biological samples. We performed

Over the years, several studies have shown that many factors are likely to affect the results of forensic hair analyses and complicate their interpretation. Among these factors, one of the major drawbacks in hair analysis is the affectability of deposited xenobiotics by cosmetic treatments which could be eventually used to adulterate the sample. It is well known that some cosmetic treatments containing

During a party in another country, several adults sniffed a powder presented as being LSD. The next morning, two subjects, including a French citizen, were found dead. After a body examination that concluded death was due to respiratory and cardiac collapses, the French citizen’s corpse was returned to France and buried. Four years later, the body was exhumed, and an autopsy that did not reveal traumatic

Electronic dance music (EDM) festivals have become a popular venue for recreational drug use, including the use of traditional stimulants like 3,4-methylenendioxymethamphetamine (MDMA) and novel psychoactive substances (NPS). Using this cohort of people who use drugs recreationally, this study sought to collect biological specimens and self-reported drug use data from EDM festival attendees in the

The aim of this review was to report the most recent cases of acute intoxication, fatalities and “driving under the influence” cases, involving illicit fentanyl and its newest analogues. When available, information on age, sex, circumstances of exposure, intoxication symptoms, cause of death (if applicable) and toxicology results from biological fluid testing was described. Scientific publications

Postmortem redistribution (PMR) leads to challenges in postmortem case interpretation. Particularly antidepressants and neuroleptics are expected to undergo PMR based on their physico-chemical properties. For the current study, time- and site-dependent PMR of 20 antidepressants and neuroleptics were investigated in humans (authentic cases); five of which are discussed in detail (citalopram, mirtazapine

Prior to toxicological analysis, hair as a matrix requires pre-treatment measures including decontamination, homogenization, and extraction. Decontamination is performed to differentiate between drug present from superficial deposition and drug incorporated from systemic distribution following ingestion. There are many methods for decontamination of hair samples, mostly developed by empirically using

Fentanyl and its analogues are highly abused drugs that dominate the illicit drug trade. alpha-Methylfentanyl (A-F) and beta-hydroxyfentanyl (B-F) are two fentanyl analogues that require the development of rapid detection technologies. The current study established and validated a rapid and high-sensitivity liquid chromatography–tandem mass spectrometry (LC–MS-MS) method to measure A-F and B-F concentrations

Synthetic stimulants are the largest class of novel psychoactive substances (NPS) identified each year by forensic laboratories internationally. While hundreds of these drugs appear in drug powders, only a few proliferate in use among forensically relevant populations, eventually emerging in postmortem and clinical investigations. Beta-keto-methylenedioxyamphetamines (i.e., NPS with names ending in

Benzodiazepines are a commonly prescribed class of drugs that have the potential for abuse. The Palm Beach County Sheriff’s Office received drug seizure submissions that included novel and/or non-routine benzodiazepines of increasing prevalence from 2017 to 2019. This prompted the development of a method of analysis for these compounds in biological specimens. The method tests for 16 novel and non-routine

Postmortem ethanol formation is a well-known problem in forensic toxicology. Ethyl glucuronide (EtG) and ethyl sulfate (EtS) are ethanol metabolites that can be used to distinguish antemortem alcohol intake from postmortem formation of ethanol and in addition can be a helpful tool in assessment of the hip-flask defense. To an aliquot of 100 µL whole blood, internal standard (IS) and water was added

Postmortem drug redistribution (PMR) is a well-known phenomenon in forensic toxicology with implications for medico-legal death investigations. Paired antemortem (AM) specimen and postmortem (PM) mortuary admission femoral blood drug concentrations from 811 coronial cases were used to construct a retrospective compilation of PM/AM drug concentration ratios for 42 parent drugs and metabolites. The median

The advent of hundreds of new compounds aimed at the substance misuse market has posed new analytical challenges. A semi-quantitative liquid chromatography–high resolution mass spectrometry (LC–HRMS) method has been developed to detect exposure to two novel stimulants, mephedrone and ethylphenidate, and selected metabolites. Centrifuged urine (50 µL) was diluted with LC eluent containing internal standards

To date, more than 800 molecules are classified as New Psychoactive Substances (NPS), and it is reported that this number increases every year. Whereas several cases of polydrug consumption which led to acute intoxication and death are reported, a lack of effective analytical screening method to detect NPS and classical drug of abuse in human matrices affects the prompt identification of the probable

Identifying the source of ethanol in a decedent remained a complicated problem for forensic toxicologists because of postmortem ethanol formation. As ethanol’s non-oxidative metabolites, ethyl glucuronide (EtG) and ethyl sulfate (EtS) have the potential to distinguish between antemortem ethanol consumption and postmortem ethanol formation, due to their high sensitivity and selectivity. In the current

The incidence of fentanyl in forensic toxicology analyses in the U.S. has dramatically increased over the past several years. The increase in death cases has been well studied, however little has been reported on the impact to drug impaired driving. Fentanyl driving under the influence of drugs (DUID) case data from 2014 to 2019 is presented. The data was obtained from three toxicology laboratories

Mebroqualone is an analogue of methaqualone, and there is a very little published information regarding the toxicity of this designer drug. We describe two cases with non-lethal levels of mebroqualone in blood collected at autopsy. Case 1 was an accidental death that involved a house fire, and the decedent was found to have a blood mebroqualone concentration of 10,228 ng/mL. Case 2 was a completed

A liquid chromatography–tandem mass spectrometry (LC–MS-MS) method was developed for 25 antipsychotic drugs and their metabolite in urine for monitoring medication compliance of mentally disordered criminals on probation. Target compounds were extracted with a solid-phase extraction technique using a newly developed hydrophilic-lipophilic balanced sorbent to remove interferences and minimize the matrix

γ-Hydroxybutyric acid (GHB) and its corresponding lactone γ-butyrolactone (GBL) are misused as knock out (k.o.) drugs. The short detection window and the major inter- and intra-individual variations of endogenous GHB concentrations in commonly used matrices such as blood and urine complicate the analytical proof of an exogenous GHB/GBL administration. We searched for an alternative way to prove an

Antipsychotic drugs (AP) are widely prescribed for the treatment of schizophrenia and psychosis. The pharmacological treatment of schizophrenia is often performed with the simultaneous use of two or more antipsychotic agents to achieve the desired control of psychotic symptoms. Available AP include both conventional (typical) and new (atypical) antipsychotic medications. Atypical AP, such as quetiapine

The emergence of novel designer benzodiazepines continues to be a public health concern. Flualprazolam is one of these drugs. It was initially identified in 2017. Users forums suggest it is slightly more potent than alprazolam and has longer-lasting central nervous system depressant effects. Here we report a simple, sensitive liquid chromatography–tandem mass spectrometry method for flualprazolam and

The trend for the concomitant prescription of antidepressants and antipsychotics is increasing. This calls for a veracious screening and quantifying method for forensic and clinical use. In this study, a liquid chromatography–tandem mass spectrometry (LC–MS–MS) method was developed and validated for the simultaneous determination and quantification of 38 antidepressants, antipsychotics, and relevant

Due to its specificity, PEth 16:0/18:1 has gained increased popularity as a marker for high alcohol consumption in the last years. As conflicting results regarding the stability of PEth 16:0/18:1 in whole blood have been published, there are still uncertainties related to optimum handling, transport and storage of blood samples for the analysis of PEth 16:0/18:1.

New psychoactive substances (NPS) continue to appear on the drug market. Until recently, new synthetic opioids, which are amongst the most dangerous NPS, primarily encompassed analogues of the potent analgesic fentanyl. Lately, also other new synthetic opioids have increasingly started to surface. This is the first report on the identification and full chemical characterization of brorphine, a novel

A positive non-linear relation between dose of ethanol ingested and the area under the curve (AUC) for ethyl glucuronide (EtG) in urine is previously observed. The relation between both doses and AUC of ethanol and the AUC for EtG in blood is not previously published and this study aimed to investigate this relationship. After an overnight fast, 10 healthy volunteers ingested 0.5 gram ethanol per kilo

AbstractA comparative analysis of enzyme-linked immunosorbent assay (ELISA) and quadrupole time-of-flight mass spectrometry (LC-QTOF) for the detection of opioids in blood samples is presented. The Orange County Crime Lab (OCCL) was concerned that the opioid drug class was not accurately detected at low concentrations due to the use of LC-QTOF as a non-targeted screening method for multiple classes

AbstractA comparative analysis of enzyme-linked immunosorbent assay (ELISA) and quadrupole time-of-flight mass spectrometry (LC-QTOF) for the detection of opioids in blood samples is presented. The Orange County Crime Lab (OCCL) was concerned that the opioid drug class was not accurately detected at low concentrations due to the use of LC-QTOF as a non-targeted screening method for multiple classes

A procedure has been developed for the determination of third generation synthetic cannabinoids in oral fluid samples by using a semi-automated microextraction by packed sorbent (MEPS) procedure and gas chromatography–mass spectrometry (GC–MS) determination. Five synthetic cannabinoids were employed as model compounds 5F-ADB, MMB-CHMICA, THJ-2201, CUMYL-4CN-BINACA, and MDMB-CHMCZCA. The most adequate

New psychoactive substances (NPS) are a major public health problem, primarily due to the increased number of acute poisoning cases. Detection of these substances is a challenge. The aim of this research was to develop and validate a sensitive screening method for 104 drugs of abuse, including synthetic cannabinoids, synthetic cathinones, fentanyl analogues, phenethylamines and other abused psychoactive

In the world of forensic and clinical toxicology, proper sample preparation is one of the key steps in identification and quantification of drugs of abuse. Traditional extraction methods such as solid-phase extraction and liquid-liquid extraction are often laborious and not-selective for the target analytes being measured. Molecularly imprinted polymers (MIP) can be synthesized for sample extraction

Gamma-hydroxybutyrate (GHB) is misused as an intoxicant, either alone or concurrently with other substances. Because GHB is illegal, the precursor chemicals 1,4-butanediol and gamma-butyrolactone are also misused for the same effect, either through pre-ingestion alteration or endogenous metabolism to GHB. We describe a case of a 50-year-old-man with a history of polysubstance misuse who experienced

In case of basic biological materials (blood, urine, vitreous humor) being unavailable, bone marrow can be used for toxicological tests. The aim of the study was to assess the concentration of various xenobiotics in the bone marrow, as well as in the blood and the vitreous humor. The analysis was performed in the biological material originating from the autopsy (n = 120), using the LC–MS method and

The popularity of electronic cigarettes (electronic nicotine delivery systems or ENDS) has grown rapidly over the past decade. With the continued evolution of ENDS, and the arrival of newer replaceable pod devices on the market, it is prudent to examine their emissions to help determine potential health risks to the user. Metal containing particles were examined in aerosol from several pod-based devices

Fluvoxamine is a selective serotonin reuptake inhibitor, with a half-life of about 30 hours, that is commonly prescribed in the treatment of depression and obsessive and compulsive disorders. Though its more favorable adverse effect profile in comparison to tricyclic antidepressants, overdosages could lead to severe central nervous system depression.

While earlier studies have attempted to resolve the challenges encountered when interpreting gamma-hydroxybutyric acid (GHB) concentrations in hair (primarily due to its endogenous presence), few have had large sample sizes. The first objective of this study was to evaluate the inter-individual variation of endogenous GHB concentrations. The second objective, to be detailed in another report, was to

A method for analyzing Δ9-tetrahydrocannabinol (THC), 11-hydroxy-Δ9-THC (THC-OH) and 11-nor-Δ9-THC-9-carboxylic acid (THC-COOH) in postmortem solid specimens using liquid chromatography–tandem mass spectrometry was developed and validated. A Stomacher instrument was used to prepare these tissues before extraction. Prior to solid phase extraction, liver, kidney, stomach, lung, brain, muscle, bladder

In clinical toxicology, laboratories need screening methods allowing unambiguous identification of the compounds in a short turnaround time to either confirm or exclude the hypothesis of drug overdose, or poisoning with a toxicant.