Urine Drug Testing of Chronic Pain Patients. V. Prevalence of Propoxyphene Following its Withdrawal from the United States MarketPuet, Brandi; DePriest, Anne; Knight, Julie; Heltsley, Rebecca; Black, David L.; Caplan, Yale H.; Cone, Edward J.
doi: 10.1093/jat/bks083pmid: 23129731
Propoxyphene is an opioid analgesic that was surrounded by controversy concerning its safety and efficacy during its lifespan in the US market. Propoxyphene was withdrawn in November of 2010 from the US market and is still being detected one year post-withdrawal in urine specimens from the pain management population. In this study, the prevalence of propoxyphene was determined in a total of 417,914 urine specimens collected from 630 clinics involved in pain management located in 24 states during the period of January 1, 2010, through December 31, 2011. Propoxyphene and norpropoxyphene were measured in urine by a validated liquid chromatography–tandem mass spectrometry procedure with a lower limit of quantitation of 50 ng/mL. The positivity rate for propoxyphene prevalence declined sharply between November and December of 2010 and further declined at a gradual rate, ending in a prevalence of 0.27% (one out of every 370 specimens, n = 25,658) for the month of December 2011. The presented data provide evidence of the dramatic decline in the use of propoxyphene products since their removal from the medical market, and may be beneficial to US urine drug testing programs determining the need for continual monitoring of propoxyphene levels.
Validation of LC–TOF-MS Screening for Drugs, Metabolites, and Collateral Compounds in Forensic Toxicology SpecimensGuale, Fessessework; Shahreza, Shahriar; Walterscheid, Jeffrey P.; Chen, Hsin-Hung; Arndt, Crystal; Kelly, Anna T.; Mozayani, Ashraf
doi: 10.1093/jat/bks084pmid: 23118149
Liquid chromatography time-of-flight mass spectrometry (LC–TOF-MS) analysis provides an expansive technique for identifying many known and unknown analytes. This study developed a screening method that utilizes automated solid-phase extraction to purify a wide array of analytes involving stimulants, benzodiazepines, opiates, muscle relaxants, hypnotics, antihistamines, antidepressants and newer synthetic “Spice/K2” cannabinoids and cathinone “bath salt” designer drugs. The extract was applied to LC–TOF-MS analysis, implementing a 13 min chromatography gradient with mobile phases of ammonium formate and methanol using positive mode electrospray. Several common drugs and metabolites can share the same mass and chemical formula among unrelated compounds, but they are structurally different. In this method, the LC–TOF-MS was able to resolve many isobaric compounds by accurate mass correlation within 15 ppm mass units and a narrow retention time interval of less than 10 s of separation. Drug recovery yields varied among spiked compounds, but resulted in overall robust area counts to deliver an average match score of 86 when compared to the retention time and mass of authentic standards. In summary, this method represents a rapid, enhanced screen for blood and urine specimens in postmortem, driving under the influence, and drug facilitated sexual assault forensic toxicology casework.
Phenazepam and its Effects on DrivingStephenson, Jon B.; Golz, David E.; Brasher, Mary Jo
doi: 10.1093/jat/bks080pmid: 23074215
Phenazepam use in the state of Georgia has increasingly become a trend for a drug market looking at new and different recreational drugs. This paper examines the psychomotor effects of phenazepam on individuals and their ability to operate a motor vehicle. This study reviewed phenazepam cases of impaired drivers that were submitted to the Georgia Bureau of Investigation's Division of Forensic Sciences between March, 2010, and August, 2011. A total of 11 cases were reviewed, of which five had only phenazepam detected and six had multiple drugs detected in addition to phenazepam. Concentrations ranged from 0.04 to 3.2 mg/L, with a median of 0.17 mg/L and a mean of 0.50 mg/L (0.23 mg/L, excluding the 3.2 mg/L blood concentration). The observed effects where symptomatic of central nervous system depression with slurred speech, lack of balance, slow reactions, drowsiness and confusion. This review indicates that the use of phenazepam at concentrations similar to other low-dose benzodiazepines such as clonazepam can have a significant impact on an individual's ability to drive.
Evaluation of the NexScreen and DrugCheck Waive RT Urine Drug Detection CupsLin, Chia-Ni; Nelson, Gordon J.; McMillin, Gwendolyn A.
doi: 10.1093/jat/bks087pmid: 23144203
Urine drug testing is an important tool that is commonly used to assess patient compliance with prescription regimens. Point-of-collection immunoassay devices allow for timely availability of laboratory test results to guide therapy during the same office visit. Two waived immunoassay-based urine drug screen cups were evaluated in this study. The NexScreen cup and the DrugCheck Waive RT cup claim to detect 10–12 drug classes of commonly used and/or abused drugs. This study included a sensitivity and precision challenge with 4–6 replicates at concentrations 0–150% of the manufacture's claimed cutoff, using drug-free urine spiked with purified reference standards. The stability of test results was evaluated by reading the results at intervals between five and 1,440 min. Specificity was evaluated by parallel comparison of pooled patients' specimens, representing 56 patients and 41 known drug compounds. When comparing results to validated liquid chromatography–mass spectrometry results, false positives were observed in the NexScreen cups for benzodiazepine, methamphetamine, methadone, opiates and tricyclic antidepressant tests, but there were no false negatives. The DrugCheck Waive RT cups showed false negative results for barbiturates and opiates, but no false positives. Overall, the NexScreen cup demonstrated better sensitivity than claimed, whereas the sensitivity of the DrugCheck Waive RT cup did not meet claims.
Fatal Mephedrone Intoxication—A Case ReportAdamowicz, Piotr; Tokarczyk, Bogdan; Stanaszek, Roman; Slopianka, Markus
doi: 10.1093/jat/bks085pmid: 23134715
A death caused by a new designer drug, 4-methylmethcathinone (mephedrone), is reported. Eight small plastic bags containing white powder were found in the jacket of a young dead male. Spot tests conducted by the police officer indicated the presence of 4-bromo-2,5-dimethoxyphenethylamine (2C-B) in the powders. Laboratory routine screening analyses of blood and vitreous humor did not reveal any positive results; therefore, 2C-B was excluded.Analysis of powders was conducted using gas chromatography–mass spectrometry and high-pressure liquid chromatography with diode array detection. The purity of mephedrone found in all powder samples was in the range of 80.4–87.3%. In connection with these findings, blood and vitreous humor samples were analyzed for mephedrone. Analyses were conducted using liquid chromatography–tandem mass spectrometry. Mephedrone was found in blood and vitreous humor at the concentrations of 5.5 and 7.1 µg/mL, respectively, revealing that this was a fatal mephedrone intoxication.
An Accidental Fatal Intoxication with MethoxetamineWikström, Maria; Thelander, Gunilla; Dahlgren, Maria; Kronstrand, Robert
doi: 10.1093/jat/bks086pmid: 23111916
This paper reports an unintentional death involving the administration of methoxetamine [2-(3-methoxyphenyl)-2-(ethylamino)-cyclohexanone] and offers some reference values from living drug abusers. Methoxetamine is a new recreational drug with a similar structure to ketamine. The deceased was a 26-year-old male with a history of drug abuse; he was found lying on the floor in his apartment. Several “red-line” plastic bags were found, one of which was labeled “2-(3-methoxyphenyl)-2-(ethylamino)-cyclohexanone” and another labeled “Haze.” In four cases from living subjects with unknown doses, concentrations of methoxetamine were found from 0.13 to 0.49 µg/g. In three of the cases, the blood samples also contained natural or synthetic cannabinoids. In the autopsy case, a considerably higher concentration of methoxetamine, 8.6 µg/g, was found in femoral blood. In addition, tetrahydrocannabinol and the three different synthetic cannabinoids AM-694, AM-2201, and JWH-018, were present in femoral blood. The circumstances and the high femoral blood concentration of methoxetamine point toward an unintentional, acute fatal intoxication with methoxetamine, although the presence of the three synthetic cannabinoids may have contributed to the death.