Poster Abstracts
Jeffrey Gudin, MD
Faculty, Practicing Physician
University of Miami
Englewood, New Jersey
More than 106,000 persons in the U.S. died from drug-involved overdose in 2021, including illicit drugs and prescription opioids. In addition to the dangers of known drugs, there has been a worldwide increase in morbidity and mortality related to new and novel synthetic drugs of abuse. The United Nations office on Drugs and Crime defines new psychoactive substances (NPS) as substances of abuse that are not controlled by international drug conventions but which may pose a public health threat. These drugs/chemicals may lack available lab testing methods, and are often synthetic forms of opioids including fentanyl, benzodiazepines, cannabinoids, stimulants, and others. There is an urgent need to address the current gaps in drug monitoring for these dangerous substances.
Purpose/Objectives:
Develop a framework for testing Novel Psychoactive Substances (NPS) at a National Reference Laboratory.
Method:
Laboratory methods were developed using a definitive quantitative analysis of multiple NPS classes including designer benzodiazepines, opioids, fentanyl analogs, stimulants, and synthetic cannabinoids and other illicit additives.
Results:
A single qualitative liquid chromatography tandem mass spectrometry method was successfully validated for multiple drugs and metabolites in different NPS classes: 15 designer benzodiazepines drugs/metabolites are quantified including Bromazolam, Clonazolam, Flubromazolam, 4Cl-Deschloroalprazolam and metabolites; 18 fentanyl analogs including Carfentanil, Fluorofentanyl, and Methoxyacetyl Fentanyl; 17 designer opioids including Isotonitazene, Metonitazene, Protonitazene, and metabolites; 15 designer stimulants including Pentylone, Eutylone, and metabolites; 20 synthetic cannabinoids and metabolites; and 3 other illicit additives such as Xylazine and Tianeptine.
Conclusions: Although the medical community has curbed opioid prescribing and related harms, deaths involving synthetic opioids and stimulants continue to rise in the US. New designer drugs have emerged that evade detection by current testing methods. It will be critical for laboratories to develop tests that keep pace with the appearance of these NPS in our communities to aid with surveillance and the development of early warning networks. Monitoring data in real-time has the potential to alert regulatory authorities to emerging substance use problems, prompting an early clinical and regulatory response. Laboratories testing for NPS will need robust surveillance systems for real time monitoring and will need NPS methods updated at least annually to stay clinically relevant.
Disclosures:
J.Neifeld, R. Solano, S. Bartock – all receive salaries from Quest Diagnostics.
J Gudin is a consultant to Quest Diagnostics but has not receive any funding related to this project.
References: NONE