The Opioid Epidemic: Moving Toward an Integrated, Holistic Analytical Response

Abstract

In many jurisdictions, public safety and public health entities are working together to enhance the timeliness and accuracy of the analytical characterization and toxicology testing of novel synthetic opioids. The improved sharing and early detection of these analytical data are intended to inform surveillance, interdiction efforts, patient intervention and treatment, all of which are critical to curbing the opioid epidemic. Forensic practitioners working to identify novel synthetic opioids struggle to provide timely results when encountering new or unknown substances, such as the fentanyl analogs. These compounds, which mimic heroin in pharmacologic effect but can be far more potent, are inconsistently present in chemical identification libraries, and are currently largely unavailable as reference materials for analytical comparison. Additionally, federal, state and local governments as well as nongovernmental organizations require potency, toxicity and potential-for-abuse data to evaluate the potential health risks of emerging drug threats. Subsequent scheduling efforts and criminal prosecutions also require these thorough drug characterization studies. Pilot programs have demonstrated that early communication of real-time drug toxicity and analytical data significantly impacts the successful response to emerging opioids. High-quality, real-time, national-level data on chemical composition, toxicological test data, drug toxicity and overdoses, and analysis of seized materials by law enforcement are needed to track drug trends. However, the USA still lacks a national system to coordinate and communicate toxicology, medical and medical examiner and coroner data with the broader medical and law enforcement communities. Opportunities to address these gaps as well as recent advancements collected through interagency efforts and technical workshops in the toxicology and analytical chemistry communities are presented here. Opportunities for partnership, increased communication and expanding best practices to move toward an integrated, holistic analytical response are also explored.

Nonfatal Drug Overdoses Treated in Emergency Departments — United States, 2016–2017

“…The findings in this report are subject to at least seven limitations. First, CDC did not assess polysubstance overdose, and it is possible that some overdoses were not classified correctly given limits of drug testing in EDs (8). Second, CDC could not determine whether illicit or prescribed drugs were driving some drug-specific overdose rate increases from 2016 to 2017.…”

Novel Opioids: Systematic Web Crawling Within the e-Psychonauts’ Scenario

“…For some opioids, larger dosages of naloxone may be required to reverse the opioid toxidrome than needed in case of a typical heroin overdose (Armenian et al, 2018;Lovrecic et al, 2019). The greatest levels of concerns remain related to fentanyl analogs, because of their harmful potential (Schifano et al, 2019a), the continuous high incidence of emerging analogs on the markets over the last years (Schueler, 2017), and the difficulties in identifying them with analytical chemistry techniques (Gerace et al, 2018b;Morrow et al, 2019). Conversely, those substances here identified possessing a full/partial kappa opioid receptor agonist activities (including salvinorin A and its derivatives; tifluadom; and pethidine) are likely to be particularly attractive for opioid and other research chemical consumers prone to a recreational experimentation associated with complex psychoactive effects (Coffeen and Pellicer, 2019).…”

Mass spectral similarity mapping applied to fentanyl analogs

“…The rise of fentanyl and related analogs, synthetic opioids with fast onset and high therapeutic index (see [22,23] and references therein), is a major contributor to this social problem. Forensic practitioners struggle to provide confident identifications when encountering novel designer fentanyl analogs [24]. This section of the manuscript describes how constructing a mass spectral similarity map of fentanyl analog spectra, as described in sections 2.1 and 2.2, can be used to determine whether a query spectrum is a fentanyl molecule, or an analog that differs from fentanyl by up to two modifications.…”