A new quantitative drug checking technology for harm reduction: Pilot study in Vancouver, Canada using paper spray mass spectrometry

Abstract

Introduction. Drug checking services for harm reduction and overdose prevention have been implemented in many jurisdictions as a public health intervention in response to the opioid overdose crisis. This study demonstrates the first on-site use of paper spray mass spectrometry for quantitative drug checking to address the limitations of current on-site drug testing technologies. Methods. Paper spray mass spectrometry was used to provide on-site drug checking services at a supervised consumption site in the Downtown Eastside of Vancouver, British Columbia, Canada during a 2-day pilot test in August 2019. The method included the targeted quantitative measurement of 49 drugs and an untargeted full scan to assist in identifying unknown/unexpected components. Results. During the pilot, 113 samples were submitted for analysis, with 88 (78%) containing the client expected substance. Fentanyl was detected in 45 of 59 expected fentanyl samples, and in 50 (44%) samples overall at a median concentration of 3.6% (w/w%). The synthetic precursor of fentanyl, 4-anilino-N-phenethyl-piperidine (4-ANPP), was found in 74.0% of all fentanyl samples at a median concentration of 2.2%, suggesting widespread poor manufacturing practices. Etizolam was detected in 10 submitted samples anticipated to be fentanyl at a median concentration of 2.5%. No clients submitting these samples expected etizolam or a benzodiazepine in their sample. In three instances, it was co-measured with fentanyl, and in seven cases it was detected alone. Discussion and Conclusions. The quantitative capabilities and low detection limits demonstrated by paper spray mass spectrometry offer distinct benefits over existing on-site drug checking methods and harm reduction services.

Drug checking services for people who use drugs: a systematic review

“…Publication bias may limit the representativeness of the included literature, as studies not showing positive impacts of DCS could be under‐represented. Timing of the search is another limitation, and several peer‐reviewed articles have been published since [ 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 ], including one Canadian study among drug sellers [ 100 ]. Our eligibility criteria excluded studies where DCS were not implemented although they may have reported outcomes on our domains, such as facilitators and barriers to use of DCS [ 112 ].…”

“…Publication bias may limit the representativeness of the included literature, as studies not showing positive impacts of DCS could be under-represented. Timing of the search is another limitation, and several peer-reviewed articles have been published since [99][100][101][102][103][104][105][106][107][108][109][110][111], including one Canadian study among drug sellers [100].…”

Current Attitudes Toward Drug Checking Services and a Comparison of Expected with Actual Drugs Present in Street Drug Samples Collected from Opioid Users

“…Lacking tolerance for opioids, users of (expected) nonopioid street drugs can experience overdoses and fatalities when even a very small amount of a potent opioid such as fentanyl or analog is present in their drug. Recent publications in the scienti c literature and popular press indicate adulteration of non-opioids with fentanyl is occurring with more frequency, often having fatal consequences [1,48,49,50] As drug testing methods evolve, however, more sensitive and comprehensive testing methods such as portable gas chromatograph-mass spectrometry and Fourier-transform infrared spectroscopy (FTIR) that can be provided as point-of-care testing are being evaluated and could soon come into wider use[16, 30,51,52]. These testing methods represent what we assess as a reasonable compromise between more advanced but expensive and technologically complex testing methods and accessible, easy-to-use but less informative methods available for take-home use.…”

A direct mass spectrometry method for cannabinoid quantitation in urine and oral fluid utilizing reactive paper spray ionization

“…10 The PS-MS analysis of illicit drugs has been reported in the literature. [11][12][13][14] Unfortunately, detection limits for direct THC or THC-COOH analysis with PS-MS tend to be high due to the poor ionization efficiency of cannabinoids. Some groups have increased sensitivity for cannabinoids with PS-MS, but at the cost of including undesirable reagents and/or additional sample preparation steps.…”