An Analysis of the Duration of Fentanyl and Its Metabolites in Urine and Saliva

Silverstein, Jeffrey H.; Rieders, Michael F; McMullin, Matthew; Schulman, Steven P.; Zahl, K.

doi:10.1213/00000539-199303000-00030

Cited by 74 publications

(32 citation statements)

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“…Urine drug testing identifies nonpharmaceutical fentanyl and clandestine opioid use during approximately the prior 72 h [24]. In one study of seven surgical patients who received fentanyl intraoperatively, 100% had detectable fentanyl in urine postoperatively using GC/MS with a detection threshold of 0.1 ng/mL.…”

Section: Discussionmentioning

confidence: 99%

Self-identification of nonpharmaceutical fentanyl exposure following heroin overdose

Griswold

Chai

Krotulski

et al. 2017

Clinical Toxicology

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Objective To compare user self-identification of nonpharmaceutical fentanyl exposure with confirmatory urine drug testing in emergency department (ED) patients presenting after heroin overdose. Methods This was a cross-sectional study of adult ED patients who presented after a heroin overdose requiring naloxone administration. Participants provided verbal consent after which they were asked a series of questions regarding their knowledge, attitudes and beliefs toward heroin and non-pharmaceutical fentanyl. Participants also provided urine samples, which were analyzed using liquid chromatography coupled to quadrupole time-of-flight mass spectrometry to identify the presence of fentanyl, heroin metabolites, other clandestine opioids, common pharmaceuticals and drugs of abuse. Results Thirty participants were enrolled in the study period. Ten participants (33%) had never required naloxone for an overdose in the past, 20 participants (67%) reported recent abstinence, and 12 participants (40%) reported concomitant cocaine use. Naloxone was detected in all urine drug screens. Heroin or its metabolites were detected in almost all samples (93.3%), as were fentanyl (96.7%) and its metabolite, norfentanyl (93.3%). Acetylfentanyl was identified in nine samples (30%) while U-47700 was present in two samples (6.7%). Sixteen participants self-identified fentanyl in their heroin (sensitivity 55%); participants were inconsistent in their qualitative ability to identify fentanyl in heroin. Conclusions Heroin users presenting to the ED after heroin overdose requiring naloxone are unable to accurately identify the presence of nonpharmaceutical fentanyl in heroin. Additionally, cutting edge drug testing methodologies identified fentanyl exposures in 96.7% of our patients, as well as unexpected clandestine opioids (like acetylfentanyl and U-47700).

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Section: Discussionmentioning

confidence: 99%

Self-identification of nonpharmaceutical fentanyl exposure following heroin overdose

Griswold

Chai

Krotulski

et al. 2017

Clinical Toxicology

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“…Unfortunately, fentanyl detection requires specific testing and is not readily detected on most routine opioid drug screens used in clinical settings [24][25][26]. Thus, if a lab is not testing for fentanyl, its presence will go undetected.…”

Section: Case Groupmentioning

confidence: 99%

Fentanyl-associated Fatalities Among Illicit Drug Users in Wayne County, Michigan (July 2005–May 2006)

Algren¹,

Monteilh²,

Punja³

et al. 2013

J. Med. Toxicol.

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Background During the summer of 2005, multiple cities in the United States began to report outbreaks of fentanyl-associated fatalities among illicit drug users. The objectives of this study were to (1) determine if an outbreak of fentanyl-associated fatalities occurred in mid-2005 to mid-2006 and (2) to examine trends and compare features of fentanyl-contaminated heroinassociated fatalities (FHFs) with non-fentanyl, heroinassociated fatalities (NFHFs) among illicit drug users. Methods Baseline prevalence of fentanyl-and heroinassociated deaths was estimated from January to May 2005 based on recorded cause of death (determined by the medical examiner (ME)) using the Wayne County, MI, USA toxicology database. The database was then queried for both FHFs and NFHFs between July 1, 2005 and May 12, 2006. A FHF was defined as having fentanyl or norfentanyl (metabolite) detected in any postmortem biological sample and either (1) detection of heroin or its metabolite (6-acetylmorphine) and/or cocaine or its metabolite (benzoylecgonine) in a postmortem biological specimen or (2) confirmation of fentanyl abuse as the cause of death by the ME or a medical history available sufficient enough to exclude prescription fentanyl or other therapeutic opioid use. A NFHF was defined as detection of heroin, 6-acetylmorphine (heroin metabolite) or morphine in any postmortem biological specimen, heroin overdose listed as the cause of death by the ME, and absence of fentanyl detection on postmortem laboratory testing. Information was systematically collected, trended for each group and then compared between the two groups with regard to demographic, exposure, autopsy, and toxicology data. Logistic regression was performed using SAS v 9.1 examining the effects of age, gender, and marital status with fentanyl group status.Results Monthly prevalence of fentanyl-associated fatalities among illicit drug users increased from an average of two in early 2005 to a peak of 24 in May, 2006. In total, 101 FHFs and 90 NFHFs were analyzed. The median age of decedents was 46 and 45 years for the fentanyl and non-fentanyl groups, respectively. Fentanyl-contaminated heroin-associated fatalities (FHFs) were more likely to be female (p=0.003). Women aged over 44 years (OR=4.67;) and divorced/widowed women (OR = 14.18;95 % CI = 1.59-127.01) were more likely to be FHFs when compared to women aged less than 44 years and single, respectively. A significant interaction occurred between gender and age, and gender and marital status. Most FHFs had central (heart) blood samples available for fentanyl testing (n=96; 95 %): fentanyl was detected in most (n=91; 95 %). Of these, close to half had no detectable heroin (or 6-acetylmorphine) concentrations (n=37; 40.7 %). About half of these samples had detectable cocaine concentrations (n=20; 54 %). Median fentanyl concentration in central blood samples was 0.02 μg/ml (n=91, range <0.002-0.051 μg/ml) and 0.02 μg/ml (n=32, range <0.004-0.069 μg/ml) in peripheral blood samples. The geometric mean of the ratio of ...

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“…The high potency of fentanyls, 50-100 times more potent than morphine, along with the low renal clearance of fentanyl analogs, results in low concentrations (0.8 ng/mL-4 ng/mL) of the intact fentanyl excreted via urine following therapeutic doses [7]. The biological half-life of fentanyl is 1-3.5 hours [8]; however, the nor-metabolite, the oxidative n-dealkylation at the piperdine nitrogen of the parent compound, has been detected at concentrations of 0.3 to 0.7 ng/mL up to 96 hours following therapeutic doses [9]. It is important to note that the common nor-metabolites are not unique to each fentanyl analog; therefore, to correctly identify the exposure agent, the native compound of all suspected fentanyls must be also monitored, (e.g.…”

Section: Introductionmentioning

confidence: 99%

Comparison of two automated solid phase extractions for the detection of ten fentanyl analogs and metabolites in human urine using liquid chromatography tandem mass spectrometry

Shaner

Kaplan

Hamelin

et al. 2014

Journal of Chromatography B

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Two types of automated solid phase extraction (SPE) were assessed for the determination of human exposure to fentanyls in urine. High sensitivity is required to detect these compounds following exposure because of the low dose required for therapeutic effect and the rapid clearance from the body for these compounds. To achieve this sensitivity, two acceptable methods for the detection of human exposure to seven fentanyl analogs and three metabolites were developed using either off-line 96-well plate SPE or on-line SPE. Each system offers different advantages: off-line 96-well plate SPE allows for high throughput analysis of many samples, which is needed for large sample numbers, while on-line SPE removes almost all analyst manipulation of the samples, minimizing the analyst time needed for sample preparation. Both sample preparations were coupled with reversed phase liquid chromatography and isotope dilution tandem mass spectrometry (LC-MS/MS) for analyte detection. For both methods, the resulting precision was within 15%, the accuracy within 25%, and the sensitivity was comparable with the limits of detection ranging from 0.002-0.041ng/mL. Additionally, matrix effects were substantially decreased from previous reports for both extraction protocols. The results of this comparison showed that both methods were acceptable for the detection of exposures to fentanyl analogs and metabolites in urine.

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An Analysis of the Duration of Fentanyl and Its Metabolites in Urine and Saliva

Cited by 74 publications

References 0 publications

Self-identification of nonpharmaceutical fentanyl exposure following heroin overdose

Self-identification of nonpharmaceutical fentanyl exposure following heroin overdose

Fentanyl-associated Fatalities Among Illicit Drug Users in Wayne County, Michigan (July 2005–May 2006)

Comparison of two automated solid phase extractions for the detection of ten fentanyl analogs and metabolites in human urine using liquid chromatography tandem mass spectrometry

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