Non-targeted screening for novel psychoactive substances among agitated emergency department patients

Lung, Derrick; Wilson, Nathan; Chatenet, Francois-Thibaut; Lacroix, Clémence; Gerona, Roy

doi:10.3109/15563650.2016.1139714

Cited by 35 publications

(21 citation statements)

References 15 publications

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“…Their potency and molecular variability have contributed to numerous outbreaks of severe clinical illness [1,2]. Synthetic cannabinoid (SC) use, a subclass of NPS, has increased dramatically over the last decade [1,3–5]. In the early 2000s, SCs became available on internet marketplaces and were sold as “natural herbs.” These products are typically labeled as “not for human consumption” though their use became widespread in the United States and Europe.…”

Section: Introductionmentioning

confidence: 99%

Synthetic cannabinoid “Black Mamba” infidelity in patients presenting for emergency stabilization in Colorado: a P SCAN Cohort

Brandehoff

Adams

McDaniel

et al. 2017

Clinical Toxicology

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Background Use of new psychoactive substances (NPS) has increased over the last decade. During this period, variability of both clinical presentations and chemical compositions of these compounds has increased. Synthetic cannabinoids (SCs) are the most commonly used NPS and there are more than 100 documented unique molecules in this class. “Black Mamba”, often associated to ADB-FUBINACA, is the most commonly used SC in Colorado. It has been linked to kidney injury, myocardial toxicity, seizures, and death. Objectives We aim to identify the chemical constituents and quantification of eight cases of reported “Black Mamba” use in order to further understand the clinical variability in patients presenting for emergency stabilization. Methods We report data from eight cases of reported “Black Mamba” use prospectively captured through the Colorado site of the Psychoactive Surveilance Consortium and Analysis Network (P SCAN). P SCAN is a geographically representative group of academic hospitals that capture clinical presentation, outcome, and biologic samples from patients that present for emergency stabilization following NPS use. Serum and urine samples were analyzed and quantified by liquid chromatography-quadrupole time-of-flight mass spectrometry after a qualitative screen for over 600 unique NPS compounds. Results In the reported eight cases, the median age was 28 years old. There were four male and four females. Four patients had agitation/delirium and four patients had chest pain. Normal saline, benzodiazepines and ondansetron were the common treatment provided in the emergency department (ED). Two patients were discharged from the ED and six patients being admitted for emergency observation with a median length of stay (LOS) of six hours. No deaths were reported. Confirmatory testing revealed that only five patients (62.5%) had SCs found in blood or urine samples. Cocaine, NRG-3, 3-methoxyphencyclidine hydrochloride (MeO-PCP), and methamfetamine were identified in other presentations. Conclusions The wide range of clinical presentations from “Black Mamba” use may be explained by the wide variability of chemical constituents found by laboratory analysis.

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Section: Introductionmentioning

confidence: 99%

Synthetic cannabinoid “Black Mamba” infidelity in patients presenting for emergency stabilization in Colorado: a P SCAN Cohort

Brandehoff

Adams

McDaniel

et al. 2017

Clinical Toxicology

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“…They critically discussed the pros and cons of low-resolution mass spectrometry (LRMS) and HRMS for NPS screening approaches in urine, blood, hair, and urinated soil collected during rave parties. They concluded that non-targeted screening procedures (general unknown screening) could easily be performed by HRMS (Kinyua et al 2015;Lung et al 2016), although most authors still develop targeted screening procedures. They also discussed the advantage of so-called sequential window acquisition of all theoretical fragment ion spectra (SWATH) for very fast scanning (QTOF) instruments as a promising option for non-targeted HRMS screening in clinical and forensic toxicology (Roemmelt et al 2014;Scheidweiler et al 2015;Roemmelt et al 2015).…”

Section: Screening For Detection Of Pharmaceuticals Doa and Toxinsmentioning

confidence: 99%

High-resolution mass spectrometry in toxicology: current status and future perspectives

Maurer

Meyer

2016

Arch Toxicol

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This paper reviews high-resolution mass spectrometry (HRMS) approaches using time-of-flight or Orbitrap techniques for research and application in various toxicology fields, particularly in clinical toxicology and forensic toxicology published since 2013 and referenced in PubMed. In the introduction, an overview on applications of HRMS in various toxicology fields is given with reference to current review articles. Papers concerning HRMS in metabolism, screening, and quantification of pharmaceuticals, drugs of abuse, and toxins in human body samples are critically reviewed. Finally, a discussion on advantages as well as limitations and future perspectives of these methods is included.

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“…In addition, Lung et al [72] reported the use of non-targeted analysis for the detection of NPS in clinical toxicology with DIA and suspect screening. The efficacy of non-targeted screening, in part, relies on the adoption of appropriate data acquisition techniques, however, data acquisition constitutes only one part of the non-targeted screening workflow [74].…”

Section: Non-targeted/untargeted Screening Strategiesmentioning

confidence: 99%

“…Custom databases populated with data from different sources have been developed and utilized in two studies [51,72], however, most databases described encompass many categories of drugs and not just NPS so it is unclear how comprehensive they actually are or the number of NPS derivatives is simply not reported.…”

Section: Suspect Screeningmentioning

confidence: 99%

Current applications of high-resolution mass spectrometry for the analysis of new psychoactive substances: a critical review

Pasin

Cawley

Bidny³

et al. 2017

Anal Bioanal Chem

111

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The proliferation of new psychoactive substances (NPS) in recent years has resulted in the development of numerous analytical methods for the detection and identification of known and unknown NPS derivatives. High-resolution mass spectrometry (HRMS) has been identified as the method of choice for broad screening of NPS in a wide range of analytical contexts due to its ability to measure accurate masses using data-independent acquisition (DIA) techniques. Additionally, it has shown promise for non-targeted screening strategies that have been developed in order to detect and identify novel analogues without the need for certified reference materials (CRMs) or comprehensive mass spectral libraries. This paper reviews the applications of HRMS for the analysis of NPS in forensic drug chemistry, clinical and forensic toxicology. It provides an overview of the sample preparation procedures in addition to data acquisition, instrumental analysis and data processing techniques.Furthermore, it will give an overview of the current state of non-targeted screening strategies with discussion on future directions and perspectives of this technique.3

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Non-targeted screening for novel psychoactive substances among agitated emergency department patients

Abstract: This study demonstrates that prospective, non-targeted NPS screening in a selected ED patient population is feasible and effective in identifying NPS.

Cited by 35 publications

References 15 publications

Synthetic cannabinoid “Black Mamba” infidelity in patients presenting for emergency stabilization in Colorado: a P SCAN Cohort

Synthetic cannabinoid “Black Mamba” infidelity in patients presenting for emergency stabilization in Colorado: a P SCAN Cohort

High-resolution mass spectrometry in toxicology: current status and future perspectives

Current applications of high-resolution mass spectrometry for the analysis of new psychoactive substances: a critical review

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