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A Novel Oral Fluid Assay (LC-QTOF-MS) for the Detection of Fentanyl and Clandestine Opioids in Oral Fluid After Reported Heroin Overdose

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Abstract

Introduction

The adulteration of heroin with non-pharmaceutical fentanyl and other high-potency opioids is one of the factors contributing to striking increases in overdose deaths. To fully understand the magnitude of this problem, accurate detection methods for fentanyl and other novel opioid adulterant exposures are urgently required. The objective of this work was to compare the detection of fentanyl in oral fluid and urine specimens using liquid chromatography quadrupole time-of-flight mass spectrometry (LC-QTOF-MS) in a population of heroin users presenting to the Emergency Department after overdose.

Methods

This was a prospective observational study of adult Emergency Department patients who presented after a reported heroin overdose requiring naloxone administration. Participants provided paired oral fluid and urine specimens, which were prepared, extracted, and analyzed using a dual LC-QTOF-MS workflow for the identification of traditional and emerging drugs of abuse. Analytical instrumentation included SCIEX TripleTOF® 5600+ and Waters Xevo® G2-S QTOF systems.

Results

Thirty participants (N = 30) were enrolled during the study period. Twenty-nine participants had fentanyl detected in their urine, while 27 had fentanyl identified in their oral fluid (overall agreement 93.3%, positive percent agreement 93.1%). Cohen’s Kappa (k) was calculated and demonstrated moderately, significant agreement (k = 0.47; p value 0.002) in fentanyl detection between oral fluid and urine using this LC-QTOF-MS methodology. Additional novel opioids and metabolites, including norfentanyl, acetylfentanyl, and U-47700, were detected during this study.

Conclusion

In this study of individuals presenting to the ED after reported heroin overdose, a strikingly high proportion had a detectable fentanyl exposure. Using LC-QTOF-MS, the agreement between paired oral fluid and urine testing for fentanyl detection indicates a role for oral fluid testing in surveillance for nonpharmaceutical fentanyl. Additionally, the use of LC-QTOF-MS allowed for the detection of other clandestine opioids (acetylfentanyl and U-47700) in oral fluid.

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Funding

Analyses for this study were funded by the Fredric Rieders Family Foundation. Additional costs were supported by the Overdose Prevention Fund and NIH 5K24DA037109 (PI: Boyer).

Author information

Authors and Affiliations

  1. Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA

    Matthew K. Griswold, Brittany P. Chapman & Kavita M. Babu

  2. Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Peter R. Chai & Edward W. Boyer

  3. Center for Forensic Science Research and Education, Fredric Rieders Family Foundation, Willow Grove, PA, USA

    Alex J. Krotulski, Melissa Friscia & Barry K. Logan

  4. Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA

    Neha Varma

Authors
  1. Matthew K. Griswold
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  2. Peter R. Chai
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  3. Alex J. Krotulski
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  4. Melissa Friscia
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  5. Brittany P. Chapman
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  6. Neha Varma
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  7. Edward W. Boyer
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  8. Barry K. Logan
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  9. Kavita M. Babu
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Contributions

PRC, EWB, BKL, and KMB conceived the study, designed the trial, and obtained research funding. MKG, PRC, BC, and KMB undertook recruitment of participants and managed the data including quality control. MF, AJK, and BKL designed and conducted analysis of oral fluid and urine specimens. NV conducted the statistical analyses. KMB and EWB drafted the manuscript, and all authors contributed substantially to its revision. KMB takes responsibility for the paper as a whole.

Corresponding author

Correspondence to Kavita M. Babu.

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Conflicts of Interest

The authors declare that they have no conflicts of interest.

Additional information

Portions of this manuscript were accepted as a poster presentation at the American College of Medical Toxicology Annual Scientific Meeting 2017, San Juan, Puerto Rico

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Griswold, M.K., Chai, P.R., Krotulski, A.J. et al. A Novel Oral Fluid Assay (LC-QTOF-MS) for the Detection of Fentanyl and Clandestine Opioids in Oral Fluid After Reported Heroin Overdose. J. Med. Toxicol. 13, 287–292 (2017). https://doi.org/10.1007/s13181-017-0632-6

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  • DOI: https://doi.org/10.1007/s13181-017-0632-6

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