Prevalence of drugs of abuse found in testing of illicit drug seizures and urinalysis of selected population in Hong Kong

Fluorodeschloroketamine found as a street drug in drug seizures and drug driving cases in Hong Kong

BACKGROUND

With the decline of the use of ketamine, one of the common drugs of abuse in Hong Kong, detection of ketamine-related analogues in local laboratories has been encountered.

AIM

A brief account of the occurrence of fluorodeschloroketamine (FDCK) in forensic cases is reported through a retrospective study of all drug seizures and driving under the influence of drugs (DUID) cases since its first appearance.

METHODS

Identification of FDCK in drug seizures was achieved through gas chromatography - mass spectrometry (GC-MS) and/or liquid chromatography - diode array detection (LC-DAD) methods while its quantification was performed using gas chromatography - flame ionization detection (GC-FID). For the analysis of blood samples in DUID cases, identification and quantification were performed using LC-MS/MS by monitoring the respective transitions of FDCK and fluorodeschloronorketamine (FDCNK) using ketamine-d4 and norketamine-d4 respectively as internal standards.

RESULTS

Since its first submission in November 2018, a total of 74 drug seizure cases (151 items) and 6 drug driving cases were encountered till December 2019. Drug seizures found with FDCK were physically similar to those of ketamine seizures. The majority of items were detected with FDCK only (103 items, ∼67%) or as a mixture of FDCK with ketamine (42 items, ∼28%). The drug purity detected with either FDCK only or FDCK mixed with ketamine was high which was similar to those purity found in ketamine seizures. The blood drug concentrations of FDCK of the 6 drug driving cases were in the range of <0.002-1.1 μg/mL and other psychoactive drug(s)/metabolite(s) were also identified. Except for one case where the analysis of the metabolite, fluorodeschloronorketamine (FDCNK), was not conducted due to insufficient sample, the FDCK (FDCNK) concentrations in blood found in the 6 cases were <0.002 (0.005), 0.002 (0.002), 0.002 (0.003), 0.02 (0.035), 0.87 (0.44) and 1.1 (not determined) μg/mL.

CONCLUSIONS

With the drug seizures found with FDCK resembled in physical appearance with ketamine seizures, users might likely misuse it as ketamine. Though complicated by other drugs found, it is speculated that the two cases with higher concentration of FDCK found in blood (1.1 and 0.87 μg/mL) might have contributed to the impairment observed.

Changes in drug availability patterns on Tanzanian mainland: The effects of the surge operations deterrent strategy

This study investigated the recent changes in illegal substances availability on the Tanzanian mainland as a result of the government's surge operations as a deterrent approach against illicit drug production, trafficking and usage from 2017 to 2020, as well as the consequences of the COVID-19 pandemic on the drug market. Overall, 247467 seizures of illegal substances weighing 25357.9 kg were tested at The Government Chemist Laboratory Authority (GCLA), an average of 6339.5 kg annually. According to the findings, cannabis was the most frequently encountered substance, accounting for 80.6%, 88.2%, and 83% of all incidents, samples, and weight, respectively. Heroin came in second with 12.6% of the total incidents and 7.4% of the total number of samples, while khat came in second with 15.2% of the weight of the seized illegal substances during the period under study. Apart from a 202 and 4709 decline in heroin incidents and samples, the weight jumped from 15.3 kg in 2017 to 303.5 kg in 2020. Generally, the overall weight of the seizures decreased by 67.3% from 13036.4 kg in 2017-3890.7 kg in 2020. The results were particularly noticeable in the case of cannabis, which plunged by 76.5% from 11771.1 kg in 2017-2727 kg in 2020. Despite the eruption of the COVID-19 pandemic and associated lockdowns and travel limitations, heroin seizures increased by 67.4% in 2020 compared to the preceding three years combined.

Long-term safety of ketamine and esketamine in treatment of depression

INTRODUCTION

Ketamine is an NMDA receptor antagonist that can produce rapid-acting antidepressant effects. Esketamine (Spravato), the S-enantiomer of racemic ketamine, was approved by the FDA for treatment-resistant depression in 2019. Here we review what is known about the long-term safety of both racemic ketamine and esketamine as therapies for psychiatric disorders.

AREAS COVERED

In this article, we conducted a safety review of ketamine and esketamine. In looking at ketamine and esketamine long-term safety effects, we considered data available from experimental studies and several phase-three clinical trials.

EXPERT OPINION

Based on available data, the most common side effects of ketamine/esketamine are generally transient, mild, and self-limited. These include dissociation, nausea, headache, elevated heart rate, and blood pressure. Treatment with esketamine may lead to an increased risk of lower urinary tract symptoms, such as dysuria or urgency. However, severe bladder pathology has not been reported among patients receiving doses of esketamine/ketamine in line with prescribing guidelines for depression. There is considerable data that ketamine at high doses can lead to long-term impairments in cognition. However, the esketamine clinical trials found that cognition generally remains stable or improves over time, suggesting that when used appropriately, there is no increased risk of cognitive impairment.

Emergency department visits due to new psychoactive substances and other illicit drugs in Taiwan: preliminary results of the Taiwan Emergency Department Drug Abuse Surveillance (TEDAS) project

INTRODUCTION

The use of new psychoactive substances (NPSs) has markedly increased worldwide; thus, it is important to monitor NPS-related effects. The Taiwan Emergency Department Drug Abuse Surveillance (TEDAS) project aims to assess the patterns of recreational drug use in patients presenting to emergency departments (EDs) across the country. Here, we report the preliminary results of this project.

METHODS

This observational study included the collection and analysis of urine samples and assessment of the clinical presentation of patients from 79 EDs across Taiwan. Clinical features were recorded through a questionnaire filled by attending doctors or nurses who collected urine samples for clinical diagnosis. Urine samples were analyzed for 110 drugs and metabolites using electrospray ionization liquid chromatography-tandem mass spectrometry (LC-MS/MS).

RESULTS

Between February and November 2019, a total of 2649 patients were enrolled for urine drug analysis. A total of 675 cases older than 12 years (males, n = 480) had NPS or other illicit drugs detected in their urine samples. Overall, 1271 counts of drugs, among which 717 (56.4%) were NPS. At least one NPS was detected in 340 patients (50.4%), and 292 cases were positive for multiple drugs. The most frequently detected drug was methamphetamine/amphetamine, followed by synthetic cathinones, ketamine and its two analogs, and opioids. The most common drug combination was cathinones plus ketamine and/or its analogs (n = 56). Younger patients (OR = 3.3, p≤.0001) and women (OR = 1.5, p = .01) were more likely to have NPS detected in their urine samples. NPS-positive cases frequently experienced chest pain (OR = 2.6, p = .03), tachycardia (OR = 2.6, p = .0002), and suicide attempt/non-suicidal self-harm (OR = 1.8, p = .004), whereas depressed consciousness (OR = 0.5, p = .001) was less frequent among NPS-positive cases than among other illicit drug-positive cases.

CONCLUSIONS

The TEDAS project provides a nationwide epidemiological profile of recreational drug use in Taiwan. More than half of the recreational drugs were NPSs, which were comprehensively detected using LC-MS/MS.

Trends in illicit drugs based on the analysis of seizures from the Tanzania mainland drugs market

This study aimed at investigating the pattern of confiscated illegal drugs in the Tanzania mainland drug market from 2011 to 2016. The samples used in this study were seized by the police force and other law enforcement agents and were analysed at the Government Chemist Laboratory Authority, GCLA. A total of 90,366 samples weighing 17961.5 Kg were seized and analysed during the six years, an average of 15,061 samples corresponding to 2993.6 Kg per year. The overall results indicated cannabis to be the leading drug in terms of number of cases, number of samples and weights with 51.02%, 60.50% and 56.90%, respectively, but from 2011 to 2015 heroin had the highest percentage of both number of cases and samples by 58.46% and 55.91% of all seizures, respectively followed by cannabis. In terms of weight, heroin accounted for 67.55% and 26.32% in 2011 and 2012, respectively, whereas, the rest of the years' percentage weights were between 0.50 and 6.00% of the total seizures. The trend indicated a steady decrease in heroin seizures over the six years and an increased cannabis seizure. In 2016 cannabis was 78.28% and 80.89% of the total number of cases and samples, respectively. The results also indicated the decrease of cocaine cases and a significant increase in the amount khat. The year 2016 recorded the highest number of cases and number of samples with a total of 1212 and 48,440, respectively, which resulted from the increase in cannabis seizures by 72.28% and 80.89% of the total number of cases and samples, respectively, as compared to 2015. The second and third highest years were 2013 and 2014, respectively. The least was 2011 with 3493 samples. The trend also indicated heroin seizures were highest in 2011 (62.04%), 2014 (75.31%) and 2015 (79.26%) whereas cocaine seizures kept on decreasing gradually from 31.12% in 2011 to 0.05% in 2016. Khat (Catha edulis) had the highest weight in 2014 and 2016 and ranked second after cannabis with 43.63% of the total weight during 2011-2016 period. Benzodiazepines and amphetamine type stimulants (ATS) accounted the least in terms of number of cases and number of samples.

Determination of Ketamine and Norketamine in Hair and Evaluation of Polydrug Use in Ketamine Abusers Using Hair Analysis in Korea

This study evaluated hair samples from 28 subjects who tested positive for ketamine at Seoul Institute National Forensic Service in Korea between 2016 and 2017. Ketamine in the hair was extracted using a solution of 1% hydrochloric acid in methanol for 16 h. Extracts were analyzed using gas chromatography-mass spectrometry (GC-MS) or liquid chromatography-tandem mass spectrometry (LC-MS-MS). The LC-MS-MS method was validated by determining the limit of detection (LOD), limit of quantification (LOQ), linearity, intra- and inter-accuracy, precision and matrix effect. In 59 ketamine-positive hair or hair segments from 28 ketamine abusers, the ketamine concentration was found to be in the range of 0.011-335.8 ng/mg (mean, 13.6; median, 1.8), and the norketamine concentration was found to be in the range of 0.001-35.7 ng/mg (mean, 7.5; median, 0.44). The ratio of norketamine to ketamine concentrations in hair was in the range of 0.01-1.46 (mean, 0.34; median, 0.26). The distribution of ketamine concentration in hair samples was as follows: 0.01-0.1 ng/mg in 11 samples (18.6%), 0.1-5 ng/mg in 33 samples (55.9%), 5-10 ng/mg in 4 samples (6.8%), 10-15 ng/mg in 2 samples (3.4%), 15-20 ng/mg in 4 samples (6.8%), 40-45 ng/mg in 2 samples (3.4%), 45-50 ng/mg in 1 sample (1.7%) and >100 ng/mg in only 2 samples (3.4%). In the hair of ketamine abusers, 26 of 28 subjects were detected simultaneously ketamine with other drugs, including methylenedioxymethamphetamine (MDMA; n = 9), methamphetamine (MA; n = 3), MDMA/MA (n = 3), MDMA/para-methoxyamphetamine (PMA; n = 3), MDMA/PMA/MA (n = 2), cocaine (n = 1) and other drugs (n = 5, propofol, zolpidem or benzodiazepines). Along with ketamine, other controlled drugs were detected in most of the hair samples: MDMA (60.7%), MA (28.6%), PMA (17.9%), zolpidem (17.9%) and propofol (14.3%) in the frequency of abuse. In conclusion, most of the ketamine abusers (92.9%) were polydrug abusers, who were concomitantly abusing other controlled substances.

Prevalence of drugs of abuse found in forensic testing of illicit drug seizures and urine samples from offenders/probationers in Hong Kong: A 3-year update

The study investigates the prevalence of drugs of abuse detected from 2016 to 2018 through i) forensic drug testing of seizures from law enforcement agencies, and ii) common drugs of abuse for urinalysis of samples obtained from offenders/probationers under mandatory drug-use surveillance programmes. Under the selected drug testing groups, an average of 4677 cases/year (c.f. 5334 cases/year in 2011-2015) of illicit drug seizures and 19,501 samples/year (c.f. 28,438 samples/year in 2011-2015) for urinalysis, were examined from 2016 to 2018. The three most commonly encountered abused drugs in the period in both types of examinations were methamphetamine (MA), cocaine and heroin. The occurrence of ketamine, the most prevalent drug [1815 (34.0%) cases/year (for drug seizures), 2074 (7.3%) samples/year (for urinalysis)] in 2011-2015, had dropped significantly to 487 (10.4%) cases/year and 350 (1.8%) samples/year respectively. The drug positive rates for urinalysis in the selected population group (i.e., offenders/probationers requiring mandatory drug testing) increased steadily from 27.3% in 2016 to 30.8% in 2018 (an average of 29.0% vs. 22.1% in 2011-2015). The ratio of single drug use to more than one drug was about 4:1, showing predominant use of single drug. While MA was the most prevalent drug in the period, cases found with cocaine and cannabis increased steadily over the past 3 years. A rising trend was noted for cases identified with new psychoactive substances (NPS) in illicit drug seizures from an average of 87 cases/year in 2011-2015 to 211 cases/year in 2016-2018 although NPS cases still contributed to less than 5% of overall drug seizures. A total of 69 substances classified as NPS were encountered with 47 NPS newly encountered in 2016-2018 but 25 NPS found in 2011-2015 disappeared in this 3-year period. Cathinones, including both synthetic and plant-based, continued to be the major category of NPS cases (∼72%) in the region followed by synthetic cannabinoids, ketamine/PCP analogs and synthetic opioids.

The Emergence of Deschloro-N-ethyl-ketamine, a Ketamine Analog, in Drug Seizures and Drug Driving Cases in Hong Kong

The study reports the detection of a newly emerged drug, deschloro-N-ethyl-ketamine (2-oxo-PCE), an analog of ketamine, through forensic drug and toxicological examinations of exhibits from drug seizure cases and blood samples taken from drivers of driving under the influence of drug (DUID) cases, respectively, in Hong Kong. The submission of 2-oxo-PCE in both types of cases was firstly encountered in October 2017. A total of 31 drug seizure cases (52 items) and 4 DUID cases were found positive with 2-oxo-PCE till October 2018. Drug seizures with 2-oxo-PCE found were all in physical form (mostly in powdery or crystalline solid), resembling those samples commonly found with ketamine but having much lower purity. Although the majority of the relevant items was found with 2-oxo-PCE as the only psychoactive substance (36 items, ~69%) or as a mixture with ketamine (10 items, ~19%), other psychoactive substances including methamphetamine, methylenedioxymethamphetamine and pentylone have also been encountered (6 items, 12%). For the four DUID cases, 2-oxo-PCE and its metabolite, deschloronorketamine, were detected in all blood samples. The 2-oxo-PCE concentrations in the four blood samples were in the range of 0.08–0.31 μg/mL, being higher than the concentrations of deschloronorketamine (in the range of 0.04–0.09 μg/mL) for each sample. The 2-oxo-PCE levels found were generally lower than the ketamine levels found in reported DUID cases. With items found with 2-oxo-PCE, which were physically indistinguishable from ketamine but having lower drug purity in seizures, the lower 2-oxo-PCE blood levels with more severe impairment signs observed for the drivers in DUID cases, it is not unreasonable to speculate that users might have taken it as ketamine without knowing of its real identity and hence was adversely affected by the more potent 2-oxo-PCE.

A Retrospective of Prevalence of Drugs of Abuse by Hair Analysis in Shanghai using LC–MS-MS

This study presents a retrospective analysis of the prevalence of drug abuse in Shanghai by hair analysis. Files and toxicology analysis results of a total of 5,610 cases requesting for hair analysis of abused drugs at the Academy of Forensic Science (AFS) in Shanghai over 12 months between August 2018 and July 2019 were reviewed. All cases of drug abuse identified by hair analysis were from the public security organs in Shanghai, China. Hair samples were analyzed for drugs of abuse and related metabolites, mainly including amphetamine (AMP), methamphetamine (MA), 3,4-methylenedioxymethamphetamine (MDMA), 3,4-methylenedioxyamphetamine (MDA), tetrahydrocannabinol (THC), ketamine (K), norketamine (NK), cocaine (COC), benzoylecgonine, morphine, 6-acetylmorphine, flunitrazepam, and 5-methoxy-N,N-diisopropyltryptamine (5-MeO-DIPT), using liquid chromatography–tandem mass spectrometry (LC–MS-MS). Among the 5,610 cases, 1,713 (30.5%) were positive for drugs of abuse, with amphetamine-type stimulants (ATS) (57%), including amphetamines (AMP and MA) (48%), MDMA and MDA (9%), being the most frequently detected drugs, followed by THC (14%), COC (8%), 5-MeO-DIPT (8%), and K (7%). The majority (75%) of positive hair samples were from male subjects. Overall, 77% of abusers were younger than 44 years old. The proportion of female subjects (22.3%) under 24 years was larger than that of male subjects (7.8%). There were 132 cases (7.7%) in which more than one type of drug was detected among 1,713 drug-positive cases. The most common combination was MDMA and K. The present study characterizes the current toxicological profile of drug abuse cases and provides a scientific basis for drug abuse prevention. Moreover, the hair concentration distributions of the commonly abused drugs in positive cases have been reported.