Study of the stability of cocaine and benzoylecgonine, its major metabolite, in blood samples

Method Consolidation to Improve Scope and Efficiency in Postmortem Toxicology

Systematic toxicological approaches that employ both ideology changes and improvements in instrumentation and sample extraction allow for improved toxicology testing efficiency through lower sensitivities, higher specificity and minimized resource use. Historically, the San Francisco Office of the Chief Medical Examiner relied heavily on a gas chromatography mass spectrometry (GC-MS) testing regime, comprised of individual drug-class confirmation and quantitation assays. Traditional methods utilizing GC-MS typically require iterations of testing, exhausting sample volume, and hindering productivity and turnaround times, particularly for polypharmacy cases frequently seen in modern postmortem toxicology. The method described here consolidated the scope of seven legacy methods into a single liquid chromatography tandem mass spectrometry (LC-MS/MS) method for better sensitivity, higher throughput, minimal sample consumption for the quantitation of drugs of abuse and improved quality assurance with the incorporation of smart, automated processing. About 100 μL of blood or urine were rapidly extracted using a simple acetonitrile protein crash and subsequent in-vial filtration and injected on to an LC-MS-MS system. The developed method was fully validated to SWGTOX and international guidelines and incorporated 55 analytes along with a customized query that facilitates rapid and consistent application of acceptability criteria for data processing and review. Applicability was demonstrated with the analysis of 1,389 samples (858 blood and 531 urine) where at least 41% of positive results may have been missed due to their decreased sensitivity and 11% of results were not within the scope of the previous analytical methods estimated. On average, cases in this study would have previously required three distinct GC-MS assays, 3 mL of blood, and upwards of 30 h of active staff time. The described LC-MS-MS analytical approach has mitigated the need to perform multiple assays, utilized only 0.1 mL of sample, significantly reduced analyst work time, incorporated 10 additional analytes and allowed for a more comprehensive testing regime to better inform cause of death determinations.

(Un)targeted Scanning of Locks of Hair for Drugs of Abuse by Direct Analysis in Real Time-High-Resolution Mass Spectrometry

Forensic hair evidence can be used to obtain retrospective timelines of drug use by analysis of hair segments. However, this is a laborious and time-consuming process, and mass spectrometric (MS) imaging techniques, which show great potential for single-hair targeted analysis, are less useful due to differences in hair growth rate between individual hairs. As an alternative, a fast untargeted analysis method was developed that uses direct analysis in real time-high-resolution mass spectrometry (DART-HRMS) to longitudinally scan intact locks of hair without extensive sample preparation or segmentation. The hair scan method was validated for cocaine against an accredited liquid chromatography/tandem mass spectrometry (LC/MS/MS) method. The detection limit for cocaine in hair was found to comply with the cutoff value of 0.5 ng/mg recommended by the Society of Hair Testing; that is, the DART hair scan method is amenable to forensic cases. Under DART conditions, no significant thermal degradation of cocaine occurred. The standard DART spot size of 5.1 ± 1.1 mm could be improved to 3.3 ± 1.0 mm, corresponding to approximately 10 days of hair growth, by using a high spatial resolution exit cone. By use of data-dependent product ion scans, multiple drugs of abuse could be detected in a single drug user hair scan with confirmation of identity by both exact mass and MS/HRMS fragmentation patterns. Furthermore, full-scan high-resolution data were retrospectively interrogated versus a list of more than 100 compounds and revealed additional hits and temporal profiles in good correlation with reported drug use.

Identification and characterization of single chain anti-cocaine catalytic antibodies

Cocaine is a powerful and addictive stimulant whose abuse remains a prevalent health and societal crisis. Unfortunately, no pharmacological therapies exist and therefore alternative protein-based therapies have been examined. One such approach is immunopharmacotherapy, wherein antibodies are utilized to either bind or hydrolyze cocaine thereby blocking it from exerting its euphoric effect. Towards this end, antibodies capable of binding and hydrolyzing cocaine were identified by phage display from a biased single chain antibody library generated from the spleens of mice previously immunized with a cocaine phosphonate transition state analog hapten. Two classes of antibodies emerged based on sequence homology and mode of action. Alanine scanning mutagenesis and kinetic analysis revealed that residues H97, H99, and L96 are crucial for antibodies 3F5 and 3H9 to accelerate the hydrolysis of cocaine. Antibodies 3F1 through 3F4, which are similar to our previously identified 3A6 class of antibodies, catalyze hydrolysis through transition state stabilization by tyrosine or histidine residues H50 and L94. Mutation of either one or both tyrosine residues to histidine conferred hydrolytic activity on previously inactive antibody 3F4. Mutational analysis of residue H50 of antibody 3F3 resulted in a glutamine mutant with a rate enhancement three times greater than wild-type. A double mutant, containing glutamineH50 and lysineH52, showed a tenfold rate enhancement over wild-type. These results indicate the power of initial selection of catalytic antibodies from a biased antibody library in both rapid generation and screening of mutants for improved catalysis.

In vitro stability of cocaine in whole blood and plasma including ecgonine as a target analyte

The in vitro stability of cocaine (COC) was monitored in fresh whole blood and plasma stabilized with potassium fluoride (0.25%) for as long as 15 days. The samples were stored at 4 degreesC, 20 degreesC and 40 degreesC. Additionally, fresh plasma samples containing either benzoylecgonine (BZE), ecgonine methyl ester (EME) or ecgonine (ECG) were stored at 4 degreesC and 20 degreesC. Data were established using subsequent solid-phase extraction procedures and high-performance liquid chromatography coupled to atmospheric pressure ionization mass spectrometry for isolation and quantitation of COC, BZE, EME, and ECG. COC, BZE, and EME concentrations decreased with increasing storage temperature and time after an apparent first-order reaction kinetic. Only ECG appeared to be stable at storage temperatures as high as 20 degreesC for the entire observation period. At 40 degreesC, the amount of ECG produced from hydrolysis of COC still totalled 80% of the initial COC concentration. Hydrolysis of COC to EME occurred more rapidly in plasma than in blood. The dynamic degradation profiles obtained were dependent on the storage temperature. The conversion of COC to BZE, EME, and ECG appeared to be stoichiometric at all time intervals at storage temperatures of 4 degreesC and 20 degreesC. The presence of any hydrolysis product of COC in blood or plasma constitutes confirmatory evidence of COC incorporation, and determination of ECG seems most promising even in samples stored under unfavorable conditions.

Fatal injuries after cocaine use as a leading cause of death among young adults in New York City

BACKGROUND

Cocaine intoxication can lead to fatal cardiovascular and cerebrovascular events. In addition, the neurobehavioral effects of cocaine may increase the likelihood that a user will receive violent fatal injuries. Since New York City is a center for the importation and distribution of cocaine, we sought to determine the extent of cocaine use among city residents with fatal injuries.

METHODS

Among a total of 14,843 residents of New York City who received fatal injuries from 1990 through 1992, we determined the proportion who used cocaine shortly before their deaths. We also determined the population-based rates of fatal injuries that were known to follow cocaine use and the proportion of all deaths of New York City residents that was represented by these cases for each demographic stratum. For adults 15 to 44 years of age, fatal injury after cocaine use was ranked with other causes of death as though it was a separate cause.

RESULTS

Cocaine use, as measured by the detection of the metabolite benzoylecgonine in urine or blood, was found in 26.7 percent of all New York City residents receiving fatal injuries; free cocaine was detected in 18.3 percent. Approximately one third of deaths after cocaine use were the result of drug intoxication, but two thirds involved traumatic injuries resulting from homicides, suicides, traffic accidents, and falls. If fatal injury after cocaine use was considered as a separate cause of death, it would rank among the five leading causes of death among those 15 to 44 years of age in New York City.

CONCLUSIONS

Fatal injuries among cocaine users account for a substantial proportion of all deaths among young adults in New York City.

Reversed-phase high-performance liquid chromatographic determination of cocaine in plasma and human hair with direct fluorimetric detection

A simple, but sensitive and specific, high-performance liquid chromatographic assay for cocaine with direct fluorimetric detection, particularly intended for the routine analysis of hair and blood samples, is described. Benzoylecgonine, eluting before cocaine in a completely resolved peak, is also detectable. Detection is based on the weak native fluorescence of cocaine and benzoylecgonine, depending on the benzene ring present in both molecules. Hair samples (20-200 mg) were incubated overnight in 2 ml of 0.25 M HCl at 45 degrees C and extracted with a commercial liquid-liquid method; the dried residue reconstituted with 500 microliters of 0.05 M NaH2 PO4 (PH 5.2) was injected. Blood plasma samples (200 microliters) were mixed with 150 microliters of 0.1 M Na2 HPO4 (pH 8.9) and extracted with 5 ml of chloroform-2-propanol (9:1); the organic phase was evaporated and the residue dissolved and injected as above. Isocratic reversed-phase liquid chromatography was carried out on a column (150 x 4.6 mm I.D.) packed with spherical 5-microns poly(styrene-divinylbenzene) particles; the mobile phase was 0.1 M potassium phosphate (pH 3)-methanol-tetrahydrofuran (70:25:5). The excitation and emission wavelengths were set at 230 and 315 nm, respectively. Under the described conditions, cocaine eluted in a symmetrical peak with a capacity factor of about 5. The limit of detection was about 1 ng/ml (0.2 ng injected), with a signal-to-noise ratio of 3.(ABSTRACT TRUNCATED AT 250 WORDS)

High-performance liquid chromatographic confirmation of cocaine and benzoylecgonine in biological samples using photodiode-array detection after toxicological screening

In the later stages after intake, the important markers of cocaine abuse are its main metabolites in urine, benzoylecgonine and ecgonine methyl ester. The efficiency of the extraction of amphoteric benzoylecgonine together with cocaine from aqueous media by means of various solvents at various pH values and by means of a mixed solid phase was tested. The extraction of benzoylecgonine with diethyl ether is not efficient, whereas chloroform, dichloromethane or mixed solid-phase extraction give satisfactory results. The analytical strategy for the general chromatographic screening and identification of unknown drugs in biological samples based on diethyl ether extraction was modified to permit the sensitive detection of cocaine abuse also on the basis of benzoylecgonine. A complementary high-performance liquid chromatographic method with photodiode-array detection after solid-phase extraction was introduced for specific confirmation and determination of cocaine and benzoylecgonine.

Cocaine-induced rausch: overt behaviour and plasma concentrations in rhesus monkeys

This study was designed to characterize the cocaine-induced rausch or hyperarousal syndrome in rhesus monkeys. This syndrome mimics the stage observed in human abusers bingeing on cocaine and is considered crucial in the progression from recreational use to compulsive abuse. However, little research has focused on this important aspect of cocaine use. Cocaine was administered i.v. at doses of 0.0, 0.5, 1.0 and 2.0 mg/kg. Plasma concentrations were determined by gas chromatograph mass spectrometry (GC/MS) using deuterated internal standards d3 cocaine and d3 benzoylecgonine (BE). Mean plasma concentrations of cocaine, were on samples collected 1 min after infusion, 46 +/- 31, 88 +/- 15 and 275 +/- 116 mg/microliters in the 0.5, 1.0 and 2.0 mg/kg dose groups, respectively. There were no detectable concentrations of BE in any of the specimens nor was cocaine detected in the saline controls. Analysis of the behavioural data revealed that the 0.5 and 1.0 mg/kg results were intermediate between the results obtained at doses of 0.0 and 2.0 mg/kg and that the 1.0 mg/kg dose produced a higher response than the 0.5 mg/kg dose up to the 12 min. Regarding individual behavioural signs, those designated escape attempts, checking, feinting, restlessness, searching, vocalizing, chewing, crouching and wide-eyed were noted most frequently. The results showed dose-response relationships for both plasma concentrations of cocaine and for the total number of overt behavioural signs. The plasma concentrations were in the range reported for human cocaine abusers.

Gas chromatographic-mass spectrometric determination of plasma and brain cocaine in mice

A gas chromatographic-mass spectrometric method is described for the determination of cocaine in mouse plasma microsamples and brain. Cocaine and [2H3]cocaine were extracted with pentane-isopropyl alcohol (97:3, v/v), chromatographed on a (5% phenyl) methylpolysiloxane capillary column, and detected by selected-ion monitoring of electron impact generated m/z 182 and 185 fragment ions. The small sample size (50 microliters), simplicity of workup, and high response linearity (mean r = 0.9993) distinguish the method. Cocaine was found in mouse brain at approximately 5 times greater concentration than in plasma after 20 or 40 mg/kg subcutaneous doses.

Rapid assay of cocaine, opiates and metabolites by gas chromatography-mass spectrometry

The simultaneous assay of cocaine, opiates and metabolites in small biological samples continues to be a difficult task. This report focuses upon tabulation of important techniques (extraction, derivatization, chromatographic conditions, detection mode, data acquisition) reported over the last decade that were used in the development of assays for these analytes. The most prevalent procedures for extraction of cocaine, opiates and metabolites were liquid-liquid and solid-phase extraction isolation methods. Following extraction analytes were derivatized and analyzed by gas chromatography-mass spectrometry. The technique most often used for chromatographic separation was fused-silica capillary column gas chromatography. Detection generally was performed by selected ion monitoring in the positive-ion electron-impact ionization mode, although full-scan acquisition and positive- and negative-ion chemical ionization methods have been used. It was apparent from the review that there is a continuing need for greater sensitivity and selectivity in the assay of highly potent opiates and for cocaine and metabolites.

Cardiovascular complications of cocaine abuse

Cardiovascular complications are among the most common and dangerous complications of cocaine abuse, ranging from episodic arrhythmias to myocardial infarction, strokes, cardiomyopathy, and sudden death. The central nervous system-mediated action of cocaine triggers an increase in circulating catecholamines, resulting in arterial vasoconstriction, increase in myocardial oxygen demand, myocardial ischemia, tachycardia, and other arrhythmias. The peripheral cardiovascular action of cocaine involves the inhibition of reuptake of catecholamines at adrenergic nerve terminals, with local release of epinephrine, direct stimulation and vasospasm of the coronary arteries, coronary intimal hyperplasia, inhibition of baroreceptors, interference with the electrical conduction through the myocardium, and direct myocardial toxicity. The cardiovascular complications of cocaine include cardiac dysrhythmias and hypertension, acute myocardial infarction, myocarditis, infectious endocarditis, ventricular dysfunction, dilated cardiomyopathy, hypotensive shock, and cerebral strokes. Cocaine-related vascular changes in the pregnant woman and fetus have been related to an increased incidence of abortion, abruptio placentae, and congenital anomalies of the fetus.

“Cocaine-Related” Deaths: Media Coverage in the War on Drugs

A 1989 newspaper story describing twenty-nine cocaine-related deaths in British Columbia is used to illustrate the lands of unwarranted inferences that are propagated by the news media during the current War on Drugs. The newspaper story conveys the impression that most of the deaths involved well-integrated, moderate drug users, that all twenty-nine deaths were caused by cocaine, and that these deaths provided evidence of an epidemic of dangerous cocaine use sweeping the province. However, the coroner's files on which the story was based, and related research, provide strong evidence that all three frightening inferences are wrong. A more careful analysis of these deaths as a consequence of chronic deterioration in a fringe population can contribute to the development of realistic drug policy.

An improved method for the rapid screening of illicit cocaine preparations using high performance liquid chromatography with electrochemical detection

Electrochemical detection in HPLC offers a very sensitive and selective alternative to UV detection for a number of classes of compounds. While there have been no reports of the use of electrochemical detection for the determination of cocaine in illicit preparations or biological fluids, it is now possible to use on-line, continuous post-column photolytic derivatization to generate electroactive species from cocaine which may then be detected downstream using a conventional electrochemical detector operated at oxidative working electrode potentials. In this manuscript the construction, optimization and characterization of system parameters are discussed, and the sensitive and highly selective nature of this novel detection method is demonstrated to be uniquely suited to the rapid identification and quantitation of cocaine in simulated illicit preparations.

Radioimmunoassay of benzoylecgonine in samples of forensic interest

A simple and economical radioimmunoassay for benzoylecgonine in blood or urine is described. Haemolysis, decomposition, common anticoagulants and sodium fluoride do not affect the results. A commercially available antiserum is used at a dilution of 1:600. The tracer is radioiodinated p-hydroxybenzoylecgonine. It is prepared by reacting p-acetoxybenzoic anhydride with methyl ecgonine followed by mild hydrolysis and radioiodination by the Iodo-gen method. The product is purified on a disposable silica cartridge and has a specific activity of about 30 TBq mmol-1. Polyethylene glycol is used to separate the bound and free fractions in the assay. The range of the dose-response curve is 0-400 ng ml-1 benzoylecgonine. The assay is largely specific for benzoylecgonine. Cocaine, ecgonine, methylecgonine and cinnamoyl cocaine have slight or negligible cross-reactivities. The inter-assay coefficient of variation is 7.5% and the recovery of benzoylecgonine from 'spiked' blood is 103%. The 'cut-off' is 20 ng ml-1 benzoylecgonine for both blood and urine. Radioimmunoassay and high-performance liquid chromatography results agree well.