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Marchei E, Graziano S, Varì MR, Minutillo A, Aquilina V, Pichini S, Rotolo MC. NPS-EQA PART I: Four years' experience in external quality assessment program in Italy for classical and new psychoactive substances analysis in oral fluid. J Pharm Biomed Anal 2024; 243:116084. [PMID: 38452420 DOI: 10.1016/j.jpba.2024.116084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/27/2024] [Accepted: 03/01/2024] [Indexed: 03/09/2024]
Abstract
In 2019, Italian National Institute of Health established an external quality assessment program (EQA) to evaluate the performance of oral fluid testing for classical and new psychoactive substances by laboratories participating in the National Early Warning System collaborative centres. This report presents the results of four rounds between 2019 and 2023. Eleven oral fluid specimens, including 3 blank samples, were prepared by adding different classes of and new psychoactive drugs at known concentrations to pre-screened drug-free oral fluid. False-negative and false-positive results were calculated for the qualitative data evaluation. The quantitative evaluation measured the imprecision and accuracy of the results, in terms of coefficient of variation (CV%) and percent error (ERR%), respectively, with respect to a mean value obtained by reference laboratories. Z-score values were then calculated. Over the years, there has been a significant improvement in false-negative results (from 42.7% in the first year to 19.4% in the last year), but not in false-positive results (from 33.3% in the first year to 22.2% in the last one). In addition to the classic drugs of abuse (e.g. cocaine, amphetamine, methadone), the substances found in false positive samples belonged to the class of synthetic cannabinoids (e.g 5-fluoro CUMYL-PINACA and 5-fluoro-EDMB-PICA), synthetic opioids (e.g butyrylfentanyl) and tryptamines (e.g. 5-methoxy-N-methyl-N-isopropyltryptamine). The four rounds yielded a mean ERR% of approximately 22.1% and a mean CV% of around 41.5%. The participating laboratories demonstrated variable performances in relation to the class of analysed psychoactive substances, as evidenced by the calculated Z-scores. Between 25% and 60% of the reported results in all rounds should be considered satisfactory. EQA is a crucial element of laboratory quality management systems. It promotes continuous improvement and maintains high standards in the field of forensic and clinical drug testing.
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Affiliation(s)
- Emilia Marchei
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy
| | - Silvia Graziano
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy
| | - Maria Rosaria Varì
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy
| | - Adele Minutillo
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy
| | - Valeria Aquilina
- Investigation, Crime and International Security, Università degli Studi Internazionali di Roma - UNINT, Rome, Italy
| | - Simona Pichini
- National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy.
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Cabarcos-Fernández P, Álvarez-Freire I, Rubio NC, Bermejo-Barrera AM, Moreda-Piñeiro A, Sánchez-Sellero I, Tabernero-Duque MJ. Evaluation of an Oral Fluid Collection Device and a Solid-Phase Extraction Method for the Determination of Coca Leaf Alkaloids by Gas Chromatography-Mass Spectrometry. Molecules 2024; 29:592. [PMID: 38338336 PMCID: PMC11154435 DOI: 10.3390/molecules29030592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/10/2024] [Accepted: 01/19/2024] [Indexed: 02/12/2024] Open
Abstract
Some South American countries have ancient traditions that may pose legal problems, such as the consumption of coca leaves, as this can provide positive results for cocaine use after the analysis of biological samples. For this reason, it is necessary to find specific markers that help differentiate legal from illegal consumption, such as tropacocaine, cinnamoylcocaine, and especially hygrine and cuscohygrine. In this work, two techniques for collecting biological samples are compared: the Quantisal® Oral Fluid collection device and passive drooling. Once the samples were collected, they were subjected to solid-phase extraction for subsequent injection into GC-MS. Different validation parameters included in international guides have been studied to evaluate whether the proposed method is valid for the defined purpose, placing special emphasis on the study of the matrix effect and little value on GC-MS analyses. With respect to this parameter, an increase in the signal was found for CUS and t-CIN, but it was not significant for the rest of the substances studied. The recoveries have varied significantly depending on the way of working, being higher when working with standardized areas. After carrying out work with the oral fluid samples collected from laboratory volunteers, the method was applied to two real samples. The results obtained support the need for further research to overcome certain limitations presented by the device.
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Affiliation(s)
- Pamela Cabarcos-Fernández
- Forensic Toxicology Service, Forensic Sciences Institute, Faculty of Medicine, Universidade de Santiago de Compostela, Rúa de San Francisco, s/n, 15782 Santiago de Compostela, Spain; (P.C.-F.); (I.Á.-F.); (N.C.R.); (A.M.B.-B.); (I.S.-S.)
| | - Ivan Álvarez-Freire
- Forensic Toxicology Service, Forensic Sciences Institute, Faculty of Medicine, Universidade de Santiago de Compostela, Rúa de San Francisco, s/n, 15782 Santiago de Compostela, Spain; (P.C.-F.); (I.Á.-F.); (N.C.R.); (A.M.B.-B.); (I.S.-S.)
| | - Nelida Cristina Rubio
- Forensic Toxicology Service, Forensic Sciences Institute, Faculty of Medicine, Universidade de Santiago de Compostela, Rúa de San Francisco, s/n, 15782 Santiago de Compostela, Spain; (P.C.-F.); (I.Á.-F.); (N.C.R.); (A.M.B.-B.); (I.S.-S.)
| | - Ana Maria Bermejo-Barrera
- Forensic Toxicology Service, Forensic Sciences Institute, Faculty of Medicine, Universidade de Santiago de Compostela, Rúa de San Francisco, s/n, 15782 Santiago de Compostela, Spain; (P.C.-F.); (I.Á.-F.); (N.C.R.); (A.M.B.-B.); (I.S.-S.)
| | - Antonio Moreda-Piñeiro
- Trace Element, Spectroscopy and Speciation Group (GETEE), Institute of Materials iMATUS, Department of Analytical Chemistry, Nutrition and Bromatology, Faculty of Chemistry, Universidade de Santiago de Compostela, Avenida das Ciencias, s/n, 15782 Santiago de Compostela, Spain;
| | - Ines Sánchez-Sellero
- Forensic Toxicology Service, Forensic Sciences Institute, Faculty of Medicine, Universidade de Santiago de Compostela, Rúa de San Francisco, s/n, 15782 Santiago de Compostela, Spain; (P.C.-F.); (I.Á.-F.); (N.C.R.); (A.M.B.-B.); (I.S.-S.)
| | - Maria Jesus Tabernero-Duque
- Forensic Toxicology Service, Forensic Sciences Institute, Faculty of Medicine, Universidade de Santiago de Compostela, Rúa de San Francisco, s/n, 15782 Santiago de Compostela, Spain; (P.C.-F.); (I.Á.-F.); (N.C.R.); (A.M.B.-B.); (I.S.-S.)
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Li X, Plotkina N, Bryksin J. Drug Screening of 49 Compounds by Liquid Chromatography-Tandem Mass Spectrometry in Saliva. Methods Mol Biol 2024; 2737:195-214. [PMID: 38036823 DOI: 10.1007/978-1-0716-3541-4_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
In recent years, the use of oral fluid as a testing matrix for drug analysis has become increasingly popular due to its benefits, such as a possibility for direct observation of a sample collection and, thus, a lower risk of adulteration. To address this trend, we have developed a quantitative LC-MS/MS method that can simultaneously analyze 49 commonly prescribed compounds in oral fluid. The assay is performed on an AB Sciex 4500 electrospray ionization mass spectrometer in multiple reaction monitoring mode.
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Affiliation(s)
- Xu Li
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Janetta Bryksin
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA.
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Cheng JYK, Hui JWS, Chan WS, So MH, Hong YH, Leung WT, Ku KW, Yeung HS, Lo KM, Fung KM, Ip CY, Dao KL, Cheung BKK. Interpol review of toxicology 2019-2022. Forensic Sci Int Synerg 2022; 6:100303. [PMID: 36597440 PMCID: PMC9799715 DOI: 10.1016/j.fsisyn.2022.100303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Bobbie Kwok-keung Cheung
- Corresponding author. Government Laboratory, 7/F, Homantin Government Offices, 88 Chung Hau Street, Ho Man Tin, Kowloon, SAR, Hong Kong, China. http://www.govtlab.gov.hk/
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Rossi B, Freni F, Vignali C, Stramesi C, Collo G, Carelli C, Moretti M, Galatone D, Morini L. Comparison of Two Immunoassay Screening Methods and a LC-MS/MS in Detecting Traditional and Designer Benzodiazepines in Urine. Molecules 2021; 27:molecules27010112. [PMID: 35011344 PMCID: PMC8746686 DOI: 10.3390/molecules27010112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/17/2021] [Accepted: 12/21/2021] [Indexed: 12/02/2022] Open
Abstract
Sensitive and specific immunoassay screening methods for the detection of benzodiazepines in urine represent an important prerequisite for routine analysis in clinical and forensic toxicology. Moreover, emerging designer benzodiazepines force labs to keep their methodologies updated, in order to evaluate the reliability of the immunochemical techniques. This study aimed at evaluating the sensitivity and specificity of two different immunoassay methods for the detection of benzodiazepines in urine, through a comparison with the results obtained by a newly developed liquid chromatographic tandem mass spectrometric (LC-MS/MS) procedure. A cohort of authentic urine samples (N = 501) were processed, before and after a hydrolysis procedure, through two immunoassays and an LC-MS/MS method. The LC-MS/MS target procedure was optimized for monitoring 25 different molecules, among traditional and designer benzodiazepines, including some metabolites. At least one of the monitored substances was detected in 100 out of the 501 samples. A good specificity was observed for the two immunoassays (>0.99), independently of the cut-offs and the sample hydrolysis. The new kit demonstrated a fairly higher sensitivity, always higher than 0.90; in particular, a high cross-reactivity of the new immunoassay was observed for samples that tested positive for lorazepam and 7-aminoclonazepam. The two immunoassays appeared adequate to monitor not only traditional benzodiazepines but also new designer ones.
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Andresen Bergström M, Lövgren H, Abrahamsson A, Eriksson EK, Lindbjer Andersson M, Komorowska M, Axelsson MAB. Rethinking Drug Analysis in Healthcare: High-Throughput Analysis of 71 Drugs of Abuse in Oral Fluid using Ion Mobility - High Resolution Mass Spectrometry. J Anal Toxicol 2021; 46:765-775. [PMID: 34746960 DOI: 10.1093/jat/bkab114] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/26/2021] [Accepted: 11/04/2021] [Indexed: 01/22/2023] Open
Abstract
We have identified a clinical need for a sensitive, specific, flexible, comprehensive, and affordable analytical technology to efficiently detect polydrug use. In addition, the current standard practise of surveilled urine sampling is uncomfortable for the patient, hence more patient-friendly sample collection methods are requested. To fill these needs, we have developed and validated a high-throughput liquid chromatography - high resolution mass spectrometry (LC-HRMS) method for analysis of DoA in oral fluid (OF). The method covers a panel of 71 substances including traditional drugs of abuse (DoA), prescription narcotics and new psychoactive substances (NPS), with a guaranteed limit of identification of <3 µg/L for 87% of the analytes. Method validation showed high accuracy (>99.7%), sensitivity (>99.7%) and specificity (100%). Most analytes had a high process efficiency during the salting out liquid-liquid extraction (SALLE) workup and no or only a minor matrix effect during the analysis. We have implemented this method in clinical routine, and present data from 18,579 OF samples collected during routine patient treatment in mainly psychiatric and addiction clinics in West Sweden between September 2020 and June 2021. 71% of the samples were positive and a total of 41,472 DoA findings were detected. Amphetamine (27%), buprenorphine (25%), nordiazepam (18%) and alprazolam (16%) were most prevalent. NPS were detected in 189 samples (1.0%). Occurrence of polydrug use was common, 34% of the positive samples contained three analytes or more and 12% six or more. To the best of our knowledge, this is the first method for comprehensive analysis of DoA in OF using HRMS and the largest dataset published on detection of DoA in OF. With the current complex and variable drug use pattern, this broad, cost-effective and reliable method has largely replaced immunoassay screening in urine in our laboratory.
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Affiliation(s)
- Moa Andresen Bergström
- Laboratory of Clinical Chemistry, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hanna Lövgren
- Laboratory of Clinical Chemistry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Abrahamsson
- Laboratory of Clinical Chemistry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Emma K Eriksson
- Laboratory of Clinical Chemistry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Marta Komorowska
- Laboratory of Clinical Chemistry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Magnus A B Axelsson
- Laboratory of Clinical Chemistry, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Laboratory Medicine, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Riggio M, Dave KA, Koscak B, Blakey M, Appleton C. Impact of Quantisal® Oral Fluid Collection Device on Drug Stability. FRONTIERS IN TOXICOLOGY 2021; 3:670656. [PMID: 35295159 PMCID: PMC8915805 DOI: 10.3389/ftox.2021.670656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 05/31/2021] [Indexed: 11/13/2022] Open
Abstract
The stability of drugs can affect drug tests and interpretations. A comprehensive study to verify drug stability in Quantisal® oral fluid (OF) collection device was undertaken in accordance with Australian standard, AS/NZS 4760:2019 (SAI-Global, 2019). The evaluation was performed for the following drugs: (±) amphetamine, (±) methylamphetamine, (±) 3,4-methylenedioxymethylamphetamine (MDMA), (−)Δ9-tetrahydrocannabinol (THC), cocaine, benzoylecgonine, morphine, codeine, and oxycodone. Stability was assessed at four different storage temperatures over seven time points at ±50% cut-off concentrations (Appendix A, Para A4-4.1, AS/NZS 4760:2019) (SAI-Global, 2019). All drugs were found to be significantly more stable at 4 and –20°C, with stability spanning at least 14 days with percentage change within ±20% from the cut-off concentrations (SAI-Global, 2019). In addition, we report a variation trend with cocaine and benzoylecgonine at elevated temperatures, suggesting hydrolytic decomposition of cocaine and a concomitant increase in benzoylecgonine quantitative values. We confirm the cross-talk by showing that the percentage change in the profile of average cocaine-benzoylecgonine measurement is within the acceptance concentration range of ±20%. This finding highlights the importance of precaution during storage and careful considerations during subsequent interpretation of liquid chromatography-mass spectrometry (LCMS) measurements.
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