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Castle JW, Syrjanen R, Di Rago M, Schumann JL, Greene SL, Glowacki LL, Gerostamoulos D. Identification of clobromazolam in Australian emergency department intoxications using data-independent high-resolution mass spectrometry and the HighResNPS.com database. J Anal Toxicol 2024:bkae012. [PMID: 38459915 DOI: 10.1093/jat/bkae012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/26/2023] [Accepted: 02/13/2024] [Indexed: 03/11/2024] Open
Abstract
The proliferation of novel psychoactive substances (NPSs) continues to challenge toxicology laboratories. In particular, the United Nations Office on Drugs and Crime considers designer benzodiazepines to be a current primary threat among all NPSs. Herein, we report detection of a new emerging designer benzodiazepine, clobromazolam, using high-resolution mass spectrometry and untargeted data acquisition in combination with a "suspect screening" method built from the crowd-sourced HighResNPS.com database. Our laboratory first detected clobromazolam in emergency department presenting intoxications included within the Emerging Drugs Network of Australia-Victoria project in the state of Victoria, Australia, from April 2022 to March 2023. Clobromazolam was the most frequent designer benzodiazepine detected in this cohort (100/993 cases, 10%). No patients reported intentional administration of clobromazolam, although over half reported exposure to alprazolam, which was detected in only 7% of cases. Polydrug use was prevalent (98%), with phenazepam (45%), methylamphetamine (71%) and other benzodiazepines (60%) most frequently co-detected. This is the first case series published in the literature concerning clobromazolam in clinical patients. The identification of clobromazolam in patients presenting to emergency departments in Victoria demonstrates how high-resolution mass spectrometry coupled with the HighResNPS.com database can be a valuable tool to assist toxicology laboratories in keeping abreast of emerging psychoactive drug use.
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Affiliation(s)
- Jared W Castle
- Department of Toxicology, Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, VIC 3006, Australia
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, VIC 3006, Australia
| | - Rebekka Syrjanen
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, VIC 3006, Australia
- Austin Health, Victorian Poisons Information Centre, Austin Hospital, 145 Studley Road, Heidelberg, VIC 3084, Australia
| | - Matthew Di Rago
- Department of Toxicology, Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, VIC 3006, Australia
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, VIC 3006, Australia
| | - Jennifer L Schumann
- Department of Toxicology, Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, VIC 3006, Australia
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, VIC 3006, Australia
- Monash Addiction Research Centre, Monash University, Moorooduc Highway, Frankston, VIC 3199, Australia
| | - Shaun L Greene
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, VIC 3006, Australia
- Austin Health, Emergency Department, Austin Hospital, 145 Studley Road, Heidelberg, VIC 3084, Australia
- Department of Critical Care, The University of Melbourne, Melbourne Medical School, Grattan Street, Parkville, VIC 3010, Australia
| | - Linda L Glowacki
- Department of Toxicology, Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, VIC 3006, Australia
| | - Dimitri Gerostamoulos
- Department of Toxicology, Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, VIC 3006, Australia
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, VIC 3006, Australia
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Maplesden J, Greene S, Syrjanen R, Di Rago M, Schumann J. An intoxication involving 2-methyl AP-237 and AP-238 from Victoria, Australia: Case report. Drug Test Anal 2024; 16:93-98. [PMID: 37253676 DOI: 10.1002/dta.3524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 05/18/2023] [Accepted: 05/19/2023] [Indexed: 06/01/2023]
Affiliation(s)
| | - Shaun Greene
- Department of Emergency Medicine, Austin Hospital, Melbourne, Australia
- Victorian Poisons Information Centre, Austin Health, Melbourne, Australia
- Department of Critical Care, University of Melbourne, Melbourne, Australia
| | - Rebekka Syrjanen
- Victorian Poisons Information Centre, Austin Health, Melbourne, Australia
- Department of Forensic Medicine, Monash University, Melbourne, Australia
| | - Matthew Di Rago
- Victorian Institute of Forensic Medicine, Monash University, Melbourne, Australia
| | - Jennifer Schumann
- Department of Forensic Medicine, Monash University, Melbourne, Australia
- Victorian Institute of Forensic Medicine, Monash University, Melbourne, Australia
- Monash Addiction Research Centre, Melbourne, Australia
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Mantinieks D, Di Rago M, Drummer OH, Glowacki L, Schumann J, Gerostamoulos D. Quantitative analysis of tetrahydrocannabinol isomers and other toxicologically relevant drugs in blood. Drug Test Anal 2023. [PMID: 38158877 DOI: 10.1002/dta.3632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/09/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024]
Abstract
A multi-analyte liquid chromatography-tandem mass spectrometry (LC-MS/MS) method is described, involving the separation of delta-9-tetrahydrocannabinol (delta-9-THC) and delta-8-THC in addition to other commonly encountered drugs and metabolites. Briefly, sample preparation involved an alkaline liquid-liquid extraction (methyl tert-butyl ether) of blood (100 μl). The solvent layer was transferred, evaporated to dryness, reconstituted, and samples then separated on an Agilent Poroshell 120 EC-C18 100 Å (50 mm × 3.0 mm, 2.7 μm) analytical column using a multi-step gradient elution of 50 mM ammonium formate in water (pH 3.5) and 0.1% formic acid in methanol over 14 min. A SCIEX Triple Quad 6500+ system operating in scheduled multiple reaction monitoring and positive electrospray ionization was used for detection. There were no interferences, and matrix effects were generally acceptable (±20% of neat response). Linearity was achieved within the calibration range, including methylamphetamine (MA) (10-1000 ng/ml), 3,4-methylenedioxy-N-methylamphetamine (MDMA) (10-1,000 ng/ml), cocaine (10-1000 ng/ml), and two THC isomers (1-100 ng/ml). Accuracies of MA, MDMA, cocaine, and two THC isomers were 3.6 to 8.9%, -1.2 to 4%, -5.3 to 5.8%, and -11 to 14%, respectively; while precision estimates of the same were 1.6 to 5.4%, 1.7 to 5.3%, 1.2 to 4.5%, and 2 to 10%, respectively. Autosampler stability and dilution integrity were within acceptable limits, and no carryover was detected at the limit of detection. This validated LC-MS/MS method made the routine identification of both delta-9-THC and delta-8-THC in blood possible.
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Affiliation(s)
- Dylan Mantinieks
- Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, Southbank, Victoria, Australia
- Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia
| | - Matthew Di Rago
- Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, Southbank, Victoria, Australia
- Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia
| | - Olaf H Drummer
- Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, Southbank, Victoria, Australia
- Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia
| | - Linda Glowacki
- Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia
| | - Jennifer Schumann
- Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, Southbank, Victoria, Australia
- Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia
| | - Dimitri Gerostamoulos
- Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, Southbank, Victoria, Australia
- Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia
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Syrjanen R, Greene SL, Castle JW, Di Rago M, Hodgson SE, Abouchedid R, Graudins A, Schumann JL. Non-fatal intoxications involving the novel benzodiazepine clonazolam: case series from the Emerging Drugs Network of Australia - Victoria project. Clin Toxicol (Phila) 2023; 61:290-293. [PMID: 36988452 DOI: 10.1080/15563650.2023.2183105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
INTRODUCTION Clonazolam is an unregistered novel benzodiazepine which emerged in global illicit drug markets in 2014. We describe the clinical features of four cases of non-fatal clonazolam mono-intoxications from patients presenting to emergency departments in Australia. CASES Four patients aged between 16 and 19 years presented to hospital with a sedative toxidrome (Glasgow Coma Scale range 8-13) and elevated heart rate (median heart rate 100 beats per minute, range 92-105) following reported benzodiazepine exposure. Three patients reported the use of a large quantity (7-20 tablets) of Xanax®, a brand of alprazolam not commercially available in Australia. Two patients required nasopharyngeal airway insertion following the development of airway obstruction. The median time to return of a normal conscious state (Glasgow Coma Scale 15) was 23 h (range 5-30 h). Clonazolam (range 0.2-2.1 µg/L) and its main metabolite 8-aminoclonazolam (range 5.9-19.1 µg/L) were the only substances detected by liquid chromatography-tandem mass spectrometry in blood samples of all patients. CONCLUSION Clonazolam intoxication resulted in sedation with mild sinus tachycardia. Three patients who reported multiple tablet exposures experienced prolonged sedation, and two of these patients developed airway obstruction. In this series, clonazolam was unknowingly ingested through possible illicit substitution within an unregulated counterfeit benzodiazepine product.
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Affiliation(s)
- Rebekka Syrjanen
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, Monash University, Southbank, Victoria, Australia
- Austin Health, Victorian Poisons Information Centre, Austin Hospital, Heidelberg, Victoria, Australia
| | - Shaun L Greene
- Austin Health, Victorian Poisons Information Centre, Austin Hospital, Heidelberg, Victoria, Australia
- Austin Health, Emergency Department, Austin Hospital, Heidelberg, Victoria, Australia
- Department of Critical Care, Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Australia
| | - Jared W Castle
- Toxicology Department, Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia
| | - Matthew Di Rago
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, Monash University, Southbank, Victoria, Australia
- Toxicology Department, Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia
| | - Sarah E Hodgson
- Austin Health, Victorian Poisons Information Centre, Austin Hospital, Heidelberg, Victoria, Australia
- Austin Health, Emergency Department, Austin Hospital, Heidelberg, Victoria, Australia
| | - Rachelle Abouchedid
- Austin Health, Victorian Poisons Information Centre, Austin Hospital, Heidelberg, Victoria, Australia
- Bendigo Health, Emergency Department, Bendigo Hospital, Bendigo, Victoria, Australia
| | - Andis Graudins
- Monash Health, Emergency Department, Dandenong Hospital, Dandenong, Victoria, Australia
- Department of Medicine, Clinical Sciences at Monash Health, FMNHS, Monash University, Victoria, Australia
| | - Jennifer L Schumann
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, Monash University, Southbank, Victoria, Australia
- Toxicology Department, Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia
- Monash Addiction Research Centre, Monash University, Frankston, Victoria, Australia
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Gerostamoulos D, Glowacki L, Pricone M, Crump K, Di Rago M, Joubert S, Lynch MJ, Woodford NW, Drummer OH. Fatal Intoxications from a Combination of 4-Fluoroamphetamine and 25C-NBOMe. J Anal Toxicol 2023; 47:191-196. [PMID: 35975553 DOI: 10.1093/jat/bkac059] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/05/2022] [Accepted: 08/15/2022] [Indexed: 11/12/2022] Open
Abstract
Six fatalities have occurred from the ingestion of a combination of new psychoactive substances (NPSs), 4-fluoroamphetamine (4FA) and 2-(4-chloro-2,5-dimethoxyphenyl)-N-[(2-methoxyphenyl)methyl]ethanamine (25C-NBOMe) over a 9-month period. Four of these fatalities (one older female and three young males) were from direct adverse effects of drugs, and one each from a fall while being intoxicated and during restraint. All cases were subject to full postmortem examinations that included collection of femoral blood. The four drug-caused fatalities had postmortem blood concentrations for 4FA and 25C-NBOMe of 330-682 ng/L (median 417) and 1.4-12 ng/mL (median 4.3), respectively. The other two cases (both young males) where death was considered to have been caused indirectly by drug intoxication had 4FA and 25C-NBOMe postmortem concentrations of 21 and 123 ng/mL, and 1.8 and 4.5 ng/mL, respectively. None of these cases showed concentrations of drugs that suggested use of high recreational doses. In one drug-caused death, capsules and a brown powder obtained from the scene were found to contain a mixture of these two NPSs. With the exception of one drug-caused death, other drugs were detected; however, the effects of the two NPSs together were regarded as the primary triggers for the deaths. There were no consistent symptoms or pathology in these cases; however, agitation/aggression was observed in two cases prior to their collapse, with seizures in possibly three cases. Pulmonary and/or cerebral edema was noted in three cases. Potentially significant natural disease (a mildly enlarged heart) was only observed in one drug-caused case. These cases illustrate a possible increased risk of sudden death with this combination of drugs, both of which can elevate serotonin concentrations as well as act as strong stimulants. These cases also illustrate the difficulty in detecting NPS in cases where no prior information is available that might suggest their use.
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Affiliation(s)
- Dimitri Gerostamoulos
- Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
- Department of Forensic Medicine, Monash University, School of Public Health and Preventive Medicine, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
| | - Linda Glowacki
- Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
| | - Maria Pricone
- Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
| | - Kerryn Crump
- Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
| | - Matthew Di Rago
- Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
- Department of Forensic Medicine, Monash University, School of Public Health and Preventive Medicine, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
| | - Samantha Joubert
- Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
| | - Matthew J Lynch
- Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
- Department of Forensic Medicine, Monash University, School of Public Health and Preventive Medicine, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
| | - Noel W Woodford
- Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
- Department of Forensic Medicine, Monash University, School of Public Health and Preventive Medicine, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
| | - Olaf H Drummer
- Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
- Department of Forensic Medicine, Monash University, School of Public Health and Preventive Medicine, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
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Di Rago M, Castle J, Leveque M, Glowacki L, Gerostamoulos D. Rapid semi-automated simplified liquid extraction (SLE) and data processing for 43 drugs of abuse in oral fluid. Toxicologie Analytique et Clinique 2022. [DOI: 10.1016/j.toxac.2022.06.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mantinieks D, Gerostamoulos D, Glowacki L, Di Rago M, Schumann J, Woodford NW, Drummer OH. Postmortem Drug Redistribution: A Compilation of Postmortem/Antemortem Drug Concentration Ratios. J Anal Toxicol 2021; 45:368-377. [PMID: 32815985 DOI: 10.1093/jat/bkaa107] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/13/2020] [Accepted: 08/10/2020] [Indexed: 11/13/2022] Open
Abstract
Postmortem drug redistribution (PMR) is a well-known phenomenon in forensic toxicology with implications for medico-legal death investigations. Paired antemortem (AM) specimen and postmortem (PM) mortuary admission femoral blood drug concentrations from 811 coronial cases were used to construct a retrospective compilation of PM/AM drug concentration ratios for 42 parent drugs and metabolites. The median PM/AM ratios for all antidepressants were > 1 and consistent with PMR In contrast, the median PM/AM ratios of most benzodiazepines were < 1. The antipsychotics were varied (0.63-3.3) and suggest the mixed effects of PMR and drug instability. Amphetamines exhibited no trends (0.90-0.95) and are likely confounded by many factors. The PM/AM ratios of cardiovascular drugs, opioids and other drugs are also reported. This research represents an expansive retrospective compilation of paired AM and PM drug concentrations for many toxicologically relevant drugs. While the median PM/AM ratios demonstrate some drug-dependent trends, there was no obvious relationship between AM specimens and PM femoral blood taken at mortuary admission.
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Affiliation(s)
- Dylan Mantinieks
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank 3006, Victoria, Australia.,Toxicology, Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank 3006, Victoria, Australia
| | - Dimitri Gerostamoulos
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank 3006, Victoria, Australia.,Toxicology, Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank 3006, Victoria, Australia
| | - Linda Glowacki
- Toxicology, Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank 3006, Victoria, Australia
| | - Matthew Di Rago
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank 3006, Victoria, Australia.,Toxicology, Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank 3006, Victoria, Australia
| | - Jennifer Schumann
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank 3006, Victoria, Australia.,Toxicology, Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank 3006, Victoria, Australia
| | - Noel W Woodford
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank 3006, Victoria, Australia.,Toxicology, Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank 3006, Victoria, Australia
| | - Olaf H Drummer
- Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank 3006, Victoria, Australia.,Toxicology, Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank 3006, Victoria, Australia
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Di Rago M, Pantatan S, Hargreaves M, Wong K, Mantinieks D, Kotsos A, Glowacki L, Drummer OH, Gerostamoulos D. High Throughput Detection of 327 Drugs in Blood by LC-MS-MS with Automated Data Processing. J Anal Toxicol 2021; 45:154-183. [PMID: 32451548 DOI: 10.1093/jat/bkaa057] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/20/2020] [Accepted: 04/19/2020] [Indexed: 12/17/2022] Open
Abstract
The described procedure provides a rapid technique for the detection and semi-quantitation of a large number of drugs in blood. This procedure uses a minimal sample volume and employs a one-step liquid extraction and automated data processing to yield rapid turnaround times. A total of 327 of the most commonly used medicinal and illicit drugs in Australia were selected including various amphetamines, anesthetics, antidepressants, antipsychotics, anticonvulsants, benzodiazepines, beta blockers, opioid and nonopioid analgesics, stimulants, THC and a large number of synthetic cannabinoids and other novel psychoactive substances. The extracts were subject to 5-minute chromatography using a Kinetex C18 50 × 4.6 mm 2.6 μm solid-core analytical column and analyzed using a Sciex 3200 Q-TRAP MS-MS (+ ESI, MRM mode, two transitions per analyte). The method was fully validated in accordance with international guidelines. Matrix effects and extraction efficiencies were acceptable with most analytes showing > 80% response and low variation (within 25%RSD). Cannabinoids were most affected by the matrix and yielded poorest recovery values but were still detectable. Precision, accuracy, repeatability and multipoint linearity were assessed for all analytes. The method has been used in routine practice in the forensic toxicology service at the Victorian Institute of Forensic Medicine in over 6000 coronial investigations using both postmortem and clinical blood specimens. This technique has greatly increased throughput, reduced turnaround times and allowed for rapid same-day analysis of results when needed. The method is routinely used in routine overnight testing with results reported to pathologists within 4 h of data acquisition. This rapid toxicological technique is used in conjunction with other investigative processes such as full-body CT imaging, review of case circumstances and medical histories to provide an efficient death investigation process.
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Affiliation(s)
- Matthew Di Rago
- Toxicology, Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia.,Department of Forensic Medicine, Monash University, Clayton, Victoria, Australia
| | - Supranee Pantatan
- Toxicology, Central Institute of Forensic Science, Bangkok, Thailand
| | - Melynda Hargreaves
- Toxicology, Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia
| | - Katherine Wong
- Toxicology, Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia
| | - Dylan Mantinieks
- Toxicology, Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia.,Department of Forensic Medicine, Monash University, Clayton, Victoria, Australia
| | - Alex Kotsos
- Toxicology, Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia
| | - Linda Glowacki
- Toxicology, Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia
| | - Olaf H Drummer
- Toxicology, Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia.,Department of Forensic Medicine, Monash University, Clayton, Victoria, Australia
| | - Dimitri Gerostamoulos
- Toxicology, Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia.,Department of Forensic Medicine, Monash University, Clayton, Victoria, Australia
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Chu M, Rago MD, Mantinieks D, Glowacki L, Woodford NW, Gerostamoulos D, Drummer OH. Time-Dependent Changes in THC Concentrations in Deceased Persons. J Anal Toxicol 2021; 45:1-7. [PMID: 32435813 DOI: 10.1093/jat/bkaa052] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/02/2020] [Accepted: 04/13/2020] [Indexed: 11/13/2022] Open
Abstract
Changes in the concentrations of Δ9-tetrahydrocannabinol (THC) in the postmortem period were investigated in a series of cases by comparing concentrations in blood taken on receipt of the body in the mortuary (admission specimen, AD) with the concentrations obtained in blood taken at autopsy some time later and also from blood specimens taken antemortem. Overall, the median THC concentration in AD blood was 13.7 ng/mL (n = 239, range LOQ-220), while the median concentration at autopsy was 13.8 ng/mL (n = 106, range LOQ-810) and 1.9 ng/mL (n = 147, range LOQ-48) antemortem. Fourteen cases had all three specimens taken from the same decedent. The corresponding AM, AD and PM median concentrations were 4.0 (range LOQ-48), 15.5 (range 4.0-176) and 4.4 ng/mL (LOQ-56), respectively. The median elapsed times from AM to AD and AD to PM were 33 and 97.5 h, respectively. In contrast, acetaminophen showed no change in blood concentration from AM to AD (6.8 and 6.0 mg/L, respectively). These data show large increases in THC concentration in the early postmortem period, followed by a decline, although the median blood concentrations at autopsy were similar to that obtained antemortem. In contrast, when blood was taken from the femoral region, subclavian and heart ventricles sites, in the same case, the THC concentrations, while variable, showed overall no significant difference. These dynamic changes reflect complex phenomenon occurring in deceased persons and will further serve to increase the uncertainty over any interpretation of postmortem THC concentrations.
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Affiliation(s)
- Mark Chu
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria 3006, Australia.,Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
| | - Matthew Di Rago
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria 3006, Australia.,Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
| | - Dylan Mantinieks
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria 3006, Australia.,Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
| | - Linda Glowacki
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
| | - Noel W Woodford
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria 3006, Australia.,Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
| | - Dimitri Gerostamoulos
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria 3006, Australia.,Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
| | - Olaf H Drummer
- Department of Forensic Medicine, Victorian Institute of Forensic Medicine, 65 Kavanagh Street, Southbank, Victoria 3006, Australia.,Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, 65 Kavanagh Street, Southbank, Victoria 3006, Australia
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10
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Drummer OH, Gerostamoulos D, Di Rago M, Woodford NW, Morris C, Frederiksen T, Jachno K, Wolfe R. Odds of culpability associated with use of impairing drugs in injured drivers in Victoria, Australia. Accid Anal Prev 2020; 135:105389. [PMID: 31812899 DOI: 10.1016/j.aap.2019.105389] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 11/25/2019] [Accepted: 11/28/2019] [Indexed: 06/10/2023]
Abstract
Culpability analysis was conducted on 5000 drivers injured as a result of a vehicular collision and in whom comprehensive toxicology testing in blood was conducted. The sample included 1000 drivers for each of 5 years from approximately 5000-6000 drivers injured and taken to hospital in the State of Victoria. Logistic regression was used to investigate differences in the odds of culpability associated with alcohol and drug use and other selected crash attributes using the drug-free driver as the reference group. Adjusted odds ratios were obtained from multivariable logistic regression models in which other potentially explanatory driver and crash attributes were included. Drivers with alcohol present showed large increases in the odds of culpability similar to that seen in other studies investigating associations between blood alcohol concentration and crash risk. Methylamphetamine also showed a large increase in the odds of culpability (OR 19) compared to the reference group at both below and above 0.1 mg/L, whereas those drivers with Δ9-tetrahydrocannabinol (THC) present showed only modest increase in odds when all concentrations were assessed (OR 1.9, 95 %CI 1.2-3.1). Benzodiazepines in drivers also gave an increase in odds (3.2, 95 %CI 1.6-6.1), but not other medicinal drugs such as antidepressants, antipsychotics and opioids. Drivers that had combinations of impairing drugs generally gave a large increase in odds, particularly combinations of alcohol with THC or benzodiazepines, and those drivers using both THC and methamphetamine.
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Affiliation(s)
- Olaf H Drummer
- Victorian Institute of Forensic Medicine and the Department of Forensic Medicine, Monash University, School of Public Health and Preventive Medicine, 65 Kavanagh Street, Southbank 3006, Victoria, Australia.
| | - Dimitri Gerostamoulos
- Victorian Institute of Forensic Medicine and the Department of Forensic Medicine, Monash University, School of Public Health and Preventive Medicine, 65 Kavanagh Street, Southbank 3006, Victoria, Australia
| | - Matthew Di Rago
- Victorian Institute of Forensic Medicine and the Department of Forensic Medicine, Monash University, School of Public Health and Preventive Medicine, 65 Kavanagh Street, Southbank 3006, Victoria, Australia
| | - Noel W Woodford
- Victorian Institute of Forensic Medicine and the Department of Forensic Medicine, Monash University, School of Public Health and Preventive Medicine, 65 Kavanagh Street, Southbank 3006, Victoria, Australia
| | - Carla Morris
- Road Policing Drug and Alcohol Section, Victoria Police, 20 Dawson St., Brunswick 3056, Victoria, Australia
| | - Tania Frederiksen
- Road Policing Drug and Alcohol Section, Victoria Police, 20 Dawson St., Brunswick 3056, Victoria, Australia
| | - Kim Jachno
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Victoria, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne 3004, Victoria, Australia
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11
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Mantinieks D, Wright P, Di Rago M, Gerostamoulos D. A systematic investigation of forensic hair decontamination procedures and their limitations. Drug Test Anal 2019; 11:1542-1555. [DOI: 10.1002/dta.2681] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/03/2019] [Accepted: 08/05/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Dylan Mantinieks
- Department of Forensic Medicine Monash University Southbank VIC 3006 Australia
- Victorian Institute of Forensic Medicine 65 Kavanagh Street Southbank VIC 3006 Australia
| | - Paul Wright
- School of Health and Biomedical Sciences RMIT University PO Box 71 Bundoora VIC 3083 Australia
| | - Matthew Di Rago
- Department of Forensic Medicine Monash University Southbank VIC 3006 Australia
- Victorian Institute of Forensic Medicine 65 Kavanagh Street Southbank VIC 3006 Australia
| | - Dimitri Gerostamoulos
- Department of Forensic Medicine Monash University Southbank VIC 3006 Australia
- Victorian Institute of Forensic Medicine 65 Kavanagh Street Southbank VIC 3006 Australia
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12
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Abstract
An overview of the detection of benzodiazepines and their respective metabolites and target analytes in urine by LC-MS/MS is described. This overview shows substantial differences in the approach to detection using this technique including optional use of β-glucuronidase to hydrolyze conjugates present in urine. There are also significant variations in the extraction method employed from the use of direct injection, liquid-liquid extraction to solid-phase extraction options, with little apparent difference in limits of detection. Chromatography was largely based on the use of C18-bonded columns; however both C8- and phenyl-bonded columns were used to affect separation. Modern-day tandem mass spectrometers are capable of exceptional sensitivity enabling detection of sub-nanogram per milliliter amounts in urine, which provide for longer detection times in the urine of suspected drug-facilitated assaults. A method employed in the laboratory of the authors is provided by way of an example for readers wishing to establish a method in their own laboratory.
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Affiliation(s)
- Olaf H Drummer
- Faculty of Medicine, Nursing and Health Sciences, Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, Southbank, VIC, Australia.
| | - Matthew Di Rago
- Faculty of Medicine, Nursing and Health Sciences, Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, Southbank, VIC, Australia
- Victorian Institute of Forensic Medicine, Southbank, VIC, Australia
| | - Dimitri Gerostamoulos
- Faculty of Medicine, Nursing and Health Sciences, Department of Forensic Medicine, School of Public Health and Preventive Medicine, Monash University, Southbank, VIC, Australia
- Victorian Institute of Forensic Medicine, Southbank, VIC, Australia
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13
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Maas A, Maier C, Iwersen-Bergmann S, Pilgrim JL, Di Rago M, Madea B, Hess C. Propofol and propofol glucuronide concentrations in hair following medical propofol administration and in forensic death cases. Forensic Toxicol 2018. [DOI: 10.1007/s11419-017-0399-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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14
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Boumba VA, Di Rago M, Peka M, Drummer OH, Gerostamoulos D. The analysis of 132 novel psychoactive substances in human hair using a single step extraction by tandem LC/MS. Forensic Sci Int 2017; 279:192-202. [PMID: 28910664 DOI: 10.1016/j.forsciint.2017.08.031] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/01/2017] [Accepted: 08/29/2017] [Indexed: 12/19/2022]
Abstract
A rapid LC-MS/MS method for the targeted screening of 132 NPS in hair is described. Drugs include cathinones and synthetic cannabinoids, as well as amphetamine-type stimulants, piperazines and other hallucinogenic compounds. This method utilizes hair pulverization in acidified methanol followed by analysis using liquid chromatography coupled with tandem MS. The limit of detection varied from 0.001 to 0.1ng/mg hair among the various analytes. The method was validated in terms of sensitivity, selectivity, repeatability and stability. The limit of reporting was set at 0.1ng/mg of hair. The method was successfully applied to 23 medico-legal cases where NPS were detected in blood or where NPS use was suspected. The identified NPS included acetyl fentanyl, 25C-NBOMe, MDPV, PB-22 and AB-FUBINACA, allowing hair to be used where historical or retrospective information on use of NPS is sought. This technique has proven to be efficient for the one step extraction from hair of different classes of NPS in routine toxicological investigations; from unstable and volatile compounds, such as most of the cathinones, to hydrophobic compounds such as synthetic cannabinoids.
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Affiliation(s)
- Vassiliki A Boumba
- Department of Forensic Medicine, Monash University, Australia; Laboratory of Forensic Medicine & Toxicology, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece.
| | - Matthew Di Rago
- Department of Forensic Medicine, Monash University, Australia; Victorian Institute of Forensic Medicine, 65 Kavanagh St., Southbank, Victoria 3006, Australia
| | - Melissa Peka
- Victorian Institute of Forensic Medicine, 65 Kavanagh St., Southbank, Victoria 3006, Australia
| | - Olaf H Drummer
- Department of Forensic Medicine, Monash University, Australia; Victorian Institute of Forensic Medicine, 65 Kavanagh St., Southbank, Victoria 3006, Australia
| | - Dimitri Gerostamoulos
- Department of Forensic Medicine, Monash University, Australia; Victorian Institute of Forensic Medicine, 65 Kavanagh St., Southbank, Victoria 3006, Australia
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15
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Rodda LN, Pilgrim JL, Di Rago M, Crump K, Gerostamoulos D, Drummer OH. A Cluster of Fentanyl-Laced Heroin Deaths in 2015 in Melbourne, Australia. J Anal Toxicol 2017; 41:318-324. [DOI: 10.1093/jat/bkx013] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 01/12/2017] [Indexed: 11/13/2022] Open
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16
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Di Rago M, Chu M, Rodda LN, Jenkins E, Kotsos A, Gerostamoulos D. Ultra-rapid targeted analysis of 40 drugs of abuse in oral fluid by LC-MS/MS using carbon-13 isotopes of methamphetamine and MDMA to reduce detector saturation. Anal Bioanal Chem 2016; 408:3737-49. [DOI: 10.1007/s00216-016-9458-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 02/14/2016] [Accepted: 03/01/2016] [Indexed: 10/22/2022]
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