Krotulski AJ
Virtual Symposium for Forensic Toxicology- 2020 Webinar MeetingNovel psychoactive substances (NPS) are responsible for increased morbidity and mortality as new drugs emerge on a weekly to monthly basis. NPS identification are generally underestimated or underrepresented due to lack of testing or knowledge about new drugs. The lack of centralized programs to accurately track and monitoring NPS identifications or intoxications make it difficult for forensic toxicologists to remain abreast to synthetic drug related trends or issues.
As a result, NPS Discovery (www.npsdiscovery.org) has developed a program to evaluate forensic toxicology samples for emerging NPS not previously identified in the biological samples and to disseminate information to national and international stakeholders. Remaining at the forefront of NPS trends is critical to tackling analytical and interpretative issues in forensic toxicology.
As a general workflow, CFSRE receives extracts of blood and urine samples, correlating to cases of suspected NPS use, from NMS Labs for re-analysis (i.e. sample-mining). This process allows for direct discovery of analytes not targeted within the initial scopes of testing (e.g. new synthetic drugs). Extracts are analyzed using a Sciex TripleTOF® 5600+ quadrupole time-of-flight mass spectrometer coupled with a Shimadzu Nexera XR ultra high performance liquid chromatograph (LC-QTOF-MS). SWATH™ acquisition is used for isolation of product ions following the acquisition of precursor ions by TOF MS scan. In addition to NPS discovery, this non-targeted analytical approach allows for complex drug characterization (e.g. combinations, metabolism, etc.).
Since 2018, more than 65 NPS have been identified for the first time nationally or internationally through our NPS Discovery program. Of these drugs includes 16 opioids, 6 opioid precursors, 13 synthetic cannabinoids, 17 stimulants, 9 hallucinogens, and two benzodiazepines. Success stories include the identification and dissemination of information regarding the emerging NPS 4F-MDMB-BINACA and isotonitazene. Both were identified through NPS Discovery for the first time in the United States. In early 2020, isotonitazene is the most prominent NPS opioid on the market, while 4F-MDMB-BINACA is the second most prevalent synthetic cannabinoid. Due to the rapid proliferation of emerging NPS, public health alerts are often issued to address the lack of awareness, their involvement in forensic and clinical casework, and the need for inclusion in testing scopes.
Forensic toxicologists should be aware of emergent NPS, as drug-specific popularity continues to increase. Laboratories should consider addition of emerging NPS to blood and urine testing procedures, incorporating metabolites when known and/or available. Novel procedures for the discovery of drugs and/or NPS missed during standard targeted analysis should be more widely implemented in forensic toxicology.
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