Qualitative Identification of Fentanyl Analogs and Other Opioids in Postmortem Cases by UHPLC-Ion Trap-MSn

Area of Science:

• Forensic Toxicology
• Analytical Chemistry
• Public Health

Background:

• Opioid-related deaths in Miami-Dade County have significantly increased since 2013.
• This rise is largely attributed to the introduction of fentanyl and its analogs into the illicit drug supply.
• Novel fentanyl analogs, including carfentanil, have emerged, posing a critical challenge to public health.

Purpose of the Study:

• To develop and validate a sensitive method for identifying numerous opioid-related compounds in postmortem samples.
• To address the growing epidemic of fentanyl and analog-related deaths in Miami-Dade County.
• To improve the accuracy and efficiency of toxicological analysis in determining the cause of death.

Main Methods:

• Ultra-high-performance liquid chromatography ion trap mass spectrometry (UHPLC-ITMS) with MSn capabilities was employed.
• The validated method could detect 44 opioid-related and analgesic compounds with limits of detection ranging from 0.1 to 5 ng/mL.
• Analysis was performed on approximately 500 postmortem specimens (blood, urine, liver, brain).

Main Results:

• Out of ~500 postmortem cases analyzed, 375 tested positive for illicit fentanyl and/or its analogs.
• Carfentanil was detected in 134 cases, with 104 of these initially missed by gas chromatography-mass spectrometry (GC-MS).
• The presence of these potent compounds was frequently a contributing factor in the cause of death.

Conclusions:

• The developed UHPLC-ITMS method is highly sensitive and specific for detecting fentanyl and its analogs in postmortem toxicology.
• This advanced screening procedure is crucial for accurately identifying novel and potent synthetic opioids, aiding medical examiners.
• The method's incorporation into the workflow enhances the toxicology laboratory's ability to assist in determining cause and manner of death in complex cases.