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Advances in fentanyl testing.

Sacha Uljon1

  • 1Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.

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Accessible fentanyl testing is crucial for public health. While immunoassays and fentanyl test strips (FTS) offer point-of-care options, mass spectrometry provides greater accuracy for detecting fentanyl and novel synthetic opioids (NSO).

Keywords:
Drug testingDrugs of abuseFentanyl testingImmunoassayLC–MS/MSMass spectrometryNSOOral fluidToxicology

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Area of Science:

  • Forensic Toxicology
  • Analytical Chemistry
  • Public Health

Background:

  • Fentanyl and novel synthetic opioids (NSO) present a growing public health crisis.
  • Accessible testing for fentanyl and NSO in biological specimens and drugs is essential.
  • Current immunoassay methods have limitations in availability, clinical approval, and detection range for fentanyl analogs and NSO.

Purpose of the Study:

  • To review the current landscape of fentanyl and NSO testing methods.
  • To compare the capabilities and limitations of immunoassays versus mass spectrometry for detecting these substances.
  • To assess the utility of various testing approaches in harm reduction programs.

Main Methods:

  • Review of available immunoassay technologies, including point-of-care tests (POCT) like fentanyl test strips (FTS).
  • Evaluation of mass spectrometry (MS) techniques, particularly liquid chromatography-tandem mass spectrometry (LC-MS/MS), for fentanyl and norfentanyl detection.
  • Comparison of immunoassay and MS methods regarding specificity, sensitivity, cost, technical skill, and turnaround time.

Main Results:

  • Immunoassays are widely available but have restricted clinical use and variable accuracy for fentanyl analogs and NSO.
  • Mass spectrometry offers high specificity and sensitivity for fentanyl and its metabolite, norfentanyl, in urine and oral fluid.
  • Newer MS methods can detect fentanyl analogs and NSO, though they are more costly and require specialized expertise.

Conclusions:

  • Both immunoassays (FTS) and mass spectrometry have roles in harm reduction strategies for fentanyl and NSO.
  • Mass spectrometry provides superior accuracy and broader detection capabilities compared to immunoassays.
  • Further development and accessibility of accurate testing methods are critical for addressing the synthetic opioid crisis.