Hair testing for 3-fluorofentanyl, furanylfentanyl, methoxyacetylfentanyl, carfentanil, acetylfentanyl and fentanyl by LC–MS/MS after unintentional overdose

Abstract

Purpose To demonstrate the usefulness of hair testing to determine exposure pattern to fentanyls. Methods A 43-year-old male was found unconscious with respiratory depression 15 min after snorting 3 mg of a powder labeled as butyrylfentanyl. He was discharged from hospital within 2 days without blood or urine testing. Two locks of hair were sampled 1 month (M1 A: 0-2 cm (overdose time frame); B: 2-4 cm; C: 4-6 cm) and 1 year (Y1: A: 0-2 cm; B: 2-4 cm) later to monitor his exposure to drugs of abuse by liquid chromatography-tandem mass spectrometry after liquidliquid extraction. Results Hair analysis at M1 showed a repetitive exposure to 3-fluorofentanyl (A/B/C: 150/80/60 pg/mg) with higher concentration in segment A reflecting the overdose period. The non-detection of butyrylfentanyl was consistent with the analysis of the recovered powder identified as 3-fluorofentanyl. Furanylfentanyl (40/20/15 pg/mg) and fentanyl (37/25/3 pg/mg) were also detected in hair. The second hair analysis at Y1 showed the use of three new fentanyls, with probably repetitive exposures to methoxyacetylfentanyl (A/B: 500/600 pg/mg), and single or few exposures to carfentanil (2.5/3 pg/mg) and acetyl fentanyl (1/1 pg/mg). A decreasing exposure to 3-fluorofentanyl (25/80 pg/mg), and increasing consumption of furanylfentanyl (310/500 pg/mg) and fentanyl (620/760 pg/mg) were also observed despite methadone treatment initiation. The patient claimed not consuming three out of the six detected fentanyls. Conclusions We report single or repetitive exposure to several fentanyls using hair testing. To our knowledge, this is the first demonstration of 3-fluorofentanyl and methoxyacetylfentanyl in hair samples collected from an authentic abuser.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Development and validation of liquid chromatography‐tandem mass spectrometry targeted screening of 16 fentanyl analogs and U‐47700 in hair: Application to 137 authentic samples

“…The second hair analysis (Y1, segments: A 0–2 cm, proximal; B 2–4 cm) showed the presence of three new fentanyl analogs: methoxyacetylfentanyl (A/B: 500/600 pg/mg), carfentanil (A/B: 2.5/3 pg/mg) and acetyl fentanyl (A/B: 1/1 pg/mg), along with the previously detected fentanyl analogs: 3‐fluorofentanyl (A/B: 25/80 pg/mg), furanylfentanyl (A/B: 310/500 pg/mg), and fentanyl (A/B: 620/760 pg/mg). This case report has recently been reported in the literature 13 . The last reanalyzed sample (No.…”

“…4 and 5), different fentanyl analogs including 3‐fluorofentanyl, methoxyacetylfentanyl, carfentanil, acetylfentanyl, furanylfentanyl, and fentanyl were detected. To our knowledge, this was the first time that 3‐fluorofentanyl and methoxyacetylfentanyl concentrations in segmented hair had been reported 13 . Toxicological data regarding 3‐fluorofentanyl are missing from the literature.…”

“…Most are based on solid phase extraction (SPE) or liquid–liquid extraction (LLE) followed by a LC–MS/MS experiment. However, these techniques have some drawbacks: they are limited by the unavailability of reference standards (RS), 11–15 and the enrichment of the library database by the addition of new multi reaction monitoring (MRM) transitions of new compounds often requires further method optimization. Moreover, targeted screening does not allow retrospective processing of MS data to identify unknown compounds.…”

Fibromyalgia: Recent Advances in Diagnosis, Classification, Pharmacotherapy and Alternative Remedies

“…Since fentanyl can inhibit windup of second pain in FM patients, it can prevent the occurrence of intense summated second pain and thereby reduce its intensity by a greater extent than first or second pains evoked by single stimuli. Among the 70,237 drug-related deaths estimated in 2017 in the US, the sharpest increase occurred among those related to fentanyl analogs with almost 29,000 overdose deaths which represents more than 45% increase from 2016 to 2017 [ 70 ]. Because the numbers of overdoses and deaths due to fentanyl will continue to increase in the coming years, studies are needed to elucidate the physiological mechanisms underlying fentanyl overdose in order to develop effective treatments aimed to reduce the risk of death [ 71 ].…”

Targeted and untargeted detection of fentanyl analogues and their metabolites in hair by means of UHPLC-QTOF-HRMS

“…Unlike blood and urine, hair analysis is increasingly used to detect long-term exposure to toxicologically relevant substances, as it offers a wide diagnostic window basically dependent on the hair length [4]. Hair analysis has been repeatedly used to ascertain past exposure and prevalence of different novel synthetic opioids (NSO) in the consumer's population [5][6][7][8][9][10][11][12][13][14]. The analytical methods currently available are generally based on the targeted detection of a limited and well-defined list of compounds to monitor, usually chosen on the base of the national or international reports, or alerts from national warning systems [15,16].…”