Newly Emerging Drugs of Abuse and Their Detection Methods

An ACLPS Critical Review

Li Liu, MD, PhD; Sarah E. Wheeler, PhD; Raman Venkataramanan, PhD; Jacqueline A. Rymer, MT(ASCP); Anthony F. Pizon, MD; Michael J. Lynch, MD; Kenichi Tamama, MD, PhD

Disclosures

Am J Clin Pathol. 2018;149(2):105-116. 

In This Article

Case Descriptions

Case 1 was a 25-year-old woman with medical history of polysubstance abuse who was found unresponsive in her home. She regained consciousness after receiving naloxone intramuscularly and was brought into the emergency department. She admitted to taking "Percocet" and "Molly." The initial urine drug screening immunoassay panel was positive for opiate and oxycodone Table 1, whereas gas chromatography–mass spectrometry (GC-MS)-based untargeted urine comprehensive drug screening detected oxycodone and ethylone. 3,4-Methylenedioxy-N-methylamphetamine (MDMA or "Molly") was not detected.

Case 2 was a 33-year-old man with medical history of polysubstance abuse who became unresponsive and was brought into the emergency department. He regained consciousness after receiving naloxone intramuscularly. He admitted to taking 10 bags of "heroin" intravenously before losing consciousness. The initial urine drug screening immunoassay panel was negative (Table 1); however, the GC-MS–based untargeted urine comprehensive drug screening detected fentanyl and methylnorfentanyl (a metabolite of 3-methylfentanyl), but not heroin or its metabolites.

In these cases, patients histories appear discordant with laboratory findings, but these are typical scenarios that reflect the current drug abuse epidemic and emerging drugs of abuse. In this article, we will review not only these issues, but also the challenges and limitations of current laboratory testing as it relates to emerging drugs.

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