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 Summary and Future Trends of Clinical Toxicology Testing of Newly Emerging Drugs of Abuse

These cases represent the current trends of "rebranding" the drugs of abuse. The "Molly" bags obtained by the patient in case 1 likely contained Ethylone, but not MDMA, whereas the "heroin" bags obtained by the patient in case 2 likely contained fentanyl and 3-methylfentanyl, but not heroin (diacetylmorphine). These cases also demonstrate the variability in street nomenclature of drugs from different classes and underscore our inability to rely on historical information to accurately identify community drug trends.

Accurate laboratory analysis and drug identification will be critical in guiding individual medical management as well as gathering epidemiologic data to inform timely public health and law enforcement responses. Immunoassay kits for these emerging drugs have been developed and are commercially available; however, besides the aforementioned FDA-cleared fentanyl immunoassay kit, none of them are FDA-cleared for clinical use. If FDA-cleared immunoassay kits are developed, it should improve the overall detection of these emerging drugs of abuse in the clinical cases that are currently unrecognized.

GC-MS has been the gold standard in toxicology testing, and GC-MS-based drug screening is still powerful and useful. But GC-MS has limited utility for detection of synthetic cannabinoids (or Spice). With its simpler and easier sample preparation and better detection capability, LC-MS-MS and even newer LC-HR-MS are gaining popularity for toxicology testing. These new technologies will become new gold standards of toxicology testing in the future.

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