Metonitazene in the United States-Forensic toxicology assessment of a potent new synthetic opioid using liquid chromatography mass spectrometry
Metonitazene in the United States-Forensic toxicology assessment of a potent new synthetic opioid using liquid chromatography mass spectrometry
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DOI：
10.1002/dta.3115
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发表时间：
2021-06-22
影响因子：
2.9
通讯作者：
Logan, Barry K.
中科院分区：
文献类型：
--
作者：
Krotulski, Alex J.;Papsun, Donna M.;Logan, Barry K.
美托尼塔因被认为是一种新的精神活性物质和新兴的强效合成阿片类药物，从2020年开始引起越来越多的公共卫生问题。Metonitazene加入了越来越多的新合成阿片类药物（NSOs），导致美国和世界其他地区吸毒者死亡。美托硝唑（一种2-苄基苯并咪唑类似物）于2020年年中首次出现在娱乐毒品供应中，随后于2020年底开始在死亡调查个案中激增。通过液相色谱四极杆飞行时间质谱法进行筛选和代谢物发现。通过液相色谱串联四极杆质谱法进行定量确认。在20例真实法医尸检病例中证实了甲硝哒唑，血液中的平均浓度为6.3 +/- 7.5 ng/ml（中位数：3.8 ng/ml，范围：0.5-33 ng/ml，n = 18），尿液中的平均浓度为15 +/- 13 ng/ml（中位数：11 ng/ml，范围：0.6-46 ng/ml，n = 14）。在30%的病例中，美托硝唑是唯一确定的阿片类药物，但也与芬太尼（55%）和苯二氮卓类药物、阿片类药物和致幻剂（45%）联合使用。法医将metonitazene列为导致死亡的药物，死亡方式总是被裁定为意外。代谢的metonitazene被认为是类似的isotonitazene，密切相关的类似物。毒理学实验室和死亡调查人员应确保将metonitazene纳入法医测试协议，同时对随后出现的国家统计局保持警惕。
Metonitazene is considered a new psychoactive substance (NPS) and emerging potent synthetic opioid, causing increased public health concern beginning in 2020. Metonitazene joins a growing list of new synthetic opioids (NSOs) contributing to deaths among people who use drugs in the United States and other parts of the world. Metonitazene (a 2-benzylbenzimidazole analogue) first appeared in mid-2020 in the recreational drug supply and subsequently began proliferating in death investigation casework towards the end of 2020. Screening and metabolite discovery were performed by liquid chromatography quadrupole time-of-flight mass spectrometry. Quantitative confirmation was performed by liquid chromatography tandem quadrupole mass spectrometry. Metonitazene was confirmed in 20 authentic forensic postmortem cases with an average concentration in blood at 6.3 +/- 7.5 ng/ml (median: 3.8 ng/ml, range: 0.5-33 ng/ml, n = 18) and in urine at 15 +/- 13 ng/ml (median: 11 ng/ml, range: 0.6-46 ng/ml, n = 14). Metonitazene was the only opioid identified in 30% of cases but was also found in combination with fentanyl (55%) and NPS benzodiazepines, opioids, and hallucinogens (45%). Medical examiners included metonitazene as a drug responsible for the cause of death, and the manner of death was always ruled to be an accident. The metabolism of metonitazene was found to be similar to that of isotonitazene, a closely related analogue. Toxicology laboratories and death investigators should ensure that metonitazene is included in forensic testing protocols, all while remaining vigilant for subsequent NSOs to emerge.