What’s the buzz in drugs of abuse?

Synthetic drug testing

Forensic toxicology laboratories are seeing an increase in the number of first-time identified psychoactive substances. Illegal drug manufacturers modify the chemical composition of synthetic drugs as a means of avoiding detection by conventional analytical techniques. As a result, laboratories must adopt alternative strategies to allow them to screen for unknown analytes more efficiently, if they are to stay one step ahead.

Laboratories faced with sample matrices containing multiple analyte species (some of which may be unknown) can benefit from adopting an untargeted mass spectrometry (MS) approach. Using full-scan MS and up-to-date analyte local and cloud-based databases, untargeted methods can detect novel drug variants that may have been missed in a more targeted scan. Recent advances in high resolution MS (HRMS) that combine full-scan capabilities with exceptionally high resolution enable both targeted and untargeted screening at high throughputs for comprehensive analysis. Next generation hybrid orbital MS techniques can be coupled with GC and LC separation methods, enabling laboratories to screen for a wide range of drug components.

When combined with crowd-sourced, cloud-based databases that allow information on new analytes to be shared between forensic laboratories, this approach can provide a powerful platform for enforcement authorities to keep pace with new drug variants and subsequently combat drug trafficking.

Lisa Thomas
Senior Director of Marketing, Clinical & Forensic
markets in the Chromatography and Mass Spectrometry group
Thermo Scientific
Manufacturer of Thermo Scientific Quadrupole-Orbitrap Systems

Heroin testing

As health systems intensify their focus on population health management as one strategy to reduce healthcare expenditures, central laboratories can add value for this effort by incorporating heroin testing into their assay menus. Heroin use has reached its highest level in the United States in 20 years.¹ This is creating a significant financial burden on the health system. FAIR Health estimated the national aggregated dollar value for opioid-related diagnoses charges rose more than 1,000 percent from 2011 to 2015 alone.²

While the rise in heroin use in and of itself is a concern, the heroin uptick presents other population health challenges for the health system—higher risks of infectious diseases such as HIV/AIDS, and increased infections resulting from needle sharing. Further, the effect of today’s heroin use is already trickling down to the next generation as the number of drug-dependent newborns facing neonatal abstinence syndrome (NAS) also is increasing.³

While drug panels are generally conducted for opiates, screening for heroin specifically has not mimicked the upward trend of heroin use. Central laboratories have an opportunity to broaden their drug testing menu on the same instruments they already possess to incorporate specific drugs of abuse. This could result in cost savings if they are relying on reference labs for LC/MS confirmation. Ultimately, incorporating a heroin assay offering could enable better patient care by arming providers with information that pertains to the specific symptoms the patient will be facing—such as when treating newborns with NAS.

Jack Kenny
Senior Vice President, Laboratory Diagnostics
Siemens Healthineers North America
Manufacturer of Syva EMIT II Plus 6-Acetylmorphine Assay

REFERENCES

1. United Nations Office on Drugs and Crime World Drug Report. http://www.unodc.org/doc/wdr2016/WORLD_DRUG_REPORT_2016_web.pdf.
2. The Impact of the Opioid Crisis on the Healthcare System FAIR Health Inc., September 2016. http://www.fairhealth.org/servlet/servlet.FileDownload?file=01532000001g4i3.
3. Incidence of Neonatal Abstinence Syndrome – 28 States, 1999-2013. Weekly / August 12, 2016 / 65(31);799–802. http://www.cdc.gov/mmwr/volumes/65/wr/mm6531a2.htm.

Rural communities see steep increase in babies born with opioid withdrawal

The number of babies born with drug withdrawal symptoms from opioids grew substantially faster in rural communities in the United States than in U.S. cities, a new study suggests.

Newborns exposed to opioids in the womb and who experience withdrawal symptoms after birth (known as neonatal abstinence syndrome) are more likely to have seizures, low birthweight, and breathing, sleeping, and feeding problems.

The study, published in JAMA Pediatrics, highlights a dramatic and disproportional rise in opioid-related complications among rural pregnant women and their infants. Researchers from the University of Michigan C.S. Mott Children’s Hospital and Monroe Carell Jr. Children’s Hospital at Vanderbilt University tracked newborns treated for opioid-related issues over 10 years.

They found that in rural areas, the rate of newborns diagnosed with neonatal abstinence syndrome increased from nearly one case per 1,000 births from 2003-2004 to 7.5 from 2012-2013. That’s a surge nearly 80 percent higher than the growth rate of such cases in urban communities.

Using national data, researchers found that between 2012 and 2013, rural infants accounted for more than 21 percent of all infants born with neonatal abstinence syndrome—a large spike from 2003, when rural infants made up only 13 percent of the neonatal abstinence syndrome cases in the U.S.

Geographical differences were mirrored by trends in national maternal opioid use, the study also found. In 2012, maternal opiate use in rural counties was nearly 70 percent higher than in urban counties—eight per 1,000 childbirth hospitalizations, compared to 4.8 in urban counties.

Over the last two decades, the U.S. has seen a surge in prescriptions for opioid pain relievers such as Vicodin and Opana. In recent years, opioid-related complications, both from painkillers and street drugs like heroin, substantially increased in the country, including among pregnant women and their infants. Newborns with the syndrome have a higher risk of adverse outcomes and longer, costlier hospital stays compared to healthy infants.

Pregnant women with opioid use disorder who are treated with drugs like buprenorphine combined with an opioid addiction treatment program have better outcomes when compared to women without access to these services. The study authors suggest that increasing the number of rural doctors authorized to prescribe buprenorphine and expanding rural mental health and substance abuse services are good first steps towards supporting rural moms with opioid addiction.

After a baby is born with signs of opioid withdrawal, however, it is important that community hospitals are staffed and resourced to treat women and infants impacted by opioid use.