= Emerging. More than 5 years before clinical availability. (19.79%)
= Expected to be clinically available in 1 to 4 years. (37.97%)
= Clinically available now. (42.25%)
MSACL 2022 : Gill

MSACL 2022 Abstract

Self-Classified Topic Area(s): Emerging Technologies > Cases in Clinical MS > Unmet Clinical Need Cases

Podium Presentation in De Anza 2 on Thursday at 15:35 (Chair: Melissa Budelier / Imir Metushi)

Opioid Overdose Harm Reduction Drug Checking and Illicit Drug Supply Surveillance by On-site Paper Spray Mass Spectrometry (PS-MS)

Armin Saatchi(1,2), Scott A. Borden(1,2), Taelor M. Zarkovic(1,3), Lucas R. Abruzzi(1,3), Bruce Wallace(2), Dennis K. Hore(2) and Chris G. Gill(1,2,3,4,5)
(1) Applied Environmental Research Laboratories (AERL), Vancouver Island University, Nanaimo, BC, Canada (2) University of Victoria, Victoria, BC, Canada (3) Vancouver Island University, Nanaimo, BC, Canada (4) Simon Fraser University, Burnaby, BC, Canada (5) University of Washington, Seattle, WA, USA

Chris Gill (Presenter)
Vancouver Island University

Presenter Bio: Chris is a Chemistry Professor at Vancouver Island University (Nanaimo, BC) as well as co-director of the Applied Environmental Research Laboratories (AERL). He maintains an active international collaboration network, including the tenure of visiting professorships during sabbaticals in Germany and Italy. He has been awarded the Distinguished Researcher Award at VIU, a Distinguished Chemistry Alumni Award at the University of British Columbia, and has recently moved his laboratories into expanded space in the recently completed VIU Health and Sciences Centre. The AERL conducts pure & applied research, with a central theme the development of direct, online mass spectrometry methods for measurements in complex samples. This has lead to numerous advances for direct environmental, industrial and clinical/bioanalytical measurements. The AERL’s development of mobilized direct mass spectrometry platforms for geospatially resolved quantitative environmental measurements as well as numerous hyphenated methodologies has transformed capacity for in field chemical determinations. Chris’ current research interests continue to involve the development of direct mass spectrometry instrumentation and their applications for direct, real-time chemical measurements. This includes high precision systems and approaches for improved environmental monitoring, clinical diagnostics, forensic testing, and the development and implementation of rapid, on-site drug testing strategies for use in the opioid overdose crisis.

Abstract

INTRODUCTION:
The opioid overdose crisis in Canada has resulted in more unnatural deaths than all other causes, including those from COVID. Alternative strategies are being explored by a wide spectrum of partners, including governments and health agencies, in an attempt to mitigate the societal, economic, and personal harms from illicit drug use. Drug checking has gained considerable interest and is demonstrating efficacy, allowing people who use drugs (PWUD) to submit samples of their illicit drugs for chemical analysis to receive information about the substance they intend to use. Paper spray mass spectrometry (PS-MS) is now in use by our group as a novel, on-site quantitative drug checking strategy, providing significantly increased selectivity, sensitivity and adaptability over existing on-site drug checking technologies. This work demonstrates quantitative, on-site PS-MS drug checking as a valuable tool for harm reduction in the opioid overdose crisis.

OBJECTIVES:
To demonstrate the use and effectiveness of PS-MS as an on-site, rapid, quantitative drug checking strategy for harm reduction drug checking.

METHODS:
All measurements were performed by paper spray tandem mass spectrometry with a high-throughput paper spray ion source (Thermo Scientific™ TSQ Fortis™ triple quadrupole mass spectrometer with a VeriSpray™ source). The quantitative method targeted 95 drugs, and a full scan measurement is used for unknown identification. Small drug samples (~1mg) submitted by PWUD are dissolved in methanol, diluted to within the calibration range, and then directly analyzed on-site in Victoria, BC, Canada, through a collaboration with the Vancouver Island Drug Checking Project. Presented data includes samples from January 2021-present. The time from sample submission to relaying results to a client is on the order of minutes.

RESULTS:
PS-MS results from data collected for over 3000 drug samples demonstrate that it shows excellent promise for on-site drug checking. Less skilled harm reduction personnel can successfully generate reliable PS-MS measurements for PWUD. The method shows a high degree of sensitivity and selectivity (LLOQ < 0.01% in solids). We have detected the unexpected presence of trace levels (0.03 - 0.6%) of carfentanil in samples expected to be fentanyl, and quantified the presence of etizolam and benzodiazepines in >60% of illicit opioid samples. Alternative drug checking is also conducted on-site, and although immunoassay test strips can detect the presence of fentanyl or related analogs, they lack the selectivity to explicitly detect the presence of carfentanil. Low active drug concentrations detected by PS-MS are frequently missed by FT-IR and Raman due to their inherently higher detection limits.

Expected cocaine, methamphetamine, MDMA, and ketamine samples were generally not adulterated with other actives. However, opioid samples (e.g. fentanyls and/or heroin) were frequently adulterated with multiple actives. These commonly included caffeine, etizolam, carfentanil, flualprazolam, flubromazolam, fluorofentanyl and 4-ANPP. Detection of etizolam and benzodiazepines in opioid drugs further highlights the strengths of the PS-MS method: the low levels quantified were frequently not detected by FT-IR, and benzodiazepine immunoassay strips are highly unreliable.

CONCLUSION:
On-site drug checking by PS-MS for harm reduction is effective for use by less skilled harm reduction workers. The ability or provide rapid, sensitive and quantitative drug checking has provided a comprehensive understanding of the high variability of the illicit drug supply composition. Providing rapid and accurate feedback to PWUD to inform better decisions regarding drug use (e.g. reducing dose or discarding dangerous substances) is a significant step forward in reducing harms from a toxic drug supply. PS-MS is presented as a powerful, front-line technology with demonstrated impact in a harm reduction setting. Results inform PWUD and health care professionals alike, providing oversight within a variable and unsafe drug supply.


Financial Disclosure

DescriptionY/NSource
GrantsyesThermo Fisher Scientific
Salaryno
Board MemberyesBoard of Directors, Association of the Chemical Profession of British Columbia
Stockno
ExpensesyesThermo Fisher Scientific
IP Royaltyno

Planning to mention or discuss specific products or technology of the company(ies) listed above:

yes