= Emerging. More than 5 years before clinical availability. (16.60%, 2024)
= Expected to be clinically available in 1 to 4 years. (37.02%, 2024)
= Clinically available now. (46.38%, 2024)
MSACL 2024 : Liao

MSACL 2024 Abstract

Self-Classified Topic Area(s): Practical Training > Tox / TDM / Endocrine > Troubleshooting

Podium Presentation in Colton on Wednesday at 13:30 (Chair: Deborah French)

Is the Fentanyl Result Real? Tackling Interfering Substances Amid the Opioid Epidemic

Hsuan-Chieh Liao (1), Briana Fitch (2)
(1)Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA (2)Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA

Hsuan-Chieh (Joyce) Liao, PhD, DABCC, FADLM (Presenter)
University of Washington

Briana Fitch, PhD (Presenter)
University of Southern California

Presenter Bio: Dr. Joyce Liao has more than ten years of clinical and management experience in laboratory medicine. She was a medical laboratory scientist in the newborn screening lab and obtained her Ph.D. degree in Clinical Medicine. She completed postdoctoral fellowship training in Clinical Chemistry at the University of Washington and Seattle Children’s Hospital. She is a board-certified Clinical Chemist and now serves as an Associate Director at Harborview Medical Center, focusing on toxicology and mass spectrometry testing. She continues to focus on the translation of the analytical power of mass spectrometry to real clinical applications. Her interests include toxicology, mass spectrometry, and laboratory utilization.

Presenter Bio: Briana Fitch received a PhD from the University of California San Francisco (UCSF) in Biomedical Sciences where she studied immunological and environmental causes of childhood leukemia. Her research focuses on developing and validating clinical mass spectrometry assays and immunoassays for cytokine measurement.


INTRODUCTION: The surge in illicit fentanyl use has significantly escalated opioid-related overdose fatalities. In response to the ongoing opioid epidemic, clinical laboratories are increasingly incorporating fentanyl-specific testing into their urine drug screening panels, utilizing both immunoassays and LC-MS/MS assays.

OBJECTIVES: This practical training aims to outline the strengths and limitations of LC-MS/MS in detecting fentanyl, offering insights into best practices through case studies and discussions.

METHODS: While immunoassays are cost-effective and rapid, making them ideal for initial screenings, LC-MS/MS is predominantly employed as a confirmatory test due to its superior sensitivity and specificity. However, both immunoassays and LC-MS/MS assays can yield "false positive results" due to interfering substances. High-resolution mass spectrometry may be helpful in identifying these interferences.

RESULTS: Structurally similar compounds, such as fluoroquinolone antibiotics (e.g., ciprofloxacin, ofloxacin, and their metabolites), can trigger cross-reactivity in fentanyl immunoassays. While "false positive results" in LC-MS/MS are uncommon, they can occur due to interfering substances from system reagents, instrument fluidics, or the sample itself. Detecting and resolving these issues requires systematic and logical troubleshooting approaches.

CONCLUSION: The use of LC-MS/MS as confirmatory testing, along with high-resolution mass spectrometry, can effectively identify interfering substances in immunoassays. To ensure accurate drug testing LC-MS/MS results, it is essential to continuously monitor quality metrics and employ strategic troubleshooting to effectively manage and mitigate potential interferences.

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