MSACL 2022 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.