Transcript Screens and tests for NPS

Screens and tests for NPS
Dr Paul Smith
Consultant Clinical Scientist and Forensic Toxicologist
[email protected]
Screens and tests for NPS
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Where we are now
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Scope for the future
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Potential for treatment / antidotes
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Opportunities in LLR
‘£10 legal high made
me parade naked
through Tesco’
NPS
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Many different terms
- legal highs, designer drugs,
research chemicals
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Stimulant pills / powders
Herbal smoking mixes
Cheap
Readily available
Increasing prevalence
Perception that legal = safe
Many now illegal
Cases of acute toxicity and death
EMCDDA Report 2015
Drug seizures
Immunoassay and GC-MS
• Uses commercial libraries of
drugs and metabolites
• ~1000 drugs and metabolites
• Custom the library
Drug screen by LC-MS/MS
DRUG
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4-MEC
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6-MAM
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Amphetamine
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Benzoylecgonine
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Buprenorphine
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Cocaethylene
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Cocaine
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Codeine
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Diazepam
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Dihydrocodeine
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EDDP
12
Gabapentin
13
MDA
14
MDEA
15
MDMA
16
Mephedrone (MCAT)
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Methadone
18
Methamphetamine
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Methylecgonine
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Midazolam
21
Morphine
22
Nitrazepam
23
Norbuprenorphine
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Nordiazepam
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Oxazepam
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Oxycodone
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Oxymorphone
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Pholcodine
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Pregabalin
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Temazepam
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THC-COOH
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Zopiclone
NOT able to detect synthetic cannabinoids
NPS screen by LC-MS/MS (post-mortem)
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4-Fluoroamphetamine
Paramethoxyamphetamine (PMA)
Paramethoxymethamphetamine (PMMA)
4-Methylthioamphetamine (4-MTA)
Methiopropamine
Cathinone
Cathine
Methcathinone
Flephedrone (4-fluoromethcathinone)
Mephedrone (4-methylmethcathinone)
4-MEC (4-methylethcathinone)
Methedrone (4-methoxymethcathinone)
Benzedrone
Methylone (beta-keto MDA)
Ethylone (beta-keto MDMA)
Butylone
Clephedrone (4-chloromethcathinone)
Benzylpiperazine (BZP)
Trifluoromethylphenylpiperazine (TFMPP)
3-Chlorophenylpiperazine (MCPP)
2-Aminoindane
Methylenedioxyaminoindane (MDAI)
5-Aminopropylindane (5API)
Alpha-methyltryptamine (AMT)
5-Iodoaminoindane (5IAI)
Methylenedioxypyrovalerone (MDPV)
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5-APB / 6-APB
Naphyrone
Propylhexedrine
Methoxetamine
MBDB
DOM
DOET
DOB
Diclofensine
Dimethocaine
Desoxypipradol
Ethylphenidate
Etizolam
Phenazepam
NOT able to detect synthetic cannabinoids
Herbal products containing synthetic cannabinoids
Black Mamba-type
products are usually
sold as herbal preparations containing
inert herbal material
(leaf etc.) saturated
with synthetic cannabinoids (SCs). The
pure SC powder can
also be bought
online.
1st generation
synthetic
cannabinoids
John W. Huffman, Ph.D,
Over 400 JWH compounds
“I always had a hunch that someday
somebody would say: ‘Hey, let’s try
smoking them.’ And lo and behold,
that’s what happened.”
2nd generation synthetic cannabinoids
3rd generation synthetic cannabinoids
High resolution mass spectrometry
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Expensive equipment
Specialist analysis
Targeted and nontargeted screens
High resolution as
opposed to nominal
mass (e.g. 271.5684 not
271)
Full scan mode
Capable of retrospective
compound searching
Clinical cases
Synthetic cannabinoid
detected
Other drugs detected
Extreme agitation in a
psychiatric patient
5F-PB-22
None
Prisoner found collapsed
and fitting. History of black
mamba use.
5F-AKB-48, 5F-PB-22,
MDMB-CHMICA
Mirtazapine, propofol, lignocaine, atracurium
Case
History
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2
Post mortem cases
Case
History
Synthetic cannabinoid
detected
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Mixed drug intake
5F-AKB-48
Diazepam, heroin, cocaine, mirtazapine, propranolol, phenytoin,
olanzapine
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Collapse
5F-AKB-48, 5F-PB-22
None
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Agitation
5F-AKB-48, 5F-PB-23
Amphetamine, cocaine
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Agitation
Heroin, buprenorphine, promethazine, procyclidine, diazpeam,
5F-AKB-48, MDMB-CHMICA gabapentin, lorazepam
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Heroin and mixed drugs
5F-AKB-48, 5F-PB-22
Cocaine, heroin, amphetamine,
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Hanging
5F-AKB-48, 5F-PB-23
Ethanol
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Death in custody
5F-AKB-48, MDMB-CHMICA Diazepam, mirtazapine, amitriptyline, heroin, cocaine, thc
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Dead on sofa
5F-AKB-48, MDMB-CHMICA,
THJ2201
Morphine, lorazepam, 2 aminoindane
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Drowning
AKB-48
THC, promethazine
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Assault
5F-AKB-48, 5F-PB-22
THC, papracetamol
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Unknown
JWH-018
MDPV, ethanol
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Prison death
MDMB-CHMICA
Dihydrocodeine
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Prison death
MDMB-CHMICA
Mirtazapine, alfentanil, prochlorperazine, lignocaine, atracurium,
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Unknown
MDMB-CHMICA
Ibuprofen
Other drugs detected
Signs and symptoms
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CNS: agitation, tremor, anxiety, confusion, somnolence,
syncope, hallucinations, changes in perception, acute
psychosis, nystagmus, convulsions and coma.
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Cardiac: tachycardia, hypertension, chest pain,
palpitations, ECG changes.
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Renal: acute kidney injury.
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Muscular: hypertonia, myoclonus, muscle jerking and
myalgia.
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Other: cold extremities, dry mouth, dyspnoea, mydriasis,
vomiting and hypokalaemia.
Long term effect: no documented evidence
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Treatment
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Supportive – NO ANTIDOTE
Observe patient
ECG
U&Es, creatinine and CK
Agitation and delirium - diazepam, haloperidol
Convulsions - diazepam
Rapid drug test kit
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NPT devices do exist but are limited to specific
compounds
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JWH-018
JWH-073
Opportunities in LLR
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Funding required for equipment to increase
understanding and recognition of NPS including
synthetic cannabinoids
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Epidemiology studies
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Patient monitoring
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Potential to assist treatment decisions
K2/Spice