Fentanyl Analog Detection: Analytical Challenges in the Synthetic Opioid Epidemic
This review covers the epidemiology of illicit fentanyl and fentanyl analogs (FAs) and the analytical methods available to identify them, including immunoassays, LC-MS/MS, and emerging technologies for previously undescribed analogs. Standard urine drug screens frequently miss novel FAs, making mass spectrometry essential for forensic and clinical toxicology laboratories. The compilation of structural and mass spectral data provides a critical reference for labs adapting their workflows to keep pace with rapidly evolving illicit drug formulations.
The original study
The Fentanyl Epidemic and Evolution of Fentanyl Analogs in the United States and the European Union.
- Authors
- Jannetto PJ, Helander A, Garg U, Janis GC, Goldberger B, Ketha H
- Journal
- Clinical chemistry
- Type
- Journal Article, Review
- PMID
- 30305277
Original abstract
BACKGROUND: Since 2013, an unprecedented surge in fentanyl overdose deaths has been caused by heroin laced with illicitly produced fentanyl and/or fentanyl analogs (FAs) sold as heroin. The US Drug Enforcement Agency's National Forensic Laboratory Information System reported a >300% increase in fentanyl encounters from 4697 in 2014 to 14440 in 2015. In 2015, the CDC reported 9580 deaths caused by synthetic opioids, primarily fentanyl, a 72% increase from 2014. The European Monitoring Centre for Drugs and Drug Addiction has also encountered several new FAs in the heroin supply. Counterfeit pharmaceuticals containing mixtures of fentanyl and FAs continue to be a poorly recognized worldwide problem despite the WHO classifying several FAs as a serious threat to public health. CONTENT: This review covers the epidemiology of fentanyl abuse and discusses the clinical practice implications of widespread fentanyl abuse. It includes a historical perspective on the illicit FAs that have appeared in the US and European Union and reviews the methods available to identify FAs and emerging technologies useful for identifying previously undescribed analogs. A compilation of structural and mass spectral data on FAs reported thus far is provided. SUMMARY: Fentanyl and FAs have evolved into a global public health threat. It is important to understand the analytical, clinical, and regulatory efforts underway to assist communities affected by the current fentanyl epidemic.