title: Analysis of MT-45, a Novel Synthetic Opioid, in Human Whole Blood by LC-MS-MS and its Identification in a Drug-Related Death.
abstract: MT-45 (1-cyclohexyl-4-(1,2-diphenylethyl)piperazine) is just one of the many novel psychoactive substances (NPS) to have reached the recreational drug market in the twenty-first century; it is however, one of the first designer opioids to achieve some degree of popularity, in a market currently dominated by synthetic cannabinoids and designer stimulants. A single fatality involving MT-45 and etizolam is described. A method for the quantitation of MT-45 in whole blood using liquid chromatography-tandem mass spectrometry was developed and validated. The linear range was determined to be 1.0-100 ng/mL with a detection limit of 1.0 ng/mL, and the method met the requirements for acceptable linearity, precision and accuracy. After analyzing the sample on dilution and by standard addition, the concentration of MT-45 in the decedent's blood was determined to be 520 ng/mL, consistent with other concentrations of MT-45 reported in drug-related fatalities. Etizolam was present at a concentration of 35 ng/mL. This case illustrates the importance of considering non-traditional drugs in unexplained apparent drug-related deaths.
authors.affiliation: NMS Labs, 2300 Welsh Rd, Willow Grove, PA, USA.
authors.forename: Donna
authors.initials: D
authors.lastname: Papsun
authors.affiliation: Department of Pathology, University of Vermont College of Medicine, 89 Beaumont Avenue, Burlington, VT, USA.
authors.forename: Alison
authors.initials: A
authors.lastname: Krywanczyk
authors.affiliation: Vermont Forensic Laboratory, P.O. Box 47, Waterbury, VT, USA.
authors.forename: James C
authors.initials: JC
authors.lastname: Vose
authors.affiliation: Office of the Chief Medical Examiner, 111 Colchester Avenue, Burlington, VT, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bundock
authors.affiliation: NMS Labs, 2300 Welsh Rd, Willow Grove, PA, USA The Center for Forensic Science Research and Education (CFSRE), 2300 Welsh Rd, Willow Grove, PA, USA barry.logan@nmslabs.com.
authors.forename: Barry K
authors.initials: BK
authors.lastname: Logan
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000097:blood* / Q000506:poisoning*; D002851:Chromatography, High Pressure Liquid; D015198:Designer Drugs / Q000506:poisoning; D003975:Diazepam / Q000031:analogs & derivatives / Q000506:poisoning; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D010879:Piperazines / Q000097:blood* / Q000506:poisoning*; D015203:Reproducibility of Results; D053719:Tandem Mass Spectrometry
chemical_list: D000701:Analgesics, Opioid; D015198:Designer Drugs; D010879:Piperazines; C012631:(+,-)-1-cyclohexyl-4-(1,2-diphenylethyl)piperazine; C044610:etizolam; D003975:Diazepam