Direct analysis in real time mass spectrometry (DART-MS/MS) for rapid urine opioid detection in a clinical setting

• Published in: Clinica chimica acta Vol. 564; p. 119939
• Main Authors: Choucair, Ibrahim, Shang, Emily, Tran, Minh Nguyet, Cassella-McLane, Gina, El-Khoury, Joe M.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.01.2025
• Subjects: DART-MS/MS; Drugs of abuse; LC-MS/MS; Mass spectrometry; Opioid; Pain management; HM; FENT; Opioid; Drugs of abuse; Recovery; NORFENT; LC-MS/MS; MOR; CV; OC; NORBUP; Pain management; NAL; COD; DART-MS/MS; 6MAM; HC; BUP; Mass spectrometry; OM
• ISSN: 0009-8981; 1873-3492; 1873-3492
• DOI: 10.1016/j.cca.2024.119939

•Current immunoassays for opioid detection lack specificity.•DART-MS/MS has the potential to fill the gap between immunoassays and LC-MS/MS.•DART-MS/MS is validated using clinical samples for opioid detection in urine.•DART-MS/MS showed high sensitivity and specificity for detection of most analytes.•Ion ratios can help distinguish between isobaric compound pairs. Current laboratory methods for opioid detection involve an initial screening with immunoassays which offers efficient but non-specific results and a subsequent liquid chromatography-tandem mass spectrometry (LC-MS/MS) confirmation which offers accurate results but requires extensive sample preparation and turnaround time. Direct Analysis in Real Time (DART) tandem mass spectrometry is evaluated as an alternative approach for accurate opioid detection with efficient sample preparation and turnaround time. DART-MS/MS was optimized by testing the method with varying temperatures, operation modes, extraction methods, hydrolysis times, and vortex times. The method was evaluated for 12 opioids by testing the analytical measurement range, percent carryover, precision studies, stability, and method-to-method comparison with LC-MS/MS. DART-MS/MS shows high sensitivity and specificity for the detection of 6-acetylmorphine, codeine, hydromorphone, oxymorphone, hydrocodone, naloxone, buprenorphine, norfentanyl, and fentanyl in urine samples. However, its performance was suboptimal for norbuprenorphine, morphine and oxycodone. In this proof-of-concept study, DART-MS/MS is evaluated for its rapid quantitative definitive testing of opioids drugs in urine. Further research is needed to expand its application to other areas of drug testing.