Chromatography Investigates the US Opioid Epidemic

The US is in the midst of what has been described as an opioid epidemic by no less of an authority than the U.S Department of Health and Human Services (HHS). The numbers are quite startling - and when compared with heroin, are put into even greater context. In the most recent drug survey that the HHS has reported, there were 15,482 deaths due to heroin - but 28,466 deaths attributed to overdoses on synthetic opioids. And whilst 81,00 tried heroin for the first time, an estimated 2 million people misused prescription opioids for the first time. Clearly, epidemic is an apt description.

Opioids form a crisis

The roots of the crisis belong in the 1990s, when pharmaceutical companies said that the opioid pain relievers they had developed would not cause addiction in patients that had them prescribed. So, healthcare providers began to prescribe the drugs in greater numbers. But increased prescription of opioid medicines led to increased misuse of prescription and non-prescription opioids. It soon became clear that the opioid medications could be highly addictive.

Opioids disrupt pain signals by binding to receptors in the brain and spinal cord. They also activate reward areas of the brain by releasing dopamine which can create a feeling of wellbeing. Natural opioids - morphine and codeine - are derived from opium poppy plants. Heroin is derived from morphine. Semi-synthetic opioids - hydrocodone - are derived from natural and synthetic ingredients. Then there are fully synthetic opioids like fentanyl - originally developed as an anaesthetic for surgery - is 100 times as powerful as morphine. Illicitly produced fentanyl has been a driving factor in the number of deaths in recent years.

Chromatography analyses the deaths

A recent report in the Journal of Forensic Sciences has looked at the opioid epidemic in Wisconsin during the years 2013-2017. The report states: illicit opioids as the leading cause of non‐natural death—surpassing all other categories; for example, homicide, motor vehicle accidents and suicide, and documents the recent emergence of fentanyl/fentanyl analogs as the most deadly and dominant opioid agents causing non‐natural deaths.

To confirm that a death is due to an opioid requires an autopsy and toxicology testing. Blood is the preferred specimen when testing for death determination. The preferred method of the toxicology testing of blood post-mortem are gas and liquid chromatography. Using chromatography to test blood samples is the topic of the article, Heterogeneity of Glycated Haemoglobin as Revealed by Chromatography, Isoelectric Focusing and Mass Spectrometry: The A1c Test Standardisation and Assessment of Individual Variabilities in Haemoglobin Glycation.

The report concludes with: ‘This report documents the primacy of illicit heroin and fentanyl as the cause of deaths from opioid drugs and are responsible for the huge surge in opioid deaths in from 2015 to 2017.’ The authors state that although heroin deaths increased, the real surge in overdose deaths came from fentanyl and its analogues.