Psychoactive substances in blood: methods of toxicological analysis and prevalence of use on patients with traumatic injuries

Author(s)

Henrique Silva Bombana

• Document type: Doctoral Thesis
• Press: São Paulo.
• Institution: Universidade de São Paulo (USP). Faculdade de Medicina (FM/SBD)
• Defense date: 2021-06-25

Examining board members

Vilma Leyton; Julia Maria D Andrea Greve; Julio de Carvalho Ponce; Maurício Yonamine

• Advisor: Vilma Leyton

Abstract

Forensic toxicology is applied in different contexts, like medico-legal investigation to determine cause of death, monitoring the use of alcohol and drugs among drivers, fatal exposure to intoxicants and others. Forensic and analytical toxicology are, most of the times, used together. Therefore, a robust and trustworthy analysis is required. Green Analytical Chemistry aims for the reduction on the use of toxic solvents and residues to discard after analysis. In this field many novel analytical methods gained attention, such as liquid and solid phase microextractions and its variations. The present work aimed on the development and validation of methods using liquid and solid phase microextraction using whole blood samples for the determination of amphetamine-type stimulants (amphetamine, methamphetamine, fenproporex, 3,4-metilendioximethamphetamine - MDMA, 3,4-metilendioxiamphetamine - MDA and 3,4-metilendioxiethylamphetamine - MDEA), cocaine and products of biotransformation (anhydroecgonine methyl ester - AEME, cocaethylene and benzoylecgonine) and cannabinoids. Besides, the validated methods were applied on blood samples from patients attended and hospitalized at the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), in order to assess the consumption of those substances by trauma patients, also to verify the profile of the attended injured patients. Liquid phase microextraction were used for the amphetamine-like stimulants and cocaine and its derivatives, while solid phase microextraction for the determination of cannabinoids. All the analytical methods were developed and validated accordingly to international guidelines and all the parameters were within the values requested. Therefore, all the three methods presented good results for precision, bias, linearity, recovery, and dilution integrity. Both techniques are easy to perform and could be introduced in a laboratory routine. The analysis of the samples of the injured patients pointed that 31.4% of them used at least one substance before injury. Alcohol was the most prevalent (22.9%) followed by cocaine (12.2%) and cannabis (5%). No amphetamine-type stimulants were detected. Road traffic crashes corresponded for the main injury mechanism (55.5% of the included patients) and motorcyclists were the majority of the patients. Among drivers, one in each three, resented positive results for at least one substance. Patients that consumed any substance before injury were mostly males, younger than those who did not consume any drug, completed high school and were mostly single. Accidents involving the consumption of drugs were more likely to happen during nighttime (AU)

• FAPESP's process: 17/13882-2 - Illicit drugs in blood samples: new methodologies for toxicological analysis
• Grantee: Henrique Silva Bombana
• Support Opportunities: Scholarships in Brazil - Doctorate