Performance of Fentanyl Immunoassays in an ED Patient Population.

BACKGROUND: Fentanyl is a synthetic opioid fueling the current opioid crisis in the United States. While emergency department (ED) visits due to opioid-related overdoses, injection complications, and withdrawals become increasingly more frequent, fentanyl is not detected in routine toxicology testing. We evaluated 2 FDA-approved fentanyl immunoassays in a sampled ED population. METHODS: De-identified, remnant urine specimens (n = 213) collected from patients presenting to a large ED were analyzed using ARK Fentanyl II (ARK II) and Immunalysis SEFRIA (SEFRIA) fentanyl immunoassays on an Architect c16000 (Abbott) analyzer. All discrepant specimens were evaluated by LC-MS/MS. Additionally, polysubstance abuse patterns and trends were analyzed. RESULTS: While intra-assay imprecision was comparable for ARK II and SEFRIA, inter-assay imprecision for ARK II and SEFRIA varied from 8.0% to 1.8% and from 37% to 12.5%, respectively. SEFRIA had a marginally higher false-positivity rate (3%) than ARK II (1%). Both assays had equivalent sensitivity of 95%, with ARK II (99%) having greater specificity than SEFRIA (97%). Fentanyl was detected in 13.7% of drug-panel-positive patient samples and most frequently observed in patients also testing positive for amphetamines and cocaine. Notably, fentanyl was detected in 5.3% of patient samples that were negative for all other drugs in our standard toxicology panel. CONCLUSIONS: A sizable portion of drug-positive samples from our ED were positive for fentanyl, with a subset of patients testing positive for fentanyl alone. Implementation of fentanyl testing into routine toxicology panels can elucidate polysubstance abuse paradigms and capture ED patients that would go undetected in standard panels.

The effects of three chemical algaecides on cell numbers and toxin content of the cyanobacteria Microcystis aeruginosa and Anabaenopsis sp.

Toxic cyanobacteria blooms are a growing concern for public health and safety, due in part to the production of the hepatotoxin microcystin by certain species, including Microcystis aeruginosa. Management strategies for controlling cyanobacteria blooms include algaecide treatments, often with copper sulfate, and more recently oxidizers such as sodium percarbonate that produce hydrogen peroxide. This study assessed the effects of two copper-containing algaecides and one sodium percarbonate-containing algaecide on mitigating cell numbers and toxin content of cultured M. aeruginosa and summer (July) bloom samples of Anabaenopsis sp. in a brackish stormwater detention pond. Monitoring of the bloom revealed that Anabaenopsis sp. was associated with elevated levels of orthophosphate compared to nitrogen (dissolved inorganic nitrogen to phosphorus ratios were 0.19-1.80), and the bloom decline (September-October) was likely due to lower autumn water temperatures combined with potential grazing by the dinoflagellate Protoperidinium quinquecorne. Laboratory-based algaecide experiments included three dose levels, and cyanobacteria cell numbers and microcystin concentrations (particulate and dissolved) were evaluated over 7 d. Following exposure, copper-containing treatments generally had lower cell numbers than either sodium percarbonate-containing or control (no algaecide) treatments. Addition of algaecides did not reduce overall microcystin levels, and a release of toxin from the particulate to dissolved phase was observed in most treatments. These findings indicate that algaecide applications may visibly control cyanobacteria bloom densities, but not necessarily toxin concentrations, and have implications for public health and safety.

Comparison of methods for evaluating acute and chronic toxicity in marine sediments.

Sublethal test methods are being used with increasing frequency to measure sediment toxicity, but little is known about the relative sensitivity of these tests compared to the more commonly used acute tests. The present study was conducted to compare the sensitivity of several acute and sublethal methods and to investigate their correlations with sediment chemistry and benthic community condition. Six sublethal methods (amphipod: Leptocheirus plumulosus survival, growth, and reproduction; polychaete: Neanthes arenaceodentata survival and growth; benthic copepod: Amphiascus tenuiremis life cycle; seed clam: Mercenaria mercenaria growth; oyster: Crassostrea virginica lysosome destabilization; and sediment-water interface testing with mussel embryos, Mytilus galloprovincialis) and two acute methods (amphipod survival with Eohaustorius estuarius and L. plumulosus) were used to test split sediment samples from stations in California. The test with Amphiascus proved to be the most sensitive sublethal test and the most sensitive overall, identifying 90% of the stations as toxic. The Leptocheirus 10-d test was the most sensitive of the acute tests, identifying 60% of the stations as toxic. In general, the sublethal tests were not more sensitive to sediments than the acute tests, with the sublethal tests finding an average of 35% of the stations to be toxic while the acute found 44%. Of the sublethal tests, only the Amphiascus endpoints and Neanthes growth significantly (p

Seasonal variation in lysosomal destabilization in oysters, Crassostrea virginica.

Lysosomal destabilization assays have been used as valuable biomarkers of pollutant exposures in a variety of bivalve and fish species. The responses of oysters, Crassostrea virginica, deployed at and native to various reference and degraded sites were evaluated for lysosomal destabilization during both summer and winter seasons. In both native and deployed oysters, lysosomal destabilization rates tended to be higher during the winter at both reference and polluted sites. There are at least two hypothetical explanations. Greater lysosomal destabilization rates may be related to physiological changes associated with mobilization of nutrient reserves during the winter and gametogenesis. However, lysosomal destabilization in deployed oysters was correlated with tissue metal concentrations. These data also support a second hypothesis that seasonal differences in physico-chemical factors (such as reduced levels of acid volatile sulfides) may increase the bioavailability of metals during the winter so that adverse effects are more pronounced.

Comparative in situ and laboratory sediment bioassays with juvenile Mercenaria mercenaria.

Sediment toxicity assays were conducted with juvenile Mercenaria mercenaria to compare the results of laboratory assays and in situ deployments. Juvenile clams were deployed for one week at a variety of degraded and undegraded sites in Charleston Harbor, South Carolina. USA, during the summers of 1998, 1999, and 2000. Parallel laboratory assays were conducted with sediments collected from the deployment sites. Mortality and a sublethal endpoint, seed clam growth rate, were used to compare toxicity between reference and degraded sites. Growth rates of field-deployed clams tended to be higher than growth rates for laboratory assays, especially at the reference sites. Field studies indicated a higher potential for toxicity than did the laboratory studies at degraded sites. These studies suggest that laboratory assays may underestimate potential sediment toxicity at degraded sites. However, field growth rates may be affected by natural environmental factors (e.g., pH, dissolved oxygen, and salinity), so regression normalization techniques were used to distinguish the effects of these variables from those of contaminants.