Fentanyl is a synthetic opioid used in pain management with a potency 50-100 times that of morphine. Due to fentanyl's high potency, very low dosages are needed to elicit the desired response. Fentanyl is gaining popularity as a drug of abuse. Overdose of fentanyl causes respiratory depression that can lead to death. Fentanyl undergoes N-dealkylation in the liver to its inactive metabolite norfentanyl. Quantitation of fentanyl and its metabolite norfentanyl in whole blood can be performed using liquid chromatography-mass spectrometry. In this method, whole blood samples are spiked with deuterated internal standards for fentanyl and norfentanyl. The samples are alkalized with potassium hydroxide and the drugs are extracted with an organic solvent. Extracts are dried and reconstituted, then injected on LC-MS/MS. They are quantitated using positive ion multiple reaction monitoring (MRM) mode.
Keywords: Fentanyl; Norfentanyl; Opioid crisis; Pain management; Tandem mass spectrometry.
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