- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05740657
Hair Analysis of Fentalogs by Liquid Chromatography-tandem Mass-spectrometry (LC-MS/MS)
Evaluation of Fentalogs and Their Metabolites in Hair of Patients in a Monitored Clinical Context by Means of Hair Analysis
Study Overview
Detailed Description
In recent years, new synthetic opioids (NSOs) have emerged in the illicit drug supply in an increasing rate. Many of these new registered opioids can structurally be assigned to the so called fentalogs, which are pharmacologically active derivatives of the approved pain management drug fentanyl. Many of these compounds are highly potent, relatively cheap and thereby especially fueling the current opioid crisis in the USA and posing a significant challenge for authorities, the healthcare system and forensic toxicology globally. Most of the time opioids are consumed without the user's knowledge as they are sold as heroin or counterfeit prescription pills like oxycodone or Xanax® which further increases the dangers posed by this problematic substance class. Recent cases of designer fentanyl intoxication show that this problem is also encountering Switzerland. Due to their potency, overdoses of the above-mentioned substances quickly occur, which in absence of intensive medical support can be fatal even when the antagonist naloxone is used. In order to better address the NSOs related socio-economic and health care problems, a fundamental understanding of these substance classes is essential.
As a consequence of the increasing prevalence of designer opioids, forensic and clinical laboratories worldwide are continuously challenged with updating their analytical methods for the identification and quantification of these new drugs in various biological matrices. The classical matrices used in forensic toxicology are blood and urine which represent time windows of hours to days. Keratinized matrices like hair and nail are considered complementary matrices as they provide additional information to the more traditional matrices covering time windows up to several months. The analysis of hair (a keratinized matrix) can provide significant information about the intake of opioids over extended time periods and therefore can provide access to a much wider diagnostic window than blood or urine. It allows getting information about a past exposure to the substance, repeated intake or even a single intake.
According to the Swiss Society of Legal Medicine, Swiss laboratories that offer forensic hair analysis must be able to quantify opioids in hair. The analysis of classical opioids like morphine and respective metabolites is well established in hair. However, knowledge about the incorporation of medically used fentalogs (e.g. fentanyl, remifentanil and sufentanil) and illegal designer fentalogs in hair is still limited.
The goal of this study is to gain knowledge about the incorporation and concentration of fentalogs in hair to help establish a high forensic standard for the detection these new substances. The specific aim of this study is to analyze hair samples from patients (children) of a study cohort described below which received medically approved fentalogs (either fentanyl, remifentanil or sufentanil) and to gain insights into the deposition of these substances into hair. The investigators will focus on a study cohort (150 patients) that has received medical fentanyl for pain management therapy in a clinical and therefore controlled setting. Furthermore, the study cohort consists of children which have some benefits to address the above raised research question. The hair of children is thinner and more porous than adult's hair, so that substances can incorporate into hair more easily. This makes children's hair an ideal target for our research study to see if fentalogs will be incorporated into hair. Furthermore, it is known that cosmetic treatment like e.g. bleaching etc. destroys substance that are incorporated in hair, therefore cosmetically treated hair is not suitable for the study. The probability that young children have cosmetically treated hair is considered very low.
As substances are incorporated into hair via sweat and blood, the analysis of these matrices can help to understand the general incorporation mechanisms of substances into hair. Therefore, the investigators intend to additionally analyze sweat samples from children to gain knowledge about fentalog concentrations and metabolites in sweat which can be helpful to understand their incorporation into hair.
The knowledge of this study can be used in forensic toxicology to distinguish between the intake of medically prescribed opioids and illegal new synthetic opioids.
Study Type
Enrollment (Anticipated)
Contacts and Locations
Study Contact
- Name: Tina M. Binz, Dr.
- Phone Number: +41 44 635 7614
- Email: TinaMaria.Binz@irm.uzh.ch
Study Contact Backup
- Name: Max Polke
- Phone Number: +41 44 635 76 43
- Email: max.polke@irm.uzh.ch
Study Locations
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-
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Zurich, Switzerland, 8032
- Recruiting
- University's Children Hospital
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Contact:
- Florian Zapf, Dr.
- Phone Number: +41442667053
- Email: Florian.Zapf@kispi.uzh.ch
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Principal Investigator:
- Florian Zapf, Dr.
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Sampling Method
Study Population
Description
Inclusion Criteria:
- Obtained written informed consent from parents or legal caretaker and oral consent from the patient concerned.
- Patients age: from date of birth irrespective of gestational age to completed 13th year of life
- Patients that received single or multiple treatment (either with single doses or continuous drip) of fentanyl, remifentanil or sufentanil either during operation or on the intensive care unit
Exclusion Criteria:
- Patients age older than 14 years
- Inability to understand the study procedure due to language or cognitive reasons (applies to parents and children)
- denied or missing informed consent
- Insufficient amount of head hair to obtain hair sample
- Cosmetic hair treatment, like coloring, bleaching and dying
Study Plan
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
---|---|
KISPI 000
Patients of the group received one or multiple clinically approved opioids, namely; Fentanyl, Remifentanil, Sufentanil, Hydrocodone, Oxycodone and Morphine
|
Drug application during hospital stay
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Detection of opioid concentration and opioid metabolite concentration in hair quantified by liquid chromatography-tandem mass spectrometry
Time Frame: through study completion, an average of one year
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Investigators will collect hair samples from participants for quantification of opioids.
Investigators will analyse which opioid concentration will be detectable in hair following opioid intake/application in a medical setting (unit pg opioid per mg hair).
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through study completion, an average of one year
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Detection of opioid concentration and opioid metabolite concentration in sweat quantified by liquid chromatography-tandem mass spectrometry
Time Frame: through study completion, an average of one year
|
Investigators will collect sweat samples from participants for quantification of opioids.
Investigators will analyse which opioid concentration will be detectable in sweat following opioid intake/application in a medical setting (unit ng opioid per mL sweat).
|
through study completion, an average of one year
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Normative values in hair
Time Frame: after data evaluation, 3 months after end of study (one year)
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Investigators will establish normative value ranges for opioid concentrations in hair based on the cohort of 150 hair samples.
The analysis will be done by using descriptive statistics (box plots) including the median, mean, the 10 % and 90 % percentile values ( unit ng opioid per mg hair).
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after data evaluation, 3 months after end of study (one year)
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Normative values in sweat
Time Frame: after data evaluation, 3 months after end of study (one year)
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Investigators will establish normative value ranges for opioid concentrations in sweat based on the cohort of 75 sweat samples.
The analysis will be done by using descriptive statistics (box plots) including the median, mean, the 10 % and 90 % percentile values (unit ng opioid per mL sweat).
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after data evaluation, 3 months after end of study (one year)
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Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Tina Binz, University Zurich
- Principal Investigator: Florian Zapf, Dr., University's Children Hospital
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Anticipated)
Study Completion (Anticipated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Estimate)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
- Physiological Effects of Drugs
- Central Nervous System Depressants
- Peripheral Nervous System Agents
- Analgesics
- Sensory System Agents
- Anesthetics, Intravenous
- Anesthetics, General
- Anesthetics
- Analgesics, Opioid
- Narcotics
- Adjuvants, Anesthesia
- Remifentanil
- Fentanyl
- Morphine
- Oxycodone
- Sufentanil
- Hydromorphone
- Alfentanil
Other Study ID Numbers
- 2022-01693
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
IPD Sharing Time Frame
IPD Sharing Access Criteria
IPD Sharing Supporting Information Type
- STUDY_PROTOCOL
- SAP
- ANALYTIC_CODE
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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