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SOFTEMBER ABSTRACTS SOFTEMBER POSTER ABSTRACTS...............................................2-56 SOFTEMBER PLATFORM ABSTRACTS .................................... 57-127 SOFTEMBER POSTER ABSTRACTS A 4-Year Systematic Analysis of Commercial E-liquids: The Evolution of G.R.A.S. to Inhaled Toxins Authors and Affiliations: Alaina K. Holt, B.S.*(1), Justin L. Poklis, B.S.(2), and Michelle R. Peace, Ph.D.(1) (1) Department of Forensic Science and (2) Department of Pharmacology & Toxicology, Virginia Commonwealth University, Richmond, VA Background/Introduction: Electronic cigarettes (e-cigs) were originally developed as an alternate method for nicotine delivery. The e-liquids are made of ratios of humectant formulations, pharmacologically active ingredients, flavoring chemicals, volatiles, preservative chemicals, and other “enhancing” chemicals. E-cigs have also been adopted for drugs other than nicotine (DOTN), including cannabidiol (CBD) and tetrahy- drocannabinol (THC). E-liquid manufacturers use chemicals that are generally regarded as safe (GRAS) for oral consumption. The FDA promulgated regulations to govern e-cigarette devices and e-liquids in May 2016, yet product approval deadlines are May 2020. The flavoring bans that were instituted in January 2020 only govern pod-based products. E-liquid formulations for re-filling e-cigarettes have not been heavily scrutinized by regulatory agencies, under the auspice that only pod-based products are most likely to be used by children. E-liquid formulations have evolved as a result of vaping preferences, public health sentiment, and looming regulations. Quality assurance and product safety remain inadequate, demonstrated recently by e-cigarette or vaping product associated lung injury (EVALI). Objectives: The objective of this study was to evaluate the chemical composition of e-liquids and to establish over time humectant formulations, pharmacologically active ingredients, flavoring chemicals, volatiles, preservative chemicals, and other “enhancements”. Methods: Construction design of the pods/cells were documented prior to e-liquid analysis. Undiluted e-liquids were screened using AccuTOF Direct Analysis in Real Time Mass Spectrometry (DART-MS). Glycol concentrations and general unknown screening were performed using gas chromatography-mass spectrometry (GC-MS). Volatiles were evaluated by headspace gas chromatography with a flame ionization detector (HS GC-FID). Results: E-liquids were found to have varying ratios of PG and VG, ranging anywhere from 100% PG to 100% VG. Newer e-liquids contained polyethylene glycol (PEG), diacylglycerols, and various mid-chain triglycerides (MCTs). Pharmacologically active ingredients included nicotine, minor tobacco alkaloids, caffeine, mitragynine, paynantheine, cannabinoids, synthetic cannabinoids, gamma-butyrolactone (GBL), and dextromethorphan. Multiple flavorants included terpenes, pyranones, aldehydes, and some esters. Preservatives includ- ed butylated hydroxytoluene, benzoic acid, decanoic acid, and triethyl citrate. Volatiles included: methanol, ethanol, acetone, and isopropanol. Chemical enhancements included Vitamin E, gamma-tocopherol, phytol, olivetol, and flavorant-PG adducts. Conclusion/Discussion: Surveillance shows that PG and VG are still commonly used, but an expansion of chemicals used as humectants was observed. Alter- native pharmacologically active ingredients also expanded, while the legal cannabis industry helped drive e-cigarette design. Over time, vanillin and ethyl maltol (vanilla and caramel) are the most prevalent identified flavorants, followed by mint and fruit flavorants. Volatiles continue to be a component of e-liquid formulations. Ethanol is common as a solvent for flavorants or psychoactive com- pounds. Chemicals that are food-grade preservatives, vitamins, organic acids, and terpenoids have become more prevalent in recent years. In the vacuum of strong and clear federal regulations, the e-cigarette industry has rapidly expanded product types. Formu- lations are made of chemicals that are considered GRAS by the FDA, which has generally provided an aura of safety for consumers. However, the recent EVALI epidemic exposed the toxic nature of vaping. The e-cig industry has facilitated the public consumption of recreational drugs and the abuse of these substances by providing efficient drug delivery devices. PAGE 3 A Decade of Fentanyl Related Overdoses in San Francisco Authors and Affiliations: Kelsa L. West, M.S.* (1); Luke N. Rodda, Ph.D (1,2) (1) Office of the Chief Medical Examiner, San Francisco, California, United States (2) Department of Laboratory Medicine, University of California, San Francisco, California Background/Introduction: Fentanyl is now most widely known for its national trends as an illicit recreational drug among individuals with opioid use disorder. In 2017, fentanyl was classified as the number one drug involved in drug overdoses in the United States, killing an average of 8.7 out of every 100,000 people. Problematic more so is the addition of fentanyl into, or consumed with, other drug products can exacerbate CNS depression, particularly to opioid naive individuals who may be unaware of such additions. Objectives: It was the goal of this research to offer insight to accidental overdose trends involving sole fentanyl consumption, as well as co-con- sumption with medicinal opioids, heroin, methamphetamine, and cocaine in San Francisco from 2009-2019. Methods: Biological samples were analyzed through various methods over the studied period. Screening methods included ELISA and Biochip. Confirmation and quantitative methods included GC-MS and LC-MS/MS. All investigative, toxicological and autopsy data for this study was sourced from the final reports. In addition, the following demographic information was collected: race/ethnicity, age, sex, time of death, date of death, and zip code where the decedent was pronounced deceased. Inclusion criteria for this study included only accidental overdose cases that contained at least one of the following compounds of interest: fentanyl, norfentanyl, 6-monoace- tylmorphine, morphine, codeine, hydrocodone, hydromorphone, oxycodone, oxymorphone, methadone, tramadol, buprenorphine and norbuprenorphine. All studied cases where the decedent was admitted to the hospital and received medicinal fentanyl were also excluded for the purpose of this study. Results: From 2009-2019, over 3,400 total cases were positive for either fentanyl, heroin, medicinal opioids, cocaine, methamphetamine, or any combination thereof. Approximately 60% of those cases were determined as accidental overdoses. More than half of accidental overdose cases directly attributed poly-drug consumption to the cause of death rather than isolated use. From 2009-2016, there was an increase of 163%, followed by a sharp increase of 1010% from 2016-2019, resulting in an overall increase of 2813% from 2009-2019. In 2019, accidental overdose deaths were predominately due to the use of fentanyl, followed by methamphetamine and cocaine. Males made up over 70% of all accidental overdoses, and those of white and black ethnicity were overrepresented (91%) compared to the ethnic make-up of the community. The 55-64 year-old population was most affected overall however, fentanyl-relat- ed deaths were more prominent in the 25-34 year-old age group. Conclusion/Discussion: This comprehensive study shows that fentanyl-related deaths have been increasing, demonstrating continued workload demands that forensic toxicology laboratories are facing. It is expected that surrounding cities, counties and states on the West Coast should also be experiencing similar trends. Early implementation of extensive naloxone programs within the community have significantly reduced the amount of overdose fatalities, with thousands of survived overdoses being recorded each year due to such efforts. PAGE 4 A Rapid and Reliable LC-MS-MS Method for Cannabidiol (CBD) and 11-nor-9-Carboxy-THC in Urine Authors and Affiliations: Nicholas R. Rhodes, and Sue Brown* Paradigm Labs, Saint Simons Island, Georgia, USA Background/Introduction: Recently, there has been an increase in the legality of cannabis in the United States and internationally. Legalization and usage of hemp is also expanding and increasing. The Agriculture Improvement Act of 2018 removed hemp-derived products from the list of Schedule I substances on the controlled substances list. This policy change has seen an increase in popularity of cannabidiol (CBD) products being proposed to have therapeutic benefits. CBD is the significant component of many cannabis and hemp products. Our laboratory is a high production drug testing laboratory serving physicians managing patients with chronic pain and patients in drug treatment facilities. These physicians have requested CBD testing of their patients either due to patients taking CBD products on their own, or the physician suggesting to their patients to take CBD products. Objectives: A rapid, reliable, and sensitive method for cannabidiol (CBD) and 11-nor-9-Carboxy-THC (THC-COOH) was developed and validated to analyze our client’s request for CBD testing in urine samples of their patients. Methods: Working calibrators and positive control containing CBD and THC-COOH, and a hydrolysis control containing THC-COOH glucuronide were prepared in drug free urine from purchased standards. Stock Internal Standard (IS) was prepared in methanol with CBD-D3 and THC-COOH-D9. Samples were prepared with a Tecan Evo 100 automated aliquotor in a 96
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