A new LC-MS-MS method can detect 104 drugs of abuse, including synthetic cannabinoids, cathinones, fentanyl analogues, and other psychoactive compounds, in oral fluid samples collected with a Quantisal™ device. The method uses a 13.5-minute run and achieves limits of detection as low as 0.05 ng/mL for most analytes, though some require higher concentrations. Matrix effects are generally around 60%, and recoveries range from 47.2% to 127%. Drug stability is best at -20°C, but even frozen, some synthetic cannabinoids degrade more than 20% over 90 days. The method was successfully tested on seven authentic samples, confirming 17 different analytes.
MDMA (midomafetamine) is being reviewed by the FDA to treat post-traumatic stress disorder. A phase I study found that a high-fat/high-calorie meal did not change MDMA plasma concentrations, only delayed the time to reach peak concentration. A population pharmacokinetic model showed no meaningful effects from age, weight, sex, race, or fed status. A physiologically based pharmacokinetic model predicted that splitting the clinical dose (120 or 180 mg MDMA HCl) into two doses two hours apart results in slightly lower early exposure and a delayed peak compared to a single dose. The model also confirmed MDMA is a strong inhibitor of CYP2D6 but does not meaningfully affect drugs cleared by renal transporters.