A liquid chromatography-tandem mass spectrometry method was developed to detect ten plant-derived psychoactive substances in urine simultaneously. The method uses direct injection of diluted urine with three deuterated internal standards, achieving separation in 14 minutes. Calibration curves were linear with correlation coefficients above 0.999. Imprecision at high (1000 micrograms per liter) and low (50 micrograms per liter) concentrations ranged from 4.9% to 13.8% and 8.3% to 26%, respectively. Ion suppression effects were limited. The method proved useful for investigating authentic intoxication cases and covered clinically relevant concentration ranges.
Over a 4-year period, 103 urine samples from mainly young people (age range 13-52 years, median 19) were collected at emergency wards in Sweden from patients who admitted or were suspected of ingesting psychoactive plant materials. Among 53 cases where ingestion of any of 11 plant-derived substances was admitted or suspected, 41 (77%) were confirmed by bioanalytical methods. Psilocin from hallucinogenic mushrooms was the most frequent drug, accounting for 54% of cases. The most common means of drug acquisition (56%) was purchase over the Internet. Having bioanalytical methods for detection of plant-derived psychoactives is important for clinical toxicology services.