What once was old is new again: The emergence of traditional stimulants and hallucinogens in Miami-Dade County postmortem casework

Abstract

Since 2011, the Miami-Dade Medical Examiner Department (MDME) has detected over fifty different Novel Psychoactive Substances (NPS) in routine postmortem casework. On average, cases containing NPS account for 15% of the total number of cases analyzed per year at the MDME. While the incidence and variety of NPS has steadily increased in Miami in the past decade, so has the number of cases containing more traditional stimulants and hallucinogens, such as methamphetamine, methylenedioxymethamphetamine (MDMA), methylenedioxyamphetamine (MDA), lysergic acid diethylamide (LSD), and psilocin. Interestingly, this increase in prevalence of traditional stimulants and hallucinogens coincided with the beginning of the pandemic, suggesting a shift in the drug market possibly due to supply chain issues and strict travel restrictions. Screening and quantitative results from the analysis of various postmortem matrices (whole blood, liver, brain, urine, and gastric contents) were collected from 2011 to Q1 2022. All biological specimens were extracted using solid phase extraction (SPE) and screened on a routine basic drug screening method utilizing gas chromatography coupled to a nitrogen phosphorous detector and mass spectrometer (GC-NPD-MS). If needed, cases were also screened/confirmed on a sensitive, targeted method for the detection of stimulants and hallucinogens, utilizing liquid chromatography ion trap mass spectrometry (LC-Ion Trap-MS). Additionally, cases positive for methamphetamine, MDMA, and MDA were quantified utilizing liquid chromatography triple quadrupole mass spectrometry (LC-QQQ-MS). Cases were organized by year, and the data was tabulated for cases where the following analytes were reported as detected: methamphetamine, MDMA, MDA, psilocin, and LSD. Further data analysis was conducted to assess parameters such as quantitative values for the analytes of interest, additional analytes detected, cause of death (COD), manner of death (MOD), race, gender, and age. Since 2020, methamphetamine, MDMA, MDA, LSD, and psilocin have been detected in 366 postmortem cases. All targeted analytes except for LSD had a higher incidence of detection after 2019, with methamphetamine nearly tripling in the rate of detection from 2019 to 2021, and subsequently, more implicated in the cause of death for accidental overdoses. Psilocin had the largest increase in reported cases, with just one case detected in 2018, and eight cases detected in 2020 and 2021. MDMA and MDA both nearly doubled in rate of detection from 2019 to 2020. In addition, in 2020 the MDME reported its highest detected concentration of MDMA in peripheral blood, 62.5 mg/L. LSD detection remained the same, with three cases detected between 2016–2019, and three cases detected in 2020 and 2021. Methamphetamine was the most detected analyte out of the five, with 236 cases detected between 2011–2019, and 246 cases detected between 2020-Q1 2022. Of note, dimethyltryptamine (DMT) was detected for the first time in MDME casework in 2021, and TFMPP was detected in Q1 2022 for the first time since 2011. The introduction of NPS into the drug market has completely altered the landscape for forensic toxicology casework. However, with the implementation of class-wide drug scheduling and strict pandemic restrictions on air and sea travel, drugs that were not often detected in postmortem cases in Miami managed to surge in popularity and contribute to the highest rate of accidental drug overdoses recorded in the county. While monitoring NPS trends and prevalence is still necessary, it is important not to lose sight of analytes that once were considered “old news”, as there is always a possibility for them to make an impact in todays volatile drug supply.