{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T16:38:31Z","timestamp":1792600711972,"version":"4.5.0"},"reference-count":21,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2021,6,22]],"date-time":"2021-06-22T00:00:00Z","timestamp":1624320000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100005289","name":"National Institute of Justice","doi-asserted-by":"publisher","award":["2020\u2010DQ\u2010BX\u20100007"],"award-info":[{"award-number":["2020\u2010DQ\u2010BX\u20100007"]}],"id":[{"id":"10.13039\/100005289","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["analyticalsciencejournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Drug Testing and Analysis"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Metonitazene is considered a new psychoactive substance (NPS) and emerging potent synthetic opioid, causing increased public health concern beginning in 2020. Metonitazene joins a growing list of new synthetic opioids (NSOs) contributing to deaths among people who use drugs in the United States and other parts of the world. Metonitazene (a 2\u2010benzylbenzimidazole analogue) first appeared in mid\u20102020 in the recreational drug supply and subsequently began proliferating in death investigation casework towards the end of 2020. Screening and metabolite discovery were performed by liquid chromatography quadrupole time\u2010of\u2010flight mass spectrometry. Quantitative confirmation was performed by liquid chromatography tandem quadrupole mass spectrometry. Metonitazene was confirmed in 20 authentic forensic postmortem cases with an average concentration in blood at 6.3\u2009\u00b1\u20097.5\u00a0ng\/ml (median: 3.8\u00a0ng\/ml, range: 0.5\u201333\u2009ng\/ml, <jats:italic>n<\/jats:italic>\u2009=\u200918) and in urine at 15\u2009\u00b1\u200913\u2009ng\/ml (median: 11\u2009ng\/ml, range: 0.6\u201346\u2009ng\/ml, <jats:italic>n<\/jats:italic>\u2009=\u200914). Metonitazene was the only opioid identified in 30% of cases but was also found in combination with fentanyl (55%) and NPS benzodiazepines, opioids, and hallucinogens (45%). Medical examiners included metonitazene as a drug responsible for the cause of death, and the manner of death was always ruled to be an accident. The metabolism of metonitazene was found to be similar to that of isotonitazene, a closely related analogue. Toxicology laboratories and death investigators should ensure that metonitazene is included in forensic testing protocols, all while remaining vigilant for subsequent NSOs to emerge.<\/jats:p>","DOI":"10.1002\/dta.3115","type":"journal-article","created":{"date-parts":[[2021,6,17]],"date-time":"2021-06-17T02:09:34Z","timestamp":1623895774000},"page":"1697-1711","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":93,"title":["Metonitazene in the United States\u2014Forensic toxicology assessment of a potent new synthetic opioid using liquid chromatography mass spectrometry"],"prefix":"10.1002","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1775-1882","authenticated-orcid":false,"given":"Alex J.","family":"Krotulski","sequence":"first","affiliation":[{"name":"Center for Forensic Science Research and Education Fredric Rieders Family Foundation  Willow Grove Pennsylvania USA"},{"name":"College of Life Sciences Thomas Jefferson University  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donna M.","family":"Papsun","sequence":"additional","affiliation":[{"name":"NMS Labs  Horsham Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara E.","family":"Walton","sequence":"additional","affiliation":[{"name":"Center for Forensic Science Research and Education Fredric Rieders Family Foundation  Willow Grove Pennsylvania USA"},{"name":"College of Life Sciences Thomas Jefferson University  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2400-4711","authenticated-orcid":false,"given":"Barry K.","family":"Logan","sequence":"additional","affiliation":[{"name":"Center for Forensic Science Research and Education Fredric Rieders Family Foundation  Willow Grove Pennsylvania USA"},{"name":"College of Life Sciences Thomas Jefferson University  Philadelphia Pennsylvania USA"},{"name":"NMS Labs  Horsham Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,6,22]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"Center for Disease Control and Prevention.Coronavirus disease 2019.;2020. 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Ciba Pharmaceutical Products Inc Summit NJ USA;1960."},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02161117"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1021\/acschemneuro.1c00037"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01486702"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1021\/acschemneuro.1c00064"},{"key":"e_1_2_8_12_1","unstructured":"KrotulskiAJ ShudaS FogartyMF DeckerS.Metonitazene. NMS Labs;2020. Accessed February 13 2021.https:\/\/www.npsdiscovery.org\/wp-content\/uploads\/2020\/07\/Metonitazene_073020_NMSLabs_Report.pdf"},{"key":"e_1_2_8_13_1","unstructured":"UNODC.Early warning advisory (EWA) on new psychoactive substances (NPS). Accessed January 11 2019.https:\/\/www.unodc.org\/LSS\/Home\/NPS"},{"key":"e_1_2_8_14_1","unstructured":"United Nations.Single convention on narcotic drugs 1961.; 1972:44.https:\/\/www.unodc.org\/pdf\/convention_1961_en.pdf"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/jat\/bkaa016"},{"issue":"118","key":"e_1_2_8_16_1","first-page":"36819","article-title":"Temporary placement of isotonitazene in Schedule I","volume":"85","author":"Drug Enforcement Administration","year":"2020","journal-title":"Fed Regist"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/1556-4029.14623"},{"issue":"233","key":"e_1_2_8_18_1","first-page":"78047","article-title":"Temporary placement of brorphine in Schedule I","volume":"85","author":"Drug Enforcement Administration","year":"2020","journal-title":"Fed Regist"},{"key":"e_1_2_8_19_1","unstructured":"KrotulskiAJ PapsunDM WaltonSE LoganBK.Metonitazene begins proliferation as newest synthetic opioid among latest cycle of non\u2010fentanyl related drugs. 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