The analysis of drug material in the field is an important function of law enforcement agencies, forensic drug laboratories, and drug checking services. Portable testing techniques employed by these different groups range from inexpensive screening tools with low discriminating power, such as presumptive chemical color tests, to more sophisticated portable analytical techniques that behave as miniaturized versions of their laboratory counterparts, such as gas chromatography–mass spectrometry (GC–MS). Rapid non‐destructive analysis in the field and non‐laboratory environments is afforded by portable and handheld Fourier transform infrared (FTIR) spectrometers with little to no sample preparation, while handheld Raman analyzers have the added potential for drug material identification through sealed packaging using spatially offset Raman spectroscopy (SORS). Utilization of the most suitable testing technique for the given environment is demonstrated at international borders and airports wherein ion mobility spectroscopy (IMS) is frequently employed for the detection of drug (and explosive) residues owing to its ease of operation and rapid analysis. Advances in technology and materials have provided analysts with new portable testing techniques, including paper spray ionization–MS (PSI‐MS), an ambient MS technique that provides sensitive, rapid, and reliable analysis without the need for sample preparation steps. A growing area of research and interest in the development of sensitive and selective optical and electrochemical portable (bio)sensors for in‐field analysis of drug material indicates that new commercial sensors for drug detection will be available in the foreseeable future.This article is categorized under: Forensic Chemistry and Trace Evidence > Controlled and Emerging Drug Compounds Forensic Chemistry and Trace Evidence > Emerging Technologies and Methods Toxicology > Drug Analysis

Increasing reports of neurological and psychiatric complications due to psychostimulant synthetic cathinones (SCs) have recently raised public concern. However, the precise mechanism of SC toxicity is unclear. This paucity of understanding highlights the need to investigate the in-vitro toxicity and mechanistic pathways of three SCs: butylone, pentylone, and 3,4-Methylenedioxypyrovalerone (MDPV). Human neuronal cells of SH-SY5Y were cultured in supplemented DMEM/F12 media and differentiated to a neuronal phenotype using retinoic acid (10 μM) and 12-O-tetradecanoylphorbol-13-acetate (81 nM). Trypan blue and lactate dehydrogenase assays were utilized to assess the neurotoxicity potential and potency of these three SCs. To investigate the underlying neurotoxicity mechanisms, measurements included markers of oxidative stress, mitochondrial bioenergetics, and intracellular calcium (Ca²⁺), and cell death pathways were evaluated at two doses (EC₁₅ and EC₄₀), for each drug tested. Following 24 h of treatment, all three SCs exhibited a dose-dependent neurotoxicity, characterized by a significant (p < 0.0001 vs. control) production of reactive oxygen species, decreased mitochondrial bioenergetics, and increased intracellular Ca²⁺ concentrations. The activation of caspases 3 and 7 implicated the orchestration of mitochondrial-mediated neurotoxicity mechanisms for these SCs. Identifying novel therapeutic agents to enhance an altered mitochondrial function may help in the treatment of acute-neurological complications arising from the illicit use of these SCs.

The increasingly large quantities of potentially illicit samples received for confirmatory analysis highlights the importance and demand for preliminary testing procedures that are simple, rapid, selective, inexpensive and able to be used in the field. Colour testing fulfils the aforementioned requirements and is a technique frequently employed to achieve presumptive identification. Piperazine analogues (often marketed as ‘legal ecstasy’) are a group of psychoactive substances that have recently become established on the illicit drug market and are not effectively discriminated or identified by current colour testing methods. Herein, we report on the development and validation of a chemical spot test for piperazine analogues present in unknown seized materials using the spectrophotometric reagent, sodium 1,2-naphthoquinone-4-sulphonate (NQS). Primary testing revealed that NQS reacts almost instantly to form an intense, bright orange-red coloured complex with the representative piperazine 1-benzylpiperazine (BZP) at room temperature. The results of the test, assessed by colour development, were evaluated visually and variables affecting the coloured reaction were optimised. The colour test method was validated to meet requirements for use in preliminary screening, providing qualitative and reliable presumptive test results. Validation studies show that the characteristic colour change is unique to the piperazine class at room temperature, and is unaffected by the presence of common cutting agents, i.e. glucose and caffeine, in test samples of 5% purity, and other drugs such as N-methyl-3,4-methylenedioxyamphetamine (MDMA). The NQS reagent stability was found to be limited to storage in a refrigerated environment for no more than one week before results were affected. The operational limit of detection was found to be 40 μg.

Central precocious puberty (CPP), which is traditionally defined as the development of secondary sexual characteristics before age 8 years in girls and age 9 years in boys, results from the premature activation of the hypothalamic-pituitary-gonadal (HPG) axis. CPP can be associated with short adult stature, adverse psychosocial outcomes, and increased cardiometabolic and cancer risks in adulthood. Gonadotropin-releasing hormone (GnRH) agonists can effectively suppress premature activation of the HPG axis and have the potential to increase adult height as well as improve psychosocial and long-term health outcomes among patients with CPP. However, as secular trends have continued to shift toward earlier age of pubertal onset, some subpopulations of children with CPP, as it is currently defined, may not require the same extent of diagnostic evaluation and treatment. Develop evidence-based recommendations related to the diagnosis and treatment of CPP. A multidisciplinary panel of clinical experts, along with experts in guideline methodology and systematic literature review, used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach to address 10 clinical questions related to the diagnosis and treatment of CPP. Systematic reviews of health-related benefits and harms were conducted for each clinical question. The guideline development panel (GDP) also used the GRADE evidence-to-decision (EtD) framework to address stakeholder values and preferences, costs and required resources, cost-effectiveness, acceptability, feasibility, and potential impacts on health equity. In girls with thelarche (Tanner stage B2) between ages 7.0 and 8.0 years, the GDP suggests watchful waiting via periodic physical examinations (every 4-6 months) rather than immediately performing evaluation with laboratory testing or radiologic imaging. In addition, the GDP suggests that all girls with breast development (ie, Tanner stage B2) before age 7 years should first be observed for 4 to 6 months to differentiate unsustained or slowly progressive puberty vs rapidly progressive puberty. These recommendations are largely based on evidence that girls with slowly progressive puberty attain a normal adult height without treatment. When hormonal evaluation is performed to confirm central (GnRH-dependent) activation as the cause of precocious puberty, the GDP suggests starting the evaluation with ultrasensitive basal luteinizing hormone (LH) concentration rather than routine GnRH/GnRH agonist (GnRHa) stimulation testing for all patients. While brain magnetic resonance imaging has been a traditional part of CPP evaluation, the GDP suggests that it should not be routinely performed in girls ages 6.0 to 8.0 years and boys ages 8.0 to 9.0 years without central nervous system (eg, neuro-ophthalmologic) symptoms, largely based on a low prevalence of pathologic intracranial findings in these age groups. The GDP suggests against routine genetic testing for patients with CPP, although they judged that genetic testing (eg, MKRN3 sequencing) should be considered for patients with familial CPP through a shared decision-making process. The GDP suggests GnRHa treatment for many children with CPP, although available evidence suggests that some patient subgroups (eg, older girls with slowly progressive CPP) may be less likely to receive a net benefit with this treatment. Rather than always starting GnRHa treatment with a monthly injectable formulation, the GDP suggests that treatment should be initiated with the formulation (such as a longer-acting formulation) that is anticipated to be used long-term. The GDP suggests against routine addition of growth hormone therapy to increase adult height. They also suggest against the routine biochemical testing (eg, LH, sex steroids) to monitor pubertal suppression while receiving GnRHa, instead reserving biochemical testing to confirm clinically suspected treatment failure. Finally, the GDP suggests against routinely continuing GnRHa treatment beyond chronologic age 10.0 to 11.0 years (girls) or 11.0 to 12.0 years (boys) and/or bone age 11.0 to 12.0 years (girls) or 12.0 to 13.0 years (boys). These clinical recommendations were developed to address important uncertainties in the diagnosis and treatment of children with CPP. They are based on the best available scientific evidence regarding clinical outcomes judged to be most important to patients and families. The GDP's overarching goal was to suggest diagnostic and therapeutic strategies that will most likely provide net clinical benefits while simultaneously considering important contextual factors such as cost and feasibility. The guideline-development process highlighted important knowledge gaps and the substantial need for additional research.