Oral fluid analysis by LC-MS/MS: Comparison between drivers tested in random checks and after an electro/trance festival

Abstract

Aim

To compare substances consumed by 2 populations of drivers – electro/trance festival (teknival) goers and drivers tested on random checks – by analyzing oral fluid samples collected on FLOQswabs™ devices.

To assess trends in new psychoactive substance (NPS) consumption during electro/trance music events such as teknival.

Method

Following driving checks during a teknival in the summer of 2024, our laboratory received 68 FLOQswabs™ samples for confirmatory analysis under French regulations. The first qualitative analysis, performed by liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS), targeted amphetamine, methamphetamine, MDA, MDMA, MDEA, morphine, 6-monoacteylmorphine (6-MAM), cocaine, benzoylecgonine (BZE) and delta-9-tetrahydrocannabinol (THC). The previously reported protocol was implemented, according to the legal thresholds (Romeuf, Toxac, 2023, 35, 124–132). With the same injection, cannabidiol (CBD) and hexahydrocannabinol (HHC) were also targeted. In a second injection, unknown NPS screening was carried out by LC-MS/MS. The same methodology was applied to a representative population of 68 oral fluid samples collected on the same device during classic random checks for driving under influence of drugs.

Results

Sixty-six teknival samples were positive for at least one substance listed in the regulations, as were 64 from the random checks. Concerning cannabinoids, THC and CBD were more often detected in control samples (80.9% and 42.6%, respectively) than in teknival samples (61.8% and 26.5%). Morphine and 6-MAM were detected in only 1 control sample. Cocaine was systematically associated with its metabolite, BZE, with higher prevalence in teknival samples (44.1%) than in control samples (27.9%). Likewise, amphetamines, and particularly MDMA, were detected in 42.6% of teknival samples but in only 13.0% of control samples. On NPS analysis, ketamine was the most frequently detected substance in both populations, with higher prevalence in teknival samples (61.8%) than in controls (19.1%). In 98.0% of cases, ketamine was associated with at least one other substance. Few NPSs were found in the control population, with only diphenidine and HHC detected, in 1 case each; conversely, in the teknival population, dimethyltryptamine (DMT) and LSD were detected in 17.6% and 11.7% of cases, respectively. X-MMC and the benzofuran x-APB were identified in 2 cases each.

Conclusion

As expected, almost all swabs were positive for least at one substance, as confirmation is only required when the first oral fluid test by immunoassay is positive.

In both study populations, THC was the most frequently consumed substance. Cocaine and MDMA were consumed more frequently in the teknival context. Ketamine, which was detected in both populations, is one of the substances most commonly used in partying, particularly in combination with other substances (cocaine, amphetamine, MDMA or x-MMC). These various combinations enable specific effects to be obtained, such as sociability or managing come-down from other psychoactive substances. DMT and LSD were systematically co-consumed, but detected only in teknival attendees, in a non-negligeable proportion. These substances are hallucinogens, characteristic of alternative party settings. X-MMC, x-APB, HHC and diphenidine were detected in isolated cases, highlighting active but marginal consumption. A trend for NPS consumption may be suspected from the present data, but a larger-scale study would be necessary to assess prevalence of NPS in regular drivers. It is therefore important to note that, as required by the law, only drivers testing positive on initial oral fluid screening are required to provide a second sample (on a swab) for confirmation. Current screening tests are not able to detect substances such as LSD, DMT or ketamine, and are therefore interpreted as negative, so that other potential compounds go undetected.