Mass spectrometric approaches in impaired driving toxicology

Driving under the influence of prescribed or illegal drugs increases the risk of having road accidents, just like driving under the influence of alcohol. In forensic toxicology, an increasing number of blood samples must be analyzed for drugs. Immunoassays tailored for a limited number of drugs (of abuse) are usually applied as prescreening tests at the roadside and/or in the laboratory. However, many other common drugs, such as anesthetics, antidepressants, antiepileptics, antihistamines, newer designer drugs, herbal drugs, neuroleptics (antipsychotics), opioids, or sedative-hypnotics, can also impair drivers. Therefore, this paper reviews multianalyte single-stage and tandem gas or liquid chromatography-mass spectrometry (GC-MS or LC-MS) procedures for the screening, identification, and validated quantification of such drugs in blood that have been reported since 2003. Basic information about the biosample assayed, workup, chromatography, the mass spectral detection mode, and validation data is summarized in tables. The pros and cons of the reviewed procedures are critically discussed, particularly with respect to their probable usefulness in impaired driving toxicology.