First-Of-Its-Kind Quantitative Method Assesses Opioid Exposure in Newborns

Traditional blood testing for opioids typically demands large blood volumes, which are hard to collect from chronic opioid users who often have damaged veins or other medical complications. Meanwhile, urine-based tests frequently yield unreliable results. The issue is even more concerning among pregnant women, with statistics showing that one in five expectant mothers in the U.S. self-reports opioid misuse. This can lead to neonatal abstinence syndrome (NAS), a condition in which newborns experience withdrawal symptoms due to prenatal opioid exposure. Currently, the diagnosis of opioid exposure in infants relies primarily on evaluating symptoms and reviewing the mother's substance use history, as no standard blood-based diagnostic test exists for opioid detection in newborns. Researchers have now introduced new diagnostic methods for identifying opioid compounds in both adults suffering from opioid use disorder and infants affected by NAS.

The new techniques, described in two research studies published by Brown University (Providence, RI, USA), could offer healthcare professionals more effective tools to address opioid-related health conditions. In the first study, featured in Scientific Reports, the researchers describe a rapid method for identifying six different opioid compounds using only a minimal amount of serum, approximately equivalent to a finger prick. The team developed a fully automated liquid chromatography-tandem mass spectrometry (LC-MS/MS) assay that can detect opioid compounds from micro-samples such as serum or dried blood spots. The technique demonstrated the ability to precisely quantify six opioids — buprenorphine, methadone, codeine, hydrocodone, morphine, and oxycodone — using just 20 microliters of serum, which is less than a single drop.

The researchers then incorporated this diagnostic approach into an ongoing clinical trial investigating the use of oxytocin alongside opioid agonist therapy. By utilizing the microsampling technique, they were able to detect opioid usage that conventional urine testing had missed. This more refined detection allowed the research team to demonstrate that oxytocin could be an effective adjunct treatment for reducing opioid use in patients with opioid use disorder. Following the success of detecting opioids through small blood samples in adults, the researchers explored further applications. In a second study published in SLAS Technology, they showcased a technique for detecting opioids in dried blood spots, a sample type that is routinely collected from newborns across the country. This breakthrough could enable the first quantitative assessment of opioid exposure in neonates.

The team developed a device designed to extract possible opioid compounds from dried blood spots, which are usually obtained from a newborn’s heel shortly after birth. The device works by applying an electric field to the dried blood spot to extract the target compounds. After this extraction, the sample can be analyzed using mass spectrometry, a technique already commonly used in neonatal screening labs. The findings confirmed that the method could reliably detect various opioid substances such as codeine, hydrocodone, morphine, methadone, and oxycodone. Additionally, the process is fully automated, making it well-suited for clinical implementation, according to the researchers. They believe this advancement could enhance both diagnosis and treatment of NAS. By knowing the exact concentration of opioids present in an infant’s system, clinicians may be able to make more informed decisions about whether medication is required and determine the appropriate dosage. The researchers emphasize that both studies aim to create more accessible, practical, and patient-centered diagnostics, and they hope their findings will lead to real-world applications in the treatment and management of opioid exposure.

“This wasn’t about creating another lab tool,” said Ramisa Fariha, a postdoctoral research associate in molecular biology, cell biology, and biochemistry at Brown, who led the research. “It was about reimagining what’s possible at the point of care. We were responding to a void that was always there, and we wanted to address it.”

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