This method is the first analytical method for the detection and quantitation of carfentanil and naltrexone at clinically relevant concentrations using liquid chromatography-mass spectrometry. Samples were alkalinized with 100 microl of 1 M NaOH and extracted 2x with 2 ml of toluene. The extractions were combined and dried under N(2) at 40 degrees C in a H(2)O bath. Chromatography was performed using a Zirchrom PBD column and a mobile phase of 30:70 acetonitrile/10 mM ammonium acetate and 0.1 mM citrate (pH=4.4) at a flow rate of 0.3 ml/min. The lower limit of quantitation was 8.5 pg/ml for carfentanil and 0.21 ng/ml for naltrexone.