A 43-year-old male psychiatric outpatient died within hours of ingesting as much as 600 mg of olanzapine, a newer antipsychotic agent related to clozapine. Analysis of postmortem blood and urine by gas chromatography with nitrogen-selective detection yielded olanzapine concentrations of 1238 and 6987 μg/L, respectively, greatly in excess of levels expected following therapeutic administration of the drug. Based on the toxicology findings, the decedent's known history of suicide attempts, and the circumstances surrounding the death, this case was ruled a suicide by olanzapine overdosage.

Eleven cases of suspected driving under the influence (DUI) of flualprazolam are presented. Data from police reports and drug recognition examinations (DRE), when available, were evaluated. In all cases, significant driving impairments were observed including weaving, driving slowly, stopping in the roadway, or collisions. Objective signs of impairment in all cases were generally consistent with those expected from central nervous system depressants. Both the mean and median blood flualprazolam concentrations were less than 15 ng/mL. Though comprehensive analysis was not performed on each specimen, the data from this study support the conclusion that flualprazolam at low concentrations may significantly impair the ability to safely drive.

A driving under the influence of drugs (DUID) case with an extremely high blood fentanyl concentration and concomitant use of methamphetamine is presented. As the increase of the appearance of fentanyl in drug seizures continues, the likelihood of tolerant users increases as well. Data presented on fentanyl in ante-mortem cases over time from several regions of North America show geographic differences on whether fentanyl concentrations are increasing. This case is an example of a blood concentration that could have been assumed to be fatal if presented on its own; a reminder that concentrations, especially those of opioids, must be interpreted with care.

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