11-Year Study of Fentanyl in Driving Under the Influence of Drugs Casework

Abstract

Prior to 2017, heroin and other prescription opioids were the most prevalent opioids implicated in driving under the influence of drugs (DUID) investigation cases and fentanyl was rarely included in the scope of toxicological analysis. Fentanyl has become the most frequently identified opioid in DUID cases with many suspected heroin cases turning out to be only fentanyl. A review of fentanyl positive DUID cases at NMS Labs was performed to provide prevalence information, change in concentration, patterns of combined drug use, indicators of impairment, and driving behavior in order to assist with toxicological interpretation of DUID scenarios involving fentanyl. Fentanyl positive DUID cases received between January 2010 and December 2020 were examined. Blood results were confirmed and quantitated for fentanyl, norfentanyl and acetylfentanyl using a liquid chromatography–tandem mass spectrometry (LC–MS-MS) analysis with a limit of quantitation (LOQ) of 0.10, 0.20 and 0.10 ng/mL, respectively. Of 153,234 blood cases examined for DUID over 11 years, fentanyl confirmed positive in 6,779 (4.4%) cases. However, there were significant changes in positivity over time. Fentanyl percent positivity increased from 0.60% in 2010 to 12% in 2020. Of 5,976 confirmed fentanyl positive cases in 2018 through 2020, blood concentrations greater than 4.0 ng/mL were observed in 44% (2018), 55% (2019), and 59% (2020) of cases. Polypharmacy was common with 87% of blood samples confirming positive for fentanyl and at least one other compound. Stimulants was the most commonly identified drug class in cases where at least one additional drug class was present. This study illustrates the importance of including fentanyl in a routine blood DUID panel.

Preclinical Efficacy and Selectivity of Vaccines Targeting Fentanyl, Alfentanil, Sufentanil, and Acetylfentanyl in Rats

“… 22 Toxicology results from impaired driving cases show the frequent presence of acetylfentanyl in samples from drivers who tested negative for alcohol, but positive for fentanyl or other substances. 23 , 24 Additionally, acetylfentanyl has been detected in hair samples from people who use heroin, 25 and in the urine of patients who tested positive for nonprescribed opioids, 26 highlighting the prevalence of fentanyl analogues in illicit mixtures of fentanyl or other opioids.…”

“…Alfentanil is a fast-acting fentanyl derivative used for anesthesia, and acetylfentanyl (desmethyl fentanyl) is an impurity frequently encountered in illicit fentanyl and is less potent than fentanyl but with a narrow therapeutic window . Toxicology results from impaired driving cases show the frequent presence of acetylfentanyl in samples from drivers who tested negative for alcohol, but positive for fentanyl or other substances. , Additionally, acetylfentanyl has been detected in hair samples from people who use heroin, and in the urine of patients who tested positive for nonprescribed opioids, highlighting the prevalence of fentanyl analogues in illicit mixtures of fentanyl or other opioids.…”

The impact of fentanyl on DUIDs and traffic fatalities: Blood and oral fluid data

“…While most blood concentrations detected in DUID fentanyl cases were below 10 ng/mL, many cases reported by Havro et al, Chan-Hosokawa and Bierly, and Rohrig et al were within concentrations that would be considered fatal in postmortem toxicology [7][8][9].…”

“…Several laboratories across the United States have noted an increase in fentanyl analogs in driving under the influence of drugs (DUID) casework. In 11 years, from 2010 to 2020, Chan-Hosokawa and Bierly found 4.4% of 153,234 cases positive for fentanyl; however, in 2020, 12% of the cases evaluated were positive for fentanyl [7].…”

“…Polydrug detection was also determined in the majority (>80%) of cases previously reported [7][8][9].…”