An Examination of the Postmortem Redistribution of Fentanyl and Interlaboratory Variability,

Krinsky, Clarissa S.; Lathrop, Sarah; Zumwalt, Ross E.

doi:10.1111/1556-4029.12381

Cited by 19 publications

(10 citation statements)

References 16 publications

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“…Carfentanil references: (Shanks and Behonick, 2017 ; Swanson et al, 2017 ; Hikin et al, 2018 ) . Fentanyl references: (Anderson and Muto, 2000 ; Kuhlman et al, 2003 ; Martin et al, 2006 ; Coopman et al, 2007 ; Biedrzycki et al, 2009 ; Carson et al, 2010 ; Krinsky et al, 2011 , 2014 ; Palamalai et al, 2013 ; Marinetti and Ehlers, 2014 ; McIntyre et al, 2014 ; Bakovic et al, 2015 ; Moore et al, 2015 ; Pearson et al, 2015 ; Poklis et al, 2015 ; Rodda et al, 2017 ; Dwyer et al, 2018 ) . Furanyl fentanyl references: (Mohr et al, 2016 ; Guerrieri et al, 2017a ; Martucci et al, 2017 ; Papsun et al, 2017 ) .…”

Section: Concentrations In Postmortem Specimens and Other Findingsmentioning

confidence: 99%

Postmortem Toxicology of New Synthetic Opioids

et al. 2018

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One hundred fifteen Americans die every day from opioid overdose. These overdose fatalities have been augmented by the increased availability of potent synthetic opioids, such as fentanyl and its derivatives. The death rate of synthetic opioids, other than methadone, increased by 72.2% from 2014 to 2015, and doubled from 2015 to 2016, situating the USA in the midst of an opioid overdose epidemic. The analytical identification of these opioids in postmortem samples and the correct toxicological data interpretation is critical to identify and implement preventive strategies. This article reviews the current knowledge of postmortem toxicology of synthetic opioids and the chemical and pharmacological factors that may affect drug concentrations in the different postmortem matrices and therefore, their interpretation. These factors include key chemical properties, essential pharmacokinetics parameters (metabolism), postmortem redistribution and stability data in postmortem samples. Range and ratios of concentrations reported in traditional and non-traditional postmortem specimens, blood, urine, vitreous humor, liver and brain, are summarized in tables. The review is focused on fentanyl and derivatives (e.g., acetyl fentanyl, butyryl fentanyl, carfentanil, furanyl fentanyl, 4-methoxybutyrylfentanyl, 4-fluorobutyrylfentanyl, ocfentanil) and non-traditional opioid agonists (e.g., AH-7921, MT-45, U-47700). All of these data are critically compared to postmortem data, and chemical and pharmacological properties of natural opioids (morphine), semi-synthetic (oxycodone, hydrocodone, hydromorphone, and oxymorphone), and synthetic opioids (methadone and buprenorphine). The interpretation of drug intoxication in death investigation is based on the available published literature. This review serves to facilitate the evaluation of cases where synthetic opioids may be implicated in a fatality through the critical review of peer reviewed published case reports and research articles.

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Section: Concentrations In Postmortem Specimens and Other Findingsmentioning

confidence: 99%

Postmortem Toxicology of New Synthetic Opioids

et al. 2018

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“…Krinsky et al. reported that the mean ratio of fentanyl concentration in peripheral blood samples drawn the day before autopsy and at the time of autopsy was 1.80 . However, in the Andresen et al.…”

Section: Resultsmentioning

confidence: 97%

“…Postmortem redistribution of fentanyl in the blood can occur (6,10,15,(23)(24)(25). Moore et al have reported that femoral blood concentrations taken 0.5 and 2 h after death increased from 1.6 to 14 ng/mL (15).…”

Section: Methods Validationmentioning

confidence: 99%

“…Moore et al have reported that femoral blood concentrations taken 0.5 and 2 h after death increased from 1.6 to 14 ng/mL (15). Krinsky et al reported that the mean ratio of fentanyl concentration in peripheral blood samples drawn the day before autopsy and at the time of autopsy was 1.80 (23). However, in the Andresen et al study, there was no clear relationship between the postmortem blood concentration and the length of the postmortem interval (24).…”

Section: Methods Validationmentioning

confidence: 99%

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A Fatal Case of Poisoning with Fentanyl Transdermal Patches in Japan

Nara

Yamada

Saka

et al. 2019

Journal of Forensic Sciences

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Fentanyl transdermal patches have been used to treat cancer‐ and noncancer‐related chronic pain. However, its inappropriate or illegal application may cause fatal poisoning. We herein present the case of a Japanese woman in her 40s who was found dead with seven 25‐μg/h fentanyl transdermal patches on her body. We established a detailed toxicological analysis procedure to quantify fentanyl, and its metabolite norfentanyl, and other drugs (acetaminophen, allylisopropylacetylurea, celecoxib, estazolam, promethazine, and sertraline) in human whole blood by ultra‐high‐performance liquid chromatography–tandem mass spectrometry. The measured fentanyl and norfentanyl concentrations in the femoral and cardiac blood were 0.051 and 0.072 μg/mL and 0.033 and 0.076 μg/mL, respectively. The decedent's fentanyl concentrations were consistent with previously reported postmortem blood levels for fatal cases of poisoning by fentanyl transdermal patches. Based on the decedent's case history, autopsy findings, and toxicological analyses, the cause of death was identified as intoxication with transdermal fentanyl.

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“…This approach should be adopted in all cases of death from uncertain or questionable causes [ 66 , 70 ]. Past medical history and ante-mortem distribution, crime scene investigation, post-mortem toxicology examination, and toxicology findings should be carefully analyzed and considered on a case-by-case basis in light of all other data [ 11 , 98 , 105 , 106 , 107 ].…”

Section: Discussionmentioning

confidence: 99%

Novel Synthetic Opioids: The Pathologist’s Point of View

et al. 2018

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Background: New Psychoactive Substances (NPS) constitute a broad range of hundreds of natural and synthetic drugs, including synthetic opioids, synthetic cannabinoids, synthetic cathinones, and other NPS classes, which were not controlled from 1961 to 1971 by the United Nations drug control conventions. Among these, synthetic opioids represent a major threat to public health. Methods: A literature search was carried out using public databases (such as PubMed, Google Scholar, and Scopus) to survey fentanyl-, fentanyl analogs-, and other synthetic opioid-related deaths. Keywords including “fentanyl”, “fentanyl analogs”, “death”, “overdose”, “intoxication”, “synthetic opioids”, “Novel Psychoactive Substances”, “MT-45”, “AH-7921”, and “U-47700” were used for the inquiry. Results: From our literature examination, we inferred the frequent implication of fentanyls and synthetic opioids in side effects, which primarily affected the central nervous system and the cardiovascular and pulmonary systems. The data showed a great variety of substances and lethal concentrations. Multidrug-related deaths appeared very common, in most reported cases. Conclusions: The investigation of the contribution of novel synthetic opioid intoxication to death should be based on a multidisciplinary approach aimed at framing each case and directing the investigation towards targeted toxicological analyses.

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An Examination of the Postmortem Redistribution of Fentanyl and Interlaboratory Variability,

Cited by 19 publications

References 16 publications

Postmortem Toxicology of New Synthetic Opioids

Postmortem Toxicology of New Synthetic Opioids

A Fatal Case of Poisoning with Fentanyl Transdermal Patches in Japan

Novel Synthetic Opioids: The Pathologist’s Point of View

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