Fatal misuse of transdermal fentanyl patches

Prangenberg, Julian; Maas, Alexandra; Kraemer, Michael; Doberentz, Elke; Madea, Burkhard

doi:10.1016/j.forsciint.2019.06.016

Cited by 19 publications

(12 citation statements)

References 42 publications

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“…A total of 1226 records were screened of which 17 studies were included (Figure 1). [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] Of the 17 included articles, eight were case reports and nine were case series (see Table 1). The quality of reporting of included case studies was generally good.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

<p>Causes, Nature and Toxicology of Fentanyl-Associated Deaths: A Systematic Review of Deaths Reported in Peer-Reviewed Literature</p>

Cheema¹,

McGuinness²,

Hadi³

et al. 2020

JPR

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Section: Resultsmentioning

confidence: 99%

“…Of the 17 articles included in this systematic review only one study reported non measurable fentanyl concentration in blood. 24 Three studies reported norfentanyl concentrations. 21,25,34 Norfentanyl is one of the main metabolites of fentanyl that is produced by oxidative N-dealkylation.…”

Section: Toxicologymentioning

confidence: 99%

<p>Causes, Nature and Toxicology of Fentanyl-Associated Deaths: A Systematic Review of Deaths Reported in Peer-Reviewed Literature</p>

Cheema¹,

McGuinness²,

Hadi³

et al. 2020

JPR

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“…Micro-segmental analysis can clearly differentiate distribution profiles between external contamination and drug administration (Figs. 1,2,3,4,5). For instance, whether a detected drug was derived from external contaminants can be determined if concentrations of an unchanged drug remain high and metabolite ratios remain low along the hair shaft (Fig.…”

Section: Distinguishing External Contamination From Drug Administration With Hairsmentioning

confidence: 99%

“…Understanding how a drug is administered is important to elucidate the circumstances of drug-related crimes during investigations. Drugs can be administered via various routes, such as orally, topically, intravenously and by inhalation [1][2][3][4][5]. The choice of administration route affects the time course of drug concentrations in the blood and can change the duration of pharmacological effects.…”

Section: Introductionmentioning

confidence: 99%

Distribution profiles of diphenhydramine and lidocaine in scalp, axillary, and pubic hairs measured by micro-segmental hair analysis: good indicator for discrimination between administration and external contamination of the drugs

et al. 2021

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Purpose Drug distribution in scalp hair can provide historical information about drug use, such as the date and frequency of drug ingestion. We previously developed micro-segmental hair analysis, which visualizes drug distribution at 0.4-mm intervals in individual hairs. The present study examines whether the distribution profiles of drugs can be markers for the administration or external contamination of the drugs using scalp, axillary, and pubic hairs. Methods A single dose of anti-itch ointment containing diphenhydramine (DP) and lidocaine (LD) was topically applied to the axillary or pubic areas of two volunteers; DP was also orally administered; and LD was intra-gingivally injected. Scalp, axillary, and pubic hairs were assessed using our micro-segmental analysis. Results The localization of DP and LD differed within individual scalp hair strands, implying DP and LD were predominantly incorporated into scalp hair via the bloodstream and via sweat/sebum, respectively, showing double-peak profiles. However, DP and LD were distributed along the shafts of axillary and pubic hairs without appearance of the double-peak profiles when the ointment had been applied to the axillary and pubic areas. The distributions of DP and LD in scalp hairs did not significantly differ according to administration routes, such as oral administration, gingival injection, and topical application. Conclusions Micro-segmental analysis revealed differences in the distribution profiles of drugs in hairs, and distinguished hairs with and without external contamination. These findings will be useful for understanding of the mechanism of drug uptake into hair and for estimating the circumstances for a drug use.

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“…Although the awareness of these problems has increased in the last few years, this did not prevent further deaths due to fentanyl. Recent studies have even reported an increasing number of fentanyl intoxications and deaths by fentanyl overdoses, both intentional and unintentional [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Case report on postmortem fentanyl measurement after overdose with more than 67 fentanyl patches

Peeters

Vleut

Tan³

et al. 2021

Forensic Toxicol

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Purpose Fentanyl is an analgesic that is frequently prescribed, which resulted in non-intentional as well as intentional misuse and deaths. Here, we present a postmortem case of a patient who clearly died of a fentanyl overdose due to an extensive number of fentanyl patches combined with oral intake of fentanyl and cocaine. We aimed to show how postmortem analysis can be used to interpret postmortem fentanyl concentrations in unique cases like the one we present. Case description A 23-year-old male was found dead in his bedroom with 67 non-prescribed patches of fentanyl on his body. In the room, there also were fentanyl tablets of 100 µg and cocaine powder, which had possibly also been taken by the deceased. To confirm the cause of death, urine and subclavian blood were retrieved to perform a standard postmortem toxicology screening. The toxicological screening revealed the presence of several drugs, including cocaine, fentanyl, lidocaine and paracetamol. Further analysis of the quantitative postmortem values of fentanyl with ultra-performance liquid chromatography-tandem mass spectrometry revealed a fentanyl concentration of 57.9 µg/L. Considering several issues around postmortem drug analyses, this value seemed to be in line with concentrations found in previously reported postmortem cases. Conclusion We were able to confirm the expected cause of death with an extensive toxicological screening in combination with the circumstantial evidence. We identified fentanyl as most important cause for the fatal outcome in this specific case and simultaneously contributed to the limited availability of knowledge on postmortem fentanyl concentrations.

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Fatal misuse of transdermal fentanyl patches

Cited by 19 publications

References 42 publications

<p>Causes, Nature and Toxicology of Fentanyl-Associated Deaths: A Systematic Review of Deaths Reported in Peer-Reviewed Literature</p>

<p>Causes, Nature and Toxicology of Fentanyl-Associated Deaths: A Systematic Review of Deaths Reported in Peer-Reviewed Literature</p>

Distribution profiles of diphenhydramine and lidocaine in scalp, axillary, and pubic hairs measured by micro-segmental hair analysis: good indicator for discrimination between administration and external contamination of the drugs

Case report on postmortem fentanyl measurement after overdose with more than 67 fentanyl patches

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