Illicit Fentanyl-Related Fatalities in Florida: Toxicological Findings

Abstract

Fentanyl induces pharmacological effects and abuse liability comparable to other prescription opioids and heroin. A surge in fentanyl-related fatalities has been periodically reported throughout the USA. The University of Florida Forensic Toxicology Laboratory observed a significant increase in fentanyl-related deaths starting in mid-2014. The present report evaluated toxicological findings, demographics of the decedents and circumstances of death in the postmortem cases that were submitted to the laboratory for toxicological analysis from July 2014 to January 2015 and that were tested for fentanyl in biological specimens. The cases originated from 6 of the 24 Florida Medical Examiner Districts, with the majority from District 12 (Desoto, Manatee and Sarasota counties). The specimens were analyzed for fentanyl by gas chromatography-mass spectrometry; the limit of detection (LOD) was 0.62 ng/mL and the limit of quantification (LOQ) was 2.5 ng/mL. During the 7-month period, the laboratory tested 143 postmortem cases for fentanyl and 50% had quantifiable fentanyl in postmortem blood. Fentanyl concentrations ranged from 2.5 to 68 ng/mL (n = 66; median: 9.8 ng/mL); six cases were positive for fentanyl >LOD but <LOQ. The majority of the cases (85%) had indications of possible drug abuse with heroin use being the most often suspected. Concurrent detection of 6-acetylmorphine, morphine and cocaine along with other opioids and benzodiazepines was common. Of the 59 deaths from District 12, the cause of death was accidental drug intoxication with fentanyl as a sole or contributing factor for 57 cases (two non-drug intoxication deaths). The median age of the 57 decedents was 35 (range: 19-63) years. Males represented 87% of the deaths and 96% were Whites. Most of the decedents (n = 53) had no prescription for fentanyl. Considering fentanyl's high potency and abuse liability, the recent rise in fentanyl-related deaths is a serious public health concern and signifies the urgent need to establish prevention and treatment efforts.

The Effects of Intramuscular Naloxone Dose on Mu Receptor Displacement of Carfentanil in Rhesus Monkeys

“…In the current macaque model, a subclinical dose of radiolabeled [ 11 C]carfentanil was used to estimate RO resulting from an IM injection of naloxone. Thus, the results of this study may underestimate the dose and plasma level of NLX required to achieve a clinically significant level of RO, as very high levels of synthetic opioids have been found in overdose patients [24][25][26][27][28]. However, this study does suggest that for an invariable dose of carfentanil, increasing doses of IM NLX result in greater RO and, furthermore, increasing doses of IM NLX results in higher systemic levels.…”

Fentanyl novel derivative‐related deaths

“…In vivo effects of FEN-derived drugs (euphoria, respiratory depression, drowsiness, respiratory depression, and so on) resemble those of narcotics (Skulska, Kała, & Parczewski, 2005;Nelson & Schwaner, 2009;Stogner, 2014;Lee et al, 2016;Mohr et al, 2016). Not surprisingly, many FEN-related deaths are discovered and must therefore be considered in suspected cases of overdose, even if the routine toxicological test is negative (Martin et al, 1991;Kronstrand et al, 1997;Mohr et al, 2016;Dussy et al, 2016).…”

Norcarfentanil: carfentanil misuse or remifentanil treatment?

“…Since 2013, new synthetic opioid (NSO) derivatives have emerged on the American and European illicit drug markets [1][2][3]. A significant number of opioid overdoses and deaths have been associated with the use of fentanyl and its synthetic analogs in the United States [4][5][6][7][8][9][10][11]. For example, in Ohio, more than 4000 deaths were linked to opioids in 2016, with a 36% increase attributed to heroin and carfentanil abuse [11].…”