A case report of carfentanil-related fatality in France

Gaulier, Jean‐Michel; Richeval, Camille; Phanithavong, Mélodie; Brault, Sandrine; Allorge, Delphine; Dumestre-Toulet, Véronique

doi:10.1016/j.toxac.2019.01.002

Cited by 15 publications

(25 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, in case of an established NPS acute intoxication, hair analysis can provide the drug abuse history of the victim and, consecutively, is able to support clinicians in post‐acute medical management 29,30 . Despite these interests, reports of hair analysis following nonfatal NPS‐related acute intoxication are scarce in the literature 12,31–35 …”

Section: Discussionmentioning

confidence: 99%

“…Toxicological investigations performed in blood and urine samples of Cases #1 and #2 also included selective assays for alcohols, several classes of therapeutic drugs, DOA, or other toxicants using various analytical methods: immunoassays, headspace gas chromatography with flame ionization detection (HS‐GC‐FID), and liquid chromatography with tandem mass spectrometry detection (LC–MS/MS) 4,5,10,11 . Metabolites of NPS were in vitro investigated by analyzing human liver microsome (HLM) incubates by LC‐HRMS, and then, they were retrospectively investigated in biological samples as previously reported 4,5,11,12 . Additional method details are provided in the Supporting Information.…”

Section: Methodsmentioning

confidence: 99%

“…In both presented cases, aforementioned LC‐HRMS and LC–MS/MS methods were used for hair analysis as previously reported 12–14 . Hair samples (Case #1: 34‐cm length dark hair strand; Case #2: 14‐cm length brown hair strand) were decontaminated using 2 × 2‐min baths in water, followed by 2 × 1‐min baths in dichloromethane.…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Hair analysis can support the follow‐up addiction care after acute New Psychoactive Substances intoxication: Illustration by two cases

Lagoutte-Renosi¹,

Richeval

Phanithavong³

et al. 2020

Drug Testing and Analysis

Self Cite

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Hair analysis can support the follow‐up addiction care after acute New Psychoactive Substances intoxication: Illustration by two cases

Lagoutte-Renosi¹,

Richeval

Phanithavong³

et al. 2020

Drug Testing and Analysis

Self Cite

View full text Add to dashboard Cite

“…In a previous study investigating exposure to fentanyl analogs through hair testing in 40 individuals in inpatient detoxification, Palamar et al [37] have reported acetylfentanyl hair concentrations ranging from 2.1 to 3200 pg/mg (median: 26 pg/mg) showing that this fentanyl analog integrates well into the hair matrix. In a case of carfentanil related fatality, hair concentrations found in victim's hair ranged from 54 to 166 pg/mg, which probably reflected a repeated exposure to this fentanyl analog over the studied period of 9 months [38], but could also be due to contamination by sebum and postmortem fluids [39].…”

Section: Validation Results For the Analytical Methodsmentioning

confidence: 96%

Hair testing for 3-fluorofentanyl, furanylfentanyl, methoxyacetylfentanyl, carfentanil, acetylfentanyl and fentanyl by LC–MS/MS after unintentional overdose

et al. 2019

View full text Add to dashboard Cite

Purpose To demonstrate the usefulness of hair testing to determine exposure pattern to fentanyls. Methods A 43-year-old male was found unconscious with respiratory depression 15 min after snorting 3 mg of a powder labeled as butyrylfentanyl. He was discharged from hospital within 2 days without blood or urine testing. Two locks of hair were sampled 1 month (M1 A: 0-2 cm (overdose time frame); B: 2-4 cm; C: 4-6 cm) and 1 year (Y1: A: 0-2 cm; B: 2-4 cm) later to monitor his exposure to drugs of abuse by liquid chromatography-tandem mass spectrometry after liquidliquid extraction. Results Hair analysis at M1 showed a repetitive exposure to 3-fluorofentanyl (A/B/C: 150/80/60 pg/mg) with higher concentration in segment A reflecting the overdose period. The non-detection of butyrylfentanyl was consistent with the analysis of the recovered powder identified as 3-fluorofentanyl. Furanylfentanyl (40/20/15 pg/mg) and fentanyl (37/25/3 pg/mg) were also detected in hair. The second hair analysis at Y1 showed the use of three new fentanyls, with probably repetitive exposures to methoxyacetylfentanyl (A/B: 500/600 pg/mg), and single or few exposures to carfentanil (2.5/3 pg/mg) and acetyl fentanyl (1/1 pg/mg). A decreasing exposure to 3-fluorofentanyl (25/80 pg/mg), and increasing consumption of furanylfentanyl (310/500 pg/mg) and fentanyl (620/760 pg/mg) were also observed despite methadone treatment initiation. The patient claimed not consuming three out of the six detected fentanyls. Conclusions We report single or repetitive exposure to several fentanyls using hair testing. To our knowledge, this is the first demonstration of 3-fluorofentanyl and methoxyacetylfentanyl in hair samples collected from an authentic abuser.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

show abstract

“…In an inpatient detoxification program, Palamar et al reported acetylfentanyl hair concentrations ranging from 2.1 to 3200 pg/mg (median: 26 pg/mg) showing good integration of this compound into the hair matrix 28 . In a case of carfentanil related death, the hair concentration reported ranged from 54 to 166 pg/mg, suggesting a repeated exposure over the studied period of 9 months 29 , without excluding contamination by sebum and postmortem fluids 30 . As expected, acetyl norfentanyl and norcarfentanil, the respective metabolites of acetylfentanyl and carfentanil were not detected as the concentrations of the parent drugs were very low in our study.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of liquid chromatography‐tandem mass spectrometry targeted screening of 16 fentanyl analogs and U‐47700 in hair: Application to 137 authentic samples

Larabi

Martin

Etting

et al. 2020

Drug Testing and Analysis

View full text Add to dashboard Cite

This study was to validate a LC–MS/MS method for the determination of 17 new synthetic opioids (NSOs) in hair including 3‐fluorofentanyl, 3‐methylfentanyl, acetylfentanyl, acetylnorfentanyl, alfentanyl, butyrylfentanyl, butyrylnorfentanyl, carfentanil, fentanyl, furanylfentanyl, furanylnorfentanyl, methoxyacetylfentanyl, norcarfentanil, norfentanyl, ocfentanil, sufentanil, and U‐47700, and to apply it to 137 authentic samples. Twenty milligrams of hair was decontaminated in dichloromethane and underwent liquid extraction. 10 μL of the reconstituted residue were injected onto the system. The separation was performed in 12 minutes in a gradient mode at a flow rate of 300 μL/min using a Hypersyl Gold PFP column (100 × 2.1 mm i.d., 1.9 μm) maintained at 30°C. Compounds were detected in positive ionization and MRM modes using a TSQ Endura mass spectrometer (ThermoFisher). The method was validated according to EMA guidelines. The LLOQ was in the range 1–50 pg/mg, and the calibration ranged from the LLOQ‐1000 pg/mg. Intra‐ and inter‐day accuracy (bias) and precision were < 15%. Extraction recoveries of parent drugs and metabolites were 74–120% and 7–62%, respectively. The matrix effect was in the range 59–126% (CVs ≤ 12.9%). Fentanyl was found in six cases at concentrations of < 1–1650 pg/mg (n = 14 segments). Five fentanyl analogs were quantified in two cases: 3‐fluorofentanyl (25–150 pg/mg, n = 5), furanylfentanyl (15–500 pg/mg, n = 5), methoxyacetylfentanyl (500–600 pg/mg, n = 2), acetylfentanyl (1 pg/mg, n = 2), carfentanyl (2.5–3 pg/mg, n = 2). This fully validated method allowed us to test for the first time 3‐fluorofentanyl and norcarfentanil in hair among 15 other NSOs, and brings new data regarding 3‐fluorofentanyl and methoxyacetylfentanyl hair concentrations.

show abstract

A case report of carfentanil-related fatality in France

Cited by 15 publications

References 34 publications

Hair analysis can support the follow‐up addiction care after acute New Psychoactive Substances intoxication: Illustration by two cases

Hair analysis can support the follow‐up addiction care after acute New Psychoactive Substances intoxication: Illustration by two cases

Hair testing for 3-fluorofentanyl, furanylfentanyl, methoxyacetylfentanyl, carfentanil, acetylfentanyl and fentanyl by LC–MS/MS after unintentional overdose

Development and validation of liquid chromatography‐tandem mass spectrometry targeted screening of 16 fentanyl analogs and U‐47700 in hair: Application to 137 authentic samples

Contact Info

Product

Resources

About