Acetyl Fentanyl Toxicity: Two Case Reports

Abstract

Acetyl fentanyl is an illicit fentanyl analog recently appearing in forensic casework. A quantitative method was created for measuring acetyl fentanyl in various biological matrices acquired post-mortem due to recent positive screening results in casework. Initial detection by immunoassay and standard gas chromatography mass spectrometry (GC/MS) methods have been previously reported for acetyl fentanyl and are examined further here. A Selective Ion Monitoring (SIM) method was created using a GC/MS for quantitation. In two separate cases, acetyl fentanyl was found to be in similar concentrations to those previously reported and ruled to be the cause of death. Acetyl fentanyl concentrations were determined in blood samples, liver, brain, vitreous humor, and urine. Individual 1 had acetyl fentanyl concentrations as follows: heart blood-285 ng/mL, femoral blood-192 ng/mL, liver-1,100 ng/g, brain-620 ng/g, and urine-3,420 ng/mL. Individual 2 had acetyl fentanyl concentrations as follows: heart blood-210 ng/mL, femoral blood-255 ng/mL, urine-2,720 ng/mL and vitreous humor-140 ng/mL. Experimental conditions for screening and quantitation are provided, using immunoassay and GC/MS methods. Due to the recent emergence of acetyl fentanyl, more data will need to be generated to fully differentiate recreational and fatal concentrations of acetyl fentanyl to assist toxicologists accurately understanding its physiological impact.

Postmortem distribution of mepirapim and acetyl fentanyl in biological fluid and solid tissue specimens measured by the standard addition method

“…As described in our previous report, the concentrations of mepirapim in blood specimens were much higher than those of various other synthetic cannabinoids (0.1-199 ng/mL) in previous reports of poisoning deaths [2,[18][19][20]. On the other hand, the concentrations of acetyl fentanyl in the femoral vein and heart whole blood were at levels relatively similar to those of previous reports; the acetyl fentanyl blood levels in fatal cases were 6-600 ng/mL [10], 250-260 ng/mL [11], 153 ng/mL [12], 270 ng/mL [13], 192-285 ng/mL [14] and 235 ng/mL [15]. The urinary level of unchanged mepirapim in the deceased individual was also as high as 309 ng/mL, although the concentration was slightly lower than that previously found (527 ng/mL) [4].…”

“…Recently, acetyl fentanyl has been 1 3 encountered in clinical and forensic case studies [8][9][10][11][12][13][14][15]. The number of available reports dealing with determination of acetyl fentanyl from multiple specimens in authentic cases has been limited [3,10,11,15].…”

Misuse of Novel Synthetic Opioids: A Deadly New Trend

“…Because of the cross-reactivity between fentanyl and its analogs in ELISA tests, the presence of fentanyl analogs often goes unnoticed (Stogner, 2014). Numerous case reports describe opioid overdose patients who displayed positive ELISA results for fentanyl, but did not have fentanyl present when specimens were assayed by GC-MS (McIntyre et al, 2015; Fort et al, 2016; McIntyre et al, 2016). Acetylfentanyl, butyrylfentanyl, and possibly other analogs, cross-react with fentanyl ELISA, so the presence of these fentanyl-related NSO requires additional analytical confirmation.…”

Systematic review of the clinical consequences of butyrfentanyl and corresponding analogues

“…An emerging concern is that a number of NPSs are readily available online including BF, 4-methoxybutyrylfentanyl, acetylfentanyl, U-47770, and AH-7921 Cole et al, 2015;Helander et al, 2016;Rambaran et al, 2018Rambaran et al, , 2017Solimini et al, 2018). Many dosage forms are available and anecdotal accounts of experiences related to these NSOs are posted on internet forums Fort et al, 2016;Rambaran et al, 2018Rambaran et al, , 2017. Since 2013, there have been 40 fatal BF overdoses in the United States, a majority originating from New York, and as many as 88 reports of BF between 2014 and 2015 from California, Florida, Illinois, Indiana, Kansas, Minnesota, North Dakota, New York, Ohio, Oregon, Pennsylvania, Tennessee, Virginia, and Wisconsin (Drug Enforcement Administration, Department of Justice, 2016).…”