An Acute Acetyl Fentanyl Fatality: A Case Report With Postmortem Concentrations

Abstract

In this case report, we present an evaluation of the distribution of postmortem concentrations of acetyl fentanyl in a fatality attributed to the drug. A young man who had a history of heroin abuse was found deceased at his parents' home. Toxicology testing, which initially screened positive for fentanyl by ELISA, subsequently confirmed acetyl fentanyl by gas chromatography-mass spectrometry specific ion monitoring (GC-MS SIM) analysis following liquid-liquid extraction. No other drugs or medications, including fentanyl, were detected. The acetyl fentanyl peripheral blood concentration was quantified at 260 ng/mL compared with the central blood concentration of 250 ng/mL. The liver concentration was 1,000 ng/kg, the vitreous was 240 ng/mL and the urine was 2,600 ng/mL. The cause of death was certified due to acute acetyl fentanyl intoxication, and the manner of death was certified as an accident.

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].…”

“…Moreover, the concentrations in urine were lower than those in the liver and brain, which suggested that death was rapid [10,11]. Further, our detailed analyses revealed that the highest levels of acetyl fentanyl were distributed to the myocardium, kidney and spleen rather than to the liver and brain.…”

“…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].…”

“…The number of available reports dealing with determination of acetyl fentanyl from multiple specimens in authentic cases has been limited [3,10,11,15]. In addition, the number of specimens was few; one report included five specimens [11], and another one included four specimens [15]. The most detailed report was provided by Poklis et al [10], including seven specimens using 14 fatal cases.…”

Identification of a new psychoactive substance in seized material: the synthetic opioid N‐phenyl‐N‐[1‐(2‐phenethyl)piperidin‐4‐yl]prop‐2‐enamide (Acrylfentanyl)

“…The proportion of illicit drug overdose deaths involving fentanyls has grown in Canada during the last few years to exceed 50% in some parts of the country 14, 15, 16. Since 2012, 12 deaths in Russia17 and more than 50 deaths in the USA have been associated with acetylfentanyl 18, 19, 20, 21, 22. Other fentanyl analogues, such as butyrfentanyl, 3‐methylfentanyl, and furanylfentanyl, have also been linked to serious adverse events 23, 24, 25.…”