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Published:
Journal of Analytical Toxicology,
ISSN 0146-4760,
Volume 27, Number 7, October 2003,
pp. 499-504
Fentanyl Use, Misuse, and Abuse: A Summary of 23 Postmortem
Cases
James J. Kuhlman, Jr.[1], Rebecca McCaulley[2],
Tara J. Valouch[1], and George S. Behonick[1]
[1]Virginia Division of Forensic Science, Western Laboratory, 6600 Northside
High School Road, Roanoke, Virginia 24019 and
[2]Department of Justice Sciences,
University of Alabama at Birmingham, 1530 3rd Avenue S, Birmingham, Alabama
35294
We report the rapidly increasing finding of fentanyl in medical
examiner cases in southwestern Virginia. During the past 3 years, fentanyl
cases have increased from 3 in 2000 to 12 in 2002. The first medical examiner
case of 2003 was a fentanyl poisoning. Nineteen of 23 cases were attributed
to fentanyl misuse or abuse of fentanyl transdermal patches. Routes of administration
were transdermal, transmucosal/oral, intravenous, and combinations of routes
of administration. Fentanyl was identified using a solid-phase extraction basic
drug screen in blood and/or urine followed by full scan gas chromatography–mass
spectrometry (GC–MS) in the electron impact ionization mode. Fentanyl
quantitation was performed using selected ion monitoring GC–MS. The method
was linear from 1 to 50 µg/L with a limit of quantitation of 1 µg/L.
Fentanyl blood concentrations ranged from 2 to 48 µg/L with a mean concentration
of 18 µg/L. The age range of the decedents was 16–53 with an average
age of 37. Southwestern Virginia is currently a “hot spot” for
misuse and abuse of oxycodone and methadone. The rapid rise in the number of
fentanyl cases over the past three years, the increasing availability of fentanyl
patches, and the large number of case histories indicating misuse or abuse
suggest that fentanyl is rapidly becoming an additional desired opioid similar
to oxycodone and methadone. Reproduction
of editorial content of this journal is prohibited without publisher’s
permission.
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