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Published:
Journal of Analytical Toxicology,
ISSN 0146-4760,
Volume 32, Number 7, September,
pp.522-528
CASE REPORT:
Detection of Clenbuterol in Heroin Users in Twelve Postmortem Cases
at the Philadelphia Medical Examiner’s Office
William E. Wingert1, Lisa A. Mundy1, Lauren Nelson1, Stella
C. Wong2, and John Curtis3
1The Philadelphia Medical Examiner’s Office, 321
University Avenue, Philadelphia, Pennsylvania 19104;
2Department of Emergency
Medicine, Nazareth Hospital, 2601 Holme Avenue, Philadelphia, Pennsylvania
19152; and
3Department of Emergency Medicine, Drexel University
College of Medicine, Philadelphia, Pennsylvania 19102
The presence of clenbuterol, a β2-adrenergic
agonist banned for human use in the United States because of
its serious side effects, is reported in a series of 12 postmortem
cases in which the cause of death was attributed to illicit drug
use. During the first three months of 2007, postmortem specimens
from cases previously screening positive for opiates or fentanyl
were screened specifically for clenbuterol using enzyme-linked
immunosorbent assay. Confirmation of clenbuterol was performed
using solid-phase extraction, derivatization with trimethylboroxine,
and analysis utilizing a gas chromatograph–mass spectrometer
(GC–MS) operated in the full-scan mode. The limits of detection
and quantitation in blood were 2.5 and 5 ng/mL, respectively.
Linearity was from 5 to 100 ng/mL. Clenbuterol was positive in
12/106 (11%) drug-related cases and in 12/575 (2.1%) of the total
cases tested. In each of the 12 cases positive for clenbuterol,
heroin use was either confirmed by the presence of 6-acetylmorphine
or strongly suspected by the presence of morphine with a history
of heroin abuse. Because the use of clenbuterol in the United
States is restricted to veterinary medicine, its detection is
an unexpected finding. Its presence in these cases serves as
a caution to emergency room physicians and toxicologists to consider
and test for clenbuterol when treating a suspected heroin user
who presents atypically. This is the first known series of clenbuterol-positive
cases of illicit drug users to be reported from a medical examiner’s
toxicology laboratory.
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