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Reliability of postmortem fentanyl concentrations in determining the cause of death.
J Med Toxicol. 2013 Mar; 9(1):34-41.JM

Abstract

INTRODUCTION

Transdermal fentanyl, an opioid used for management of marked pain, also is abused and may cause death.

METHODS

We reviewed medical examiner reports of 92 decedents who had one or more fentanyl transdermal patches on their body and had fentanyl detected in their postmortem toxicology analysis.

RESULTS

The manners of death included 40 accidents, 36 natural, 8 suicides, 5 therapeutic complications, and 3 undetermined deaths. Among the accidental fentanyl intoxication deaths, 32 of 37 involved substance abuse. The majority (95 %) of the 37 accidental deaths involving fentanyl were multi-drug intoxications. The substance abuse deaths had a mean fentanyl blood concentration (26.4 ng/ml or μg/L) that was over twice that of the natural group (11.8 ng/ml). Our analysis suggests a relationship between total patch dosage and mean postmortem fentanyl concentration up to the 100-μg/h dose.

CONCLUSIONS

The very wide and overlapping ranges of postmortem fentanyl concentrations effectively nullify the utility of correlating the dose and expected postmortem concentration for any particular death. Based on the variable relationship between dose and blood concentration, the antemortem dose cannot be reliably predicted based on the postmortem concentration. This does not, however, render the medical examiner/coroner unable to determine the cause and manner of death because the toxicology results are only one datum point among several that are considered. Although there was a weakly positive relationship between body mass index and fentanyl concentration, further research is needed to determine whether adipose tissue represents a significant depot for postmortem release of fentanyl.

Authors+Show Affiliations

New York City Office of Chief Medical Examiner and Department of Forensic Medicine, New York University School of Medicine, New York, NY 10016, USA. jgill@ocme.nyc.govNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22890811

Citation

Gill, James R., et al. "Reliability of Postmortem Fentanyl Concentrations in Determining the Cause of Death." Journal of Medical Toxicology : Official Journal of the American College of Medical Toxicology, vol. 9, no. 1, 2013, pp. 34-41.
Gill JR, Lin PT, Nelson L. Reliability of postmortem fentanyl concentrations in determining the cause of death. J Med Toxicol. 2013;9(1):34-41.
Gill, J. R., Lin, P. T., & Nelson, L. (2013). Reliability of postmortem fentanyl concentrations in determining the cause of death. Journal of Medical Toxicology : Official Journal of the American College of Medical Toxicology, 9(1), 34-41. https://doi.org/10.1007/s13181-012-0253-z
Gill JR, Lin PT, Nelson L. Reliability of Postmortem Fentanyl Concentrations in Determining the Cause of Death. J Med Toxicol. 2013;9(1):34-41. PubMed PMID: 22890811.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Reliability of postmortem fentanyl concentrations in determining the cause of death. AU - Gill,James R, AU - Lin,Peter T, AU - Nelson,Lewis, PY - 2012/8/15/entrez PY - 2012/8/15/pubmed PY - 2013/8/7/medline SP - 34 EP - 41 JF - Journal of medical toxicology : official journal of the American College of Medical Toxicology JO - J Med Toxicol VL - 9 IS - 1 N2 - INTRODUCTION: Transdermal fentanyl, an opioid used for management of marked pain, also is abused and may cause death. METHODS: We reviewed medical examiner reports of 92 decedents who had one or more fentanyl transdermal patches on their body and had fentanyl detected in their postmortem toxicology analysis. RESULTS: The manners of death included 40 accidents, 36 natural, 8 suicides, 5 therapeutic complications, and 3 undetermined deaths. Among the accidental fentanyl intoxication deaths, 32 of 37 involved substance abuse. The majority (95 %) of the 37 accidental deaths involving fentanyl were multi-drug intoxications. The substance abuse deaths had a mean fentanyl blood concentration (26.4 ng/ml or μg/L) that was over twice that of the natural group (11.8 ng/ml). Our analysis suggests a relationship between total patch dosage and mean postmortem fentanyl concentration up to the 100-μg/h dose. CONCLUSIONS: The very wide and overlapping ranges of postmortem fentanyl concentrations effectively nullify the utility of correlating the dose and expected postmortem concentration for any particular death. Based on the variable relationship between dose and blood concentration, the antemortem dose cannot be reliably predicted based on the postmortem concentration. This does not, however, render the medical examiner/coroner unable to determine the cause and manner of death because the toxicology results are only one datum point among several that are considered. Although there was a weakly positive relationship between body mass index and fentanyl concentration, further research is needed to determine whether adipose tissue represents a significant depot for postmortem release of fentanyl. SN - 1937-6995 UR - https://www.unboundmedicine.com/medline/citation/22890811/Reliability_of_postmortem_fentanyl_concentrations_in_determining_the_cause_of_death_ L2 - https://dx.doi.org/10.1007/s13181-012-0253-z DB - PRIME DP - Unbound Medicine ER -