Tags

Type your tag names separated by a space and hit enter

Three Cases of Fatal Acrylfentanyl Toxicity in the United States and a Review of Literature.
J Anal Toxicol. 2018 Jan 01; 42(1):e6-e11.JA

Abstract

Fentanyl analogs pose a unique challenge for forensic pathologists and toxicologists. The extreme potency of these analogs results in minute blood, urine and vitreous concentrations that are technically difficult to identify. This in addition to their absence from standard drug screening may potentiate a setting of apparent drug overdose without an immediately identifiable source. The following case series illustrates three such encounters with acrylfentanyl, an analog whose presence has not yet been reported in the scientific literature in the United States. In case 1, a 23-year-old male with a history of heroin abuse was found unresponsive in a field several feet away from his parked vehicle. Drugs and paraphernalia recovered from the vehicle tested positive for methamphetamine and acrylfentanyl. Directed toxicology was requested, revealing acrylfentanyl concentrations of 0.3 ng/mL. In case 2, a 43-year-old male with a history of heroin abuse was found unresponsive in his home after allegedly injecting what he thought to be heroin. Directed toxicology revealed an acrylfentanyl concentration of 0.95 ng/mL in peripheral blood. In case 3, a 26-year-old male with a history of heroin abuse use found unresponsive on the bathroom floor of a grocery store. Drug paraphernalia and a plastic baggy with residue were present. Directed analysis of peripheral blood for fentanyl analogs revealed acrylfentanyl and furanylfentanyl at concentrations of 0.32 and 0.95 ng/mL, respectively. In all three cases, the initial comprehensive blood toxicology did not reveal the presence of acrylfentanyl, highlighting the need for directed testing when scene findings and history suggest a possible substance outside the scope of traditional screening.

Authors+Show Affiliations

Department of Pathology and Laboratory Medicine, Medical University of South Carolina, 65 Ashley Ave, Charleston, SC 29425, USA.Axis Laboratories, Forensic Toxicology, 2265 Executive Drive, Indianapolis, IN 46241, USA.Axis Laboratories, Forensic Toxicology, 2265 Executive Drive, Indianapolis, IN 46241, USA.South Carolina Law Enforcement Division, Toxicology, 4400 Broad River Rd, Columbia, SC 29210, USA.Department of Pathology and Laboratory Medicine, Medical University of South Carolina, 65 Ashley Ave, Charleston, SC 29425, USA.Department of Pathology and Laboratory Medicine, Medical University of South Carolina, 65 Ashley Ave, Charleston, SC 29425, USA.

Pub Type(s)

Case Reports
Journal Article
Review

Language

eng

PubMed ID

29036502

Citation

Butler, Daniel C., et al. "Three Cases of Fatal Acrylfentanyl Toxicity in the United States and a Review of Literature." Journal of Analytical Toxicology, vol. 42, no. 1, 2018, pp. e6-e11.
Butler DC, Shanks K, Behonick GS, et al. Three Cases of Fatal Acrylfentanyl Toxicity in the United States and a Review of Literature. J Anal Toxicol. 2018;42(1):e6-e11.
Butler, D. C., Shanks, K., Behonick, G. S., Smith, D., Presnell, S. E., & Tormos, L. M. (2018). Three Cases of Fatal Acrylfentanyl Toxicity in the United States and a Review of Literature. Journal of Analytical Toxicology, 42(1), e6-e11. https://doi.org/10.1093/jat/bkx083
Butler DC, et al. Three Cases of Fatal Acrylfentanyl Toxicity in the United States and a Review of Literature. J Anal Toxicol. 2018 Jan 1;42(1):e6-e11. PubMed PMID: 29036502.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Three Cases of Fatal Acrylfentanyl Toxicity in the United States and a Review of Literature. AU - Butler,Daniel C, AU - Shanks,Kevin, AU - Behonick,George S, AU - Smith,Dustin, AU - Presnell,Susan E, AU - Tormos,Lee Marie, PY - 2017/05/02/received PY - 2017/09/14/accepted PY - 2017/10/17/pubmed PY - 2018/9/19/medline PY - 2017/10/17/entrez SP - e6 EP - e11 JF - Journal of analytical toxicology JO - J Anal Toxicol VL - 42 IS - 1 N2 - Fentanyl analogs pose a unique challenge for forensic pathologists and toxicologists. The extreme potency of these analogs results in minute blood, urine and vitreous concentrations that are technically difficult to identify. This in addition to their absence from standard drug screening may potentiate a setting of apparent drug overdose without an immediately identifiable source. The following case series illustrates three such encounters with acrylfentanyl, an analog whose presence has not yet been reported in the scientific literature in the United States. In case 1, a 23-year-old male with a history of heroin abuse was found unresponsive in a field several feet away from his parked vehicle. Drugs and paraphernalia recovered from the vehicle tested positive for methamphetamine and acrylfentanyl. Directed toxicology was requested, revealing acrylfentanyl concentrations of 0.3 ng/mL. In case 2, a 43-year-old male with a history of heroin abuse was found unresponsive in his home after allegedly injecting what he thought to be heroin. Directed toxicology revealed an acrylfentanyl concentration of 0.95 ng/mL in peripheral blood. In case 3, a 26-year-old male with a history of heroin abuse use found unresponsive on the bathroom floor of a grocery store. Drug paraphernalia and a plastic baggy with residue were present. Directed analysis of peripheral blood for fentanyl analogs revealed acrylfentanyl and furanylfentanyl at concentrations of 0.32 and 0.95 ng/mL, respectively. In all three cases, the initial comprehensive blood toxicology did not reveal the presence of acrylfentanyl, highlighting the need for directed testing when scene findings and history suggest a possible substance outside the scope of traditional screening. SN - 1945-2403 UR - https://www.unboundmedicine.com/medline/citation/29036502/Three_Cases_of_Fatal_Acrylfentanyl_Toxicity_in_the_United_States_and_a_Review_of_Literature_ L2 - https://academic.oup.com/jat/article-lookup/doi/10.1093/jat/bkx083 DB - PRIME DP - Unbound Medicine ER -