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Detection of fentanyl and fentanyl analogues in biological samples using liquid chromatography-high resolution mass spectrometry.
Forensic Sci Int. 2019 Jul; 300:13-18.FS

Abstract

BACKGROUND

Fentanyl and analogues such as butyrylfentanyl, carfentanil, 4-fluorobutyrylfentanyl, and furanylfentanyl may be either added to, or sold as, heroin. Fentanyl and carfentanil have approximately 100 and 10,000 times the potency of morphine, respectively, and there is thus a high risk of death with the use of these drugs.

METHODS

We looked for fentanyl/fentanyl analogues using liquid chromatography-high resolution mass spectrometry (LC-HRMS) in selected biological samples obtained post-mortem February 2017-end January 2018. Suspicion of fentanyl poisoning arose from the circumstances of death, a history of heroin use, and the geographical area in which the deceased was discovered, supplemented by drugs intelligence data.

RESULTS

Of the 84 deaths investigated, fentanyl and/or a fentanyl analogue were detected in 40 (48%). The fentanyls encountered were carfentanil (N = 17), fentanyl (9), carfentanil and fentanyl together (12), and fentanyl, carfentanil, 4-fluorobutyrylfentanyl, and butyrylfentanyl together (2). The median (range) post-mortem blood fentanyl concentration was 2.66 (0.21-107) μg/L and the median (range) carfentanil concentration was 0.24 (0.03-1.66) μg/L. The most prevalent compounds present together with fentanyls were ethanol [N = 28, median (range) post-mortem blood concentration: 44 (<10-249) mg/dL)], benzoylecgonine [N = 22, 0.64 (<0.05-3.17) mg/L] and free morphine [N = 20, 0.05 (<0.05-0.34) mg/L]. Deaths in hospital excluded, median blood free morphine, and ethanol concentrations were significantly lower in deaths where fentanyl/fentanyl analogues were present, but there was much overlap with the blood concentrations of these analytes in the non-fentanyl related deaths. A routine drugs of abuse assay using LC-HRMS identified fentanyl with 100% sensitivity and carfentanil with 89% sensitivity.

CONCLUSIONS

Given their potency, misuse of fentanyl and its analogues is likely to cause severe toxicity. A simple LC-HRMS method detected all cases in which fentanyl was identified post-mortem and most of the cases in which carfentanil was detected.

Authors+Show Affiliations

Specialised Clinical Chemistry, Sheffield Teaching Hospitals NHS Foundation Trust, United Kingdom. Electronic address: edmund.rab@sth.nhs.uk.Specialised Clinical Chemistry, Sheffield Teaching Hospitals NHS Foundation Trust, United Kingdom.LGC Sport and Specialised Analytical Services, Fordham, Cambridgeshire, United Kingdom.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31063883

Citation

Rab, Edmund, et al. "Detection of Fentanyl and Fentanyl Analogues in Biological Samples Using Liquid Chromatography-high Resolution Mass Spectrometry." Forensic Science International, vol. 300, 2019, pp. 13-18.
Rab E, Flanagan RJ, Hudson S. Detection of fentanyl and fentanyl analogues in biological samples using liquid chromatography-high resolution mass spectrometry. Forensic Sci Int. 2019;300:13-18.
Rab, E., Flanagan, R. J., & Hudson, S. (2019). Detection of fentanyl and fentanyl analogues in biological samples using liquid chromatography-high resolution mass spectrometry. Forensic Science International, 300, 13-18. https://doi.org/10.1016/j.forsciint.2019.04.008
Rab E, Flanagan RJ, Hudson S. Detection of Fentanyl and Fentanyl Analogues in Biological Samples Using Liquid Chromatography-high Resolution Mass Spectrometry. Forensic Sci Int. 2019;300:13-18. PubMed PMID: 31063883.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Detection of fentanyl and fentanyl analogues in biological samples using liquid chromatography-high resolution mass spectrometry. AU - Rab,Edmund, AU - Flanagan,Robert J, AU - Hudson,Simon, Y1 - 2019/04/17/ PY - 2018/12/11/received PY - 2019/04/03/revised PY - 2019/04/06/accepted PY - 2019/5/8/pubmed PY - 2019/6/18/medline PY - 2019/5/8/entrez KW - Carfentanil KW - Fentanyl KW - Fentanyl analogues KW - Heroin-related deaths KW - Liquid chromatography–high resolution mass spectrometry KW - Substance misuse SP - 13 EP - 18 JF - Forensic science international JO - Forensic Sci Int VL - 300 N2 - BACKGROUND: Fentanyl and analogues such as butyrylfentanyl, carfentanil, 4-fluorobutyrylfentanyl, and furanylfentanyl may be either added to, or sold as, heroin. Fentanyl and carfentanil have approximately 100 and 10,000 times the potency of morphine, respectively, and there is thus a high risk of death with the use of these drugs. METHODS: We looked for fentanyl/fentanyl analogues using liquid chromatography-high resolution mass spectrometry (LC-HRMS) in selected biological samples obtained post-mortem February 2017-end January 2018. Suspicion of fentanyl poisoning arose from the circumstances of death, a history of heroin use, and the geographical area in which the deceased was discovered, supplemented by drugs intelligence data. RESULTS: Of the 84 deaths investigated, fentanyl and/or a fentanyl analogue were detected in 40 (48%). The fentanyls encountered were carfentanil (N = 17), fentanyl (9), carfentanil and fentanyl together (12), and fentanyl, carfentanil, 4-fluorobutyrylfentanyl, and butyrylfentanyl together (2). The median (range) post-mortem blood fentanyl concentration was 2.66 (0.21-107) μg/L and the median (range) carfentanil concentration was 0.24 (0.03-1.66) μg/L. The most prevalent compounds present together with fentanyls were ethanol [N = 28, median (range) post-mortem blood concentration: 44 (<10-249) mg/dL)], benzoylecgonine [N = 22, 0.64 (<0.05-3.17) mg/L] and free morphine [N = 20, 0.05 (<0.05-0.34) mg/L]. Deaths in hospital excluded, median blood free morphine, and ethanol concentrations were significantly lower in deaths where fentanyl/fentanyl analogues were present, but there was much overlap with the blood concentrations of these analytes in the non-fentanyl related deaths. A routine drugs of abuse assay using LC-HRMS identified fentanyl with 100% sensitivity and carfentanil with 89% sensitivity. CONCLUSIONS: Given their potency, misuse of fentanyl and its analogues is likely to cause severe toxicity. A simple LC-HRMS method detected all cases in which fentanyl was identified post-mortem and most of the cases in which carfentanil was detected. SN - 1872-6283 UR - https://www.unboundmedicine.com/medline/citation/31063883/Detection_of_fentanyl_and_fentanyl_analogues_in_biological_samples_using_liquid_chromatography_high_resolution_mass_spectrometry_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0379-0738(19)30139-2 DB - PRIME DP - Unbound Medicine ER -