Lee Dayong, Chronister Chris W, Broussard Wilson A, Utley-Bobak Suzanne R, Schultz Daniel L, Vega Russell S, Goldberger Bruce A
Forensic Toxicology Laboratory, Division of Forensic Medicine, Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA Houston Forensic Science Center, Houston, TX, USA.
Forensic Toxicology Laboratory, Division of Forensic Medicine, Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, Gainesville, FL, USA.
J Anal Toxicol. 2016 Oct;40(8):588-594. doi: 10.1093/jat/bkw087.
Fentanyl induces pharmacological effects and abuse liability comparable to other prescription opioids and heroin. A surge in fentanyl-related fatalities has been periodically reported throughout the USA. The University of Florida Forensic Toxicology Laboratory observed a significant increase in fentanyl-related deaths starting in mid-2014. The present report evaluated toxicological findings, demographics of the decedents and circumstances of death in the postmortem cases that were submitted to the laboratory for toxicological analysis from July 2014 to January 2015 and that were tested for fentanyl in biological specimens. The cases originated from 6 of the 24 Florida Medical Examiner Districts, with the majority from District 12 (Desoto, Manatee and Sarasota counties). The specimens were analyzed for fentanyl by gas chromatography-mass spectrometry; the limit of detection (LOD) was 0.62 ng/mL and the limit of quantification (LOQ) was 2.5 ng/mL. During the 7-month period, the laboratory tested 143 postmortem cases for fentanyl and 50% had quantifiable fentanyl in postmortem blood. Fentanyl concentrations ranged from 2.5 to 68 ng/mL (n = 66; median: 9.8 ng/mL); six cases were positive for fentanyl >LOD but <LOQ. The majority of the cases (85%) had indications of possible drug abuse with heroin use being the most often suspected. Concurrent detection of 6-acetylmorphine, morphine and cocaine along with other opioids and benzodiazepines was common. Of the 59 deaths from District 12, the cause of death was accidental drug intoxication with fentanyl as a sole or contributing factor for 57 cases (two non-drug intoxication deaths). The median age of the 57 decedents was 35 (range: 19-63) years. Males represented 87% of the deaths and 96% were Whites. Most of the decedents (n = 53) had no prescription for fentanyl. Considering fentanyl's high potency and abuse liability, the recent rise in fentanyl-related deaths is a serious public health concern and signifies the urgent need to establish prevention and treatment efforts.
芬太尼产生的药理作用和滥用倾向与其他处方类阿片药物及海洛因相当。在美国，与芬太尼相关的死亡人数激增的情况时有报道。佛罗里达大学法医毒理学实验室发现，自2014年年中起，与芬太尼相关的死亡人数显著增加。本报告评估了2014年7月至2015年1月期间提交至该实验室进行毒理学分析且生物样本中检测了芬太尼的尸检案例的毒理学结果、死者人口统计学特征及死亡情况。这些案例来自佛罗里达24个法医辖区中的6个，其中大部分来自第12辖区（德索托县、马纳蒂县和萨拉索塔县）。通过气相色谱 - 质谱联用仪分析样本中的芬太尼；检测限（LOD）为0.62 ng/mL，定量限（LOQ）为2.5 ng/mL。在这7个月期间，该实验室对143例尸检案例进行了芬太尼检测，50%的案例在尸检血液中检测到可定量的芬太尼。芬太尼浓度范围为2.5至68 ng/mL（n = 66；中位数：9.8 ng/mL）；6例芬太尼检测结果呈阳性但高于检测限低于定量限。大多数案例（85%）有药物滥用迹象，最常怀疑的是使用海洛因。同时检测到6 - 乙酰吗啡、吗啡、可卡因以及其他阿片类药物和苯二氮䓬类药物的情况很常见。在第12辖区的59例死亡案例中，57例（两例非药物中毒死亡）的死因是意外药物中毒，芬太尼是唯一或促成因素。57例死者的年龄中位数为35岁（范围：19 - 63岁）。男性占死亡人数的87%，96%为白人。大多数死者（n = 53）没有芬太尼处方。鉴于芬太尼的高效力和滥用倾向，近期与芬太尼相关的死亡人数上升是一个严重的公共卫生问题，表明迫切需要开展预防和治疗工作。
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