Shanks Kevin G, Behonick George S
Email:
Axis Forensic Toxicology, 5780 W 71st Street, Indianapolis, IN 46278, USA.
J Anal Toxicol. 2017 Jul 1;41(6):466-472. doi: 10.1093/jat/bkx042.
Carfentanil is a mu (μ) opioid receptor agonist and is estimated to be ~10,000 times more potent than morphine in animal (non-human) models. It is not approved for human use and is only used to immobilize large exotic animals in veterinary medicine. In mid-2016, carfentanil emerged as a contaminant in street heroin in the USA and was central to a large number of emergency department visits and deaths. We describe an analytical method for the detection and quantification of carfentanil in whole blood specimens via a protein precipitation extraction with acetonitrile and liquid chromatography with triple quadrupole mass spectrometry. From 1 September 2016 to 1 January 2017, carfentanil was identified in 262 postmortem blood specimens. Blood concentrations ranged from 10.2 to 2,000 ng/L, with a mean concentration equal to 193 ng/L and a median concentration equal to 98.4 ng/L. We describe 13 fatalities from the Midwest region (Indiana, Kentucky, Michigan and Ohio) of the USA in which our laboratory performed comprehensive toxicology and in which carfentanil was detected and associated with cause of death. We recommend that any analytical method applied to the detection of this substance in human whole blood specimens be sufficiently sensitive to detect sub-100 ng/L concentrations and preferably utilize a 10-50 ng/L reporting limit.
卡芬太尼是一种μ阿片受体激动剂，在动物（非人类）模型中，其效力估计比吗啡强约10000倍。它未被批准用于人类，仅在兽医学中用于使大型外来动物麻醉。2016年年中，卡芬太尼在美国街头海洛因中作为一种污染物出现，并成为大量急诊就诊和死亡事件的核心因素。我们描述了一种通过乙腈蛋白沉淀萃取和三重四极杆质谱液相色谱法检测和定量全血样本中卡芬太尼的分析方法。从2016年9月1日至2017年1月1日，在262份尸检血样中检测到了卡芬太尼。血药浓度范围为10.2至2000 ng/L，平均浓度为193 ng/L，中位数浓度为98.4 ng/L。我们描述了来自美国中西部地区（印第安纳州、肯塔基州、密歇根州和俄亥俄州）的13例死亡案例，在这些案例中我们实验室进行了全面毒理学检测，检测到了卡芬太尼并将其与死因相关联。我们建议，任何应用于检测人类全血样本中该物质的分析方法都应具有足够的灵敏度，能够检测到低于100 ng/L的浓度，且报告限最好设定为10 - 50 ng/L。
