Pearson Julia, Poklis Justin, Poklis Alphonse, Wolf Carl, Mainland Mary, Hair Laura, Devers Kelly, Chrostowski Leszek, Arbefeville Elise, Merves Michele
Hillsborough County Medical Examiner Department.
Department of Pharmacology and Toxicology, Virginia Commonwealth University.
Acad Forensic Pathol. 2015 Dec;5(4):676-689. doi: 10.23907/2015.072.
In the last two years, an epidemic of 40 fatal heroin overdose cases has occurred in the Tampa area of Florida. Of these cases, 14 involved fentanyl and acetyl fentanyl. Victim demographics, case histories, toxicology findings, and causes and manners of death for all 40 deaths are presented. In 26 deaths in which acetyl fentanyl or fentanyl were not involved, free and total peripheral blood morphine concentrations were consistent with fatal heroin intoxications, averaging 0.16 mg/L and 0.35 mg/L, respectively. In the heroin cases with fentanyl present (n=7), the average free morphine concentration was 0.040 mg/L, the average total morphine concentration was 0.080 mg/L, and the average fentanyl concentration was 0.012 mg/L. In the cases with heroin, fentanyl, and acetyl fentanyl (n=3), the average free morphine concentration was 0.010 mg/L, the average total morphine concentration was 0.030 mg/L, the average fentanyl concentration was 0.018 mg/L, and the average acetyl fentanyl concentration was 0.008 mg/L. In the cases involving only acetyl fentanyl (without heroin or fentanyl, n=4), the average acetyl fentanyl concentration was 0.47 mg/L and the average acetyl norfentanyl concentration was 0.053 mg/L. The presented cases, with associated drug concentrations, case histories, demographics, and causes and manners of death may help provide assistance with the interpretation of the postmortem findings. Based on case circumstances, autopsy results, and toxicology results, it is evident that fentanyl and/or acetyl fentanyl, when present, contributed to the cause of death.
在过去两年中，佛罗里达州坦帕地区发生了40起致命海洛因过量致死的疫情。在这些病例中，14起涉及芬太尼和乙酰芬太尼。呈现了所有40例死亡病例的受害者人口统计学信息、病史、毒理学发现以及死亡原因和方式。在26例未涉及乙酰芬太尼或芬太尼的死亡病例中，外周血游离吗啡和总吗啡浓度与致命海洛因中毒一致，平均分别为0.16毫克/升和0.35毫克/升。在存在芬太尼的海洛因病例（n = 7）中，平均游离吗啡浓度为0.040毫克/升，平均总吗啡浓度为0.080毫克/升，平均芬太尼浓度为0.012毫克/升。在同时含有海洛因、芬太尼和乙酰芬太尼的病例（n = 3）中，平均游离吗啡浓度为0.010毫克/升，平均总吗啡浓度为0.030毫克/升，平均芬太尼浓度为0.018毫克/升，平均乙酰芬太尼浓度为0.008毫克/升。在仅涉及乙酰芬太尼（无海洛因或芬太尼，n = 4）的病例中，平均乙酰芬太尼浓度为0.47毫克/升，平均去甲乙酰芬太尼浓度为0.053毫克/升。所呈现的病例以及相关的药物浓度、病史、人口统计学信息、死亡原因和方式可能有助于为死后检查结果的解释提供帮助。根据病例情况、尸检结果和毒理学结果，很明显，芬太尼和/或乙酰芬太尼一旦存在，就会导致死亡。
