Elliott Simon P, Hernandez Lopez Elena
Alere Forensics, Malvern Hills Science Park, Geraldine Road, Malvern WR14 3SZ, UK.
J Anal Toxicol. 2018 May 1;42(4):e41-e45. doi: 10.1093/jat/bkx109.
The potent opioid and veterinary drug, carfentanil has recently entered the illicit drug market, especially in relation to heroin and cocaine. Recent publications have reported carfentanil concentrations found in fatalities occurring in the USA. This article presents the toxicological findings in seven heroin/cocaine cases occurring in the UK within a short period of time where carfentanil was detected and measured. Carfentanil was detected along with other drugs in all cases with no alcohol detected in the post-mortem blood in any of the cases. Of the other drugs detected, of particular note, cannabinoids were detected in three, cocaine in four, other opioids (methadone, dihydrocodeine and tramadol) in four and benzodiazepines were detected in four of the seven fatalities. A high concentration of ketamine and norketamine was found in one case. Morphine and its glucuronide metabolites were also measured where detected in six of the seven cases. The carfentanil concentrations were found to be between 0.22 and 3.3 ng/mL (mean 0.93, median 0.66 ng/mL) in post-mortem femoral blood. In one case where aortic and ventricular post-mortem blood was submitted for analysis in addition to femoral blood, comparative concentrations of 1.05 (aortic), 0.57 (ventricular) and 0.50 (femoral) ng/mL were found. The concentrations support the necessity to ensure laboratory detection methods for carfentanil and subsequent measurement are appropriate as concentrations below 0.3 ng/mL may be present in post-mortem blood. The concentrations also support the notion that there is no particular "toxic" or "fatal" post-mortem blood carfentanil concentration associated with its use.
强效阿片类兽药卡芬太尼最近进入了非法毒品市场，尤其是与海洛因和可卡因相关的市场。最近的出版物报道了在美国发生的死亡案例中检测到的卡芬太尼浓度。本文介绍了在英国短时间内发生的七例海洛因/可卡因案件的毒理学调查结果，其中检测并测量了卡芬太尼。在所有案例中均检测到卡芬太尼与其他药物，尸检血液中均未检测到酒精。在检测到的其他药物中，特别值得注意的是，七例死亡案例中有三例检测到大麻素，四例检测到可卡因，四例检测到其他阿片类药物（美沙酮、二氢可待因和曲马多），四例检测到苯二氮卓类药物。在一例中发现了高浓度的氯胺酮和去甲氯胺酮。在七例中的六例检测到吗啡及其葡萄糖醛酸代谢物的情况下，也对其进行了测量。尸检股动脉血中的卡芬太尼浓度在0.22至3.3纳克/毫升之间（平均0.93，中位数0.66纳克/毫升）。在一例中，除股动脉血外，还提交了主动脉和心室尸检血进行分析，发现比较浓度分别为1.05（主动脉）、0.57（心室）和0.50（股动脉）纳克/毫升。这些浓度支持了确保卡芬太尼实验室检测方法及后续测量合适的必要性，因为尸检血液中可能存在低于0.3纳克/毫升的浓度。这些浓度也支持了这样一种观点，即使用卡芬太尼后，尸检血液中不存在特定的“中毒”或“致命”浓度。
