Consultant in Pharmacology & Toxicology Wichita, KS, USA.
New Hampshire State Police Forensic Laboratory Concord, NH, USA.
J Anal Toxicol. 2021 Apr 12;45(4):389-396. doi: 10.1093/jat/bkaa105.
The incidence of fentanyl in forensic toxicology analyses in the USA has dramatically increased over the past several years. The increase in death cases has been well studied; however, little has been reported on the impact to drug impaired driving. Fentanyl driving while under the influence of drugs (DUID) case data from 2014 to 2019 is presented. The data were obtained from three toxicology laboratories in the Northeast, Southeast, and Midwest regions of the USA. Fentanyl whole blood concentrations ranged from 0.1 to 157 ng/mL in living drivers with a 466% to 524% increase in fentanyl-positive DUID cases from 2014 to 2019, depending on the US region. The vast majority of fentanyl cases involved poly-drug use. Twenty case histories are presented where fentanyl was the only drug identified. The mean (standard deviation) fentanyl concentration for these cases was 5.2 ± 3.8 ng/mL with a median of 3.7 ng/mL, and the concentrations ranged from 2.0 to 16 ng/mL. Naloxone administration was documented in exactly half of these cases similar to another study involving carfentanil-impaired driving. The case histories also demonstrate that some recreational opioid users may display limited signs of impairment either due to tolerance or naloxone administration. The top three observations in common among the cases were the driver was found unresponsive behind the wheel, the vehicle left the travel lane or roadway, and the driver was involved in a crash. The increase in fentanyl use not only poses a risk for overdose and death, but is also a significant concern for traffic safety. This study supports the movement of fentanyl from a Tier II drug to Tier I due to its significant potential for impairment and increase in prevalence in impaired driving cases.
在美国，法医毒理学分析中芬太尼的发生率在过去几年中急剧增加。死亡案例的增加已经得到了充分的研究；然而，关于药物致驾驶能力受损的影响却鲜有报道。本文介绍了 2014 年至 2019 年期间芬太尼药物致驾驶能力受损（DUID）案例的数据。这些数据来自美国东北部、东南部和中西部地区的三个毒理学实验室。在有生命的驾驶员中，芬太尼全血浓度范围为 0.1 至 157ng/mL，2014 年至 2019 年，芬太尼阳性 DUID 案例的数量增加了 466%至 524%，具体取决于美国地区。绝大多数芬太尼案例涉及多药物使用。本文介绍了 20 个案例病史，其中仅发现芬太尼一种药物。这些病例的平均（标准差）芬太尼浓度为 5.2±3.8ng/mL，中位数为 3.7ng/mL，浓度范围为 2.0 至 16ng/mL。这些案例中有一半记录了纳洛酮的使用，与另一项涉及卡芬太尼致驾驶能力受损的研究相似。病例病史还表明，一些娱乐性阿片类药物使用者可能由于耐受或纳洛酮的使用而表现出有限的受损迹象。这些病例有三个共同的观察结果，即驾驶员在方向盘后面无反应，车辆离开行驶车道或道路，以及驾驶员发生碰撞。芬太尼使用的增加不仅会带来过量和死亡的风险，而且对交通安全也是一个重大关注。这项研究支持将芬太尼从二级药物升级为一级药物，因为它具有显著的致驾驶能力受损潜力，并增加了在驾驶能力受损案例中的流行率。
