Department of Forensic Toxicology, NYC Office of Chief Medical Examiner, New York, NY 10016, USA.
J Anal Toxicol. 2021 Sep 17;45(8):835-839. doi: 10.1093/jat/bkab066.
The detection of novel fentanyl analogs in both seized drugs and toxicological specimens has presented a significant challenge to laboratories with respect to identification, sourcing reference drug standards, the time required for method development and ensuring sufficient method sensitivity. The New York City Office of Chief Medical Examiner has included testing for valerylfentanyl as part of a panel of synthetic opioids since May 2017 but did not identify the first valerylfentanyl-positive case until July 2018. Unlike many other illicit fentanyl analogs that were briefly identified before being replaced with a new analog, valerylfentanyl has persisted over time and continues to be identified in New York City acute polydrug intoxications. Since July 2018, a total of 69 cases were identified to be valerylfentanyl positive, but there were no cases where it was the sole intoxicant. Eighty-four percentage of decedents were male, with the majority being Hispanic males (49%) between the ages of 50 and 59 years (39%). The cause of death in all 69 cases involved acute polydrug intoxications, while the manner of death was deemed an accident in 68 cases and undetermined in one case. Concentrations of valerylfentanyl in postmortem blood ranged from <0.10 to 21 ng/mL, with 44.9% (N = 31) of the concentrations at or below the lower limit of quantification (0.10 ng/mL) but above the limit of detection (0.05 ng/mL). Fentanyl was present in 100% of the cases and in higher concentrations (1.6-116 ng/mL). The most common other drug classes detected with valerylfentanyl were other opiates (76.8%), cocaine/metabolites (50.7%), benzodiazepines (29%) and ethanol (21.7%). Valerylfentanyl is a relatively unknown fentanyl analog with limited information in the scientific literature. This study presents the first publication detailing a series of postmortem cases involving valerylfentanyl in acute intoxications and includes key demographic information and femoral blood concentrations for improved interpretation and analysis.
新型芬太尼类似物在缴获毒品和毒理学样本中的检测对实验室来说是一个重大挑战，因为这涉及到鉴定、获取参考药物标准、方法开发所需的时间以及确保足够的方法灵敏度。自 2017 年 5 月以来，纽约市首席法医办公室已将检测瓦莱里芬太尼作为合成阿片类药物检测组的一部分，但直到 2018 年 7 月才首次发现瓦莱里芬太尼呈阳性的病例。与许多其他被新类似物取代之前曾短暂出现过的非法芬太尼类似物不同，瓦莱里芬太尼随着时间的推移一直存在，并继续在纽约市急性多药中毒中被发现。自 2018 年 7 月以来，共有 69 例被确定为瓦莱里芬太尼阳性，但没有单独使用瓦莱里芬太尼的中毒案例。84%的死者为男性，其中大多数是 50 至 59 岁的西班牙裔男性（49%）。69 例死亡原因均为急性多药中毒，68 例死因被认定为意外，1 例死因未确定。69 例死后血液中瓦莱里芬太尼浓度范围为<0.10 至 21ng/ml，44.9%（n=31）的浓度在定量下限（0.10ng/ml）以下但在检测下限（0.05ng/ml）以上。芬太尼在所有病例中均有存在，浓度较高（1.6-116ng/ml）。与瓦莱里芬太尼同时检测到的其他药物类别最常见的是其他阿片类药物（76.8%）、可卡因/代谢物（50.7%）、苯二氮䓬类（29%）和乙醇（21.7%）。瓦莱里芬太尼是一种相对未知的芬太尼类似物，科学文献中关于它的信息有限。本研究首次详细介绍了一系列涉及急性中毒中瓦莱里芬太尼的死后案例，包括关键人口统计学信息和股动脉血浓度，以提高解释和分析能力。
