Kronstrand R, Druid H, Holmgren P, Rajs J
Department of Forensic Chemistry, University Hospital, Linköping, Sweden.
Forensic Sci Int. 1997 Aug 22;88(3):185-93. doi: 10.1016/s0379-0738(97)00068-6.
During a 16-month period, nine fatalities occurred among white male drug-addicts, where fentanyl was detected at postmortem toxicological analysis. The street samples associated with these cases confirmed the presence of fentanyl as an additive in low-concentration amphetamine powders with caffeine, phenazone and sugar as cutting agents. In seven of the cases, an acute intoxication by fentanyl was considered to be the immediate cause of death, and in one case, it was likely, but no analysis of fentanyl was performed in blood, and in another case the death was suicide by hanging. This appears to be the first report of a cluster of fentanyl-related deaths outside the United States, and the occurrence of fentanyl in combination with amphetamine has not previously been reported. In addition, in all cases, femoral blood was collected, and samples were handled and analysed according to standardized, quality-controlled procedures. The previous history, circumstances surrounding the death, autopsy findings, histology and toxicology examination of each case are presented. The gas chromatographic-mass spectrometric method for fentanyl is also described. Fentanyl concentrations ranged from 0.5 to 17 ng g-1 blood, and from 5 to 160 ng ml-1 urine. Other drugs found were amphetamine (8 cases), ethanol (5 cases) and benzodiazepines (5 cases). Morphine was found in only one case. The average age of men was 33.9 years (range 22-44); six were found in their own of friend's apartment, two inside buildings (stairways) and one was found outdoors. We conclude that fentanyl is a dangerous substance that should be considered in drug-addict deaths even outside the United States, particularly when the remaining toxicology is unremarkable, and the cause of death cannot be ascertained
在16个月的时间里，9名白人男性吸毒者死亡，尸检毒理学分析检测出了芬太尼。与这些病例相关的街头样本证实，芬太尼作为添加剂存在于低浓度的苯丙胺粉末中，这些粉末以咖啡因、非那宗和糖作为掺杂物。在7例病例中，芬太尼急性中毒被认为是直接死因；在1例病例中，有可能是芬太尼中毒，但未对血液进行芬太尼分析；在另1例病例中，死亡原因是上吊自杀。这似乎是美国以外首例关于芬太尼相关死亡聚集的报告，且此前未报告过芬太尼与苯丙胺混合出现的情况。此外，在所有病例中均采集了股静脉血，并按照标准化、质量控制程序对样本进行处理和分析。文中呈现了每个病例的既往史、死亡相关情况、尸检结果、组织学和毒理学检查。还描述了芬太尼的气相色谱-质谱分析法。芬太尼浓度在血液中为0.5至17 ng g-1，在尿液中为5至160 ng ml-1。发现的其他药物有苯丙胺（8例）、乙醇（5例）和苯二氮卓类药物（5例）。仅在1例病例中发现了吗啡。男性的平均年龄为33.9岁（范围22 - 44岁）；6人死于自己或朋友的公寓内，2人死于建筑物内（楼梯间），1人死于户外。我们得出结论，芬太尼是一种危险物质，即使在美国以外，在吸毒者死亡事件中也应予以考虑，特别是当其余毒理学检查无异常且无法确定死因时。
