scholarly journals Emerging Synthetic Fentanyl Analogs

2017 ◽  
Vol 7 (1) ◽  
pp. 36-40 ◽  
Author(s):  
Harold E. Schueler
Keyword(s):  
Illicit Drug ◽  
Forensic Toxicology ◽  
Drug Market ◽  
Medical Examiner ◽  
The Internet ◽  
Blood Concentrations ◽  
Fentanyl Analogs ◽  
Femoral Blood ◽  
Drug Traffickers ◽  
Death Investigation

Hundreds of synthetic substances have been introduced into the illicit drug market over the last ten years, but none of these drugs has had as poisonous a consequence as the emergence of the synthetic fentanyl analogs. Initially, pharmaceutical grade or illicit fentanyl was mixed with heroin, allegedly to boost the potency of the heroin. Then, the amounts of fentanyl spiked gradually increased until the proportion of fentanyl was greater than the proportion of heroin. Ultimately, many overdose cases began consisting of only fentanyl. The emergence of numerous synthetic fentanyl analogs, including acetylfentanyl, butyrylfentanyl, acrylfentanyl, furanylfentanyl and β-hydroxythiofentanyl, which are manufactured in China, were made available to the illicit drug traffickers over the Internet. In July of 2016, the most potent commercially available opioid, carfentanil, started appearing in illicit drug submissions and medical examiner death investigation cases in Northeast Ohio. Postmortem femoral blood carfentanil concentrations are in the picogram per milliliter (pg/mL) range, which is extremely low, and tests the limits of detection for most analytical forensic toxicology laboratories. The interpretation of these low carfentanil blood concentrations in antemortem and postmortem specimens is made difficult due to the overlap in the concentrations between these specimen types. The presence of these powerful synthetic fentanyl analogs presents a challenge to forensic toxicology laboratories preparing to analyze for these substances.

Improvements in Toxicology Testing to Identify Fentanyl Analogs and Other Novel Synthetic Opioids in Fatal Drug Overdoses, Connecticut, January 2016–June 2019

2021 ◽  
Vol 136 (1_suppl) ◽  
pp. 80S-86S
Author(s):  
Heather A. Clinton ◽  
Shobha Thangada ◽  
James R. Gill ◽  
Amy Mirizzi ◽  
Susan B. Logan
Keyword(s):  
Drug Overdose ◽  
Drug Market ◽  
Medical Examiner ◽  
Testing Methods ◽  
Synthetic Opioids ◽  
Postmortem Toxicology ◽  
Drug Overdoses ◽  
Fentanyl Analogs ◽  
Novel Synthetic Opioids ◽  
Overdose Deaths

Objectives Drug overdose deaths in Connecticut increasingly involve a growing number of fentanyl analogs and other novel nonfentanyl synthetic opioids (ie, novel synthetics). Current postmortem toxicology testing methods often lack the sophistication needed to detect these compounds. We examined how improved toxicology testing of fatal drug overdoses can determine the prevalence and rapidly evolving trends of novel synthetics. Methods From 2016 to June 2019, the Connecticut Office of the Chief Medical Examiner increased its scope of toxicology testing of suspected drug overdose deaths in Connecticut from basic to enhanced toxicology testing to detect novel synthetics. The toxicology laboratory also expanded its testing panels during this time. We analyzed toxicology results to identify and quantify the involvement of novel synthetics over time. Results From 2016 to June 2019, 3204 drug overdose deaths received enhanced toxicology testing; novel synthetics were detected in 174 (5.4%) instances. Ten different novel synthetics were detected with 205 total occurrences. Of 174 overdose deaths with a novel synthetic detected, most had 1 (n = 146, 83.9%) or 2 (n = 26, 14.9%) novel synthetics detected, with a maximum of 4 novel synthetics detected. Para-fluorobutyrylfentanyl/FIBF, furanylfentanyl, and U-47700 were most identified overall, but specific novel synthetics came in and out of prominence during the study period, and the variety of novel synthetics detected changed from year to year. Conclusions Enhanced toxicology testing for drug overdose deaths is effective in detecting novel synthetics that are not identified through basic toxicology testing. Identifying emerging novel synthetics allows for a timely and focused response to potential drug outbreaks and illustrates the changing drug market.

Auras of Detection: Power and Knowledge in Drug Prohibition

2021 ◽  
pp. 009145092110354
Author(s):  
Jennifer J. Carroll
Keyword(s):  
Law Enforcement ◽  
Knowledge Production ◽  
Illicit Drug ◽  
Drug Market ◽  
Epistemic Authority ◽  
People Who Use Drugs ◽  
Drug Supply ◽  
Political Implications ◽  
Starting Point ◽  
Drug Checking

Drug checking is an evidence-based strategy for overdose prevention that continues to operate (where it operates) in a legal “gray zone” due to the legal classification of some drug checking tools as drug paraphernalia—the purview of law enforcement, not public health. This article takes the emergence of fentanyl in the U.S. drug supply as a starting point for examining two closely related questions about drug checking and drug market expertise. First, how is the epistemic authority of law enforcement over the material realities of the drug market produced? Second, in the context of that authority, what are the socio-political implications of technologically advanced drug checking instruments in the hands of people who use drugs? The expertise that people who use drugs maintain about the nature of illicit drug market and how to navigate the illicit drug supply has long been discounted as untrustworthy, irrational, or otherwise invalid. Yet, increased access to drug checking tools has the potential to afford the knowledge produced by people who use drugs a technological validity it has never before enjoyed. In this article, I engage with theories of knowledge production and ontological standpoint from the field of science, technology, and society studies to examine how law enforcement produces and maintains epistemic authority over the illicit drug market and to explore how drug checking technologies enable new forms of knowledge production. I argue that drug checking be viewed as a form of social resistance against law enforcement’s epistemological authority and as a refuge against the harms produced by drug criminalization.

Investigation and Review of Unexpected Infant and Child Deaths

PEDIATRICS ◽  
1993 ◽  
Vol 92 (5) ◽  
pp. 734-735
Author(s):  
Keyword(s):  
Public Health ◽  
United States ◽  
Child Abuse ◽  
Child Death ◽  
Significant Proportion ◽  
The United States ◽  
Medical Examiner ◽  
Sudden Infant ◽  
Child Deaths ◽  
Death Investigation

A significant proportion of infant and child deaths are preventable. Of the 55 861 deaths of children aged 14 and younger in the United States in 1989, more than three fourths occurred in children under the age of 2 years.1 Approximately one third of the latter were unexpected, including those due to sudden infant death syndrome (SIDS) or trauma, or deaths that were otherwise unexplained. Child abuse deaths occur in greatest numbers among infants, followed by those in toddlers and preschool children.2 Children younger than 6 years of age are most vulnerable to abuse because of their small size, incomplete verbal skills, and often limited contact with adults other than their primary caretakers.3 With few exceptions, throughout the United States there is no uniform system for the investigation of infant and child deaths. Many jurisdictions lack appropriately trained pathologists, interagency collaboration hat would facilitate sharing of information about the family, and a surveillance system to evaluate data regarding infant deaths. As a result, progress in the understanding of SIDS is inhibited, cases of child abuse and neglect may be missed, familial genetic diseases go undiagnosed, public health threats may be unrecognized, and inadequate medical care may be undetected. Lack of adequate infant and child death investigation is an impediment to preventing illness, injury and death of other children at risk. Adequate death investigation requires the participation of numerous individuals including medical examiner/coroner, public health officials, the patient's physician, the pathologist, and personnel from agencies involved with child welfare and social services and law enforcement.

Is there fentanyl contamination in the Australian illicit drug market?

2020 ◽  
Author(s):  
Alexandra Voce ◽  
Tom Sullivan
Keyword(s):  
Drug Use ◽  
Illicit Drug ◽  
Drug Market ◽  
Illicit Substance ◽  
The Past

This research investigates fentanyl use among police detainees participating in the Drug Use Monitoring in Australia program. Three percent of respondents tested positive to fentanyl and/or norfentanyl during urinalysis, and 11 percent reported lifetime fentanyl use. Nonprescribed fentanyl use was associated with use of and dependence on other drugs in the past 12 months. Three percent of all detainees believed they had used an illicit substance mixed with fentanyl. No detainees who tested positive to fentanyl reported using the drug in the past 12 months. These findings suggest fentanyl contamination may be occurring in the Australian illicit drug market.

Review of Synthetic Cannabinoids on the Illicit Drug Market

2019 ◽  
pp. 273-319
Author(s):  
Mahmoud A. ElSohly ◽  
Sohail Ahmed ◽  
Shahbaz W. Gul ◽  
Waseem Gul
Keyword(s):  
Illicit Drug ◽  
Synthetic Cannabinoids ◽  
Drug Market

scholarly journals Femoral blood concentrations of flualprazolam in 33 postmortem cases

2020 ◽  
Vol 307 ◽  
pp. 110101 ◽  
Author(s):  
Pirkko Kriikku ◽  
Ilpo Rasanen ◽  
Ilkka Ojanperä ◽  
Gunilla Thelander ◽  
Robert Kronstrand ◽  
...  
Keyword(s):  
Blood Concentrations ◽  
Femoral Blood

High Correlation between Ethanol Concentrations in Postmortem Femoral Blood and in Alternative Biological Specimens, but Large Uncertainty When the Linear Regression Model Was Used for Prediction in Individual Cases

2020 ◽  
Vol 44 (5) ◽  
pp. 415-421 ◽  
Author(s):  
G Thelander ◽  
F C Kugelberg ◽  
A W Jones
Keyword(s):  
Linear Regression ◽  
Regression Model ◽  
Pleural Cavity ◽  
Medical Examiner ◽  
Outcome Variable ◽  
Large Uncertainty ◽  
Lung Fluid ◽  
Femoral Blood ◽  
The Mean ◽  
Alternative Specimen

Abstract In connection with medicolegal autopsies peripheral blood (e.g. from a femoral vein) is the specimen of choice for toxicological analysis, although alternative specimens are also sometimes submitted, such as bile, cerebrospinal fluid (CSF), vitreous humor (VH), bladder urine, pleural effusions and/or lung fluid. Ethanol concentrations were determined in duplicate in femoral blood and in various alternative biological specimens by headspace gas chromatography. The analysis was carried out on two different fused silica capillary columns furnishing different retention times for ethanol and both n-propanol and t-butanol were used as internal standards. The results were evaluated by linear regression using blood alcohol concentration (BAC) as dependent or outcome variable and the concentrations in an alternative specimen as independent or predictor variable. The Pearson correlation coefficients were all statistically highly significant (P < 0.001); r = 0.94 (bile), r = 0.98 (CSF), r = 0.97 (VH), r = 0.92 (urine), r = 0.94 (lung fluid) and r = 0.96 (pleural cavity effusions). When the regression model was used to predict femoral BAC from the mean concentration in an alternative specimen the mean and 95% prediction intervals were 1.12 ± 0.824 g/L (bile), 1.41 ± 0.546 g/L (CSF), 1.15 ± 0.42 g/L (VH), 1.29 ± 0.780 g/L (urine), 1.25 ± 0.772 g/L (lung fluid) and 0.68 ± 0.564 g/L (pleural cavity effusions). This large uncertainty for a single new observation needs to be considered when alcohol-related deaths are evaluated and interpreted. However, the analysis of alternative specimens is recommended in medical examiner cases to provide supporting evidence with regard to the origin of ethanol, whether this reflects antemortem (AM) ingestion or postmortem (PM) synthesis.

Femoral blood concentrations of the designer benzodiazepine etizolam in post-mortem cases

2020 ◽  
pp. 002580242097381
Author(s):  
Laura J Hikin ◽  
Paul R Smith ◽  
Peter D Maskell ◽  
Hassan Kurimbokus ◽  
Emily Ashong ◽  
...  
Keyword(s):  
Drug Abusers ◽  
Post Mortem ◽  
Limited Data ◽  
Spectrometry Method ◽  
Blood Concentrations ◽  
Blunt Force Trauma ◽  
The World ◽  
Femoral Blood ◽  
The Mean ◽  
Multiple Drugs

Etizolam is a thienodiazepine that although licensed for clinical usage in Japan, India and South Korea is commonly abused and detected in post-mortem cases around the world. To date, there are limited data in the literature to allow for the interpretation of blood concentrations of etizolam in post-mortem cases. A liquid chromatography with tandem mass spectrometry method was used to quantitate etizolam concentrations in 28 post-mortem cases where etizolam was detected. The median concentration of etizolam in femoral blood was 8.5 ng/mL (range 1.0–172.0 ng/mL; n = 24); in antemortem plasma, the etizolam concentration range was 4–44 ng/mL ( n = 4). The mean age of the individuals abusing etizolam was 38.5 ± 8.4 years (median 39 years), with the majority being male (86%). In all of the cases, multiple drugs were detected, with the most common being pregabalin (61%) followed by morphine/heroin (54%), diazepam (54%) and benzoylecgonine (21%), illustrating the increasing problem of poly-substance use in drug abusers. The cause of death in the cases in which etizolam was detected was multi-drug toxicity in 87.5% of the cases, with 12.5% unrelated to drug use (hangings and blunt-force trauma). These data will further help forensic practitioners with the interpretation of post-mortem etizolam concentrations.

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