Affiliation:
1. Department of Forensic Toxicology New York City Office of Chief Medical Examiner New York City New York USA
Abstract
AbstractForensic toxicology laboratories are navigating a period of time with increasing drug overdose deaths, an opioid epidemic, the impact of the COVID‐19 pandemic, and the illicit drug market flooded with novel psychoactive substances. In New York City, the Department of Forensic Toxicology has experienced a 56% increase in postmortem casework in the past decade with fentanyl detected in 80% of all overdose deaths. Over a period of 2.5 years, 15,638 postmortem cases were tested for the presence of fentanyl and fentanyl analogs using liquid‐chromatography tandem mass spectrometry (LCMSMS). Fentanyl was detected in approximately one third of cases and of these 4447 cases with femoral blood. A twofold increase in cases with high concentrations of fentanyl (>100 ng/mL) was observed between 2021 and 2022. The minor metabolite and precursor chemical, 4‐ANPP (4‐anilino‐N‐phenethylpiperidine) may help differentiate between illicit and licit fentanyl. 4‐ANPP blood concentrations were <10 ng/mL in 98% of the cases and the 4‐ANPP:fentanyl ratio was <0.67 for 99.1% of blood specimens. Only six cases had 4‐ANPP concentrations higher than the corresponding fentanyl blood concentration. This study also highlights, the changing fentanyl analogs found in postmortem cases since 2016 in NYC with the emergence of fluorofentanyl initially identified in 2020 and continuing to dominate in comparison with the prevalence of other analogs, many of which are no longer detected in casework. The detection of one of the latest drugs to be mixed with fentanyl, namely xylazine, has also increased in prevalence by 36.7% in 2022 compared with 2021.
Subject
Genetics,Pathology and Forensic Medicine
Reference39 articles.
1. Drug Overdose Deaths in the United States, 2001–2021
2. DiNapoliTP.Continuing crisis: drug overdose deaths in New York. New York State Comptroller.2022https://www.osc.state.ny.us/reports/continuing‐crisis‐drug‐overdose‐deaths‐new‐york. Accessed 21 Jul 2023.
3. Unintentional drug poisoning (overdose) deaths in new York City in 2021;Askari MS;Epi Data Brief,2023
4. Duragesic(R) Transdermal Patch: Postmortem Tissue Distribution of Fentanyl in 25 Cases
5. Overdose Deaths Involving Fentanyl and Fentanyl Analogs — New York City, 2000–2017
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