Reliability of postmortem fentanyl concentrations in determining the cause of death.
BACKGROUND
Transdermal fentanyl, an opioid used for management of marked pain, also is abused and may cause death.


METHODS
We reviewed medical examiner reports of 92 decedents who had one or more fentanyl transdermal patches on their body and had fentanyl detected in their postmortem toxicology analysis.


RESULTS
The manners of death included 40 accidents, 36 natural, 8 suicides, 5 therapeutic complications, and 3 undetermined deaths. Among the accidental fentanyl intoxication deaths, 32 of 37 involved substance abuse. The majority (95 %) of the 37 accidental deaths involving fentanyl were multi-drug intoxications. The substance abuse deaths had a mean fentanyl blood concentration (26.4 ng/ml or μg/L) that was over twice that of the natural group (11.8 ng/ml). Our analysis suggests a relationship between total patch dosage and mean postmortem fentanyl concentration up to the 100-μg/h dose.


CONCLUSIONS
The very wide and overlapping ranges of postmortem fentanyl concentrations effectively nullify the utility of correlating the dose and expected postmortem concentration for any particular death. Based on the variable relationship between dose and blood concentration, the antemortem dose cannot be reliably predicted based on the postmortem concentration. This does not, however, render the medical examiner/coroner unable to determine the cause and manner of death because the toxicology results are only one datum point among several that are considered. Although there was a weakly positive relationship between body mass index and fentanyl concentration, further research is needed to determine whether adipose tissue represents a significant depot for postmortem release of fentanyl.
New York City Office of Chief Medical Examiner and Department of Forensic Medicine, New York University School of Medicine, New York, NY 10016, USA. jgill@ocme.nyc.gov
James R
JR
Gill
Peter T
PT
Lin
Lewis
L
Nelson
D000059:Accidents; D000279:Administration, Cutaneous; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D002423:Cause of Death; D062787:Drug Overdose / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D005260:Female; D005283:Fentanyl / Q000097:blood / Q000506:poisoning*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000097:blood / Q000506:poisoning*; D009519:New York City / Q000453:epidemiology; D015203:Reproducibility of Results; D012869:Skin Absorption; D015813:Substance Abuse Detection / Q000379:methods*; D057968:Transdermal Patch / Q000009:adverse effects*; D055815:Young Adult
D009294:Narcotics; D005283:Fentanyl