title: Postmortem tissue distribution of acetyl fentanyl, fentanyl and their respective nor-metabolites analyzed by ultrahigh performance liquid chromatography with tandem mass spectrometry.
abstract: In the last two years, an epidemic of fatal narcotic overdose cases has occurred in the Tampa area of Florida. Fourteen of these deaths involved fentanyl and/or the new designer drug, acetyl fentanyl. Victim demographics, case histories, toxicology findings and causes and manners of death, as well as, disposition of fentanyl derivatives and their nor-metabolites in postmortem heart blood, peripheral blood, bile, brain, liver, urine and vitreous humor are presented. In the cases involving only acetyl fentanyl (without fentanyl, n=4), the average peripheral blood acetyl fentanyl concentration was 0.467 mg/L (range 0.31 to 0.60 mg/L) and average acetyl norfentanyl concentration was 0.053 mg/L (range 0.002 to 0.086 mg/L). In the cases involving fentanyl (without acetyl fentanyl, n=7), the average peripheral blood fentanyl concentration was 0.012 mg/L (range 0.004 to 0.027 mg/L) and average norfentanyl blood concentration was 0.001 mg/L (range 0.0002 to 0.003 mg/L). In the cases involving both acetyl fentanyl and fentanyl (n=3), the average peripheral blood acetyl fentanyl concentration was 0.008 mg/L (range 0.006 to 0.012 mg/L), the average peripheral blood acetyl norfentanyl concentration was 0.001 mg/L (range 0.001 to 0.002 mg/L), the average peripheral blood fentanyl concentration was 0.018 mg/L (range 0.015 to 0.021mg/L) and the average peripheral blood norfentanyl concentration was 0.002 mg/L (range 0.001 mg/L to 0.003 mg/L). Based on the toxicology results, it is evident that when fentanyl and/or acetyl fentanyl were present, they contributed to the cause of death. A novel ultrahigh performance liquid chromatography (UPLC) tandem mass spectrometry (MS/MS) method to identify and quantify acetyl fentanyl, acetyl norfentanyl, fentanyl and norfentanyl in postmortem fluids and tissues is also presented.
authors.affiliation: Department of Pharmacology and Toxicology, Virginia Commonwealth University, Richmond, VA, United States. Electronic address: jlpoklis@vcu.edu.
authors.forename: Justin
authors.initials: J
authors.lastname: Poklis
authors.affiliation: Department of Pharmacology and Toxicology, Virginia Commonwealth University, Richmond, VA, United States; Department of Pathology, Virginia Commonwealth University, Richmond, VA, United States; Department of Forensic Science, Virginia Commonwealth University, Richmond, VA, United States. Electronic address: apoklis@mcvh-vcu.edu.
authors.forename: Alphonse
authors.initials: A
authors.lastname: Poklis
authors.affiliation: Department of Pathology, Virginia Commonwealth University, Richmond, VA, United States; Department of Forensic Science, Virginia Commonwealth University, Richmond, VA, United States. Electronic address: cewolf@vcu.edu.
authors.forename: Carl
authors.initials: C
authors.lastname: Wolf
authors.affiliation: Hillsborough County Medical Examiner Department, Tampa, FL, United States. Electronic address: mainlandm@hillsboroughcounty.org.
authors.forename: Mary
authors.initials: M
authors.lastname: Mainland
authors.affiliation: Hillsborough County Medical Examiner Department, Tampa, FL, United States. Electronic address: hairl@hillsboroughcounty.org.
authors.forename: Laura
authors.initials: L
authors.lastname: Hair
authors.affiliation: Hillsborough County Medical Examiner Department, Tampa, FL, United States. Electronic address: deversk@hillsboroughcounty.org.
authors.forename: Kelly
authors.initials: K
authors.lastname: Devers
authors.affiliation: Hillsborough County Medical Examiner Department, Tampa, FL, United States. Electronic address: chrostowskil@hillsboroughcounty.org.
authors.forename: Leszek
authors.initials: L
authors.lastname: Chrostowski
authors.affiliation: Hillsborough County Medical Examiner Department, Tampa, FL, United States. Electronic address: arbefevillee@hillsboroughcounty.org.
authors.forename: Elise
authors.initials: E
authors.lastname: Arbefeville
authors.affiliation: Hillsborough County Medical Examiner Department, Tampa, FL, United States. Electronic address: mervesm@hillsboroughcounty.org.
authors.forename: Michele
authors.initials: M
authors.lastname: Merves
authors.affiliation: Hillsborough County Medical Examiner Department, Tampa, FL, United States. Electronic address: pearsonjm@hillsboroughcounty.org.
authors.forename: Julia
authors.initials: J
authors.lastname: Pearson
mesh_terms: D000328:Adult; D001646:Bile / Q000737:chemistry; D001923:Brain Chemistry; D002853:Chromatography, Liquid / Q000379:methods; D015198:Designer Drugs / Q000032:analysis / Q000493:pharmacokinetics; D005283:Fentanyl / Q000031:analogs & derivatives* / Q000032:analysis / Q000493:pharmacokinetics*; D053593:Forensic Toxicology; D006801:Humans; D008099:Liver / Q000737:chemistry; D008875:Middle Aged; D009294:Narcotics / Q000032:analysis / Q000493:pharmacokinetics*; D011180:Postmortem Changes; D053719:Tandem Mass Spectrometry; D014018:Tissue Distribution; D014822:Vitreous Body / Q000737:chemistry
chemical_list: D015198:Designer Drugs; D009294:Narcotics; C080127:norfentanyl; C000594854:N-(1-phenethylpiperidin-4-yl)-N-phenylacetamide; D005283:Fentanyl
keywords: Acetyl fentanyl; Fentanyl; Postmortem tissue distribution; UPLC/MS/MS