title: A fatal poisoning case by intravenous injection of "bath salts" containing acetyl fentanyl and 4-methoxy PV8.
abstract: A man in his 30's was found at home, not breathing. He was admitted to an emergency hospital and the doctor confirmed his death. He had a history of methamphetamine abuse spanning several years, and while fresh needle marks were visible on his arm, the only other autopsy findings indicated an acute death. A small plastic bag containing a pale brown white powder, and a small amount of liquid in a syringe were found at the scene. The police forensic laboratory detected acetyl fentanyl and 4-methoxy PV8 (4-methoxy PHPP) in both the powder and the liquid. Scan analysis by gas chromatography-mass spectrometry (GC-MS) and liquid chromatography-mass spectrometry (LC-MS) identified acetyl fentanyl and 4-methoxy PV8 in the urine sample. Both drugs were quantitated simultaneously by liquid chromatography-tandem mass spectrometry (LC-MS/MS), using the selected reaction monitoring method. The concentration of acetyl fentanyl in the femoral vein blood, urine, and gastric contents were 153, 240, and 880ng/mL respectively, and the concentration of 4-methoxy PV8 in the femoral vein blood, urine, and gastric contents were 389, 245, and 500ng/mL respectively. Cause of death was attributed to acute poisoning by "bath salts" containing acetyl fentanyl and 4-methoxy PV8. Evidence indicated that self-administered intravenous injection was the most likely scenario, and that the deceased had been a habitual user of the "bath salt" drug for some time. Drugs detected in the gastric contents could be explained by the gastric secretion of basic drugs, or drug-containing bile entering the gastric contents.
authors: Department of Forensic Medicine, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan. Electronic address: yonemie@kumamoto-u.ac.jp.
authors: Kosei
authors: K
authors: Yonemitsu
authors: Department of Forensic Medicine, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan.
authors: Ako
authors: A
authors: Sasao
authors: Department of Forensic Medicine, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan.
authors: Satoko
authors: S
authors: Mishima
authors: Department of Forensic Medicine, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan.
authors: Yuki
authors: Y
authors: Ohtsu
authors: Department of Forensic Medicine, Faculty of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan.
authors: Yoko
authors: Y
authors: Nishitani
mesh_terms: D000328:Adult; D000470:Alkaloids / Q000032:analysis* / Q000506:poisoning; D015198:Designer Drugs / Q000737:chemistry* / Q000506:poisoning*; D005283:Fentanyl / Q000031:analogs & derivatives* / Q000032:analysis / Q000506:poisoning; D005766:Gastrointestinal Contents / Q000737:chemistry; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D009294:Narcotics / Q000032:analysis* / Q000506:poisoning; D019966:Substance-Related Disorders / Q000150:complications
chemical_list: D000470:Alkaloids; D015198:Designer Drugs; D009294:Narcotics; C023665:cathinone; C000594854:N-(1-phenethylpiperidin-4-yl)-N-phenylacetamide; D005283:Fentanyl
keywords: 4-Methoxy PV8; Acetyl fentanyl; Bath salts; Intravenous injection; Sudden death