An Acute Butyr-Fentanyl Fatality: A Case Report with Postmortem Concentrations

Area of Science:

• Forensic Toxicology
• Analytical Chemistry
• Pharmacology

Background:

• Fentanyl analogs, such as butyr-fentanyl, are potent synthetic opioids increasingly implicated in drug overdose fatalities.
• Understanding the postmortem distribution of these novel psychoactive substances is crucial for accurate cause of death determination.

Observation:

• A fatal overdose case involving a male with a history of intravenous drug abuse is presented.
• Drug paraphernalia was found at the scene, and initial screening indicated fentanyl presence.
• Postmortem toxicology analysis confirmed butyr-fentanyl and acetyl-fentanyl, with quantitative measurements in blood, liver, vitreous humor, urine, and gastric contents.

Findings:

• Butyr-fentanyl was quantified at 97 ng/mL (central blood), 58 ng/mL (peripheral blood), 320 ng/g (liver), 40 ng/mL (vitreous), 670 ng/mL (urine), and 170 mg (gastric).
• Acetyl-fentanyl was also detected, with concentrations of 32 ng/mL (central blood), 38 ng/mL (peripheral blood), 110 ng/g (liver), 38 ng/mL (vitreous), 540 ng/mL (urine), and <70 mg (gastric).
• Benzoylecgonine was detected at low concentrations; no other significant drugs were identified.

Implications:

• The study highlights the significant postmortem concentrations of butyr-fentanyl and acetyl-fentanyl, contributing to the cause of death.
• Accurate toxicological analysis using methods like GC-MS SIM is essential for identifying and quantifying these potent synthetic opioids.
• This case underscores the public health risks associated with the illicit use of fentanyl analogs.