Five Postmortem Case Reports with Qualitative Analysis of Cyclopropylfentanyl by LC-MS-MS

Area of Science:

• Forensic Toxicology
• Analytical Chemistry
• Pharmacology

Background:

• Cyclopropylfentanyl (CPF) is a potent synthetic opioid. In January 2018, the U.S. Drug Enforcement Agency (DEA) temporarily classified CPF as a Schedule I controlled substance due to its high potential for abuse and lack of accepted medical use.
• The emergence of novel synthetic opioids like CPF poses significant challenges to public health and forensic laboratories.

Observation:

• The Nassau County Medical Examiner Toxicology Laboratory identified and confirmed CPF in postmortem cardiac blood specimens from five decedents over a five-month period (December 2017-May 2018).
• Autopsy findings and decedent histories were reviewed in conjunction with toxicological results.
• CPF was detected in cardiac blood samples at concentrations ranging from 5.6 to 82 ng/mL.

Findings:

• CPF was qualitatively identified and confirmed in all five postmortem cases.
• The analytical method involved alkaline liquid-liquid extraction followed by liquid chromatography-tandem mass spectrometry (LC-MS/MS).
• Cyclopropylfentanyl was determined to be a contributing factor in the cause of death for all five individuals.

Implications:

• This study underscores the presence and lethality of cyclopropylfentanyl in postmortem cases, emphasizing the need for ongoing toxicological surveillance of emerging synthetic opioids.
• The findings highlight the critical role of forensic toxicology laboratories in identifying and quantifying novel psychoactive substances to inform public health strategies and law enforcement efforts.
• Accurate and sensitive analytical methods are essential for detecting CPF and other fentanyl analogues in biological specimens to establish cause of death and understand their role in drug-related fatalities.