Reference data for the interpretation of toxicological findings of fentanyl and selected analogues

Numerous incidents of fentanyl-related fatalities have been reported, with blood fentanyl concentrations ranging from 3.0-28 ng/mL; in comparison, recommended serum concentrations range from 1-2 ng/mL for analgesia and 10-20 ng/mL for anaesthesia [26,56]. Case series of reported fentanyl concentrations in adults who died from transdermal, intravenous, and oral abuse of fentanyl patches were 18 ng/mL (range 4-54), 59 (3-383) and 28 (7-97), respectively [29,72]. In fentanyl-only related deaths, average blood concentrations have been increasing, with a 2003 case series reporting an average result of 9 ng/mL, and a 2014 case series reporting an average of 30 ng/mL. A cluster of 9 fentanyl-laced heroin deaths were reported in Australia with reported average and median femoral blood concentrations of 18 and 29 ng/mL (range <1-45) accompanied by morphine, 140 and 80 ng/mL (range 20-400 ng/mL). The combination of heroin and fentanyl has become a routine toxicological finding in suspected opioid overdose death investigations, but even fentanyl by itself is posing an increased risk of overdose and death to recreational users.

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