SOFT 2004 Meeting Abstracts - Society of Forensic Toxicologists

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TILL DEATH DO US PART: FENTANYL POISONING IN A HUSBAND AND WIFE
George S. Behonick, Ph.D:, Tara Valouch, B.S., Virginia Division of Forensic Science Western
Laboratory and Susan E. Venuti, M.D., Assistant Chief Medical Examiner, Western District Office of The
Chief Medical Examiner and Assistant Clinical Professor, Department of Legal Medicine at Virginia
Commonwealth University, 6600 Northside High School Road, Roanoke, V A 24019
One treatment modality for chronic pain is the application of fentanyl transdermal patches (Duragesic®).
However, the transdermal therapeutic system, designed for the rate-controlled delivery of drug, is
increasingly favored by members of the opioid-misusing/abusing population. Deliberate misuse or abuse
may include cutaneous application of mUltiple patches, transmucosal absorption (buccal cavity), inhalation
of volatilized fentanyl and intravenous injection of contents extracted from trans dermal patches. The selfdelivery
of drug also occurs by simultaneously combining different routes of administration. Herein we
describe a case report of two fatal fentanyl poisonings which occurred in a married couple within a five
hour time interval. We discuss the available medical histories of the two decedents (including prescribed
medications) together with first responder witness reports and significant findings from both autopsies and
the postmortem toxicological analyses in each case. Physical evidence included a 75 jlg/h fentanyl
transdermal patch retrieved from the oral cavity or airway of the female decedent during resuscitative
efforts at the scene and a "disrupted" (e.g., cut) 75 jlg/h fentanyl transdermal patch recovered in the
personal effects of the male decedent at autopsy. The postmortem blood fentanyl concentrations measured
in the 45-year-old white female decedent and the 52-year-old white male decedent were 0.050 mg/L and
0.030 mg/L, respectively. Fentanyl was extracted from blood using solid phase extraction and quantitated
by 81M GCMS using a previously published procedure.
Key Words: fentanyl, poisoning, blood
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