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Fentanyl is a potent, short-acting narcotic analgesic widely used as surgical anaesthetic. This article presents a case in which fentanyl was self-injected by a 41-year old nurse, an employee at the hospital emergency department, who was found dead at home. She had no known history of drug and alcohol abuse. Two syringes, one empty and one filled with a clear liquid, were found near the body, while a needle was stuck into her hand.
Toxicological analysis showed fentanyl poisoning. Fentanyl overdose was declared the cause of death and the manner of death was classified as suicide.
To our knowledge, death due to the intravenous injection of fentanyl has not previously been reported in Croatia.
KEY WORDS: death, intravenous injection, toxicology
KLJUCNE RIJECI: intravensko ubrizgavanje, smrt, toksikologija
Fentanyl, N-[1-(2-phenylethyl)-4-piperidinyl]- N-phenyl-propanamide (Figure 1), is a narcotic analgesic, which primarily binds to opioid µ-receptors, producing not only the analgesia for which it is primarily used but also sedation, euphoria, and at high doses, respiratory depression and death (1). It was introduced into medical practice in the 1960s as an intravenous anaesthetic under the trade name of Sublimaze (2). Fentanyl has an LD50 of 3.1 mg kg-1 in rats, and 0.03 mg kg-1 in monkeys.
Fentanyl overdose is classically associated with intravenous use of α-methylfentanyl and 3- methylfentanyl, a powder form that is chemically different from therapeutic fentanyl (3). Occasionally these fentanyl derivates are sold as heroin and at other times they go by street monikers such as synthetic heroin and China white, which is the same term used for high-quality south-east Asian heroin (4). However, fentanyl overdose has also been reported in cases of excessive transdermal application and ingestion or inhalation of transdermal patches (5-8).
The transdermal fentanyl system is designed to deliver a specific dose at a constant rate based on the initial concentration present in the patch. This delivery system effectively limits the peak versus trough concentration, which is a common problem associated with other routes of administration. We present a case in which a fatal dose of fentanyl was injected.
MATERIALS AND METHODS
Multiple samples were collected and stored at 4 °C until analysis in order to establish drug distribution. Samples were screened for ethanol, common drugs of abuse and other basic...