A CLUSTER OF FENTANYL-RELATED DEATHS AMONG DRUG-ADDICTS IN SWEDEN

During a 16-month period, nine fatalities occurred among white male dr ug-addicts, where fentanyl was detected at postmortem toxicological an alysis. The street samples associated with these cases confirmed the p resence of fentanyl as an additive in low-concentration amphetamine po wders with caffeine, phenazone and sugar as cutting agents. In seven o f the cases, an acute intoxication by fentanyl was considered to be th e immediate cause of death, and in one case, it was likely, but no ana lysis of fentanyl was performed in blood, and in another case the deat h was suicide by hanging. This appears to be the first report of a clu ster of fentanyl-related deaths outside the United States, and the occ urrence of fentanyl in combination with amphetamine has not previously been reported. In addition, in all cases, femoral blood was collected , and samples were handled and analysed according to standardized, qua lity-controlled procedures. The previous history, circumstances surrou nding death, autopsy findings, histology and toxicology examination of each case are presented. The gas chromatographic-mass spectrometric m ethod for fentanyl is also described. Fentanyl concentrations ranged f rom 0.5 to 17 ng g(-1) blood, and from 5 to 160 ng ml(-1) urine. Other drugs found were amphetamine (8 cases), ethanol (5 cases) and benzodi azepines (5 cases). Morphine was found in only one case. The average a ge of the men was 33.9 years (range 22-44); six were found in their ow n or friend's apartment, two inside buildings (stairways) and one was found outdoors. We conclude that fentanyl is a dangerous substance tha t should be considered in drug-addict deaths even outside the United S tates, particularly when the remaining toxicology is unremarkable, and the cause of death cannot be ascertained. (C) 1997 Elsevier Science I reland Ltd.