Postmortem Fentanyl Concentrations: A Review

Fentanyl is a potent synthetic narcotic analgesic available through the prescription of various formulations; intravenous injection, transmucosal lollipops and lozenges, as well as transdermal patches. Over the years, fentanyl has been a steadily increasing topic of discussion in the literature with pharmacokinetic studies, postmortem case studies, antemortem case studies, comparison of postmortem specimens for cause of death interpretation, comparison of specimens in regards to postmortem redistribution, as well as many others. The objective of this paper was to review the fentanyl literature, assemble some key concepts into a single publication, and introduce additional scientific data through retrospective studies from the Los Angeles County Department of Coroner and the San Diego Medical Examiner’s Office that support, as well as refute, some concepts previously published. Our paper is organized into sections by history, dosing, pharmacology and pharmacokinetics, toxicity, biological concentrations, postmortem concentrations, and postmortem redistribution that include discussion and data relating central to peripheral blood ratios, and liver to peripheral blood ratios. Overall, this paper “Postmortem Fentanyl Concentrations: A Review” examines over 85 different literary sources, independently interprets scientific data, and draws conclusions with support from retrospective laboratory studies.