The incidence of fentanyl in forensic toxicology analyses in the USA has dramatically increased over the past several years. The increase in death cases has been well studied; however, little has been reported on the impact to drug impaired driving. Fentanyl driving while under the influence of drugs (DUID) case data from 2014 to 2019 is presented. The data were obtained from three toxicology laboratories in the Northeast, Southeast, and Midwest regions of the USA. Fentanyl whole blood concentrations ranged from 0.1 to 157 ng/mL in living drivers with a 466% to 524% increase in fentanyl-positive DUID cases from 2014 to 2019, depending on the US region. The vast majority of fentanyl cases involved poly-drug use. Twenty case histories are presented where fentanyl was the only drug identified. The mean (standard deviation) fentanyl concentration for these cases was 5.2 ± 3.8 ng/mL with a median of 3.7 ng/mL, and the concentrations ranged from 2.0 to 16 ng/mL. Naloxone administration was documented in exactly half of these cases similar to another study involving carfentanil-impaired driving. The case histories also demonstrate that some recreational opioid users may display limited signs of impairment either due to tolerance or naloxone administration. The top three observations in common among the cases were the driver was found unresponsive behind the wheel, the vehicle left the travel lane or roadway, and the driver was involved in a crash. The increase in fentanyl use not only poses a risk for overdose and death, but is also a significant concern for traffic safety. This study supports the movement of fentanyl from a Tier II drug to Tier I due to its significant potential for impairment and increase in prevalence in impaired driving cases.

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芬太尼与驾驶障碍

在过去的几年中，美国法医毒理学分析中芬太尼的发生率急剧上升。对死亡案件增加的情况进行了充分的研究；然而，关于药物不良驾驶的影响的报道很少。列出了2014年至2019年受药物影响的芬太尼驾驶情况（DUID）的病例数据。数据来自美国东北，东南和中西部地区的三个毒理学实验室。活体驾驶员中的芬太尼全血浓度范围为0.1至157 ng / mL，从2014年至2019年，芬太尼阳性DUID病例的芬太尼阳性病例增加466％至524％，具体取决于美国地区。绝大多数芬太尼病例涉及多药使用。介绍了二十例病史，其中以芬太尼为唯一药物。这些病例的芬太尼平均浓度（标准差）为5.2±3.8 ng / mL，中位数为3.7 ng / mL，浓度范围为2.0至16 ng / mL。与上述涉及卡芬太尼受损的驾驶的另一项研究类似，纳洛酮的使用正好记录在这些案例的一半中。案例历史还表明，由于耐受性或纳洛酮的使用，一些休闲类鸦片使用者可能显示出有限的损伤迹象。在这些案例中，最常见的三个观察结果是驾驶员被发现在方向盘后无反应，车辆离开行车道或行车道，并且驾驶员参与了撞车事故。芬太尼使用量的增加不仅会造成用药过量和死亡的风险，而且也是交通安全的重要问题。