Prior to 2017, heroin and other prescription opioids were the most prevalent opioids implicated in driving under the influence of drugs (DUID) investigation cases, and fentanyl was rarely included in the scope of toxicological analysis. Fentanyl has become the most frequently identified opioid in DUID cases, with many suspected heroin cases turning out to be only fentanyl. A review of fentanyl-positive DUID cases at NMS Labs was performed to provide prevalence information, change in concentration, patterns of combined drug use, indicators of impairment and driving behavior in order to assist with the toxicological interpretation of DUID scenarios involving fentanyl. Fentanyl-positive DUID cases received between January 2010 and December 2020 were examined. Blood results were confirmed and quantitated for fentanyl, norfentanyl and acetylfentanyl using a liquid chromatography tandem mass spectrometry analysis with a limit of quantitation of 0.10, 0.20 and 0.10 ng/mL, respectively. Of 153,234 blood cases examined for DUID over 11 years, fentanyl was confirmed positive in 6,779 (4.4%) cases. However, there were significant changes in positivity over time. Fentanyl percentage positivity increased from 0.60% in 2010 to 12% in 2020. Of 5,976 confirmed fentanyl-positive cases in 2018–2020, blood concentrations >4.0 ng/mL were observed in 44% (2018), 55% (2019) and 59% (2020) of cases. Polypharmacy was common with 87% of blood samples confirmed positive for fentanyl and at least one other compound. Stimulant was the most commonly identified drug class in cases where at least one additional drug class was present. This study illustrates the importance of including fentanyl in a routine blood DUID panel.

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芬太尼在毒品个案影响下驾驶的 11 年研究

2017年之前，海洛因和其他处方类阿片是涉毒驾驶（DUID）调查案件中最普遍的阿片类药物，芬太尼很少被纳入毒理学分析范围。芬太尼已成为 DUID 病例中最常见的阿片类药物，许多疑似海洛因病例最终证明只是芬太尼。在 NMS 实验室对芬太尼阳性 DUID 病例进行了审查，以提供流行信息、浓度变化、组合药物使用模式、损伤指标和驾驶行为，以帮助对涉及芬太尼的 DUID 情景进行毒理学解释。对 2010 年 1 月至 2020 年 12 月期间收到的芬太尼阳性 DUID 病例进行了检查。芬太尼的血液结果得到确认和定量，去甲芬太尼和乙酰芬太尼使用液相色谱串联质谱分析，定量限分别为 0.10、0.20 和 0.10 ng/mL。在 11 年间检查 153,234 例 DUID 血液病例中，芬太尼在 6,779 例（4.4%）中被确认为阳性。然而，随着时间的推移，积极性发生了显着变化。芬太尼阳性百分比从 2010 年的 0.60% 增加到 2020 年的 12%。在 2018-2020 年确认的 5,976 例芬太尼阳性病例中，44%（2018 年）、55%（2019 年）和59%（2020 年）的案例。多药治疗很常见，87% 的血样证实芬太尼和至少一种其他化合物呈阳性。在至少存在一种其他药物类别的情况下，兴奋剂是最常见的药物类别。