The detection of novel fentanyl analogs in both seized drugs and toxicological specimens has presented a significant challenge to laboratories with respect to identification, sourcing reference drug standards, the time required for method development and ensuring sufficient method sensitivity. The New York City Office of Chief Medical Examiner has included testing for valerylfentanyl as part of a panel of synthetic opioids since May 2017 but did not identify the first valerylfentanyl-positive case until July 2018. Unlike many other illicit fentanyl analogs that were briefly identified before being replaced with a new analog, valerylfentanyl has persisted over time and continues to be identified in New York City acute polydrug intoxications. Since July 2018, a total of 69 cases were identified to be valerylfentanyl positive, but there were no cases where it was the sole intoxicant. Eighty-four percentage of decedents were male, with the majority being Hispanic males (49%) between the ages of 50 and 59 years (39%). The cause of death in all 69 cases involved acute polydrug intoxications, while the manner of death was deemed an accident in 68 cases and undetermined in one case. Concentrations of valerylfentanyl in postmortem blood ranged from <0.10 to 21 ng/mL, with 44.9% (N = 31) of the concentrations at or below the lower limit of quantification (0.10 ng/mL) but above the limit of detection (0.05 ng/mL). Fentanyl was present in 100% of the cases and in higher concentrations (1.6–116 ng/mL). The most common other drug classes detected with valerylfentanyl were other opiates (76.8%), cocaine/metabolites (50.7%), benzodiazepines (29%) and ethanol (21.7%). Valerylfentanyl is a relatively unknown fentanyl analog with limited information in the scientific literature. This study presents the first publication detailing a series of postmortem cases involving valerylfentanyl in acute intoxications and includes key demographic information and femoral blood concentrations for improved interpretation and analysis.

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纽约市首席法医办公室确定了涉及缬草芬太尼的急性中毒

在缉获的药物和毒理学标本中检测新型芬太尼类似物对实验室在鉴定、采购参考药物标准、方法开发所需的时间和确保足够的方法灵敏度方面提出了重大挑战。自 2017 年 5 月以来，纽约市首席法医办公室已将戊基芬太尼检测作为合成阿片类药物的一部分，但直到 2018 年 7 月才发现首例戊基芬太尼阳性病例。与之前曾简要发现的许多其他非法芬太尼类似物不同被一种新的类似物所取代，戊酰芬太尼随着时间的推移持续存在，并继续在纽约市急性多药中毒中被发现。自 2018 年 7 月以来，共有 69 例确诊为戊酰芬太尼阳性，但没有任何情况下它是唯一的麻醉剂。84% 的死者是男性，其中大多数是 50 至 59 岁之间的西班牙裔男性 (49%) (39%)。69例死亡原因均涉及急性多药中毒，68例死亡方式为意外，1例死亡原因不明。死后血液中戊酰芬太尼的浓度范围为 <0.10 至 21 ng/mL，其中 44.9% (N = 31) 的浓度等于或低于定量下限 (0.10 ng/mL) 但高于检测限 (0.05纳克/毫升）。芬太尼存在于 100% 的病例中，并且浓度更高（1.6-116 ng/mL）。用戊酰芬太尼检测到的最常见的其他药物类别是其他阿片类药物（76.8%）、可卡因/代谢物（50.7%）、苯二氮卓类药物（29%）和乙醇（21.7%）。Valerylfentanyl 是一种相对未知的芬太尼类似物，科学文献中的信息有限。本研究发表了第一份出版物，详细介绍了一系列涉及缬草芬太尼在急性中毒中的死后病例，并包括关键的人口统计信息和股血浓度，以改进解释和分析。