Since 2014, the Miami-Dade Medical Examiner Department (MDME) has observed a drastic increase in the number of fentanyl and fentanyl analog (fentanyl-related substances, FRS) fatalities since its introduction into the heroin and cocaine supply. Due to the prevalence of FRS in Miami-Dade County, the MDME toxicology laboratory began documenting each case in which fentanyl and/or a fentanyl analog was identified. Additional information monitored included demographics (age, race, and sex), other drugs identified, cause of death, and manner of death. From 2014 to 2022, the MDME toxicology laboratory analyzed a total of 1,989 cases that tested positive for FRS, of which 1,707 had detectable and/or quantifiable fentanyl concentrations in postmortem cases. The majority of the decedents were white males (62%), and the predominant age range was 25-34 years. The most prevalent manner of death was accident (93%) with the most common cause of death listed as acute combined drug toxicity of fentanyl in combination with other drugs (79%). Other drugs found in combination with fentanyl included heroin, cocaine (most prevalent), synthetic cathinones, and ethanol. Of all FRS cases, 9% (170 cases) involved fentanyl alone as a cause of death, while 2% (38 cases) included only fentanyl analogs. Fentanyl concentrations ranged from 1.0 to 1,646 ng/mL in peripheral blood, 1.2 to 449 ng/mL in central blood, 3.2 to 28 ng/mL in donor blood (obtained during tissue harvesting), 1.1 to 108 ng/mL in antemortem blood, 8.5 to 1130 ng/g in liver, and 2.0 to 471 ng/g in brain. Drug concentrations were also reported for an additional eight fentanyl analogs. Considering the prevalence, high potency, and constant evolution of FRS, it is important to continuously monitor trends and report drug concentrations in complex medical examiner casework in an effort to educate pathologists, law enforcement, and local governments.

中文翻译：

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芬太尼相关物质的演变：迈阿密戴德县法医部门尸检生物样本中的流行率和药物浓度

自 2014 年以来，迈阿密戴德县法医部门 (MDME) 观察到，自芬太尼和芬太尼类似物（芬太尼相关物质，FRS）引入海洛因和可卡因供应以来，死亡人数急剧增加。由于迈阿密戴德县 FRS 的流行，MDME 毒理学实验室开始记录每个发现芬太尼和/或芬太尼类似物的病例。监测的其他信息包括人口统计数据（年龄、种族和性别）、已发现的其他药物、死亡原因和死亡方式。从2014年到2022年，MDME毒理学实验室总共分析了1,989例FRS检测呈阳性的病例，其中1,707例死后病例中可检测和/或可量化芬太尼浓度。大多数死者是白人男性 (62%)，主要年龄范围为 25-34 岁。最常见的死亡方式是意外事故（93%），最常见的死亡原因是芬太尼与其他药物合用引起的急性联合药物毒性（79%）。与芬太尼结合使用的其他药物包括海洛因、可卡因（最常见）、合成卡西酮和乙醇。在所有 FRS 病例中，9%（170 例）仅涉及芬太尼作为死亡原因，而 2%（38 例）仅涉及芬太尼类似物。外周血中的芬太尼浓度范围为 1.0 至 1,646 ng/mL，中心血中的芬太尼浓度为 1.2 至 449 ng/mL，供体血液（组织采集期间获得）中的芬太尼浓度为 3.2 至 28 ng/mL，生前血液中的芬太尼浓度为 1.1 至 108 ng/mL，肝脏中为 8.5 至 1130 ng/g，脑中为 2.0 至 471 ng/g。还报告了另外八种芬太尼类似物的药物浓度。考虑到 FRS 的流行性、高效性和不断演变，持续监测趋势并报告复杂法医案例中的药物浓度非常重要，以便教育病理学家、执法部门和地方政府。