Carfentanil (CaF) is a new synthetic opioid (NSO) solely approved for veterinary use (to incapacitate various species of large exotic wildlife) as it is 10,000 times more powerful than morphine. CaF has wildly recently appeared emerged in the NPS market and many overdose deaths have been reported in the USA since 2016.

In December 2017, a 41-years-old polydrugs abuser for several years, especially of NPS purchased on the darkweb, is found dead in his room, a syringe planted under the tongue. His history includes recent carfentanyl intoxication treated with Nalscue^®. The prosecutor requires autopsy and toxicological analyzes.

Autopsy specimens (blood and urine) were analyzed using standard laboratory techniques (GC-FID, GC-MS and LC-MS/MS). A LC-HRMS method was used to perform a broad and specific search for NSOs including Caf in blood, urine and hair samples.

Blood and urine positive results include CaF, illicit (or not) drugs (see Table 1) and ethanol (BAC 0.5g/L).

In addition, these drugs were also identified in (brown, 9cm length) hair sample together with additional drugs i.d. pharmaceuticals (cyamemazine, codeine, diazepam, quetiapine, sildenafil), illicit drugs (heroin, cocaine, MDMA), other NSOs (benzoylfentanyl and 4-fluobutyrylfentanyl) and other NPS (ethylhexedrone, diclazepam and methoxetamine). Observed CaF hair concentrations ranged from 54 to 166pg/mg in the three 3-cm length hair segment. CaF use is here associated with other opioids, illicit drugs and psychotropic depressants of the respiratory system, like the other cases described in the literature. Blood concentration of CaF is of the same order or higher than those reported in cases of lethal poisoning described in the USA and recently in UK [1Elliott S.P., et al. A series of deaths involving carfentanil in the UK and associated postmortem blood concentrations J Anal Toxicol 2018 ;  42 : e41-e45

Cliquez ici pour aller à la section Références, 2Shanks K.G., et al. Detection of carfentanil by LC-MS-MS and reports of associated fatalities in the USA J Anal Toxicol 2017 ;  41 : 466-472 [cross-ref]

Cliquez ici pour aller à la section Références]. To our knowledge, this is the first identification of this fentanyl derivative in a fatality in France.

Although hair results strongly suggest a significant tolerance of the victim to NSOs, the relatively high postmortem CaF concentration observed in the victim's blood (4.20μg/L) together with the absence of metabolite (especially NorCaF) in blood or urine, suggest a sudden death immediately following a significant CaF dose intake (presumably injected).