{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T04:26:24Z","timestamp":1789014384812,"version":"build-2803163510"},"reference-count":16,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2023,12,20]],"date-time":"2023-12-20T00:00:00Z","timestamp":1703030400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,3,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>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 (FRSs)) 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 (COD) and manner of death (MOD). 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 decedents were white males (62%), and the predominant age range was 25\u201334\u2009years. The most prevalent MOD was accident (93%) with the most common COD 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 COD, while 2% (38 cases) included only fentanyl analogs. Fentanyl concentrations ranged from 1.0 to 1,646\u2009ng\/mL in peripheral blood, 1.2 to 449\u2009ng\/mL in central blood, 3.2 to 28\u2009ng\/mL in donor blood (obtained during tissue harvesting), 1.1 to 108\u2009ng\/mL in antemortem blood, 8.5 to 1,130\u2009ng\/g in liver and 2.0 to 471\u2009ng\/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.<\/jats:p>","DOI":"10.1093\/jat\/bkad089","type":"journal-article","created":{"date-parts":[[2023,12,21]],"date-time":"2023-12-21T02:35:15Z","timestamp":1703126115000},"page":"104-110","source":"Crossref","is-referenced-by-count":9,"title":["The evolution of fentanyl-related substances: Prevalence and drug concentrations in postmortem biological specimens at the Miami-Dade Medical Examiner Department"],"prefix":"10.1093","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-1313-6476","authenticated-orcid":false,"given":"Jocelyn","family":"Martinez","sequence":"first","affiliation":[{"name":"Miami-Dade Medical Examiner Department, Toxicology Laboratory , 1851 NW 10th Avenue, Miami, FL 33136, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Gonyea","sequence":"additional","affiliation":[{"name":"Miami-Dade Medical Examiner Department, Toxicology Laboratory , 1851 NW 10th Avenue, Miami, FL 33136, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M Elizabeth","family":"Zaney","sequence":"additional","affiliation":[{"name":"Miami-Dade Medical Examiner Department, Toxicology Laboratory , 1851 NW 10th Avenue, Miami, FL 33136, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7152-1570","authenticated-orcid":false,"given":"Joseph","family":"Kahl","sequence":"additional","affiliation":[{"name":"Miami-Dade Medical Examiner Department, Toxicology Laboratory , 1851 NW 10th Avenue, Miami, FL 33136, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diane M","family":"Moore","sequence":"additional","affiliation":[{"name":"Miami-Dade Medical Examiner Department, Toxicology Laboratory , 1851 NW 10th Avenue, Miami, FL 33136, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,12,20]]},"reference":[{"key":"2024030117230410900_R1","article-title":"Recommended methods for the identification and analysis of fentanyl and its analogues in biological specimens (2017)","author":"United Nations","year":"2017"},{"key":"2024030117230410900_R2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3389\/fphar.2019.00238","article-title":"Metabolic pathways and potencies of new fentanyl analogs","volume":"10","author":"Wilde","year":"2019","journal-title":"Frontiers in Pharmacology"},{"key":"2024030117230410900_R3","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.neuropharm.2017.10.016","article-title":"Fentanyl, fentanyl analogs and novel synthetic opioids: a comprehensive 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