Fatal Fentanyl Patch Misuse in a Hospitalized Patient with a Postmortem Increase in Fentanyl Blood Concentration

Opioid‐related mortality happens, even in healthcare settings. We describe serial postmortem fentanyl blood concentrations in a hospital inpatient who fatally abused transdermal fentanyl. This is a single‐patient case report. A 42‐year‐old man with lymphoma was started on transdermal fentanyl therapy while hospitalized for chronic abdominal pain. The patient was last seen awake 1.3 h prior to being found apneic and cyanotic. During the resuscitation attempt, a small square‐shaped film was removed from the patient's oropharynx. Femoral blood was collected 0.5 and 2 h postmortem, and the measured fentanyl concentration increased from 1.6 to 14 ng/mL. Study limitations include potential laboratory or collection errors and missing data. (i) Providers must be vigilant for signs of fentanyl patch abuse. (ii) Postmortem blood concentrations are not static postmortem, likely secondary to decreasing pH, increased aqueous solubility, and tissue redistribution, and are therefore unlikely to accurately represent antemortem blood concentrations.     

Rapid extraction of oxazepam from greyhound urine for high performance liquid chromatography analysis

A rapid and efficient procedure is described for the extraction and analysis of oxazepam, the major urinary metabolite of diazepam in greyhounds. Urine was extracted by passing through a bonded silica column (Bond Elut) following enzyme hydrolysis. The adsorbed drug was eluted and then detected and measured by high performance liquid chromatography (HPLC). Recoveries were in excess of 85% at 50 ng/ml concentrations. Detection was possible up to 30 h after a single oral dose of diazepam (5 mg).     

1H nuclear magnetic resonance of heroin's D ring

The 1H nuclear magnetic resonance (NMR) chemical shifts and coupling constants of heroin's D ring H-15 alpha, H-15 beta, and H-16 alpha, and H-16 beta are presented. These assignments were accessible through the introduction of a double bond (delta 15,16) in heroin. The resulting compound, delta 15,16 didehydroheroin, was subjected to deuterium exchange or stereoselective reduction or both. Reduced products d1-16 alpha heroin d2-15 alpha, 15 beta-heroin, and d3-15 alpha, 15 beta, 16 alpha-heroin are presented. Heroin with deuterated acetyls is also presented for 1H NMR spectral clarity in the D ring area.     

Successful Restitution as a Predictor of Juvenile Recidivism

Abstract This is an evaluative study of a juvenile probationary project in which youth are ordered to pay restitution as a term of probation and, to assure them means of compliance, the juvenile court arranges for and supplies their employment. Demographic variables (age and sex) and court-related variables (plea, length of probation, amount of restitution ordered, and amount and proportion actually paid) are examined in relation to one another and, most important, in relation to recidivism as measured by subsequent law violations for which the offender was investigated, and subsequent law violations that resulted in formal charges against the youth. The data demonstrate that recidivism is related to severity of the initial offense, but more important, it is related to the youth's success in achieving the restitution goal. Successful compliance with the restitution order, when success is measured by amount of restitution paid relative to the amount ordered by the court, is significantly related to revocation of probation, time given to pay, amount ordered to be paid, and subsequent offenses charged. Indeed, the proportion of restitution paid is the most important predictor of recidivism. The data reinforce the dominant legislative position that an offender's ability to pay must be taken into account in ordering restitution.