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.     

The enhancement of intimacy and the reduction of loneliness among child molesters

The present report describes the component of our treatment program that is aimed at enhancing intimacy skills and reducing loneliness in sexual offenders. The evaluation of this component, although limited in sophistication, offers data that encourages confidence in the value of the treatment component.     

A Kantian (re)turn: Aesthetics,postmodernism and law

A review essay of P. Crowther,The Kantian Sublime: From Morality to Art (Oxford: Clarendon Press, 1989); P. Crowther,Critical Aesthetics and Postmodernism (Oxford: Clarendon Press, 1993); P. Crowther,Art and Embodiment: From Aesthetics to Self-Consciousness (Oxford: Clarendon Press, 1993).