Via STAT, a report datelined Cincinnati: As opioids spread, coroners see wave of medical mysteries. Excerpt:
One of the most common synthetic opioids is fentanyl, which is up to 100 times more potent than heroin. There are also so-called analogs of fentanyl, with slightly altered chemical structures that can be missed by drug screens.
Here in Ohio, a rash of overdoses has been attributed to an opioid known as carfentanil, which is 100 times more potent than standard fentanyl and which, until recently, was most commonly known as a sedative used by zoo veterinarians. It was blamed for a spike of 78 overdoses in Cincinnati over two days this summer.
Forensic pathologists say their job is complicated by the fact that they often have little information about how much of a drug was consumed or how soon before death. Even if there are witnesses, they may not have accurate information. In some cases, synthetic drugs are used to lace heroin or passed off as heroin to unsuspecting buyers.
“There are so many variables here and there’s so much information that we don’t get that it’s really hard to evaluate scientifically what’s significant and what isn’t,” said Dr. Lakshmi Sammarco, the coroner in Hamilton County, which includes Cincinnati.
As officials here tried to tease apart how many of the overdoses over the summer could be attributed to carfentanil, they were flying blind. Toxicologists needed a clean sample of the drug — what’s called a standard — to adjust their screening procedures for it, and the companies that normally supply standards didn’t have any. The lab wound up getting its first sample from the toxicology lab in Akron, which had gotten it from a zoo.
Eventually, the Drug Enforcement Administration also provided a standard.
Meanwhile, medical examiners had questions about how carfentanil affects the body and had to rely on limited scientific literature — just a few studies done in goats and antelopes.
“No one has any idea what level would cause someone to die,” said Robert Topmiller, a Hamilton County toxicologist. “No one has any idea what level would cause somebody to be impaired. No one knows this stuff.”
Since the summer, officials from Wisconsin to Florida have called Hamilton County asking how they adapted their screening protocol for carfentanil. But many labs still have to outsource confirmatory tests to private labs, officials say, creating another expense for these public agencies already crunched by a surge of opioid-related investigations.
Another problem with synthetic opioids is that lab equipment can prove insufficient to identify minuscule amounts of drugs in a victim’s system, even if that amount is enough to prove deadly.
“You’re actually pushing the limits of detection,” said Gilson, the Cuyahoga County medical examiner.