This article describes a postmortem case of a doctor in the context of polydrug use. A potentially lethal level of fentanyl is found in blood along with several central nervous system depressants. Benzodiazepines, fentanyl, propofol glucuronide, and venlafaxine are detected in hair over a long period of time. The hair results, which show a high increase in fentanyl and benzodiazepine use over the last 9 months of life, improve the interpretation of postmortem results.

ABSTRACT

An intern doctor was found dead at their home with several signs of venepuncture. A bottle of propofol and a filled syringe appeared at the scene. Their medical history recorded antidepressant treatment and a suicide attempt 1.5 years earlier by massive ingestion of venlafaxine and quetiapine. Toxicological investigation was requested to know previous history of drug use and to clarify the cause of death. A thorough chemical-toxicological analysis of blood, urine, gastric contents, and syringe contents was performed by GC-MS and LC-Q-TOF. A comprehensive qualitative screening of more than 500 drugs and toxins, as well as quantification of fentanyl, benzodiazepines, and propofol-glucuronide, was carried out on three 3-cm hair segments by LC-MS/MS. A high concentration of fentanyl was found in blood (38 ng/mL), together with nordiazepam (167 ng/mL), propofol (< 500 ng/mL), venlafaxine (630 ng/mL), and O-desmethylvenlafaxine (510 ng/mL). Results in hair varied from distal to proximal to the root segment: fentanyl increased (43, 56, and 175 pg/mg, respectively); propofol-glucuronide decreased (239, 73, and 37 pg/mg); and benzodiazepines increased. Venlafaxine and O-desmethylvenlafaxine were positive in all three segments. These results revealed polydrug use for at least 9 months prior to death and an increase in fentanyl use over this period. Segmental hair analysis uncovers patterns of drug misuse that improve the interpretation of postmortem results. Although death by suicide cannot be totally ruled out, the findings suggest accidental death by overdose of fentanyl in combination with other psychoactive drugs in a propofol and fentanyl abuser.