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Please help me lethal dose and nanograms of fentanyl.

Kimi#4321

Kimi#4321

Bluelighter
Joined
May 22, 2018
Messages
32
Location
Washington
Hello all I am sorry if I posted in the wrong place. Please move to right place if I did so.

Long story short. My 17 year old daughter passed away on Oct-31-2021 of a fentanyl overdose the medical examiner said they found 19.0 ng of fentanyl and 9.9 ng of n/fentanyl what it breaks down to in her system. It was in a little blue pill from Mexi supposedly orally taken. I need help understanding the dosage of this. As I can't don't main media , and I can't make sense of the scientific study. Please any help would be more then appreciated.
 
I'm sorry for your loss. It sounds like there's some missing info here, i'm guessing that those numbers are going to be something like nanograms/milliliter of blood. Even if so, it's kind of hard to determine exact dosage based on this.

It's sad that we have allowed things to get to a state where these fent pills are so prolific. One counterfeit "oxy" pill can easily contain enough fentanyl to cause an OD, which could be as little as >1mg.

Again i'm sorry for your loss, wish you the best.
 
Kimi#4321 said:
Hello all I am sorry if I posted in the wrong place. Please move to right place if I did so.

Long story short. My 17 year old daughter passed away on Oct-31-2021 of a fentanyl overdose the medical examiner said they found 19.0 ng of fentanyl and 9.9 ng of n/fentanyl what it breaks down to in her system. It was in a little blue pill from Mexi supposedly orally taken. I need help understanding the dosage of this. As I can't don't main media , and I can't make sense of the scientific study. Please any help would be more then appreciated.
Click to expand...
I'm sorry for your loss.
Those numbers are the concentrations of Fentanyl and Norfentanyl that were found in 1ml of your daughter's blood, not the amount that she ingested.
The quantity is high, very close to what would be used to induce anaesthesia in a hospital, people have died with less than half that amount especially if other drugs such as alcohol and/or benzodiazepines where involved.
On the other hand, people with high tolerance to Fentanyl have survived with up to 157 ng/ml according to a study on DUIs.

It is basically impossible to know how much Fentanyl was in the pill that killed her based on the toxicology report.
Fentanyl pills are not pharmaceutical products and the dosage can vary from batch to batch and even between pills from the same batch.
It seems that it was an accidental overdose as the ratio of Fentanyl to Norfentanyl suggests that she was alive for some time after ingesting the pill.
When someone takes a huge amount on purpose they are likely to die quickly and in that case there would be less Norfentanyl.
 
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Phobos said:
I'm sorry for your loss.
Those numbers are the concentrations of Fentanyl and Norfentanyl that were found in 1ml of your daughter's blood, not the amount that she ingested.
The quantity is high, very close to what would be used to induce anaesthesia in a hospital, people have died with less than half that amount especially if other drugs such as alcohol and/or benzodiazepines where involved.
On the other hand, people with high tolerance to Fentanyl have survived with up to 157 ng/ml according to a study on DUIs.

It is basically impossible to know how much Fentanyl was in the pill that killed her based on the toxicology report.
Fentanyl pills are not pharmaceutical products and the dosage can vary from batch to batch and even between pills from the same batch.
It seems that it was an accidental overdose as the ratio of Fentanyl to Norfentanyl suggests that she was alive for some time after ingesting the pill.
When someone takes a huge amount on purpose they are likely to die quickly and in that case there would be less Norfentanyl.
Phobos said:
I'm sorry for your loss.
Those numbers are the concentrations of Fentanyl and Norfentanyl that were found in 1ml of your daughter's blood, not the amount that she ingested.
The quantity is high, very close to what would be used to induce anaesthesia in a hospital, people have died with less than half that amount especially if other drugs such as alcohol and/or benzodiazepines where involved.
On the other hand, people with high tolerance to Fentanyl have survived with up to 157 ng/ml according to a study on DUIs.

It is basically impossible to know how much Fentanyl was in the pill that killed her based on the toxicology report.
Fentanyl pills are not pharmaceutical products and the dosage can vary from batch to batch and even between pills from the same batch.
It seems that it was an accidental overdose as the ratio of Fentanyl to Norfentanyl suggests that she was alive for some time after ingesting the pill.
When someone takes a huge amount on purpose they are likely to die quickly and in that case there would be less Norfentanyl.
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Thank you.. yes it wasn't suicide, Also have come to find out through reading on my science journals that yeah there's no way to tell they have not figured out a lethal dose for adults but I'm trying to figure out where she fits into it where she fits into I guess how much a normal person could take I guess I'm just trying to find somewhere some balanced some middle mean of what someone can take in what someone can and how long it would take for someone to pass away could you possibly explain the fentanyl and Norfentanyl and timing or how long it would normally take to succumb to overdoseing I know this is alot to ask I just have a lot of questions and there's so much unknown surrounding this situation with the people she was with and what they're saying anything would happen saying anything would help and I really appreciate you taking the time to answer to answer regardless thank you.
Click to expand...
 
falsifiedhypothesi said:
I'm sorry for your loss. It sounds like there's some missing info here, i'm guessing that those numbers are going to be something like nanograms/milliliter of blood. Even if so, it's kind of hard to determine exact dosage based on this.

It's sad that we have allowed things to get to a state where these fent pills are so prolific. One counterfeit "oxy" pill can easily contain enough fentanyl to cause an OD, which could be as little as >1mg.

Again i'm sorry for your loss, wish you the best.
Click to expand...
Yes I'm sorry it was 19.0ng and 9.9 Norfentanyl
 
Yes that is easily a lethal blood concentration of fentanyl. Alot of fentanyl overdoses are in that neighborhood.

But many people could survive much more. And some people die from less than half that when combined with other drugs, particularly benzodiazepines.

Very sorry for what happened, but knowing this information won't help you

There is indisputably a much larger discussion here, and it has nothing to do with what blood concentration of fentanyl results in death. That won't help you unfortunately.

But there may be some ways in which we can actually help you, so I am going to move this discussion to a place where you can get some more meaningful assistance.

It must be a horrible thing to lose a 17 year old

Basic Drug Discussion --> The Dark Side
 
Kimi#4321 said:
Hello all I am sorry if I posted in the wrong place. Please move to right place if I did so.

Long story short. My 17 year old daughter passed away on Oct-31-2021 of a fentanyl overdose the medical examiner said they found 19.0 ng of fentanyl and 9.9 ng of n/fentanyl what it breaks down to in her system. It was in a little blue pill from Mexi supposedly orally taken. I need help understanding the dosage of this. As I can't don't main media , and I can't make sense of the scientific study. Please any help would be more then appreciated.
Click to expand...
I am so sorry for your loss, and I completely understand you wanting a bit of closure. Have other people's comments cleared things up for you a bit better?
 
Kimi#4321 said:
Thank you.. yes it wasn't suicide, Also have come to find out through reading on my science journals that yeah there's no way to tell they have not figured out a lethal dose for adults but I'm trying to figure out where she fits into it where she fits into I guess how much a normal person could take I guess I'm just trying to find somewhere some balanced some middle mean of what someone can take in what someone can and how long it would take for someone to pass away could you possibly explain the fentanyl and Norfentanyl and timing or how long it would normally take to succumb to overdoseing I know this is alot to ask I just have a lot of questions and there's so much unknown surrounding this situation with the people she was with and what they're saying anything would happen saying anything would help and I really appreciate you taking the time to answer to answer regardless thank you.
Click to expand...
She probably took the pill 30minutes to 4 hours before dying.
She probably lost consciousness before passing, although it might have just looked like she was sleeping.
Was Fentanyl the only drug found in her? As this can complicate things further.

In regards to the contents of the pill, basically impossible to say as the absorption varies from person to person and depends on stomach contents as well.
In general, 0.5mg to 1.5mg would be a dangerous dose to ingest orally for an average sized person without a tolerance, and 2mg are usually considered likely to be lethal again, in a person without tolerance.

As far as the people that she might have been with, I can tell you that if they were high as well it might not have been so easy for them to realise the seriousness of the situation.
Depending on the specific circumstances, their fault may lie in getting all high at the same time on a new batch they didn't know the potency of, and sadly I would not expect a group of average teenagers to be so careful as to have a sober sitter.
 
Pharmaceutical Fentanyl comes as a solution for injection (Sublimaze), for transdermal delivery as a patch (Durogesic), as a tablet designed for buccal administration (Effentora) and as a nasal spray (PreFent). What is common here is that they are all designed for what is termed 'parenteral administration' which simply means not via the gastrointestinal tract. You cannot swallow fentanyl. Or rather you can, but it's bioavailability is described as 'sparse' in (chronic) studies i.e. it does not work, or at least not if one's liver is at all healthy. Fentanyl has an extremely short duration of action given that it's plasma half-life is about 18 minutes.

I won't bother you with the exact reasons for this, but I think what is important here is that whoever made this counterfeit pill relied on the user 'abusing' the pill i.e. by administering it via a parenteral route. As I understand it, imitation OxyContin makes up the bulk of these 'fakes'. Most users will crush and snort them. The serious problem here is that while oxycodone (the active drug in real OxyContin) is about twice as potent as morphine, fentanyl is around 80 times as potent. That means to approximate a 30mg OxyContin (for example), the maker of the fake would need to put less than 1mg of fentanyl into each pill.

While one might assume that these manufacturers would put the minimum amount of fentanyl into each tablet to maximise their own profit, the fact is that fentanyl is so incredibly cheap given it's potency, the trend is to put more in so that people develop tolerance and dependence. Needless to say, there is no quality control, no pharmacovigilance and given what they are doing, no concern for the end user whatsoever. They are sold by dubious pharmacists in Mexico and India. The buyer would not be aware that the medicine they purchased was fraudulent; they would not realise that they were dealing with a criminal.

The serum concentration for analgesia is around 1-2 ng/mL and around 10-20 ng/mL for anaesthesia. The latter dose regime is only used by specialists and only when mechanical ventilation and related life-support equipment is on hand. The mean concentration of fentanyl found in accidental overdose victims is 26.4 ng/mL (range 11.8-95.8 ng/mL).

I home you understand that my post is dispassionate in the attempt to provide you with the information that is useful to and understandable by you. All the data has been derived from multiple medical sources and is correct to the best of my knowledge. There are many different figures assigned to fentanyl. I think it is the order of magnitude that is important.

I have no idea under what circumstances this accident occurred so I cannot make any comments regarding this specific case. I merely wished to present what is available in textbooks, medical literature and such information as is made available to potential prescribers of medicines in which fentanyl is an active ingredient. There is a huge mythos surrounding ALL drugs but psychoactive drugs in particular and drugs of abuse specifically. Every case is unique and it is not useful to comment on specific cases.

If their is any indication as to who supplied these tablets, stopping them could be of great benefit to unwitting consumers. It goes without saying that there will almost certainly be many more of these fraudulent pills in circulation and that nobody knows if they have a pill that came from the same batch or even the same die (tablets are cast in dies, I am not making light of this terrible situation).
 
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N
Phobos said:
She probably took the pill 30minutes to 4 hours before dying.
She probably lost consciousness before passing, although it might have just looked like she was sleeping.
Was Fentanyl the only drug found in her? As this can complicate things further.

In regards to the contents of the pill, basically impossible to say as the absorption varies from person to person and depends on stomach contents as well.
In general, 0.5mg to 1.5mg would be a dangerous dose to ingest orally for an average sized person without a tolerance, and 2mg are usually considered likely to be lethal again, in a person without tolerance.

As far as the people that she might have been with, I can tell you that if they were high as well it might not have been so easy for them to realise the seriousness of the situation.
Depending on the specific circumstances, their fault may lie in getting all high at the same time on a new batch they didn't know the potency of, and sadly I would not expect a group of average teenagers to be so careful as to have a sober sitter.
Click to expand...
No they were not high it was a 41 year old man who was supplying her from what I'm figuring out or a 17 year old girl thing is they waited till she had been gone awhile she was in rigger when the medics got there
 
Feretile said:
Fentanyl has an extremely short duration of action given that it's plasma half-life is about 18 minutes.

I won't bother you with the exact reasons for this, but I think what is important here is that whoever made this counterfeit pill relied on the user 'abusing' the pill i.e. by administering it via a parenteral route. As I understand it, imitation OxyContin makes up the bulk of these 'fakes'. Most users will crush and snort them.
Click to expand...
I think most of what you wrote is true, but according to this paper Fentanyl is orally bioavailable and has a much longer half life when taken orally as opposed to when it is injected.
Here is the most relevant quote from that paper:
The absolute bioavailability of fentanyl from the buccal soluble film treatments was 71%, which is approximately double that after oral administration (35%). The percentage of an administered dose absorbed through the buccal mucosa was calculated to be 51%.
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And have a look at Figure 1, found in page 4, it seems that the half life for oral Fentanyl is about 5.5 - 6 hours.
 
Phobos said:
I think most of what you wrote is true, but according to this paper Fentanyl is orally bioavailable and has a much longer half life when taken orally as opposed to when it is injected.
Here is the most relevant quote from that paper:

And have a look at Figure 1, found in page 4, it seems that the half life for oral Fentanyl is about 5.5 - 6 hours.
Click to expand...

No - that is the elimination half-life of fentanyl, not it's plasma half-life. It's a lipophilic molecule so it's first redistributed and then eliminated. Orally, it's never initially distributed into the brain hence no oral formulation This is seen in many if not most of the short-acting agents,. On a technical front, piperidine N-dealkylation results in the totally inactive norfentanyl. It's a very strong substrate for the CYP3A class of enzyme. Not a SPECIFIC CYP3A you note, but the entire group.

That is why Janssen developed α-methyl fentanyl. Unfortunately, not only is it chiral, if it is resolved, α-methyl fentanyl demonstrates a LOWER therapeutic index than fentanyl itself. I can only guess that it is the reason why it was never introduced. I mean, The TI of fentanyl is about 300 and of morphine about 78 (figures vary because there are just so many data sources).

I think the important things are that:

1) Fentanyl is not active orally, even under chronic dosage conditions: https://clinicaltrials.gov/ct2/show/NCT00714558
2) Fentanyl is a substrate for duodenal microsomes https://pubmed.ncbi.nlm.nih.gov/9311623/
3) Fentanyl is not offered in any parenteral formal. While I do appreciate that evidence of absence is not absence of evidence, I have provided evidence if inactivity. One would have to severely hamper the liver & GI tract enzymes to make it orally active.

But by far the MOST important fact is that the concentrations were an order of magnitude higher than those seen in chronic fentanyl administration concomitant with ourpatient analgesia. I was not these, I do not have the specific data and I have no pertinent information concerning the specific individual and if I had, a sample of 1 is not subject to confidence intervals, so it's an event, not a specific fact beyond the single truly terrible outcome.

I really did not want to post any further but I feel it if important for people to know the risks.
 
Kimi#4321 said:
N

No they were not high it was a 41 year old man who was supplying her from what I'm figuring out or a 17 year old girl thing is they waited till she had been gone awhile she was in rigger when the medics got there
Click to expand...
Thats fucked up. Friends should watch each others back. Back when I did h with my old posse every now and then we always used in a group and watched so that nobody overdoses or even gets too close to it.
 
Feretile said:
1) Fentanyl is not active orally, even under chronic dosage conditions: https://clinicaltrials.gov/ct2/show/NCT00714558
Click to expand...
Following that link, I could not find any results, just the conditions of the study.
If you look at the Figure 1 in the link I posted, you will see that oral Fentanyl reaches the bloodstream without being fully metabolised so it does survive first pass, although the low bioavailability (just 35% ) suggests that yes, it is extensively metabolised by the liver as you say.
Wikipedia list a similar oral bioavailability, 33%.

Edit: Here is another link to the same paper, the first one seems to not work properly: Single-Dose Pharmacokinetics of Fentanyl Buccal Soluble Film
 
Feretile said:
No - that is the elimination half-life of fentanyl, not it's plasma half-life. It's a lipophilic molecule so it's first redistributed and then eliminated. Orally, it's never initially distributed into the brain hence no oral formulation This is seen in many if not most of the short-acting agents,. On a technical front, piperidine N-dealkylation results in the totally inactive norfentanyl. It's a very strong substrate for the CYP3A class of enzyme. Not a SPECIFIC CYP3A you note, but the entire group.

That is why Janssen developed α-methyl fentanyl. Unfortunately, not only is it chiral, if it is resolved, α-methyl fentanyl demonstrates a LOWER therapeutic index than fentanyl itself. I can only guess that it is the reason why it was never introduced. I mean, The TI of fentanyl is about 300 and of morphine about 78 (figures vary because there are just so many data sources).

I think the important things are that:

1) Fentanyl is not active orally, even under chronic dosage conditions: https://clinicaltrials.gov/ct2/show/NCT00714558
2) Fentanyl is a substrate for duodenal microsomes https://pubmed.ncbi.nlm.nih.gov/9311623/
3) Fentanyl is not offered in any parenteral formal. While I do appreciate that evidence of absence is not absence of evidence, I have provided evidence if inactivity. One would have to severely hamper the liver & GI tract enzymes to make it orally active.

But by far the MOST important fact is that the concentrations were an order of magnitude higher than those seen in chronic fentanyl administration concomitant with ourpatient analgesia. I was not these, I do not have the specific data and I have no pertinent information concerning the specific individual and if I had, a sample of 1 is not subject to confidence intervals, so it's an event, not a specific fact beyond the single truly terrible outcome.

I really did not want to post any further but I feel it if important for people to know the risks.
Click to expand...

Fentanyl is entirely orally active I’m not sure what you’re getting at? I know plenty of people who have died from oral use of fake Percocet 30 mg pills, the little blue ones Kim is definitely talking about.

Most fake 30s contain around 1 mg of fentanyl per pill, which to a non opioid tolerant individual can be entirely lethal, even when taken orally.

If fentanyl didn’t work orally kids wouldn’t be dying from it.

@Phobos he’s wrong don’t worry
 
Kimi#4321 said:
N

No they were not high it was a 41 year old man who was supplying her from what I'm figuring out or a 17 year old girl thing is they waited till she had been gone awhile she was in rigger when the medics got there
Click to expand...
@Kimi#4321 I'm so sorry this happened to your daughter. Rather than getting wrapped up in the chemistry of all this, I think time would be well spent trying to pinpoint from whom she got the pills and making sure that person sees justice served.

Have the authorities been helpful at all? It sounds like you have it narrowed down to two individuals. Have either of them at least been questioned by law enforcement? Are you aware of any type of ongoing investigation taking place?
 
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