Two Cyclopropyl Fentanyl Case Studies in Los Angeles.

Illicit fentanyl occurrence in Los Angeles, California has increased along with the emergence of several fentanyl analogs (fentalogs). The following two case studies address the original identification of cyclopropyl fentanyl in cases investigated by the Los Angeles County Department of Medical Examiner-Coroner in the summer of 2017. In the first case study, cyclopropyl fentanyl was the only drug detected in the decedent's system and was also identified in medical evidence collected at the death scene. Medical evidence is classified as any medical device, prescription(s), drug(s) and/or paraphernalia collected by the Los Angeles Medical Examiner-Coroner. The decedent in the second case study had multiple drugs present in combination with 14 ng/mL of cyclopropyl fentanyl. However, cyclopropyl fentanyl was not identified in any of the collected medical evidence. Both deaths were classified as accidental due to effects of cyclopropyl fentanyl (and/or other drugs). Due to limitations in screening methodology, it is possible to overlook fentalogs. Therefore, it is important to be hyper vigilant when assessing negative toxicology results or when many other drugs are also found. Maintaining adequate and up-to-date library databases, along with constant drug monitoring, and validation of new methodologies can help identify Novel Psychoactive Substances as they emerge. However, many of the fentalogs are only prevalent for a short amount of time as they are constantly changing to avoid detection and criminality. No other fatal cyclopropyl fentanyl cases have been identified in Los Angeles County Medical Examiner-Coroner cases since the fall 2017.