A fatal poisoning case by intravenous injection of "bath salts" containing acetyl fentanyl and 4-methoxy PV8

Forensic Sci Int. 2016 Oct;267:e6-e9. doi: 10.1016/j.forsciint.2016.08.025. Epub 2016 Aug 23.


A man in his 30's was found at home, not breathing. He was admitted to an emergency hospital and the doctor confirmed his death. He had a history of methamphetamine abuse spanning several years, and while fresh needle marks were visible on his arm, the only other autopsy findings indicated an acute death. A small plastic bag containing a pale brown white powder, and a small amount of liquid in a syringe were found at the scene. The police forensic laboratory detected acetyl fentanyl and 4-methoxy PV8 (4-methoxy PHPP) in both the powder and the liquid. Scan analysis by gas chromatography-mass spectrometry (GC-MS) and liquid chromatography-mass spectrometry (LC-MS) identified acetyl fentanyl and 4-methoxy PV8 in the urine sample. Both drugs were quantitated simultaneously by liquid chromatography-tandem mass spectrometry (LC-MS/MS), using the selected reaction monitoring method. The concentration of acetyl fentanyl in the femoral vein blood, urine, and gastric contents were 153, 240, and 880ng/mL respectively, and the concentration of 4-methoxy PV8 in the femoral vein blood, urine, and gastric contents were 389, 245, and 500ng/mL respectively. Cause of death was attributed to acute poisoning by "bath salts" containing acetyl fentanyl and 4-methoxy PV8. Evidence indicated that self-administered intravenous injection was the most likely scenario, and that the deceased had been a habitual user of the "bath salt" drug for some time. Drugs detected in the gastric contents could be explained by the gastric secretion of basic drugs, or drug-containing bile entering the gastric contents.

Keywords: 4-Methoxy PV8; Acetyl fentanyl; Bath salts; Intravenous injection; Sudden death.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Alkaloids / analysis*
  • Alkaloids / poisoning
  • Designer Drugs / chemistry*
  • Designer Drugs / poisoning*
  • Fentanyl / analogs & derivatives*
  • Fentanyl / analysis
  • Fentanyl / poisoning
  • Gastrointestinal Contents / chemistry
  • Humans
  • Injections, Intravenous
  • Male
  • Narcotics / analysis*
  • Narcotics / poisoning
  • Substance-Related Disorders / complications


  • Alkaloids
  • Designer Drugs
  • Narcotics
  • cathinone
  • N-(1-phenethylpiperidin-4-yl)-N-phenylacetamide
  • Fentanyl