By Stuart Kurtz, D-ABFT-FT
At this year’s annual meeting of NAME, we presented a handful of case reports on tianeptine. We had previously provided some information on tianeptine in a blog post from September 18, 2023. The aim of this poster was to present cases where we detected tianeptine as the primary drug of interest. There were only 2 cases out of 6 presented where this was the case. One of these cases from District 14 Florida had contributing factors of acute pneumonia, chronic pancreatitis, and hepatic steatosis. The other case from Missouri had alcohol as a contributing factor.
Initially, there was a third case that looked to be a tianeptine only fatality. Additional testing by the Lorain County OH crime lab revealed that 2 opened bottles of Neptune’s Fix Tianeptine Elixir found at the scene contained ADB-4en-PINACA and MDMB-4en-PINACA which are synthetic cannabinoids. Using this information, we were able to test the submitted specimens for these drugs via our 42130: Synthetic Cannabinoids panel and confirm the presence of both in the blood.
Due to the current gray area surrounding the sale of products containing tianeptine, scene evidence can be extremely useful. Tianeptine is screened in Axis’ 70510: Comprehensive Panel with Analyte Assurance™ in Blood and confirmed through the 13710: Novel Emerging Compounds Panel but may not be a part of routine screening in all labs. Awareness of what the lab is testing for is important when scene evidence indicates a particular drug. Labeled products can also be tested due to the inconsistent nature of the manufacturing of these products. In the above case from Lorain County OH, additional testing revealed that there were other drugs involved. Product labels are a good starting point but further testing is important to ensure that all factors can be accounted for. The FDA has urged manufacturers of Neptune’s Fix Tianeptine Elixir to recall all products and as of February 2024, all of them have done so.
We would like to thank the following offices for their contribution to this project.
- Office of the District Medical Examiner, District 15 FL, Dr. Terrell Tops & Dr. Natalia Belova
- Office of the District Medical Examiner, District 14 FL, Whit Majors & Dr. Jay Radtke
- Office of the Coroner, Lorain County, OH, Dr. Frank P. Miller
- Southwest Missouri Forensics, Nixa, MO, Carla Yoder & Dr. Ransom Ellis
If you have any questions about this post or want to request a copy of the poster, please reach out to us at 317-759-4869 option 3 or [email protected].