Forensic Toxicologists Identify Emerging Synthetic Opioids in Two Fatal Vaping Cases

Forensic researchers in Switzerland have documented two fatal intoxications involving emerging synthetic opioids detected in vaping-related investigations, demonstrating how advanced chemical analysis can identify substances that conventional toxicology screening may overlook.

The study, published on November 10, 2026, in the International Journal of Legal Medicine, examined two deaths involving nitazenes, a class of potent synthetic opioids that has become an increasing concern for forensic laboratories.

Nitazenes present analytical challenges because newly emerging chemical variants may not be included in routine toxicology screening panels or established reference libraries.

The research investigated two cases involving different nitazene compounds and additional substances capable of affecting the central nervous system.

In the first case, a 40-year-old man was found deceased at home in early 2025. Investigators recovered vaping materials, including a container associated with an opioid-containing liquid.

Laboratory analysis identified fluetonitazepyne in the recovered liquid and in the man's peripheral blood, where its concentration measured 0.58 nanograms per millilitre.

Toxicologists also detected ethanol, citalopram, lithium, and cannabinoid-related compounds.

The researchers concluded that acute fluetonitazepyne intoxication was the most likely cause of death, although the precise contribution of individual substances could not be established with certainty.

The second case involved a 22-year-old man who experienced cardiorespiratory arrest shortly after using a vaping device in October 2023.

Despite resuscitation and intensive care, he died approximately 24 hours later from complications of oxygen deprivation.

Investigators identified a nitazene compound consistent with 5-methyl etodesnitazene in blood at 3.3 nanograms per millilitre, alongside barbital at a toxic concentration of 39 milligrams per litre.

The combination was considered important because both substances can suppress central nervous system activity and breathing.

Researchers used gas chromatography–mass spectrometry (GC-MS) and liquid chromatography–high-resolution mass spectrometry (LC-HRMS) to investigate the compounds.

Untargeted high-resolution screening, supported by computational analysis, helped identify potential substances before certified reference standards were obtained.

Subsequent comparisons with reference standards supported the chemical identifications.

However, the researchers acknowledged that the blood findings in the second case could not fully distinguish between closely related 5-methyl and 6-methyl etodesnitazene isomers.

This limitation illustrates why chemical identification requires careful interpretation, particularly when emerging compounds have similar molecular structures.

The research involved only two cases and cannot establish how frequently nitazenes occur in vaping products or determine a universally fatal concentration.

Nevertheless, the findings highlight the importance of comprehensive toxicology screening and continuously updated analytical databases when investigating deaths involving newly emerging synthetic drugs.