A Fatality Involving Furanylfentanyl and MMMP, with Presumptive Identification of Three MMMP Metabolites in Urine

Nash, Christine; Butzbach, Danielle M.; Stockham, Peter; Scott, Terrance M.; Abroe, Greg; Painter, Ben; Gilbert, Jane; Kostakis, Chris

doi:10.1093/jat/bky099

Cited by 22 publications

(11 citation statements)

References 38 publications

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“…Examples of sedative designer drugs and reference substances for comparison. Full names of the substances are provided in the supplementary information either designer opioids alone or designer opioids combined with other psychoactive substances (Coopman et al 2016a, b;Cunningham et al 2016;Dussy et al 2016;Dwyer et al 2018;Elliott et al 2016;Fels et al 2017Fels et al , 2019Fort et al 2016;Garneau et al 2019;Gillespie et al 1982;Guerrieri et al 2017;Helander et al 2017a;Karinen et al 2014;Koch et al 2018;Kriikku et al 2019;Kronstrand et al 2014;Krotulski et al 2018;Martucci et al 2018;McIntyre et al 2015bMcIntyre et al , 2016McIntyre et al , 2017Mohr et al 2016;Nash et al 2019;Ojanperä et al 2006;Papsun et al 2016;Partridge et al 2018;Poklis et al 2016;Richeval et al 2019;Ruan et al 2016;Sofalvi et al 2017;Staeheli et al 2016;Swanson et al 2017;Takase et al 2016;Vorce et al 2014;Yonemitsu et al 2016). Frisoni and colleagues recently published an overview of opioid-related fatalities that were attributed to synthetic opioids (Frisoni et al 2018).…”

Section: Adverse Effects Of Synthetic Opioidsmentioning

confidence: 99%

Designer drugs: mechanism of action and adverse effects

2020

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Psychoactive substances with chemical structures or pharmacological profiles that are similar to traditional drugs of abuse continue to emerge on the recreational drug market. Internet vendors may at least temporarily sell these so-called designer drugs without adhering to legal statutes or facing legal consequences. Overall, the mechanism of action and adverse effects of designer drugs are similar to traditional drugs of abuse. Stimulants, such as amphetamines and cathinones, primarily interact with monoamine transporters and mostly induce sympathomimetic adverse effects. Agonism at l-opioid receptors and c-aminobutyric acid-A (GABA A) or GABA B receptors mediates the pharmacological effects of sedatives, which may induce cardiorespiratory depression. Dissociative designer drugs primarily act as N-methyl-D-aspartate receptor antagonists and pose similar health risks as the medically approved dissociative anesthetic ketamine. The cannabinoid type 1 (CB 1) receptor is thought to drive the psychoactive effects of synthetic cannabinoids, which are associated with a less desirable effect profile and more severe adverse effects compared with cannabis. Serotonergic 5-hydroxytryptamine-2A (5-HT 2A) receptors mediate alterations of perception and cognition that are induced by serotonergic psychedelics. Because of their novelty, designer drugs may remain undetected by routine drug screening, thus hampering evaluations of adverse effects. Intoxication reports suggest that several designer drugs are used concurrently, posing a high risk for severe adverse effects and even death.

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Section: Adverse Effects Of Synthetic Opioidsmentioning

confidence: 99%

Designer drugs: mechanism of action and adverse effects

2020

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“…MMTMP was identified in ‘Mylan Alprazolam’ tablets in conjunction with etizolam, alprazolam and cyproheptadine. MMTMP is a synthetic cathinone that has previously been identified in Queensland in powders and capsules, frequently mixed with other synthetic cathinones such as N ‐ethylpentylone, and has also been reported in a fatality in conjunction with furanyl fentanyl in South Australia 21 . The authors are not aware of any reports of MMTMP in counterfeit benzodiazepine tablets outside of Australia.…”

Section: Resultsmentioning

confidence: 99%

What's in fake ‘Xanax’?: A dosage survey of designer benzodiazepines in counterfeit pharmaceutical tablets

Blakey

Thompson

Matheson

et al. 2021

Drug Testing and Analysis

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The identification of a range of different drugs within counterfeit benzodiazepine tablets has been widely reported; however, limited information is available on the dosage of these products. A rapid dosage survey of 46 counterfeit benzodiazepine tablets from 20 seizures was conducted over a 6-month period between April and September 2020. Existing methods utilised for the determination of benzodiazepines in toxicology specimens were applied to assess the dosage of four benzodiazepines detected across five different counterfeit benzodiazepine presentations. The highest dosage variation was observed for etizolam with a range of 0.7-8.3 mg per tablet. This report demonstrates the variability in drug content and dosage that can occur between visually similar counterfeit tablets, even when co-packaged within the same seizure, highlighting the potential public harm posed by these counterfeit medications.

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“…207,208 Intoxication with synthetic opioids has been associated with noncardiogenic pulmonary oedema, acute lung injury, diffuse alveolar haemorrhage and rhabdomyolysis. 209,210 Withdrawal from synthetic opioids may present with physiological and psychological distress. 211 Statistics on morbidity and mortality may not reflect the real-life situation as users may recover, for example, from a mixed heroin/synthetic opioid overdose when naloxone is administered and the illicit drug documented will then be heroin and not a synthetic one.…”

Section: Synthetic Opioidsmentioning

confidence: 99%

New psychoactive substances: a review and updates

Shafi

Berry

Sumnall

et al. 2020

Therapeutic Advances in Psychopharmacology

174

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New psychoactive substances (NPS) are a heterogeneous group of substances. They are associated with a number of health and social harms on an individual and societal level. NPS toxicity and dependence syndromes are recognised in primary care, emergency departments, psychiatric inpatient and community care settings. One pragmatic classification system is to divide NPS into one of four groups: synthetic stimulants, synthetic cannabinoids, synthetic hallucinogens and synthetic depressants (which include synthetic opioids and benzodiazepines). We review these four classes of NPS, including their chemical structures, mechanism of action, modes of use, intended intoxicant effects, and their associated physical and mental health harms. The current challenges faced by laboratory testing for NPS are also explored, in the context of the diverse range of NPS currently available, rate of production and emergence of new substances, the different formulations, and methods of acquisition and distribution.

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A Fatality Involving Furanylfentanyl and MMMP, with Presumptive Identification of Three MMMP Metabolites in Urine

Cited by 22 publications

References 38 publications

Designer drugs: mechanism of action and adverse effects

Designer drugs: mechanism of action and adverse effects

What's in fake ‘Xanax’?: A dosage survey of designer benzodiazepines in counterfeit pharmaceutical tablets

New psychoactive substances: a review and updates

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