Acute Intoxications and Fatalities From Illicit Fentanyl and Analogues: An Update

Abstract

Illicit fentanyl and its analogues are very dangerous synthetic opioids, with high abuse potential and severe adverse effects including coma and death. They are used as adulterants in street heroin, cocaine, and methamphetamine, or as heroin substitutes sold to unaware users with a high risk of overdoses. Fentanyl and its analogues have also been identified in counterfeit medicinal products, such as oxycodone, hydrocodone, and alprazolam tablets, or as components of speedball mixtures together with cocaine or other stimulants. In recent years, a number of epidemics involving acute intoxications and deaths related to illicit fentanyl or its analogues have occurred in the United States, Europe, Canada, Australia, and Japan. In several cases, fatalities involved polysubstance use. A review of the most recent case reports or case series of acute intoxications and fatalities involving illicit fentanyl and its newest analogues is herein provided, together with the available information on intoxication symptoms, eventual death cause, and metabolites detected in different biological fluids and reported concentrations.

Novel Opioids: Systematic Web Crawling Within the e-Psychonauts’ Scenario

“…Among them, over the recent years, there has been an increase in the appearance of novel synthetic opioids (NSOs) on the recreational drug market (Zawilska, 2017). NSOs are frequently used with other illegal or prescribed drugs (Pichini et al, 2018;Pérez-Mañá et al, 2018). Owing to a range of reasons, the non-medical use of opioids such as fentanyl analogs and a range of remaining prescription/nonprescription substances is spreading worldwide (Prekupec et al, 2017;Lovrecic et al, 2019) and is affecting the entire life span, from youngsters to the elderly (Huhn et al, 2018;Kelley-Quon et al, 2019).…”

The analytical challenges of cyclopropylfentanyl and crotonylfentanyl: An approach for toxicological analysis

“…3 Furthermore, since the 1960s, a number of fentanyl analogues have been synthesised and investigated as potential pharmaceuticals through modifications of the structure to retain the analgesic effects of fentanyl but with variations in potency and activity, including adverse effects. [5][6][7][8][9] Cyclopropylfentanyl and crotonylfentanyl are 2 compounds with the same empirical formula which are analogues of fentanyl and belong to the 4-anilidopiperidine structural class. 3,4 From 2009 to 2016, 18 fentanyl analogues were detected in Europe -8 of which were reported for the first time in 2016.…”

“…As such, it is difficult to interpret the findings when they are found in forensic casework, where they are increasingly reported to be present with heroin and other illicit drugs especially in the USA, Canada, and the UK. [5][6][7][8][9] Cyclopropylfentanyl and crotonylfentanyl are 2 compounds with the same empirical formula which are analogues of fentanyl and belong to the 4-anilidopiperidine structural class. The structure of cyclopropylfentanyl differs from that of fentanyl by the replacement of the propionamide group of fentanyl with a cyclopropanecarboxamide group.…”

Determination of drug residues in used syringe needles

“…Many laboratories will not be able to detect those substances when using general GC-MS or even standard LC-MS/MS screening methods that are optimized for illicit drug panels at concentrations often several thousand times less potent. 43,44 High concentrations of other drugs might also be found in fentanyl-related overdoses; 43 the additional use of fentanyls may then not be suspected and therefore not analyzed for.…”