AH-7921: A review of previously published reports

Abstract

AH-7921 is a synthetic opioid that was developed in the early 1970s. It has resulted in several fatal and nonfatal intoxications, despite not having approval from the US Food and Drug Administration. To date, AH-7921 is listed as a schedule I drug, and there have been no clinical trials exploring the safety of AH-7921. Herein, we provide an analysis of existing case reports available in the literature regarding AH-7921. We searched PubMed, Scopus, Web of Science, and EBSCO for articles (up until December 2017) using the terms "AH-7921" and "AH7921." In total, 48 articles were identified, and 5 articles were included in our review. A total of 14 cases were found, of which 13 resulted in fatalities. The oral route of administration was reported in two cases, and most cases reported use of concomitant pharmaceutical agents. Pulmonary edema was the most common finding postmortem among deceased cases, with nine of the cases having heavier lungs. Overall, fatalities occurred with low and high concentrations of AH-7921 in the femoral blood. We strongly encourage toxicology screenings for this novel opioid to be included when an overdose of an opioid of unknown nature is suggested.

Systematic review of the clinical consequences of butyrfentanyl and corresponding analogues

“…Many of the cases presented in this review mimicked those of opioid overdoses associated with licit opioids such as respiratory depression and central nervous system depression (Schiller & Mechanic, 2018). Many patients who consumed BF and similar analogs survived as opposed to those taking other NSOs such as AH-7921 or U-47700 (Rambaran et al, 2018(Rambaran et al, , 2017. It is proposed that BF has 1/30th efficacy of that of fentanyl and is 7 times more potent than morphine.…”

“…An emerging concern is that a number of NPSs are readily available online including BF, 4-methoxybutyrylfentanyl, acetylfentanyl, U-47770, and AH-7921 Cole et al, 2015;Helander et al, 2016;Rambaran et al, 2018Rambaran et al, , 2017Solimini et al, 2018). Many dosage forms are available and anecdotal accounts of experiences related to these NSOs are posted on internet forums Fort et al, 2016;Rambaran et al, 2018Rambaran et al, , 2017. Since 2013, there have been 40 fatal BF overdoses in the United States, a majority originating from New York, and as many as 88 reports of BF between 2014 and 2015 from California, Florida, Illinois, Indiana, Kansas, Minnesota, North Dakota, New York, Ohio, Oregon, Pennsylvania, Tennessee, Virginia, and Wisconsin (Drug Enforcement Administration, Department of Justice, 2016).…”

“…These NSOs are sold under the guise of "research chemicals" where one can easily purchase these substances online without fear of prosecution. Furthermore, detection of NSOs is limited to targeted spectrometry test because urine drug screens cannot detect the substance or the result shows up as a false positive for a different agent (Rambaran et al, 2018(Rambaran et al, , 2017. The ease of obtaining NSOs coupled with difficulty detecting these substances leads to the rising morbidity and mortality associated with this new class of drugs.…”

Pharmacotherapy of Patients Taking New Psychoactive Substances: A Systematic Review and Analysis of Case Reports

“…According to the case reports, constipation in such patients can be treated with pantoprazole. For withdrawal symptoms, diazepam, pyritamide, clonidine, clomethiazole, and pipamperon are used (67).…”

Характеристика Сучасної Структури Опіоїдів Як Причини Гострих Отруєнь (Передозувань): У Фокусі Синтетичні Опіоїди

“…AH-7921 (3,4-дихлор-N{[1(диметиламіно)циклогексил]метил} бензамід) виявляє ефект, у 1,7 раза вищий, ніж морфін, провокуючи депресію дихання у мишей [23,24]. U-47700 (3,4-дихлор-N-[(1R,2R)-2-(диметиламіно)-циклогексил]-N-метилбензамід), або «U4», в експериментах на мишах проявляє 1 / 10 ефекту фентанілу, але у 7,5 раза потужніший, ніж морфін, окрім знеболення викликає ейфорію [25][26][27][28].…”