An intoxication involving 2‐methyl AP‐237 and AP‐238 from Victoria, Australia: Case report

Abstract

Novel synthetic opioids (NSOs) are an emerging threat on the global illicit substance market. Although they represent a small proportion of new psychoactive substances (NPS) overall, the number of NPSs with opioid effects reported to the United Nations Office on Drugs and Crime (UNODC) increased significantly in the decade 2009-2019. 1which is used therapeutically in China to treat chronic pain 2 but is not registered in the United States, Europe or Australia (Figure 1). 2-MethylAP-237 was categorised as a NPS when it emerged on the illicit drug market in 2019. It was first identified by a police forensic laboratory in Slovenia in March 2019 3 and reported to the European Union Early Warning System the following month. 4 Shortly after, in June 2019, 2-methyl AP-237 was the first acylpiperazine to be reported in the United States 5 and became the second most encountered non-fentanyl-related opioid in the third quarter of 2021 according to NPS Discovery. 6 Fogarty et al. 5 reported four post mortem cases and one clinical case of 2-methyl AP-237 use between February 2020 and April 2021. Concentrations ranging between 820 and