Fentanyl and a Novel Synthetic Opioid U-47700 Masquerading as Street “Norco” in Central California: A Case Report

Naloxone for heroin, prescription opioid, and illicitly made fentanyl overdoses: Challenges and innovations responding to a dynamic epidemic

“…Seizure of fentanyl powder imported from foreign laboratories and confiscation of pill presses and counterfeit pills point to the same vulnerabilities to overdose among people who misuse prescription opioids (CDC, 2016). In addition to masquerading as heroin, fentanyl has been sold on the street as counterfeit prescription medications (Armenian et al, 2017; Green & Gilbert, 2016; Sutter et al, 2017). …”

“…labeled as Oxycodone, Norco) produced with fentanyl and fentanyl analogues may have also contributed to the growing overdose epidemic (CDC, 2016). The emergence and proliferation of counterfeits create further confusion in the illicit marketplace, which contributes to inconsistency of source and greater safety concerns over drug products (Armenian et al, 2017; Green & Gilbert, 2016; Sutter et al, 2017). …”

Fentanyl, fentanyl analogs and novel synthetic opioids: A comprehensive review

“…In 5 confirmed U-47700 cases, 2 did not require any naloxone (Domanski et al, 2017), 1 improved with 0.4 mg IV naloxone (Armenian et al, 2017), 1 improved with 2 mg IV naloxone (Schneir et al, 2017), and only one required two 2 mg doses of naloxone for a response (Jones et al, 2017). In a case series of 9 MT-45 cases, 7 were given naloxone in doses ranging from 0.1-2.0 mg IV.…”

“…Numerous overdose reports have also surfaced in the scientific literature starting in 2016 (Elliott et al, 2016;Ruan et al, 2016;Domanski et al, 2017;Schneir et al, 2017;Armenian et al, 2017;Jones et al, 2017;Mohr et al, 2016;Vo et al, 2017;McIntyre et al, 2017;Dziadosz et al, 2017). MT-45 was first reported as an NPS through the Early Warning System of the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) in December 2013.…”

“…Data is acquired in an untargeted manner and can be retrospectively analyzed for new and emerging synthetics. In recent years, LC-HRMS has been used for the detection of synthetic opioids such as butyrfentanyl, 4-fluorobutyrfentanyl, acetylfentanyl, 4-methoxybutyrfentanyl, furanylfentanyl, acrylfentanyl, 4Cl-iBF, 4F-iBF, THF-F, cyclopentylfentanyl, AH-7921, MT-45, and U-47700 in individual cases, case series, outbreaks, and epidemiological surveillance efforts (Backberg et al, 2015;Wohlfarth et al, 2016;Helander et al, 2016;Schneir et al, 2017;Armenian et al, 2017;Breindahl et al, 2017;Jones et al, 2017;Steuer et al, 2016;Vo et al, 2017;Fleming et al, 2017;Guerrieri et al, 2017;Helander et al, 2017;Goggin et al, 2017;Watanabe et al, 2017;Fels et al, 2017). It has also been used for the elucidation of the metabolic pathways of emerging synthetic opioids, such as, AH-7921, butyrfentanyl, carfentanil, U-47700, furanylfentanyl, acetylfentanyl, acrylfentanyl, and 4F-iBF Jones et al, 2017;Steuer et al, 2016;Feasel et al, 2016;Fleming et al, 2017;Goggin et al, 2017;Watanabe et al, 2017).…”