Near‐fatal Intoxication with the “New” Synthetic Opioid U‐47700: The First Reported Case in the Czech Republic

Abstract

Recreational use of the potent synthetic opioid 3,4- dichloro-N-(2-(dimethylamino)cyclohexyl)-N-methylbenzamide (U-47700) is rising, accompanied by increasingly frequent cases of serious intoxication. This article reports a case of near-fatal U-47700 intoxication. A man was found unconscious (with drug powder residues). After 40 h in hospital (including 12 h of supported ventilation), he recovered and was discharged. Liquid chromatography/high-resolution mass spectrometry (LC/HRMS) or gas chromatography/mass spectrometry (GC/MS) were used to detect and quantify substances in powders, serum and urine. Powders contained U-47700 and two synthetic cannabinoids. Serum and urine were positive for U-47700 (351.0 ng/mL), citalopram (<LOQ), tetrahydrocannabinol (THC: 3.3 ng/mL), midazolam (<LOQ) and a novel benzodiazepine, clonazolam (6.8 ng/mL) and their metabolites but negative for synthetic cannabinoids. If potent synthetic opioids become cheaper and more easily obtainable than their classical counterparts (e.g., heroin), they will inevitably replace them and users may be exposed to elevated risks of addiction and overdose.

Designer Benzodiazepines: A Review of Toxicology and Public Health Risks

“…This may reflect differences in tolerance that appear after frequent drug exposure. In other cases, there is too little information or analytical data to improve our knowledge about the DBZD [74,83,104], and in many cases, because polypharmacy is the rule rather than the exception, it is not possible to assign causation to a single drug because the death is due to the drug combination [78,86,88,100,101,112]. On the other hand, it is also possible that many individuals exposed to DBZD never developed significant adverse events [154].…”

“…[1,4]benzodiazepine, also known as clonitrazolam, is the triazolo-analogue of clonazepam [1,129]. Clonazolam is described as "insanely powerful", producing strong sedation and amnesia at oral doses as low as 0.5 mg, resulting in easy accidental overdose [78]. It was found for the first time in seized yellow capsules by Swedish police on October 2014 and reported to the EMCDDA on January 2015 [51].…”

Clonazolam Intoxication Case Report

“…14 Clonazolam is commonly taken in conjunction with other substances such as synthetic opioids and, in 1 case, Benzedrex nasal decongestant. 15,16 Such combinations increase the risk of intoxication and/or death as unconsciousness and acute neuropsychiatric sequelae resulted from use with opioids and Benzedrex, respectively. 15,16 Distinguishing designer benzodiazepines from their parent analogs can prove challenging as current identification methods may rely on presumptive testing and confirmatory techniques, which are limited in scope.…”

“…15,16 Such combinations increase the risk of intoxication and/or death as unconsciousness and acute neuropsychiatric sequelae resulted from use with opioids and Benzedrex, respectively. 15,16 Distinguishing designer benzodiazepines from their parent analogs can prove challenging as current identification methods may rely on presumptive testing and confirmatory techniques, which are limited in scope. The inability to identify designer classes and their respective metabolites only fosters the number of designer benzodiazepines, which remain under the radar.…”

Toward the Interpretation of Positive Testing for Fentanyl and Its Analogs in Real Hair Samples: Preliminary Considerations

“…This group of compounds is sometimes referred to as "fentalogs." Compounds such as sufentanil, alfentanil, remifentanil and carfentanil (normally approved for human or veterinary use) (21) can now be detected in hair samples, together with other new synthetic opioids such as AH-7921 (22,23), MT-45 (24) and U-47700 (25)(26)(27). The latter are non-fentalogs with different chemical structures, which have been involved in intoxication cases and mortality in several countries.…”