Two fatalities associated with synthetic opioids: AH-7921 and MT-45

Fels, Helena; Krueger, Julia J.; Sachs, Hans; Mußhoff, Frank; Graw, Matthias; Roider, Gabriele; Stoever, Andreas E.

doi:10.1016/j.forsciint.2017.04.003

Cited by 83 publications

(57 citation statements)

References 13 publications

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“…The next year, a total of 16 cases of fatal intoxications involving AH-7921 were reported by Sweden (10), UK (three), Norway (two), and USA (one). The AH-7921 concentrations in these postmortem blood samples were found to be in the range from 0.03 to 0.99 µg/g (Sweden), 0.05, 0.58, and 4.46 mg/L (UK), 0.33 and 0.43 mg/L (Norway), and 9.1 mg/L (USA) (67–69, 81, 83). In most cases, other psychoactive compounds, mainly benzodiazepines but also amphetamines, synthetic cathinones, codeine, acetaminophen, and methoxetamine, were also detected (67–69, 81, 83).…”

Section: New Generation Of Synthetic Opioids: Ah-7921 U-47700 and Mmentioning

confidence: 88%

“…In 24 of them, MT-45 was found in combination with at least one other psychoactive substance, including anxiolytic/hypnotics (benzodiazepines), antidepressants (fluoxetine, sertraline, mirtazapine, and venlafaxine), antipsychotic drugs (olanzapine, quetiapine, and levomepromazine), antiepileptic drugs (gabapentin, lamotrigine, and carbamazepine), opioids (morphine, codeine, tramadol, fentanyl, and hydrocodone), ethylphenidate, methiopropamine, 2-aminoindane, amphetamine, THC, APBP, and ethanol (95). Very recent case reports of fatal intoxication involving MT-45 (69, 74) are summarized in Table 3.…”

Section: New Generation Of Synthetic Opioids: Ah-7921 U-47700 and Mmentioning

confidence: 99%

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An Expanding World of Novel Psychoactive Substances: Opioids

Zawilska

2017

Front. Psychiatry

151

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The abuse of novel psychoactive substances (NPS) has been increasing dramatically worldwide since late 2000s. By the end of 2015, more than 560 NPS had been reported to the European Monitoring Centre for Drugs and Drug Addiction. Although the most popular compounds are synthetic cannabinoids and psychostimulatory derivatives of cathinone (so-called β-keto-amphetamines), novel synthetic opioids have recently emerged on the recreational drug market. They include fentanyl (a potent narcotic analgesic) and its analogs (e.g., acetylfentanyl, acryloylfentanyl, carfentanil, α-methylfentanyl, 3-methylfentanyl, furanylfentanyl, 4-fluorobutyrylfentanyl, 4-methoxybutyrylfentanyl, 4-chloroisobutyrylfentanyl, 4-fluoroisobutyrylfentanyl, tetrahydrofuranylfentanyl, cyclopentylfentanyl, and ocfentanil) and compounds with different chemical structures, such as AH-7921, MT-45, and U-47700. This survey provides an overview of the pharmacological properties, pattern of use, and desired and unwanted effects of the above-listed novel opioids. Special emphasis is given to cases of non-fatal and lethal intoxication involving these compounds.

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Section: New Generation Of Synthetic Opioids: Ah-7921 U-47700 and Mmentioning

confidence: 88%

Section: New Generation Of Synthetic Opioids: Ah-7921 U-47700 and Mmentioning

confidence: 99%

An Expanding World of Novel Psychoactive Substances: Opioids

Zawilska

2017

Front. Psychiatry

151

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“…In 2013, AH-7921 was discovered as an active ingredient in synthetic cannabis products in Japan (Uchiyama et al, 2013). It has since been identified in numerous overdose cases across Europe and the US (Vorce et al, 2014;Karinen et al, 2014;Coppola and Mondola, 2014;Katselou et al, 2015;Fels et al, 2017).…”

Section: Novel Synthetic Opioidsmentioning

confidence: 99%

“…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. Since that time reports of abuse and overdose have been reported in Europe and the US (Helander et al, 2014;Papsun et al, 2016;Helander et al, 2017;Fels et al, 2017).…”

Section: Novel Synthetic Opioidsmentioning

confidence: 99%

“…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).…”

Section: Analytical Detectionmentioning

confidence: 99%

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

et al. 2018

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Fatal Poisonings Associated with New Psychoactive Substances

Kronstrand

Guerrieri

Vikingsson

et al. 2018

New Psychoactive Substances

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This chapter describes how new psychoactive substances (NPS) have been involved in fatal intoxications from 2010 and onwards. It summarizes the circumstances, antemortem symptoms, and adverse effects that have led to death after ingestion of one or more NPS and tabulates concentrations, and postmortem findings from these intoxications.Consumption of NPS exerts health problems and unknown risks for the users. Data on toxicity of many NPS are scarce or nonexistent and long-term toxicity and risks are still largely unknown. In addition, purity and composition of products containing NPS are often inconsistent or not known, which places users at high risk as evidenced by hospital emergency admissions and deaths.The most serious threat to drug users are the synthetic opioids that with strong central nervous depressant effects have caused numerous accidental deaths spread over the entire globe. The synthetic cannabinoids seem to be the most unpredictable with no clear toxidrome and unknown or poorly understood mechanisms of toxicity, but with adverse effects pointing toward the cardiovascular system. The toxidromes commonly encountered after ingestion of cathinones and phenethylamines are of sympathomimetic and hallucinogenic character, which includes risk of developing a serotonin syndrome, excited delirium, and life-threatening cardiovascular effects. In comparison to their conventional "parent" drug, i.e., heroin, cannabis, and amphetamine, most NPS appear to exhibit more severe adverse effects. The deaths attributed to NPS have dramatically increased in the last years. In our opinion, this is because of the shift from synthetic cannabinoids and cathinones to the even more toxic and dangerously potent fentanyl analogues.

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Two fatalities associated with synthetic opioids: AH-7921 and MT-45

Cited by 83 publications

References 13 publications

An Expanding World of Novel Psychoactive Substances: Opioids

An Expanding World of Novel Psychoactive Substances: Opioids

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

Fatal Poisonings Associated with New Psychoactive Substances

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