Unerwartete Komplikationen während des Entzugs vom Research Chemical AH-7921

Abstract

We describe the case of a young male patient who had consumed the morphine-like substance AH-7921 which is available via the internet. He was initially admitted to hospital because of obstipation and presented within a day of inpatient treatment for the first time with a generalized tonic-clonic epileptic seizure with subsequent urinary retention. Within a few hours, the patient then also developed bradycardia, while at the same time describing symptoms of physical opioid withdrawal which gradually deteriorated within the following hours. We initiated a treatment with buprenorphine which resulted in a considerable reduction of withdrawal symptoms, so the patient could be discharged from hospital.

AH-7921: A review of previously published reports

“…Due to the patient's panic attacks, he received diazepam, piritramide, clonidine, clomethiazole, and pipamperone. 7 All urine drug screens were negative, but serum/urine mass spectrometry measurements showed AH-7921 in both matrices. Continuing panic attacks, muscle spasms, and tachycardia led to the psychiatric team initiating buprenorphine (initial dose of 2 mg) that minimized the patient's withdrawal symptoms.…”

“…After applying the inclusion criteria, five relevant articles were included for this review with a total of 14 patients (Figure 2). [3][4][5][6][7] Of the 14 cases found, 13 were fatalities, with the subjects' ages ranging from 19 to 45 years (Table 1). [3][4][5][6] Additionally, 11 of the 13 subjects were male and 12 of the 13 cases occurred in Europe (nine in Sweden, two in Norway, one in Germany); only one case occurred in the United States.…”

“…[3][4][5][6] Regarding the remaining patient who lived after using AH-7921, Bernius et al reported on a 22-year-old male from Germany who ingested an unspecified dose of AH-7921 orally twice a day for approximately 1.5 to 2 weeks before deciding to double the dose because of increasing tolerance. 7 The patient had a history of using tramadol regularly for a headache prior to utilizing AH-7921. The patient had also utilized laxatives to overcome the effects of constipation.…”

“…The patient had also utilized laxatives to overcome the effects of constipation. 7 It was reported that approximately 4 g of AH-7921 was purchased and used over an estimated 3 months. The patient later presented to the emergency department where he described constipation, left upper abdominal pain, appetite reduction, and vomiting over 2 weeks prior to presentation.…”

“…The patient later presented to the emergency department where he described constipation, left upper abdominal pain, appetite reduction, and vomiting over 2 weeks prior to presentation. 7 Following admission, the patient was treated with an enema as well as intravenous pantoprazole. The following day, the patient experienced a tonicclonic seizure as well as withdrawal symptoms including fear and anxiety.…”