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Fentanyl and Related Opioids
Published in Ornella Corazza, Andres Roman-Urrestarazu, Handbook of Novel Psychoactive Substances, 2018
Esther Papaseit, Magí Farré, Clara Pérez-Mañá, Adriana Farré, Francina Fonseca, Marta Torrens
Fentanyl analogues are produced mainly by modifications of the propylalkylamide moiety of fentanyl, by altering the chain length on the arylalkylpiperidinyl group or substituting the aromatic substituent on the phenylalkyl moiety (UNODC, 2017b). Over the years, 1,400 fentanyl analogues have been synthesized among which must be highlighted acetylfentanyl, acryloylfentanyl, butyrylfentanyl, carfentanil, furanylfentanyl, 4-fluorobutyrylfentanyl, and ocfentanil (Quintana et al., 2017; Misailidi et al., 2018).
Licit and illicit drugs
Published in Jason Payne-James, Richard Jones, Simpson's Forensic Medicine, 2019
Jason Payne-James, Richard Jones
Some opioids are much more potent than others. Novel synthetic opioids have recently emerged on the recreational drug market. They include fentanyl (a potent narcotic analgesic) and its analogues (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. Fentanyl, for example, is more than 100 times more powerful than morphine, because it is a better fit for the μ1 receptor than morphine. The molecular structure of the opiate can also have an effect on routine drug screening tests. Routine drug screening tests (including the various test kits used in most casualty wards) are antibody based. The antibodies used have usually been designed to attach to morphine and will not react at all in the presence of synthetic opioids such as fentanyl. More worryingly, carfentanil – a synthetic fentanyl analogue approved for veterinary use, with an estimated analgesic potency approximately 10,000 times that of morphine and 20–30 times that of fentanyl, based on animal studies – has become available. Since 2016, an increasing number of reports describe detection of carfentanil in the illicit drug supply. Little is known about the pharmacology of carfentanil in humans. Its high potency and presumed high lipophilicity, large volume of distribution, and potential active metabolites have raised concerns about the management of people exposed to carfentanil as well as the safety of first responders. It has been associated with a number of deaths in association with other illicitly used drugs.
Underreporting of drug use among electronic dance music party attendees
Published in Clinical Toxicology, 2021
Joseph J. Palamar, Alberto Salomone, Katherine M. Keyes
Specimens were tested via published methods using ultra-high performance liquid chromatography–tandem mass spectrometry [41–43]. We tested for common drugs including cannabis (THC), amphetamine, methamphetamine, cocaine, MDMA, ketamine, PCP, heroin (6-MAM), and prescription opioids including morphine, codeine, oxycodone, hydrocodone, hydromorphine, and oxymorphone. We also tested for a variety of uncommon drugs and NPS including 19 synthetic cathinones (i.e. mephedrone, 4-MEC, methylone, 3,4-MDPV, pentedrone, 3-MMC, ethylcathinone, alpha-PVP, butylone, buphedrone, mexedrone, amfepramone, pentylone, methedrone, ethylone, naphyrone, 4-F-methylcathinone, 3,4-DMMC, alpha-PHiP) and 7 psychedelic phenethylamines (i.e. 2 C-B, 2 C-P, 25B-NBOMe, 25 C-NBOMe, 25H-NBOMe, 25I-NBOMe, 4-EA-NBOMe). We also tested for 5 other euphoric stimulants (i.e. 4-FA, 5/6-APB, 5-MAPB, PMA, PMMA) and 3 dissociative NPS (i.e. MXE, 4-MeO-PCP, diphenidine). In addition, we tested for fentanyl, 8 fentanyl analogs (i.e. carfentanyl, acetylfentanyl, furanylfentanyl, butyrfentanyl, acryloylfentanil, 4-fluorofentanyl, 3-methylfentanyl, ocfentanyl), and for 5 other opioid NPS (i.e. U-47,700, U-49900, AH-7921, MT-45, U-51,754).
Poison control center experience with tianeptine: an unregulated pharmaceutical product with potential for abuse
Published in Clinical Toxicology, 2018
Jeanna M. Marraffa, Christine M. Stork, Robert S. Hoffman, Mark K. Su
The United States is experiencing an epidemic of opioid addiction and overdose that has been steadily increasing over the past 15 years [1]. Initially precipitated by increased prescribing of opioid analgesics, the public health crisis of opioid addiction expanded to include heroin, fentanyl, and other novel opioid agonists [1,2]. Creative and often desperate Americans suffering from an Opioid Use Disorder are increasingly turning to “legal highs” such as over-the-counter (OTC) medications, plants and research chemicals to “get high,” or to mitigate the symptoms of opioid withdrawal. Examples of substances exploited for their opioid agonism include the OTC anti-diarrheal loperamide [3,4], the traditional medicinal plant kratom [5], and an ever-expanding list of “research chemicals” such as acetylfentanyl, acryloylfentanyl, carfentanil, ocfentanil, AH-7921, MT-45, and U-47700 [6,7]. The opioid epidemic has brought drug-related deaths across the United States to unprecedented highs in recent years, in part due to increases in illicit fentanyl and fentanyl analogs in the drug supply [6–11]. In New York City, the prevalence of novel psychoactive substance (NPS) exposures reported to poison control centers (PCCs) increased from 7.1% in 2011 to 12.6% in 2014 [12]. Between 2010 and 2016, New York City experienced a 143% increase in the rate of death due to unintentional overdose, and medical examiner data have determined that illicit fentanyl and fentanyl analogs contributed to the increase in deaths [9]. Although unpublished, these trends are consistent in all parts of New York State.
Use and knowledge of novel synthetic opioids: An Italian survey
Published in Journal of Ethnicity in Substance Abuse, 2022
Gianfranco Stigliano, Andrea Miuli, Alessandra Vizziello, Arianna Ida Altomare, Aliseo Lalli, Maria Chiara Alessi, Antonella Sociali, Annarita Rucco, Chiara Vannini, Giovanni Martinotti, Massimo di Giannantonio
Regarding the use of NSOs, the use of fentanyl and the frequency of use was asked. Regarding fentanyl derivates and other NSOs, specifically benzyl fentanyl, methyl fentanyl, acetyl fentanyl, benzoylfentanyl, 4-methoxybutyrfentanyl, furanyl fentanyl, carfentanil, acryloyl fentanyl, ocfentanil, U-49900, U-50488, MPF-47700, U-48800, U-49900, tetrahydrofuranylfentanyl, 4 F‐isobutyrylfentanyl, it was asked whether the subject had ever tried such substances. In addition to this, all subjects were asked whether they had ever heard of each of the NSOs and through what source they had heard of them (via friends, family, scientific/university journals, the internet, social media, songs, TV, or newspapers).