A Case Series of Etizolam in Opioid-Related Deaths

Gevorkyan, Jirair; Kinyua, Juliet; Pearring, Sue; Rodda, Luke N

doi:10.1093/jat/bkaa146

Cited by 23 publications

(13 citation statements)

References 33 publications

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“…The concomitant intake of etizolam and an opioid in 10 decedents (9 males and 1 female; 27–61 years old) during 2017–2019 was investigated ( 187 ). Etizolam was quantified, where available, in peripheral and central blood, urine, vitreous humor and gastric fluid.…”

Section: Nps Benzodiazepinesmentioning

confidence: 99%

Reports of Adverse Events Associated with Use of Novel Psychoactive Substances, 2017–2020: A Review

Mohr

Logan

Fogarty

et al. 2022

Journal of Analytical Toxicology

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An important role of modern forensic and clinical toxicologists is to monitor the adverse events of novel psychoactive substances (NPS). Following a prior review from 2013-2016, this critical literature review analyzes and evaluates published case reports for NPS from January 2017 through December 2020. The primary objective of this study is to assist in the assessment and interpretation of these cases as well as provide references for confirmation methods. Chemistry, pharmacology, adverse events, and user profiles (e.g., polypharmacy) for NPS are provided including case history, clinical symptoms, autopsy findings, and analytical results. Literature reviews were performed in PubMed and Google Scholar for publications using search terms such as NPS specific names, general terms (e.g., “designer drugs,” “novel psychoactive substances”), drug classes (e.g., “designer stimulants,”), and outcome-based terms (e.g., “overdose,” “death”). Government and website drug surveillance databases and abstracts published by professional forensic science organizations were also searched. Toxicological data and detailed case information were extracted, tabulated, analyzed, and organized by drug category. Case reports included overdose fatalities (378 cases), clinical treatment and hospitalization (771 cases), and driving under the influence of drugs (170 cases) for a total of 1,319 cases providing details of adverse events associated with NPS. Confirmed adverse events with associated toxidromes of more than 60 NPS were reported to include synthetic cannabinoid, NPS stimulant, NPS hallucinogen, NPS benzodiazepine, and NPS opioid cases. Fifty of these NPS were reported for the first time in January 2017 through December 2020 as compared to the previous four years surveyed. This study provides insight and context of case findings described in the literature and in digital government surveillance databases and websites during a recent four-year period. This review will increase awareness of adverse events associated with NPS use to better characterize international emerging drug threats.

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Section: Nps Benzodiazepinesmentioning

confidence: 99%

Reports of Adverse Events Associated with Use of Novel Psychoactive Substances, 2017–2020: A Review

Mohr

Logan

Fogarty

et al. 2022

Journal of Analytical Toxicology

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show abstract

“…Additionally, increased use of benzodiazepines may increase tolerance and the potential for withdrawal, especially if individuals are not aware that they are using these substances. This issue therefore demands greater urgency, as it appears to be contributing to overdose mortality in Toronto and elsewhere [ 20 ]. For instance, on February 26, 2020, a notable spike in overdoses (16 in seven hours) in Toronto was associated with drug samples containing large proportions of flualprazolam along with fentanyl and caffeine [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

“…Timely data and public health alerts are critical to inform people who may experience health harms from drug use and demonstrate the value of DCS for drug market monitoring. Examples of such alerts were issued by Toronto Public Health regarding noteworthy trends in Toronto’s unregulated drug supply [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Diverse psychotropic substances detected in drug and drug administration equipment samples submitted to drug checking services in Toronto, Ontario, Canada, October 2019–April 2020

et al. 2022

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Background The overdose crisis has generated innovative harm reduction and drug market monitoring strategies. In Toronto, Ontario, Canada, a multi-site drug checking service (DCS) pilot project was launched in October 2019. The project provides people who use drugs with information on the chemical composition of their substances, thereby increasing their capacity to make more informed decisions about their drug use and avoid overdose. DCS also provides real-time market monitoring to identify trends in the unregulated drug supply. Methods Sample data were obtained through analyses of drug and used drug administration equipment samples submitted anonymously and free of charge to DCS in downtown Toronto from October 10, 2019, to April 9, 2020, representing the first six months of DCS implementation. Analyses were conducted in clinical laboratories using liquid chromatography- and/or gas chromatography-mass spectrometry (LC–MS, GC–MS) techniques. Results Overall, 555 samples were submitted, with 49% (271) of samples that were found to contain high-potency opioids, of which 87% (235) also contained stimulants. Benzodiazepine-type drugs were found in 21% (116) of all samples, and synthetic cannabinoids in 1% (7) of all samples. Negative effects (including overdose, adverse health events, and extreme sedation) were reported for 11% (59) of samples submitted for analysis. Conclusions Toronto’s DCS identified a range of high-potency opioids with stimulants, benzodiazepine-type drugs, and a synthetic cannabinoid, AMB-FUBINACA. This information can inform a range of evidence-informed overdose prevention efforts.

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“…Over the years, VH has been successfully used in forensic casework, for illicit drugs and NPS testing. Several classic drugs of abuse have been detected in authentic VH specimens such as the following examples: ethanol [159,181,190], cocaine and its metabolites [155,164,166,172,176,181,[190][191][192], opioids and/or their metabolites [155,167,168,173,176,177,182,185,190], amphetamine and/ or methamphetamine [164,173,190], MDA derivatives [169], ketamine [172], phencyclidine [154,170], LSD and its metabolites [175], γ-hydroxybutyric acid [193], benzodiazepines [171,173,184,190], antidepressants [173,180,194,195] and barbiturates [196]. On the other hand, VH does not seem to be a good biological matrix for investigating cannabinoids [151].…”

Section: Vitreous Humormentioning

confidence: 99%

“…In addition, Lin and Lin [198] observed low vitreous concentrations of THC-COOH, a hydrophobic character compound. In regard to NPS, VH has also been implemented in toxicological analysis for a different classes including fentanyl and non-fentanyl opioids [200][201][202][203][204][205][206][207], synthetic cathinones [208][209][210][211][212], designer benzodiazepines [190], 5-(2-aminopropyl)indole [213] and phenethylamines [214][215][216].…”

Section: Vitreous Humormentioning

confidence: 99%

Alternative matrices in forensic toxicology: a critical review

et al. 2021

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Purpose The use of alternative matrices in toxicological analyses has been on the rise in clinical and forensic settings. Specimens alternative to blood and urine are useful in providing additional information regarding drug exposure and analytical benefits. The goal of this paper is to present a critical review on the most recent literature regarding the application of six common alternative matrices, i.e., oral fluid, hair, sweat, meconium, breast milk and vitreous humor in forensic toxicology. Methods The recent literature have been searched and reviewed for the characteristics, advantages and limitations of oral fluid, hair, sweat, meconium, breast milk and vitreous humor and its applications in the analysis of traditional drugs of abuse and novel psychoactive substances (NPS). Results This paper outlines the properties of six biological matrices that have been used in forensic analyses, as alternatives to whole blood and urine specimens. Each of this matrix has benefits in regards to sampling, extraction, detection window, typical drug levels and other aspects. However, theses matrices have also limitations such as limited incorporation of drugs (according to physical–chemical properties), impossibility to correlate the concentrations for effects, low levels of xenobiotics and ultimately the need for more sensitive analysis. For more traditional drugs of abuse (e.g., cocaine and amphetamines), there are already data available on the detection in alternative matrices. However, data on the determination of emerging drugs such as the NPS in alternative biological matrices are more limited. Conclusions Alternative biological fluids are important specimens in forensic toxicology. These matrices have been increasingly reported over the years, and this dynamic will probably continue in the future, especially considering their inherent advantages and the possibility to be used when blood or urine are unavailable. However, one should be aware that these matrices have limitations and particular properties, and the findings obtained from the analysis of these specimens may vary according to the type of matrix. As a potential perspective in forensic toxicology, the topic of alternative matrices will be continuously explored, especially emphasizing NPS.

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A Case Series of Etizolam in Opioid-Related Deaths

Cited by 23 publications

References 33 publications

Reports of Adverse Events Associated with Use of Novel Psychoactive Substances, 2017–2020: A Review

Reports of Adverse Events Associated with Use of Novel Psychoactive Substances, 2017–2020: A Review

Diverse psychotropic substances detected in drug and drug administration equipment samples submitted to drug checking services in Toronto, Ontario, Canada, October 2019–April 2020

Alternative matrices in forensic toxicology: a critical review

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