An Acute Ocfentanil Fatality: A Case Report with Postmortem Concentrations

Dussy, Franz; Hangartner, Sarah; Hamberg, Cornelia; Berchtold, Christian; Scherer, Uta; Schlotterbeck, Götz; Wyler, D.; Briellmann, Thomas

doi:10.1093/jat/bkw096

Cited by 31 publications

(69 citation statements)

References 6 publications

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“…OcF concentrations are similar in peripheral blood and cardiac blood. This observation is in contrast to results in 2 previous reported fatalities, which observed significant cadiac/peripheral blood concentration ratio . Additional post‐mortem blood data are needed to assess the post‐mortem redistribution (PMR) issue of OcF.…”

Section: Resultscontrasting

confidence: 90%

“…The presence of OcF as an adulterant of heroin associated to severe side effects related to its use has already been reported . The content of OcF in this pink powder was similar to those observed in 2 previously reported fatalities (apart from heroin that was not detected in these powders) (Table ) …”

Section: Resultssupporting

confidence: 86%

“…Since 2013, OcF has been identified in several seized powders (sniffed, smoked, or injected by users) across Europe: the Netherlands, Estonia, Sweden, France, Denmark, Germany, and Spain . Two fatalities were reported in 2016 in Belgium and Switzerland …”

Section: Introductionmentioning

confidence: 99%

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Fatality involving ocfentanil documented by identification of metabolites

Allibe

Richeval

Phanithavong

et al. 2017

Drug Testing and Analysis

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The use of new psychoactive substances (NPS) has rapidly increased over the last decade. In the last 4 years, producers increasingly appear to be targeting non-controlled synthetic opioids, involving fentanyl derivatives such as ocfentanil (OcF). Identification of metabolites is of major importance in the context of NPS use, as it could improve the detection window in biological matrices in clinical and forensic intoxication cases. Hence, this work aims to report a fatality involving OcF documented by the identification of metabolites. A 30-year-old woman was found dead at home: an unidentified powder was found near her body and some injection sites were found at the autopsy. Toxicological analyses allowed to determine the presence of OcF in the powder, blood (3.7/3.9 μg/L, peripheral/cardiac) and in other post-mortem samples. The most relevant potential CYP- and UGT-dependent metabolites of OcF were investigated in vitro using human liver microsome incubation and liquid chromatography coupled with high resolution mass spectrometry, and subsequently confirmed in post-mortem samples. Four OcF metabolites were produced in vitro (a mono-hydroxylated OcF, O-desmethylOcF, a hydroxylated desmethylOcF and a glucuronidated form of the O-desmethylOcF), and all except the glucuronide were observed in blood and bile post-mortem samples. Considering the relative intensity of the chromatographic peak areas, O-desmethylOcF can be suggested to be an abundant metabolite of OcF. Nevertheless, the relevance of O-desmethylOcF as being a complementary analytical target of OcF for OcF use detection needs further in vivo confirmation, especially through analysis of urines from users.

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Section: Resultscontrasting

confidence: 90%

Section: Resultssupporting

confidence: 86%

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Fatality involving ocfentanil documented by identification of metabolites

Allibe

Richeval

Phanithavong

et al. 2017

Drug Testing and Analysis

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“…The drug has recently been detected in the hidden market as an adulterant of heroin (78). Deaths involving ocfentanil were reported in Belgium (65) and in Switzerland (66), and the cases are summarized in Table 3.…”

Section: Fentanyl Carfentanil and Non-pharmaceutical Fentanyls (Npf)mentioning

confidence: 99%

An Expanding World of Novel Psychoactive Substances: Opioids

Zawilska

2017

Front. Psychiatry

158

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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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“…No difference between FENS, particularly 3‐methyl fentanyl (3MF), acetyl fentanyl (ACFEN), butyr fentanyl (BFEN) and ocfentanil (INN), FEN and opioids were noted in postmortem examinations (Coopman, Cordonnier, De Leeuw, & Cirimele, ; Cunningham, Haikal, & Kraner, ; Dussy et al, ; Takase, Koizumi, Fujimoto, Yanai, & Fujimiya, ) . The only exception was a nonfatal case of butyrfentanyl intoxication, where widespread alveolar haemorrhage was found (excluded from our tab; Cole, Dunbar, McIntire, Regelmann, & Slusher, ).…”

Section: Resultsmentioning

confidence: 99%