An epidemic of fatal 3-methylfentanyl poisoning in Estonia

Abstract

An exceptional epidemic of poisonings due to the highly potent opioid designer drug 3-methylfentanyl (TMF) was revealed among Estonian drug users in 2005-2006 by post-mortem forensic toxicology. Quantitative analysis of cis-TMF, trans-TMF, and fentanyl was performed by liquid chromatography-tandem mass spectrometry. Comprehensive toxicological analysis was performed using a multi-technique approach. The number of TMF-related fatal accidental poisonings identified was 46 and 71 for 2005 and 2006, respectively. The proportion of male victims was 91.5% and the mean age of all victims was 26 years at death. TMF was used predominantly by intravenous injection. There was no significant difference in the blood concentrations of cis-TMF and trans-TMF between pure TMF poisonings and mixed TMF poisonings. The mean combined concentration of TMF stereoisomers among pure TMF cases (1.9 microg/l) was more than ten times lower than the mean fentanyl concentration in fentanyl-related fatalities. Concomitant use of other drugs involved alcohol, amphetamines, benzodiazepines, and cannabis, but very rarely other opioids.

Fatal poisoning in Estonia 2000–2009. Trends in illegal drug-related deaths

“…Since 2009, poisoning with fentanyl and 3-methylfentanyl has been ranked highest, which is unique among EU Member States. 9 In comparison with Estonia, there have only been rare cases of poisoning with fentanyles in nearby countries, which indicates that they may be produced locally. Fentanyl is approximately 50e100 and 3-methylfentanyl 6000e7000 times as potent as morphine, 9,16 which may explain why they cause overdoses so frequently.…”

“…The same pattern could be seen in 2003, when 3-methylfentanyl replaced fentanyl. 9 Since then, mortality from fentanyles has remained at a high level. The number of poisoning cases from CO was high throughout the years under study (more than 100 cases per year).…”

“…If fentanyles were found in the blood, urine and liver, this was considered fentanyle poisoning because of their extreme toxicity. 9 The criterion for heroin poisoning was the detecting of 6-monoacetylmorphine by gas chromatography. We analysed the characteristics of all poisoning deaths, including the age and gender of the deceased and the drug(s) involved.…”

Metabolism of designer drugs. The fentanyl derivatives

“…В литера-туре [9][10][11][12][13][14][15] описаны многочисленные случаи интоксика-ции веществами данной группы. Отдельные обзоры [4,16] посвящены главным образом аспектам использования и токсическому действию производных фентанила и содер-жат минимальную информацию о их биотрансформации.…”

“…В 80-х годах прошлого столетия в США зафиксировано более 100 случаев его передозировки [9]. В последние несколько лет широко распространен в не-легальном обороте на северо-западе РФ и в странах Бал-тии [10][11][12]. В большинстве стран мира является контро-лируемой субстанцией.…”