Fentanyl novel derivative‐related deaths

Giorgetti, Arianna; Centola, Carmela; Giorgetti, Raffaele

doi:10.1002/hup.2605

Cited by 26 publications

(14 citation statements)

References 68 publications

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“…Vulnerable subjects can access online a large number of these substances (Suzuki and El-Haddad, 2017), without even being aware of what they are taking exactly (Ciccarone et al, 2017;Bardwell et al, 2019;McLean et al, 2019;Stein et al, 2019). Indeed, levels of related clinical toxicological information are sometimes available only postmortem (Giorgetti et al, 2017;Concheiro et al, 2018;D'Errico, 2018;Kraemer et al, 2019).…”

Section: Fentanyl Analogsmentioning

confidence: 99%

Novel Opioids: Systematic Web Crawling Within the e-Psychonauts’ Scenario

et al. 2020

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Background: A wide range of novel psychoactive substances (NPSs) are regularly searched and discussed online by e-psychonauts. Among NPSs, the range of prescription/non-prescription opioids (fentanyl and non-fentanyl analogs) and herbal derivatives currently represents a challenge for governments and clinicians.Methods: Using a web crawler (i.e., NPS.Finder R ), the present study aimed at assessing psychonaut fora/platforms to better understand the online situation regarding opioids.Results: The open-web crawling/navigating software identified some 426 opioids, including 234 fentanyl analogs. Of these, 176 substances (162 were very potent fentanyls, including two ohmefentanyl and seven carfentanyl analogs) were not listed in either international or European NPS databases. Conclusion:A web crawling approach helped in identifying a large number, indeed higher than that listed by European/international agencies, of unknown opioids likely to possess a significant misuse potential. Most of these novel/emerging substances are still relatively unknown. This is a reason of concern; each of these analogs potentially presents with different toxicodynamic profiles, and there is a lack of docking, preclinical, and clinical observations. Strengthening multidisciplinary collaboration between clinicians and bioinformatics may prove useful in better assessing public health risks associated with opioids.

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Section: Fentanyl Analogsmentioning

confidence: 99%

Novel Opioids: Systematic Web Crawling Within the e-Psychonauts’ Scenario

et al. 2020

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“…The most common and consistent findings on autopsy of persons that have died from novel opioid toxicity is that seen in heroin and other deaths from opiates, notably heavy lungs associated with pulmonary oedema and hyperaemia, with pneumonia also seen in some cases, particularly in cases where death process was relatively long [42,50,57,62,67,72,89,90]. Often cerebral oedema and congestion in liver and other organs is also noted.…”

Section: Resultsmentioning

confidence: 75%

Fatalities caused by novel opioids: a review

Drummer

2018

Forensic Sciences Research

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Drugs related to morphine represent not only large range of important therapeutic applications for the relief of moderate to severe pain but also give rise to a relatively large series of novel opioids that mimic the action of this naturally occurring analgesic. Most of these are based on fentanyl structures that are much more potent, and dangerous, than fentanyl itself. This publication reviews reports of fatalities attributed to 15 novel opioids with the view to assessing mortality associated with their misuse as well as reviewing published analytical procedures that would be able to detect these and other novel opioids. These drugs include reports of deaths to acetylfentanyl, acrylfentanyl, butr(yl)fentanyl, carfentanil, 2-and 4-fluorofentanyls, 4-fluorobutyrfentanyl, 4-fluoroisobutyrfentanyl, furanylfentanyl, a-and 3-methylfentanyls, 4-methoxyfentanyl, ocfentanil, as well as AH-7921, U-47700 and MT-45. Most of these cases reporting a drug-caused death involved other drugs in addition to the opioid. No obvious minimum fatal concentration was discerned for any of the opioids for which details were provided, however, the more potent members required detection limits well under 1 ng/mL and often even well below 0.1 ng/mL requiring use of the most sensitive mass spectral detection procedures, particularly when screening specimens using a non-targeted mode. Four other novel opioids have been reported in admissions to hospitals include 4-chloroisobutryfentanyl, cyclopentylfentanyl and tetrahydrofuranfentanyl, all of which are likely to have the potential to cause death. It is also likely that other analogues will appear with time.

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“…Among these, the least susceptible site to post-mortem redistribution is the liver (in relation to fentanyl) [ 86 ]. However, there is currently no consensus on the ideal sampling site [ 87 ].…”

Section: Resultsmentioning

confidence: 99%

“…In Conclusion, the confirmation or exclusion of opioid overdoses is one of the major challenges for forensic pathologists, considering what has been said and that autopsy findings are not specific. It is therefore necessary that the forensic pathologist have a broader approach and, on the basis of the data collected, request a chemical-analytical analysis to point out NPS [ 87 ].…”

Section: Discussionmentioning

confidence: 99%

Novel Synthetic Opioids: The Pathologist’s Point of View

et al. 2018

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Background: New Psychoactive Substances (NPS) constitute a broad range of hundreds of natural and synthetic drugs, including synthetic opioids, synthetic cannabinoids, synthetic cathinones, and other NPS classes, which were not controlled from 1961 to 1971 by the United Nations drug control conventions. Among these, synthetic opioids represent a major threat to public health. Methods: A literature search was carried out using public databases (such as PubMed, Google Scholar, and Scopus) to survey fentanyl-, fentanyl analogs-, and other synthetic opioid-related deaths. Keywords including “fentanyl”, “fentanyl analogs”, “death”, “overdose”, “intoxication”, “synthetic opioids”, “Novel Psychoactive Substances”, “MT-45”, “AH-7921”, and “U-47700” were used for the inquiry. Results: From our literature examination, we inferred the frequent implication of fentanyls and synthetic opioids in side effects, which primarily affected the central nervous system and the cardiovascular and pulmonary systems. The data showed a great variety of substances and lethal concentrations. Multidrug-related deaths appeared very common, in most reported cases. Conclusions: The investigation of the contribution of novel synthetic opioid intoxication to death should be based on a multidisciplinary approach aimed at framing each case and directing the investigation towards targeted toxicological analyses.

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Fentanyl novel derivative‐related deaths

Abstract: This study provides a medical-legal and toxicological assessment of this phenomenon in order to understand the role of illegal fentanyl and its congeners in deaths from FENS overdose.

Cited by 26 publications

References 68 publications

Novel Opioids: Systematic Web Crawling Within the e-Psychonauts’ Scenario

Novel Opioids: Systematic Web Crawling Within the e-Psychonauts’ Scenario

Fatalities caused by novel opioids: a review

Novel Synthetic Opioids: The Pathologist’s Point of View

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