Furanyl-Fentanyl Overdose Events Caused by Smoking Contaminated Crack Cocaine — British Columbia, Canada, July 15–18, 2016

Klar, Salman; Brodkin, Elizabeth; Gibson, Edward S.; Padhi, Shovita; Predy, C.; Green, Corey; Lee, Victoria

doi:10.15585/mmwr.mm6537a6

Cited by 63 publications

(50 citation statements)

References 2 publications

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“…However, surveillance data has detected another phenomenon in the fentanyl era: contamination of non-opioid drugs with illicit synthetic opioids. An overdose outbreak in British Columbia, Canada, where high doses up to 3.0 mg of naloxone were required for resuscitation and one fatality occurred was determined to be due to furanylfentanyl-laced crack cocaine (Klar et al, 2016). A similar episode was reported in New Haven, CT, with fentanyl distributed as white powder cocaine resulting in 9 non-fatal and 3 fatal overdoses in a 6-hour period (Tomassoni et al, 2017).…”

Section: Overdose Response In the Synthetic Opioid Eramentioning

confidence: 99%

Naloxone for heroin, prescription opioid, and illicitly made fentanyl overdoses: Challenges and innovations responding to a dynamic epidemic

Fairbairn

Coffin

Walley

2017

International Journal of Drug Policy

249

192

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Community-based overdose prevention programs first emerged in the 1990's and are now the leading public health intervention for overdose. Key elements of these programs are overdose education and naloxone distribution to people who use opioids and their social networks. We review the evolution of naloxone programming through the heroin overdose era of the 1990's, the prescription opioid era of the 2000's, and the current overdose crisis stemming from the synthetic opioid era of illicitly manufactured fentanyl and its analogues in the 2010's. We present current challenges arising in this new era of synthetic opioids, including variable potency of illicit drugs due to erratic adulteration of the drug supply with synthetic opioids, potentially changing efficacy of standard naloxone formulations for overdose rescue, potentially shorter overdose response time, and reports of fentanyl exposure among people who use drugs but are opioid naïve. Future directions for adapting naloxone programming to the dynamic opioid epidemic are proposed, including scale-up to new venues and social networks, new standards for post-overdose care, expansion of supervised drug consumption services, and integration of novel technologies to detect overdose and deliver naloxone.

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Section: Overdose Response In the Synthetic Opioid Eramentioning

confidence: 99%

Naloxone for heroin, prescription opioid, and illicitly made fentanyl overdoses: Challenges and innovations responding to a dynamic epidemic

Fairbairn

Coffin

Walley

2017

International Journal of Drug Policy

249

192

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“…During a 4-day period (July 15–18, 2016), 43 patients in British Columbia, Canada, were diagnosed as intoxicated with crack cocaine contaminated with furanylfentanyl. Most of them were men, with an average age of 42 years (range 18–63) (77). A series of furanylfentanyl-related deaths that occurred in Sweden between 2015 and 2016 (64) 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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“…As the toxicity of delivered fentanyl analog might be much higher than the ordered ones, the consumption of the same dose can increase the risk of life-threatening overdose. This phenomenon is recurring and causing mass poisonings and even deaths [28][29][30][31]. Moreover, fentanyl analogs are sold as heroin or are adulterating heroin, other illicit opioids, or even pain relievers.…”

Section: Validation Results For the Analytical Methodsmentioning

confidence: 99%

Hair testing for 3-fluorofentanyl, furanylfentanyl, methoxyacetylfentanyl, carfentanil, acetylfentanyl and fentanyl by LC–MS/MS after unintentional overdose

et al. 2019

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Purpose To demonstrate the usefulness of hair testing to determine exposure pattern to fentanyls. Methods A 43-year-old male was found unconscious with respiratory depression 15 min after snorting 3 mg of a powder labeled as butyrylfentanyl. He was discharged from hospital within 2 days without blood or urine testing. Two locks of hair were sampled 1 month (M1 A: 0-2 cm (overdose time frame); B: 2-4 cm; C: 4-6 cm) and 1 year (Y1: A: 0-2 cm; B: 2-4 cm) later to monitor his exposure to drugs of abuse by liquid chromatography-tandem mass spectrometry after liquidliquid extraction. Results Hair analysis at M1 showed a repetitive exposure to 3-fluorofentanyl (A/B/C: 150/80/60 pg/mg) with higher concentration in segment A reflecting the overdose period. The non-detection of butyrylfentanyl was consistent with the analysis of the recovered powder identified as 3-fluorofentanyl. Furanylfentanyl (40/20/15 pg/mg) and fentanyl (37/25/3 pg/mg) were also detected in hair. The second hair analysis at Y1 showed the use of three new fentanyls, with probably repetitive exposures to methoxyacetylfentanyl (A/B: 500/600 pg/mg), and single or few exposures to carfentanil (2.5/3 pg/mg) and acetyl fentanyl (1/1 pg/mg). A decreasing exposure to 3-fluorofentanyl (25/80 pg/mg), and increasing consumption of furanylfentanyl (310/500 pg/mg) and fentanyl (620/760 pg/mg) were also observed despite methadone treatment initiation. The patient claimed not consuming three out of the six detected fentanyls. Conclusions We report single or repetitive exposure to several fentanyls using hair testing. To our knowledge, this is the first demonstration of 3-fluorofentanyl and methoxyacetylfentanyl in hair samples collected from an authentic abuser.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Furanyl-Fentanyl Overdose Events Caused by Smoking Contaminated Crack Cocaine — British Columbia, Canada, July 15–18, 2016

Cited by 63 publications

References 2 publications

Naloxone for heroin, prescription opioid, and illicitly made fentanyl overdoses: Challenges and innovations responding to a dynamic epidemic

Naloxone for heroin, prescription opioid, and illicitly made fentanyl overdoses: Challenges and innovations responding to a dynamic epidemic

An Expanding World of Novel Psychoactive Substances: Opioids

Hair testing for 3-fluorofentanyl, furanylfentanyl, methoxyacetylfentanyl, carfentanil, acetylfentanyl and fentanyl by LC–MS/MS after unintentional overdose

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