Systematic review of the clinical consequences of butyrfentanyl and corresponding analogues

Abstract

Butyrfentanyl and its analogues are being increasingly used throughout the United States and Europe. Currently, lethal cases are emerging across the United States, England, and Europe without any end in sight. We therefore performed a systematic review of existing case reports on the literature of butyrfentanyl and similar analogs. We searched PubMed and Embase for articles (up until September 2018) using terms such as “butyrfentanyl” or “butyrylfentanyl.” In total, our search found 271 articles and identified 10 for inclusion in this review. A total of 33 cases were found with 61% of those being fatal. The most common route of administration was intravenous, but other routes of administration were readily used such as oral, intranasal, and inhalation. Most cases reported use of concomitant licit and illicit pharmacological agents. The toxidrome was consistent with other opioid overdoses, and naloxone was successfully used in nine of 10 patients. We encourage toxicology screenings of novel fentanyl analogs such as butyrfentanyl or 4-fluorobutyrfentanyl when an opioid overdose of unknown nature presents.

Fentanyl and other new psychoactive synthetic opioids. Challenges to prevention and treatment

“…Butyrfentanyl is another fentanyl analog that appeared in the illicit market in 2015, causing a growing number of deaths related to its use. As a result, it was scheduled by the DEA in 2017 19 .…”

Treating Non-fentanyl-derived Synthetic Opioid Overdose with a Traditional Opioid Reversal Agent

“…Another NSO recognized as a schedule I drug by the DEA is butyrfentanyl (BF), an analog of fentanyl. A recent systematic review of 10 articles covering a total of 33 cases, 20 of which postmortem, revealed a trend of significant pulmonary and cardiovascular damage among patients who used BF or a similar analog [4]. Of patients that survived, many required ICU stays, with some patients needing ventilator support due to pulmonary aspiration or intubation in the course of treatment.…”

Development and application of a High-Resolution mass spectrometry method for the detection of fentanyl analogs in urine and serum

“…Illicit drug manufacturers modify the structural backbone of fentanyl to generate fentanyl analogs to circumvent drug detection and regulation. Multiple fentanyl analogs have been detected in drug products and biological specimens over the past decade and their diversity continues to evolve [2] , [3] , [4] , [5] , [6] , [7] , [8] . The current prevalence of fentanyl analogs and synthetic opioids in patients seeking medical care is unknown as specific identification methods have not been routinely used in clinical settings.…”