The hidden web and the fentanyl problem: Detection of ocfentanil as an adulterant in heroin

Quintana, P.; Ventura, Montserrat Carbonell; Grifell, M.; Palma, Á.; Galindo, L.; Fornís, I.; Gil, Cristina; Carbón, Xoán; Caudevilla, Fernando; Farré, Magı́; Torrens, Marta

doi:10.1016/j.drugpo.2016.10.006

Cited by 66 publications

(58 citation statements)

References 16 publications

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“…Fentanyl analogues are known to be added in small amounts to street heroin. 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%

“…OcF exhibits analgesia and respiratory depression in a dose‐related manner, and a 3 μg/kg dose of OcF produced an equivalent level of analgesia to 5 μg/kg dose of fentanyl in humans . 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: Resultssupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Fatality involving ocfentanil documented by identification of metabolites

Allibe

Richeval

Phanithavong

et al. 2017

Drug Testing and Analysis

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“…If these statements are accurate, placing those dealers under arrest may put their clients directly at risk of fentanyl exposure, as they are now forced to purchase drugs from a new, less familiar, less trusted seller. This indicates that it may well be time for new approaches to reducing the risk in the drug supply, including supplier-based risk reduction (as opposed to public safety) interventions (Greenfield & Paoli, 2017; Latkin, Yang, Tobin, & German, 2013), drug checking services (Quintana et al, 2017), or the adaptation of anonymous notification services for those connected by dealer networks (Huffam et al, 2013; Tan et al, 2016), as current practices aimed at supply reduction may exacerbate opioid-related risks to public health and public safety at the local level.…”

Section: Discussionmentioning

confidence: 99%

Exposure to fentanyl-contaminated heroin and overdose risk among illicit opioid users in Rhode Island: A mixed methods study

Carroll

Marshall

Rich

et al. 2017

International Journal of Drug Policy

197

137

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Background Illicit fentanyl use has become wide spread in the US, causing high rates of overdose deaths among people who use drugs. This study describes patterns and perceptions of fentanyl exposure among opioid users in Rhode Island. Methods A mixed methods study was conducted via questionnaire with a convenience sample of 149 individuals using illicit opioids or misusing prescription opioids in Rhode Island between January and November 2016. Of these, 121 knew of fentanyl and reported known or suspected exposure to fentanyl in the past year. Semi-structured interviews were conducted with the first 47 participants. Results Study participants were predominantly male (64%) and white (61%). Demographic variables were similar across sample strata. Heroin was the most frequently reported drug of choice (72%). Self-reported exposure to illicit fentanyl in the past year was common (50.4%, n=61). In multivariate models, regular (at least weekly) heroin use was independently associated with known or suspected fentanyl exposure in the past year (adjusted prevalence ratio (APR)=4.07, 95% CI: 1.24-13.3, p=0.020). In interviews, users described fentanyl as unpleasant, potentially deadly, and to be avoided. Participants reporting fentanyl exposure routinely experienced or encountered non-fatal overdose. Heroin users reported limited ability to identify fentanyl in their drugs. Harm reduction strategies used to protect themselves from fentanyl exposure and overdose, included test hits, seeking prescription opioids in lieu of heroin, and seeking treatment with combination buprenorphine/naloxone. Participants were often unsuccessful in accessing structured treatment programs. Conclusion Among illicit opioid users in Rhode Island, known or suspected fentanyl exposure is common, yet demand for fentanyl is low. Fentanyl-contaminated drugs are generating user interest in effective risk mitigation strategies, including treatment. Responses to the fentanyl epidemic should be informed by the perceptions and experiences of local users. The rapid scale-up of buprenorphine/naloxone provision may slow the rate of fentanyl-involved overdose deaths.

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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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The hidden web and the fentanyl problem: Detection of ocfentanil as an adulterant in heroin

Cited by 66 publications

References 16 publications

Fatality involving ocfentanil documented by identification of metabolites

Fatality involving ocfentanil documented by identification of metabolites

Exposure to fentanyl-contaminated heroin and overdose risk among illicit opioid users in Rhode Island: A mixed methods study

An Expanding World of Novel Psychoactive Substances: Opioids

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