Two Hospitalizations and One Death After Exposure to Ortho-Fluorofentanyl

Helland, Arne; Brede, Wenche Rødseth; Michelsen, Lisbeth Solem; Gundersen, Per Ole M.; Aarset, Harald; Skjølås, Jan Erik; Slørdal, Lars

doi:10.1093/jat/bkx050

Cited by 27 publications

(15 citation statements)

References 2 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Since 2016, 2 (ortho)-fluorofentanyl, another isomer of 3-fluorofentanyl was directly implicated in 16 fatalities in the US and two in Europe (Sweden and Norway). Consequently, it has been scheduled as narcotic (schedule I) in 2017 in the US and by the end of 2018 in Europe [33,34]. Given the structural similarity among 3-fluorofentanyl, its two isomers and fentanyl itself, it is expected that 3-fluorofentanyl has high potency, dependence and abuse liability similar to that of fentanyl.…”

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

View full text Add to dashboard Cite

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.

show abstract

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

View full text Add to dashboard Cite

show abstract

“…Separation techniques are excellent complements to detection techniques such as MS. GC-MS [10,11,[14][15][16][17][18][19], and LC-MS [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]are the most commonly employed techniques in the analysis of fentanyls. CE-MS [35] has also been used to separate and analyze fentanyl derivatives and analogues.…”

Section: Introductionmentioning

confidence: 99%

Analysis of fentanyl derivatives by ultra high performance liquid chromatography with diode array ultraviolet and single quadrupole mass spectrometric detection

Angi

Lurie

Marginean

2019

J of Separation Science

View full text Add to dashboard Cite

Fentanyl has become pervasive as a drug of abuse and as adulterant in seized drugs. Positional isomers analyzed by gas chromatography with mass spectrometry can follow the same fragmentation pathway and therefore may not be differentiated. Additionally, electron ionization leads to lack of discernible molecular ion for most fentanyl related compounds. Liquid chromatography may be used as an orthogonal identification technique with diode array ultraviolet and mass spectrometric detection. Here we provide a chromatographic method for the separation of 20 different fentanyl analogues, homologues and positional isomers using ultra high performance liquid chromatography with photodiode array ultraviolet and mass spectrometry detection. Five different columns were investigated utilizing reverse phase chromatography and hydrophilic interaction chromatography. Chromatographic systems were evaluated to determine which could separate the most compounds overall, as well as the most positional isomers. We found that isocratic elution, with a methanol modifier (35%) and formic acid (0.1%) as an additive, on a C18 column at a temperature of 25°C could resolve 10/20 compounds overall and 16/20 positional isomers. Using electrospray ionization, compounds with different masses could easily be distinguished based on their pseudo molecular ions. Ultraviolet detection facilitated differentiation of positional isomers that could not be distinguished by either electron ionization or electrospray ionization mass spectrometry alone.

show abstract

“…Multiple sources of fentanyl contribute to the overall supply, including pharmaceutical fentanyl diverted to the illicit market, and illicitly manufactured fentanyl and fentanyl analogs, also known as fentanils . Over the last 10 years, a number of fentanyl analogues, such as acrylfentanyl, furanylfentanyl, acetylfentanyl, ortho ‐fluorofentanyl, and carfentanil, have been detected in the EU . These substances have been linked to over 100 deaths across the EU and a number of acute intoxications…”

Section: Introductionmentioning

confidence: 99%

Characteristics of opioid‐maintained clients smoking fentanyl patches: The importance of confirmatory drug analysis illustrated by a case series and mini‐review

Kimergård

Dunne

Bøgen

et al. 2018

Drug Testing and Analysis

View full text Add to dashboard Cite

The increase in opioid prescribing in many European countries over the last decade has raised concerns about associated diversion, overdose, and mortality. Fentanyl is one of these synthetic opioids that is typically prescribed as a transdermal patch for pain that requires continuous pain relief and has been the focus of investigation due to reports of overdose and death. We report a case series of 14 drug addiction treatment entrants, who entered treatment in a service located in the region of Southern Denmark from August 2015 to December 2015 for smoking fentanyl patches. Clients presented with difficulties breathing and pains in the lungs. The clients had a history of past opioid use, including heroin. Relapses resulted in treatment disengagement. Immunoassays for fentanyl were used in the service. In some cases, false negative results occurred. Clients' urine samples were subsequently analysed in a collaborating laboratory. Seven clients tested positive for fentanyl. One client was positive for both fentanyl and heroin. Analyses were also positive for other opioids and metabolites in 6 clients, predominantly codeine and oxycodone. Results from confirmatory analysis contributed to clearer insights into clients' drug histories, which facilitated personalised care plans consisting of opioid agonist therapy informed by confirmed drug use. In Denmark, prescription levels of fentanyl are high, which has been accompanied by observations of diversion and smoking in a smaller population. In addition to revision of inappropriate prescribing to reduce diversion, we recommend increased reliance upon confirmatory drug analysis in the addiction treatment sector in Denmark.

show abstract

Two Hospitalizations and One Death After Exposure to Ortho-Fluorofentanyl

Cited by 27 publications

References 2 publications

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

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

Analysis of fentanyl derivatives by ultra high performance liquid chromatography with diode array ultraviolet and single quadrupole mass spectrometric detection

Characteristics of opioid‐maintained clients smoking fentanyl patches: The importance of confirmatory drug analysis illustrated by a case series and mini‐review

Contact Info

Product

Resources

About