51
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Lei X, Xu X, Liu L, Kuang H, Xu L, Hao C, Xu C. Rapid quantitative determination of fentanyl in human urine and serum using a gold-based immunochromatographic strip sensor. J Mater Chem B 2021; 8:8573-8584. [PMID: 32814936 DOI: 10.1039/d0tb01509a] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Fentanyl is a typical opioid that is used in surgical anesthesia. However, when abused, fentanyl can lead to addiction and even death. To better control the use of fentanyl, it is necessary to develop rapid and sensitive detection methods. In this study, an ultrasensitive monoclonal antibody (mAb) was prepared and used to develop an indirect competitive enzyme-linked immunosorbent assay (ic-ELISA) and a colloidal gold-based immunochromatographic strip (CG-ICS) for the analysis of fentanyl in urine and serum. Under optimum conditions, the anti-fentanyl mAb belonging to the subtype of IgG2b showed a half-maximal inhibitory concentration (IC50) of 0.11 ng mL-1 and a linear range of detection of 0.020-0.50 ng mL-1. Fenanyl-spiked original urine and serum diluted eight times were used for the analysis of fentanyl by ic-ELISA and CG-ICS. IC50 from the standard curves was 0.46 ng mL-1 for urine and 2.6 ng mL-1 for serum in ic-ELISA and 1.6 ng mL-1 for urine and 6.27 ng mL-1 for serum in CG-ICS. The recovery test revealed that the ic-ELISA and CG-ICS, with a recovery rate of 87.0-108.4% and a coefficient of variation of 3.3-10.9%, were the same reliable tools as the liquid chromatography tandem mass spectrometry for fentanyl analysis in real samples.
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Affiliation(s)
- Xianlu Lei
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, People's Republic of China. and International Joint Research Laboratory for Biointerface and Biodetection, and School of Food Science and Technology, Jiangnan University, Wuxi, People's Republic of China
| | - Xinxin Xu
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, People's Republic of China. and International Joint Research Laboratory for Biointerface and Biodetection, and School of Food Science and Technology, Jiangnan University, Wuxi, People's Republic of China
| | - Liqiang Liu
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, People's Republic of China. and International Joint Research Laboratory for Biointerface and Biodetection, and School of Food Science and Technology, Jiangnan University, Wuxi, People's Republic of China
| | - Hua Kuang
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, People's Republic of China. and International Joint Research Laboratory for Biointerface and Biodetection, and School of Food Science and Technology, Jiangnan University, Wuxi, People's Republic of China
| | - Liguang Xu
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, People's Republic of China. and International Joint Research Laboratory for Biointerface and Biodetection, and School of Food Science and Technology, Jiangnan University, Wuxi, People's Republic of China
| | - Changlong Hao
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, People's Republic of China. and International Joint Research Laboratory for Biointerface and Biodetection, and School of Food Science and Technology, Jiangnan University, Wuxi, People's Republic of China
| | - Chuanlai Xu
- State Key Laboratory of Food Science and Technology, Jiangnan University, Wuxi, People's Republic of China. and International Joint Research Laboratory for Biointerface and Biodetection, and School of Food Science and Technology, Jiangnan University, Wuxi, People's Republic of China
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Rohrig TP, Nash E, Osawa KA, Shan X, Scarneo C, Youso KB, Miller R, Tiscione NB. Fentanyl and Driving Impairment. J Anal Toxicol 2021; 45:389-396. [PMID: 32797151 DOI: 10.1093/jat/bkaa105] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/30/2020] [Accepted: 08/08/2020] [Indexed: 11/12/2022] Open
Abstract
The incidence of fentanyl in forensic toxicology analyses in the USA has dramatically increased over the past several years. The increase in death cases has been well studied; however, little has been reported on the impact to drug impaired driving. Fentanyl driving while under the influence of drugs (DUID) case data from 2014 to 2019 is presented. The data were obtained from three toxicology laboratories in the Northeast, Southeast, and Midwest regions of the USA. Fentanyl whole blood concentrations ranged from 0.1 to 157 ng/mL in living drivers with a 466% to 524% increase in fentanyl-positive DUID cases from 2014 to 2019, depending on the US region. The vast majority of fentanyl cases involved poly-drug use. Twenty case histories are presented where fentanyl was the only drug identified. The mean (standard deviation) fentanyl concentration for these cases was 5.2 ± 3.8 ng/mL with a median of 3.7 ng/mL, and the concentrations ranged from 2.0 to 16 ng/mL. Naloxone administration was documented in exactly half of these cases similar to another study involving carfentanil-impaired driving. The case histories also demonstrate that some recreational opioid users may display limited signs of impairment either due to tolerance or naloxone administration. The top three observations in common among the cases were the driver was found unresponsive behind the wheel, the vehicle left the travel lane or roadway, and the driver was involved in a crash. The increase in fentanyl use not only poses a risk for overdose and death, but is also a significant concern for traffic safety. This study supports the movement of fentanyl from a Tier II drug to Tier I due to its significant potential for impairment and increase in prevalence in impaired driving cases.
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Affiliation(s)
| | - Emily Nash
- New Hampshire State Police Forensic Laboratory Concord, NH, USA
| | - Kei A Osawa
- Regional Forensic Science Center Wichita, KS, USA
| | - Xiaoqin Shan
- Palm Beach County Sheriff's Office West Palm Beach, FL, USA
| | - Colleen Scarneo
- New Hampshire State Police Forensic Laboratory Concord, NH, USA
| | | | - Russell Miller
- Palm Beach County Sheriff's Office West Palm Beach, FL, USA
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53
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Alipio JB, Haga C, Fox ME, Arakawa K, Balaji R, Cramer N, Lobo MK, Keller A. Perinatal Fentanyl Exposure Leads to Long-Lasting Impairments in Somatosensory Circuit Function and Behavior. J Neurosci 2021; 41:3400-3417. [PMID: 33853934 PMCID: PMC8051687 DOI: 10.1523/jneurosci.2470-20.2020] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 12/07/2020] [Accepted: 12/30/2020] [Indexed: 11/21/2022] Open
Abstract
One consequence of the opioid epidemic are lasting neurodevelopmental sequelae afflicting adolescents exposed to opioids in the womb. A translationally relevant and developmentally accurate preclinical model is needed to understand the behavioral, circuit, network, and molecular abnormalities resulting from this exposure. By employing a novel preclinical model of perinatal fentanyl exposure, our data reveal that fentanyl has several dose-dependent, developmental consequences to somatosensory function and behavior. Newborn male and female mice exhibit signs of withdrawal and sensory-related deficits that extend at least to adolescence. As fentanyl exposure does not affect dams' health or maternal behavior, these effects result from the direct actions of perinatal fentanyl on the pups' developing brain. At adolescence, exposed mice exhibit reduced adaptation to sensory stimuli, and a corresponding impairment in primary somatosensory (S1) function. In vitro electrophysiology demonstrates a long-lasting reduction in S1 synaptic excitation, evidenced by decreases in release probability, NMDA receptor-mediated postsynaptic currents, and frequency of miniature excitatory postsynaptic currents (mEPSCs), as well as increased frequency of miniature inhibitory postsynaptic currents (mIPSCs). In contrast, anterior cingulate cortical neurons exhibit an opposite phenotype, with increased synaptic excitation. Consistent with these changes, electrocorticograms (ECoGs) reveal suppressed ketamine-evoked γ oscillations. Morphologic analysis of S1 pyramidal neurons indicate reduced dendritic complexity, dendritic length, and soma size. Further, exposed mice exhibited abnormal cortical mRNA expression of key receptors involved in synaptic transmission and neuronal growth and development, changes that were consistent with the electrophysiological and morphologic changes. These findings demonstrate the lasting sequelae of perinatal fentanyl exposure on sensory processing and function.SIGNIFICANCE STATEMENT This is the first study to show that exposure to fentanyl in the womb results in behavioral, circuitry, and synaptic effects that last at least to adolescence. We also show, for the first time, that this exposure has different, lasting effects on synapses in different cortical areas.
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Affiliation(s)
- Jason B Alipio
- Department of Anatomy and Neurobiology, Program in Neuroscience, University of Maryland School of Medicine, Baltimore, Maryland 21201
| | - Catherine Haga
- Department of Anatomy and Neurobiology, Program in Neuroscience, University of Maryland School of Medicine, Baltimore, Maryland 21201
| | - Megan E Fox
- Department of Anatomy and Neurobiology, Program in Neuroscience, University of Maryland School of Medicine, Baltimore, Maryland 21201
| | - Keiko Arakawa
- Department of Anatomy and Neurobiology, Program in Neuroscience, University of Maryland School of Medicine, Baltimore, Maryland 21201
| | - Rakshita Balaji
- Department of Anatomy and Neurobiology, Program in Neuroscience, University of Maryland School of Medicine, Baltimore, Maryland 21201
| | - Nathan Cramer
- Department of Anatomy and Neurobiology, Program in Neuroscience, University of Maryland School of Medicine, Baltimore, Maryland 21201
| | - Mary Kay Lobo
- Department of Anatomy and Neurobiology, Program in Neuroscience, University of Maryland School of Medicine, Baltimore, Maryland 21201
| | - Asaf Keller
- Department of Anatomy and Neurobiology, Program in Neuroscience, University of Maryland School of Medicine, Baltimore, Maryland 21201
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54
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Selectivity and sensitivity of urine fentanyl test strips to detect fentanyl analogues in illicit drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 90:103065. [DOI: 10.1016/j.drugpo.2020.103065] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 01/01/2023]
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55
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Dalton C, Watkins R, Pritchard S, Graham S. Percutaneous absorption of Carfentanil in vitro. Toxicol In Vitro 2021; 72:105100. [PMID: 33493622 DOI: 10.1016/j.tiv.2021.105100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/11/2021] [Accepted: 01/20/2021] [Indexed: 10/22/2022]
Abstract
Carfentanil is a synthetic opioid restricted to veterinary use due to its potency. Public health concerns have been raised as to the potential of carfentanil to exhibit toxicity after absorption via the percutaneous route following unintentional contamination. The current study measured the penetration of free base carfentanil through human, pig and rat skin using in vitro static diffusion cells. The human penetration rates were compared against literature toxicology values and indicated that, dependent on the contamination density, contamination area and residence time, skin decontamination and medical countermeasures may be required to ameliorate toxicity. The pig and rat skin penetration data will form the basis of future work to develop relevant in silico and in vivo models to further elucidate likely toxic effects and the medical strategies to mitigate against them.
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Affiliation(s)
| | | | | | - Stuart Graham
- CBR Division, Dstl Porton Down, Salisbury SP4 0JQ, UK
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56
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Cannaert A, Hulpia F, Risseeuw M, Van Uytfanghe K, Deconinck E, Van Calenbergh S, Blanckaert P, Stove C. Report on a New Opioid NPS: Chemical and In Vitro Functional Characterization of a Structural Isomer of the MT-45 Derivative Diphenpipenol. J Anal Toxicol 2021; 45:134-140. [PMID: 32514558 DOI: 10.1093/jat/bkaa066] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/30/2020] [Accepted: 05/04/2020] [Indexed: 11/14/2022] Open
Abstract
In this paper, the identification and full characterization of a novel non-fentanyl opioid sourced online, which is a member of the 1-substituted-4-(1,2-diphenylethyl)piperazine derivatives related to MT-45, is reported. The sample was sold under the name "diphenpipenol," (3-[2-[4-(2-methoxyphenyl)piperazin-1-yl]-2-phenylethyl]phenol), although extensive NMR analysis showed that the product obtained was actually a diphenpipenol structural isomer, (2-[4-(2-methoxyphenyl)piperazin-1-yl]-1,2-diphenylethanol). Liquid chromatography time-of-flight mass spectrometry identified an exact mass for the protonated molecule of m/z 389.2264, with two prominent fragment ions (m/z 91.0567 and 150.0937), which were not reported in earlier literature describing MT-45 derivatives. The chemical characterization was finalized by gas chromatography-mass spectrometry, high-performance liquid chromatography diode array detector and Fourier-transform infrared spectroscopy analyses. This product is a clear example of the trend that new non-fentanyl opioids are reappearing on the recreational drug market to escape the recent changes in (inter)national legislation concerning fentanyl analogues. Although in this particular case, the product's potency and efficacy were relatively low, other new non-fentanyl opioids might possess stronger potencies and therefore pose greater health risks for ignorant users. The fact that the product was sold under the wrong name further demonstrates the well-known problematic issue of a mismatch between the adverted and true identity, confirming the irregularities of the online new psychoactive substances market.
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Affiliation(s)
- Annelies Cannaert
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium
| | - Fabian Hulpia
- Laboratory for Medicinal Chemistry, Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium
| | - Martijn Risseeuw
- Laboratory for Medicinal Chemistry, Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium
| | - Katleen Van Uytfanghe
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium
| | - Eric Deconinck
- Section of Medicines and Health Products, Scientific Direction Chemical and Physical Health Risks, Sciensano, Juliette Wytsmanstraat 14, 9050 Brussels, Belgium
| | - Serge Van Calenbergh
- Laboratory for Medicinal Chemistry, Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium
| | - Peter Blanckaert
- Belgian Early Warning System Drugs, Substance Use and Related Disorders, Sciensano, Juliette Wytsmanstraat 14, 9050 Brussels, Belgium
| | - Christophe Stove
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium
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57
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Ehrlich AT, Darcq E. Recent advances in basic science methodology to evaluate opioid safety profiles and to understand opioid activities. Fac Rev 2021; 10:15. [PMID: 33718932 PMCID: PMC7946392 DOI: 10.12703/r/10-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Opioids are powerful drugs used by humans for centuries to relieve pain and are still frequently used as pain treatment in current clinical practice. Medicinal opioids primarily target the mu opioid receptor (MOR), and MOR activation produces unmatched pain-alleviating properties, as well as side effects such as strong rewarding effects, and thus abuse potential, and respiratory depression contributing to death during overdose. Therefore, the ultimate goal is to create opioid pain-relievers with reduced respiratory depression and thus fewer chances of lethality. Efforts are also underway to reduce the euphoric effects of opioids and avoid abuse liability. In this review, recent advances in basic science methodology used to understand MOR pharmacology and activities will be summarized. The focus of the review will be to describe current technological advances that enable the study of opioid analgesics from subcellular mechanisms to mesoscale network responses. These advances in understanding MOR physiological responses will help to improve knowledge and future design of opioid analgesics.
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Affiliation(s)
- Aliza T Ehrlich
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Emmanuel Darcq
- Department of Psychiatry, Douglas Research Center, McGill University, Montréal, Canada
- INSERM U1114, UNISTRA University of Strasbourg, Strasbourg, France
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58
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Verougstraete N, Vandeputte MM, Lyphout C, Cannaert A, Hulpia F, Van Calenbergh S, Verstraete AG, Stove C. First Report on Brorphine: The Next Opioid on the Deadly New Psychoactive Substance Horizon? J Anal Toxicol 2021; 44:937-946. [PMID: 32744605 DOI: 10.1093/jat/bkaa094] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 06/29/2020] [Accepted: 07/23/2020] [Indexed: 12/20/2022] Open
Abstract
New psychoactive substances continue to appear on the drug market. Until recently, new synthetic opioids, which are among the most dangerous new psychoactive substances, primarily encompassed analogs of the potent analgesic fentanyl. Lately, also other new synthetic opioids have increasingly started to surface. This is the first report on the identification and full chemical characterization of brorphine, a novel potent synthetic opioid with a piperidine benzimidazolone structure. A powder, identified as brorphine, was obtained from a patient seeking medical help for detoxification. Brorphine was also found in a serum sample of the patient. Liquid chromatography-high-resolution mass spectrometry (LC-HRMS) identified an exact mass of m/z 400.1020 and 402.1005 for the compound, corresponding to both bromine isotopes. Further chemical characterization was performed by gas chromatography-mass spectrometry, liquid chromatography-diode array detection and Fourier-transform infrared spectroscopy analyses. Finally, the structure was confirmed by performing 1H-NMR and 13C-NMR spectroscopy. In vitro biological activity of brorphine was determined by a cell-based µ-opioid receptor activation assay, resulting in an EC50 of 30.9 nM (13.5 ng/mL) and an Emax of 209% relative to hydromorphone, confirming the high potency and efficacy of this compound. In a serum sample of the patient, brorphine and a hydroxy-metabolite were found using the LC-HRMS screening method. The presence of opioid activity in the serum was also confirmed via the activity-based opioid screening assay. The occurrence of brorphine is yet another example of how the illicit drug market is continuously evolving in an attempt to escape international legislation. Its high potency poses a serious and imminent health threat for any user.
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Affiliation(s)
- Nick Verougstraete
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium.,Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Marthe M Vandeputte
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | | | - Annelies Cannaert
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Fabian Hulpia
- Laboratory for Medicinal Chemistry, Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Serge Van Calenbergh
- Laboratory for Medicinal Chemistry, Department of Pharmaceutics, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Alain G Verstraete
- Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium.,Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Christophe Stove
- Laboratory of Toxicology, Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
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59
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Lau JKC, Romanov V, Lukow S, Hopkinson AC, Verkerk UH. Collision-induced dissociation of protonated fentanyl: A DFT study. COMPUT THEOR CHEM 2021. [DOI: 10.1016/j.comptc.2020.113117] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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60
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Cox J, Mathison K, Ott C, DelTondo J, Kraner JC, DeCaprio AP, Arroyo-Mora LE. Quantitation and Validation of 34 Fentanyl Analogs from Liver Tissue Using a QuEChERS Extraction and LC-MS-MS Analysis. J Anal Toxicol 2021; 46:232-245. [PMID: 33515247 DOI: 10.1093/jat/bkab009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/11/2021] [Accepted: 01/18/2021] [Indexed: 11/12/2022] Open
Abstract
Since 2013, drug overdose deaths involving synthetic opioids (including fentanyl and fentanyl analogs) have increased from 3,105 to 31,335 in 2018. Postmortem toxicological analysis in fentanyl-related overdose deaths is complicated by the high potency of the drug, often resulting in low analyte concentrations and associations with toxicity, multidrug use, novelty of emerging fentanyl analogs and postmortem redistribution. Objectives for this study include the development of a quick, easy, cheap, effective, rugged and safe (QuEChERS) extraction and subsequent liquid chromatography-mass spectrometry/mass spectrometry analysis, validation of the method following the American Academy of Forensic Sciences Standards Board (ASB) standard 036 requirements and application to authentic liver specimens for 34 analytes including fentanyl, metabolites and fentanyl analogs. The bias for all 34 fentanyl analogs did not exceed ±10% for any of the low, medium or high concentrations and the %CV did not exceed 20%. No interferences were identified. All 34 analytes were within the criteria for acceptable percent ionization suppression or enhancement with the low concentration ranging from -10.2% to 23.7% and the high concentration ranging from -7.1% to 11.0%. Liver specimens from 22 authentic postmortem cases were extracted and analyzed with all samples being positive for at least one target analyte from the 34 compounds. Of the 22 samples, 17 contained fentanyl and metabolites plus at least one fentanyl analog. The highest concentration for a fentanyl analog was 541.4 μg/kg of para-fluoroisobutyryl fentanyl (FIBF). The concentrations for fentanyl (n = 20) ranged between 3.6 and 164.9 μg/kg with a mean of 54.7 μg/kg. The fentanyl analog that was most encountered was methoxyacetyl fentanyl (n = 11) with a range of 0.2-4.6 μg/kg and a mean of 1.3 μg/kg. The QuEChERS extraction was fully validated using the ASB Standard 036 requirements for fentanyl, metabolites and fentanyl analogs in liver tissue.
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Affiliation(s)
- Joseph Cox
- Department of Forensic and Investigative Science, 1600 University Avenue, Oglebay Hall, Room 302, Morgantown, WV 26506, USA
| | - Kylea Mathison
- Department of Forensic and Investigative Science, 1600 University Avenue, Oglebay Hall, Room 302, Morgantown, WV 26506, USA
| | - Colby Ott
- Department of Forensic and Investigative Science, 1600 University Avenue, Oglebay Hall, Room 302, Morgantown, WV 26506, USA
| | - Joseph DelTondo
- Department of Pathology, Allegheny General Hospital, 320 E North Avenue, Pittsburgh, PA 15212, USA
| | - James C Kraner
- Office of the Chief Medical Examiner, 619 Virginia Street West, Charleston, WV 25302, USA
| | - Anthony P DeCaprio
- Department of Chemistry and Biochemistry, Florida International University (FIU), 11200 SW 8th street, Miami, FL 33199, USA
| | - Luis E Arroyo-Mora
- Department of Forensic and Investigative Science, 1600 University Avenue, Oglebay Hall, Room 302, Morgantown, WV 26506, USA
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Budelier MM, Franks CE, Farnsworth CW, Roper SM. Detecting Fentanyl Analogs in Urine Using Precursor Ion Scan Mode. J Anal Toxicol 2021; 46:bkab002. [PMID: 33416076 DOI: 10.1093/jat/bkab002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 12/15/2020] [Accepted: 01/07/2021] [Indexed: 01/14/2023] Open
Abstract
The opioid crisis has led many providers to inquire about the capabilities of urine drug testing to detect contemporary compounds such as fentanyl and fentanyl analogs. However, current methods for clinical urine drug testing, including immunoassays and targeted liquid chromatography tandem mass spectrometry, are not designed to broadly screen for the variety of fentanyl analogs that may be encountered. In this proof-of-principle study we developed a precursor ion scan method to enable semi-targeted data acquisition for structurally related fentanyl analogs. Based on the knowledge that many analogs fragment to m/z=188 and m/z=105, data was acquired on all precursor ions 250-400 Da that fragmented to these product ions. Using a tandem mass spectrometer we analyzed 102 residual urine specimens, in which we identified fentanyl, acetylfentanyl and acrylfentanyl. In 30 contrived urine samples, the precursor ion scan was also able to identify furanylfentanyl, butryrlfentanyl, 4-fluroisobutrylfentanyl, and despropionylfentanyl with accuracy ranging from 83-100%.
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Affiliation(s)
- Melissa M Budelier
- Department of Pathology and Immunology, Division of Laboratory and Genomic Medicine, Washington University, St. Louis, MO, USA
| | - Caroline E Franks
- Department of Pathology and Immunology, Division of Laboratory and Genomic Medicine, Washington University, St. Louis, MO, USA
| | - Christopher W Farnsworth
- Department of Pathology and Immunology, Division of Laboratory and Genomic Medicine, Washington University, St. Louis, MO, USA
| | - Stephen M Roper
- Department of Pathology and Immunology, Division of Laboratory and Genomic Medicine, Washington University, St. Louis, MO, USA
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62
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Bergh MSS, Bogen IL, Nerem E, Wohlfarth A, Wilson SR, Øiestad ÅML. Discovering the major metabolites of the three novel fentanyl analogues 3-methylcrotonylfentanyl, furanylbenzylfentanyl, and 4-fluorocyclopropylbenzylfentanyl for forensic case work. Forensic Toxicol 2021. [DOI: 10.1007/s11419-020-00560-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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63
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Galaj E, Xi ZX. Progress in opioid reward research: From a canonical two-neuron hypothesis to two neural circuits. Pharmacol Biochem Behav 2021; 200:173072. [PMID: 33227308 PMCID: PMC7796909 DOI: 10.1016/j.pbb.2020.173072] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/21/2020] [Accepted: 11/10/2020] [Indexed: 12/12/2022]
Abstract
Opioid abuse and related overdose deaths continue to rise in the United States, contributing to the national opioid crisis in the USA. The neural mechanisms underlying opioid abuse and addiction are still not fully understood. This review discusses recent progress in basic research dissecting receptor mechanisms and circuitries underlying opioid reward and addiction. We first review the canonical GABA-dopamine neuron hypothesis that was upheld for half a century, followed by major findings challenging this hypothesis. We then focus on recent progress in research evaluating the role of the mesolimbic and nigrostriatal dopamine circuitries in opioid reward and relapse. Based on recent findings that activation of dopamine neurons in the ventral tegmental area (VTA) and substantia nigra pars compacta (SNc) is equally rewarding and that GABA neurons in the rostromedial tegmental nucleus (RMTg) and the substantia nigra pars reticula (SNr) are rich in mu opioid receptors and directly synapse onto midbrain DA neurons, we proposed that the RTMg→VTA → ventrostriatal and SNr → SNc → dorsostriatal pathways may act as the two major neural substrates underlying opioid reward and abuse. Lastly, we discuss possible integrations of these two pathways during initial opioid use, development of opioid abuse and maintenance of compulsive opioid seeking.
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Affiliation(s)
- Ewa Galaj
- Addiction Biology Unit, Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse, Intramural Research Program, Baltimore, MD, United States of America
| | - Zheng-Xiong Xi
- Addiction Biology Unit, Molecular Targets and Medications Discovery Branch, National Institute on Drug Abuse, Intramural Research Program, Baltimore, MD, United States of America.
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64
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Pharmacokinetics and pharmacodynamics of cyclopropylfentanyl in male rats. Psychopharmacology (Berl) 2021; 238:3629-3641. [PMID: 34613431 PMCID: PMC8629808 DOI: 10.1007/s00213-021-05981-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 09/06/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Illicitly manufactured fentanyl and its analogs are a major driving force behind the ongoing opioid crisis. Cyclopropylfentanyl is a fentanyl analog associated with many overdose deaths, but limited knowledge is available about its pharmacology. In the present study, we developed a bioanalytical method for the determination of cyclopropylfentanyl and its main metabolite cyclopropylnorfentanyl and evaluated pharmacokinetic-pharmacodynamic relationships in rats. METHOD An ultra-high performance liquid chromatography tandem mass spectrometry (UHPLC-MS/MS) method was developed and validated for determination of cyclopropylfentanyl and cyclopropylnorfentanyl in rat plasma. Male Sprague-Dawley rats fitted with jugular catheters and temperature transponders received cyclopropylfentanyl (30, 100, and 300 μg/kg) or saline subcutaneously. Blood specimens were withdrawn over an 8-h time period, along with measurements of pharmacodynamic endpoints. RESULTS The analytical method was validated, and both analytes exhibited a low limit of quantification (15 pg/mL). Cyclopropylfentanyl caused dose-related increases in hot plate latency (ED50 = 48 µg/kg) and catalepsy (ED50 = 87 µg/kg) and produced long-lasting hypothermia at the highest dose. Plasma cyclopropylfentanyl rose rapidly in a dose-related fashion, reaching maximal concentration (Cmax) after 15-28 min, whereas metabolite Cmax occurred later at 45-90 min. Cyclopropylfentanyl Cmax values were similar to concentrations measured in non-fatal intoxications in humans; however, differences in parent drug: metabolite ratio indicated possible interspecies variance in metabolism. CONCLUSION Our study shows that cyclopropylfentanyl produces typical opioid-like effects in male rats. Cyclopropylfentanyl displays much greater analgesic potency when compared to morphine, suggesting that cyclopropylfentanyl poses increased overdose risk for unsuspecting users.
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Li Z, Wang P. Point-of-Care Drug of Abuse Testing in the Opioid Epidemic. Arch Pathol Lab Med 2020; 144:1325-1334. [PMID: 32579399 DOI: 10.5858/arpa.2020-0055-ra] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The United States is experiencing an opioid overdose epidemic. Point-of-care (POC) drug of abuse testing is a useful tool to combat the intensified opioid epidemic. OBJECTIVES.— To review commercially available POC drug of abuse testing involving opioids, to review opportunities and challenges for POC opioid testing and emerging testing methods in research literature, and finally to summarize unmet clinical needs and future development prospects. DATA SOURCES.— The Google search engine was used to access information for commercial opioid POC devices and the Google Scholar search engine was used to access research literature published from 2000 to 2019 for opioid POC tests. CONCLUSIONS.— The opioid epidemic provides unprecedented opportunities for POC drug testing, with significant clinical needs. Compared with gold standard tests, limitations for commercially available opioid POC testing include lower analytical sensitivity, lower specificity, and cross-reactivity. In response to unmet clinical needs, novel methods have emerged in research literature, such as microfluidics and miniature mass spectrometry. Future prospects include the development of quantitative POC devices and smarter and real-time drug testing.
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Affiliation(s)
- Zhao Li
- From the Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia
| | - Ping Wang
- From the Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia
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66
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Lloyd M, Ransom EM, Anderson NW, Farnsworth CW. Evaluation of Infectious Disease Test Ordering and Positivity Rates in Illicit Fentanyl Users. J Appl Lab Med 2020; 6:79-92. [PMID: 33313803 DOI: 10.1093/jalm/jfaa194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/12/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND The emergence of illicit fentanyl use has resulted in considerable morbidity and mortality. Although illicit use of other opioids has been associated with transmission of viral and bacterial infections, limited data exist for the prevalence of infectious diseases among illicit fentanyl users. The purpose of this study was to assess the likelihood of infectious disease testing and infection prevalence among illicit fentanyl users. METHODS Results from urine drug screens (UDSs) performed from August 13, 2019, to October 16, 2019, were obtained from the laboratory information system with concurrent microbial testing. Patients were categorized based on UDS results, and illicit drug use was inferred from physician encounter notes in the electronic medical record. RESULTS Suspected illicit drugs users with fentanyl detected by UDS were more likely to be screened [odds ratio (OR): 1.7; 95% CI, 1.26-2.4] and test positive for hepatitis C virus (HCV) by immunoassay (OR: 5.89; 95% CI, 2.93-11.31) than patients without drugs detected. Patients with suspected illicit fentanyl use who were discharged from the emergency department (ED) were less likely to be tested for HCV than patients in outpatient settings (OR: 3.47; 95% CI, 1.05-10.4) and inpatient settings (OR: 17.43; 95% CI, 6.53-45.88). Patients with suspected illicit fentanyl use were more likely to have infected abscesses or wounds (OR: 5.12; 95% CI, 2.07-13.7) and Staphylococcus aureus infections (OR: 4.5; 95% CI, 1.59-12.28) than patients without drugs detected. CONCLUSIONS Patients with a positive UDS for fentanyl and suspected illicit use were more likely to test positive for HCV, were rarely screened for HCV in the ED, and had an increased risk of invasive S. aureus wound or abscess infection. These findings may represent considerable barriers to care for patients who use fentanyl illicitly.
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Affiliation(s)
- Matthew Lloyd
- Department of Pathology and Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Eric M Ransom
- Department of Pathology and Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Neil W Anderson
- Department of Pathology and Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Christopher W Farnsworth
- Department of Pathology and Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO
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Connors NJ, Mazer-Amirshahi M, Motov S, Kim HK. Relative addictive potential of opioid analgesic agents. Pain Manag 2020; 11:201-215. [PMID: 33300384 DOI: 10.2217/pmt-2020-0048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Opioid overdoses and deaths continue to be a problem in the USA with a significant portion related to prescribed opioid analgesic agents. The role of pharmacogentic factors in opioid addiction is an active area of research. While all opioid analgesic agents have some addictive potential, it is clear that there are some with greater addictive potential. Oxycodone is the most widely abused opioid analgesic and it appears to predispose to chronic use with high likability by users. Fentanyl and hydromorphone are both very lipophilic allowing rapid penetration into the CNS, but are not rated as highly as other agents. Providers should consider the risk of addiction with the opioids they prescribe and give those with a lower addictive potential.
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Affiliation(s)
- Nicholas J Connors
- HCA Healthcare, Trident Medical Center, Charleston, SC 29406, USA.,Palmetto Poison Center, Columbia, SC 29201, USA
| | - Maryann Mazer-Amirshahi
- Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC 20010, USA
| | - Sergey Motov
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY 11219, USA
| | - Hong K Kim
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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68
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Gilbert N, Mewis RE, Sutcliffe OB. Classification of fentanyl analogues through principal component analysis (PCA) and hierarchical clustering of GC–MS data. Forensic Chem 2020. [DOI: 10.1016/j.forc.2020.100287] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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69
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Baumann MH, Tocco G, Papsun DM, Mohr AL, Fogarty MF, Krotulski AJ. U-47700 and Its Analogs: Non-Fentanyl Synthetic Opioids Impacting the Recreational Drug Market. Brain Sci 2020; 10:E895. [PMID: 33238449 PMCID: PMC7700279 DOI: 10.3390/brainsci10110895] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/16/2020] [Accepted: 11/18/2020] [Indexed: 11/17/2022] Open
Abstract
The recreational use of opioid drugs is a global threat to public health and safety. In particular, an epidemic of opioid overdose fatalities is being driven by illicitly manufactured fentanyl, while novel synthetic opioids (NSOs) are appearing on recreational drug markets as standalone products, adulterants in heroin, or ingredients in counterfeit drug preparations. Trans-3,4-dichloro-N-[2-(dimethylamino)cyclohexyl]-N-methylbenzamide (U-47700) is a prime example of a non-fentanyl NSO that is associated with numerous intoxications and fatalities. Here, we review the medicinal chemistry, preclinical pharmacology, clandestine availability, methods for detection, and forensic toxicology of U-47700 and its analogs. An up-to-date summary of the human cases involving U-47700 intoxication and death are described. The evidence demonstrates that U-47700 is a potent μ-opioid receptor agonist, which poses a serious risk for overdosing and death. However, most analogs of U-47700 appear to be less potent and have been detected infrequently in forensic specimens. U-47700 represents a classic example of how chemical entities from the medicinal chemistry or patent literature can be diverted for use in recreational drug markets. Lessons learned from the experiences with U-47700 can inform scientists, clinicians, and policymakers who are involved with responding to the spread and impact of NSOs.
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Affiliation(s)
- Michael H. Baumann
- Designer Drug Research Unit, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, 333 Cassell Drive, Suite 4400, Baltimore, MD 21224, USA
| | - Graziella Tocco
- Department of Life and Environmental Sciences, University of Cagliari, Cittadella Universitaria di Monserrato, Monserrato, 09042 Cagliari, Italy;
| | - Donna M. Papsun
- Toxicology Department, NMS Labs, 200 Welsh Road, Horsham, PA 19044, USA;
| | - Amanda L. Mohr
- Center for Forensic Science Research and Education, Fredric Rieders Family Foundation, 2300 Stratford Ave, Willow Grove, 19090 PA, USA; (A.L.M.); (M.F.F.); (A.J.K.)
| | - Melissa F. Fogarty
- Center for Forensic Science Research and Education, Fredric Rieders Family Foundation, 2300 Stratford Ave, Willow Grove, 19090 PA, USA; (A.L.M.); (M.F.F.); (A.J.K.)
| | - Alex J. Krotulski
- Center for Forensic Science Research and Education, Fredric Rieders Family Foundation, 2300 Stratford Ave, Willow Grove, 19090 PA, USA; (A.L.M.); (M.F.F.); (A.J.K.)
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Danaceau JP, Wood M, Ehlers M, Rosano TG. Analysis of 17 fentanyls in plasma and blood by UPLC-MS/MS with interpretation of findings in surgical and postmortem casework. CLINICAL MASS SPECTROMETRY (DEL MAR, CALIF.) 2020; 18:38-47. [PMID: 34820524 PMCID: PMC8601016 DOI: 10.1016/j.clinms.2020.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 10/21/2020] [Accepted: 10/23/2020] [Indexed: 11/17/2022]
Abstract
The opioid crisis is linked to an increased misuse of fentanyl as well as fentanyl analogs that originate from the illicit drug market. Much of our current understanding of fentanyl and fentanyl analog use in our communities comes from postmortem toxicology findings. In the clinical settings of addiction medicine and pain management, where the opioid abuse potential is high, the use of fentanyl, as well as specific fentanyl analogs, may be underestimated due to limited plasma testing and limited availability of assays with suitable analytical sensitivity and selectivity to detect misuse of fentanyls. We report plasma and blood assays for 17 fentanyls (these include fentanyl, fentanyl analogs, fentanyl metabolites and synthetic precursors) in clinical, and medical examiner, casework. A mixed-mode solid phase extraction of diluted plasma or precipitated blood was optimized for maximum recovery of the fentanyls with minimized matrix effects. Analysis was performed using a Waters ACQUITY UPLC I-Class interfaced with a Waters Xevo TQ-S micro tandem quadrupole mass spectrometer. Method parameters were optimized and validated for precision, accuracy, carryover, linearity and matrix effects. Application studies were performed in postmortem blood obtained in 44 fentanyl-related fatalities and in serial plasma samples from 18 surgical patients receiving intravenous fentanyl therapy while undergoing parathyroidectomy. Fentanyls found in postmortem cases included fentanyl, norfentanyl, despropionyl-fentanyl (4-ANPP), beta-hydroxy fentanyl (β-OH fentanyl), acetyl fentanyl, acetyl norfentanyl, methoxyacetyl fentanyl, furanyl fentanyl, cyclopropyl fentanyl, and para-fluorobutyryl fentanyl, with fentanyl, norfentanyl, 4-ANPP and β-OH fentanyl predominating in frequency. Fentanyl concentrations ranged from 0.2 to 56 ng/mL and fentanyl was nearly always found with 4-ANPP, norfentanyl and β-OH fentanyl. Concentrations of other fentalogs ranged from <1 to 84 ng/mL (extrapolated). In the surgical cases, fentanyl was detected and quantified along with norfentanyl and β-OH fentanyl, but without detection of 4-ANPP in any of the samples. The association and relative concentrations of β-OH fentanyl, fentanyl and norfentanyl in the postmortem and clinical studies indicated a metabolic, rather than an illicit, source of β-OH fentanyl.
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Affiliation(s)
| | | | | | - Thomas G Rosano
- Albany Medical Center (AMC), Albany, NY, USA
- National Toxicology Center, Albany NY, USA
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71
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Etazene (N,N-diethyl-2-{[(4-ethoxyphenyl)methyl]-1H-benzimidazol-1-yl}-ethan-1-amine (dihydrochloride)): a novel benzimidazole opioid NPS identified in seized material: crystal structure and spectroscopic characterization. Forensic Toxicol 2020. [DOI: 10.1007/s11419-020-00552-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Abstract
Purpose
The aim of the study was to present the spectroscopic characteristics and crystal structure of the etazene—a benzimidazole opioid, which appeared on the illegal drug market in Poland in the last weeks.
Methods
The title compound was analyzed by X-ray crystallography as well as gas and liquid chromatography combined with mass spectrometry. Spectroscopic techniques have also been used, such as nuclear magnetic resonance, infrared and ultraviolet-visible spectroscopies.
Results
We presented the identification and the broad chemical characterization of etazene, a synthetic opioid that has recently been introduced on the illegal drug market.
Conclusions
In this paper, we described single-crystal X-ray, chromatographic and spectroscopic characterization of a synthetic opioid that emerged on the new psychoactive substance (NPS) market in Poland. To the best of our knowledge, this is the first full characterization of etazene. Analytical data presented in the work can be helpful in identification and detection of the NPS in forensic and clinical laboratories.
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Non-prescription Fentanyl Positive Toxicology: Prevalence, Positive Predictive Value of Fentanyl Immunoassay Screening, and Description of Co-substance Use. J Addict Med 2020; 15:150-154. [DOI: 10.1097/adm.0000000000000723] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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73
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Arfken CL, Owens DD, Greenwald MK. US national treatment admissions with opioids and benzodiazepines. Drug Alcohol Rev 2020; 39:862-869. [PMID: 32748413 DOI: 10.1111/dar.13129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 05/29/2020] [Accepted: 06/11/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION AND AIMS Opioids and benzodiazepines (O/BZD) are increasingly involved in drug overdose deaths in the USA. Expanding treatment capacity may reduce these deaths. Knowledge about co-occurring O/BZD admissions compared to opioid admissions (opioid) is needed to plan this expansion. DESIGN AND METHODS US treatment admissions to specialty facilities for 2011-2017 were analysed for trends and 2017 for group differences. Due to 1.9 million admissions in 2017, comparisons between O/BZD and opioid admissions were summarised as effect sizes. Additional analysis compared the administratively pre-coded category 'other opiates and synthetics' to other opiates and synthetics/benzodiazepines admissions to control for possible similarity in drug source. Differences within O/BZD admissions by primary drug were explored. RESULTS Although opioid admissions showed a steady increase over time (25.9% to 38.2%), O/BZD admissions showed increases until decline in 2017 (3.2% to 4.0%). In 2017 no factor reached moderate effect size (≥0.2) in group comparisons or within the O/BZD admissions. Heroin was self-reported in 70% of both O/BZD and opioid admissions. DISCUSSION AND CONCLUSIONS No meaningful US national differences on data routinely collected were found for O/BZD compared to opioid admissions including the subgroup with other opiates and synthetics only. Efforts to expand existing opioid treatment in specialty treatments may help reduce opioid and O/BZD deaths. However, the analysis could not address whether changes in treatment would improve outcomes.
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Affiliation(s)
- Cynthia L Arfken
- Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, USA
| | | | - Mark K Greenwald
- Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, USA.,Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, USA
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74
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In vitro functional characterization of a panel of non-fentanyl opioid new psychoactive substances. Arch Toxicol 2020; 94:3819-3830. [DOI: 10.1007/s00204-020-02855-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/14/2020] [Indexed: 10/23/2022]
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75
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Li Z, Chen H, Feng S, Liu K, Wang P. Development and Clinical Validation of a Sensitive Lateral Flow Assay for Rapid Urine Fentanyl Screening in the Emergency Department. Clin Chem 2020; 66:324-332. [PMID: 32040576 DOI: 10.1093/clinchem/hvz023] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 10/07/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Rapid identification of fentanyl at the point-of-care is critical. Urine fentanyl concentrations in overdose cases start at single-digit nanograms per milliliter. No fentanyl point-of-care assay with a cutoff at single-digit nanograms per milliliter is available. METHODS A competitive lateral flow assay (LFA) was developed using gold nanoparticles and optimized for rapid screening of fentanyl in 5 minutes. Urine samples from 2 cohorts of emergency department (ED) patients were tested using the LFA and LC-MS/MS. The 2 cohorts consisted of 218 consecutive ED patients with urine drug-of-abuse screen orders and 7 ED patients with clinically suspected fentanyl overdose, respectively. RESULTS The LFA detected fentanyl (≥1 ng/mL) and the major metabolite norfentanyl (≥10 ng/mL) with high precision. There was no cross-reactivity with amphetamine, cocaine, morphine, tetrahydrocannabinol, methadone, buprenorphine, naloxone, and acetaminophen at 1000 ng/mL and 0.03%, 0.4%, and 0.05% cross-reactivity with carfentanil, risperidone, and 9-hydroxyrisperidone, respectively. In 218 consecutive ED patients, the prevalence of cases with fentanyl ≥1 ng/mL or norfentanyl ≥10 ng/mL was 5.5%. The clinical sensitivity and specificity of the LFA were 100% (95% CI, 75.8-100%) and 99.5% (95% CI, 97.3-99.9%), respectively. The positive and negative predictive values were 92.3% (95% CI, 66.7-98.6%) and 100% (95% CI, 98.2-100%), respectively. The concordance between the LFA and LC-MS/MS was 100% in the 7 suspected fentanyl overdose cases (5 positive, 2 negative). CONCLUSIONS The LFA can detect fentanyl and norfentanyl with high clinical sensitivity and specificity in the ED population with rapid fentanyl screening needs.
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Affiliation(s)
- Zhao Li
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA
| | - Hui Chen
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sheng Feng
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kengku Liu
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA
| | - Ping Wang
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, PA
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Truver MT, Smith CR, Garibay N, Kopajtic TA, Swortwood MJ, Baumann MH. Pharmacodynamics and pharmacokinetics of the novel synthetic opioid, U-47700, in male rats. Neuropharmacology 2020; 177:108195. [PMID: 32533977 DOI: 10.1016/j.neuropharm.2020.108195] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 06/03/2020] [Accepted: 06/08/2020] [Indexed: 02/01/2023]
Abstract
Novel synthetic opioids are appearing in recreational drug markets worldwide as adulterants in heroin or ingredients in counterfeit analgesic medications. Trans-3,4-dichloro-N-[2-(dimethylamino)cyclohexyl]-N-methyl-benzamide (U-47700) is an example of a non-fentanyl synthetic opioid linked to overdose deaths. Here, we examined the pharmacodynamics and pharmacokinetics of U-47700 in rats. Male Sprague-Dawley rats were fitted with intravenous (i.v.) catheters and subcutaneous (s.c.) temperature transponders under ketamine/xylazine anesthesia. One week later, rats received s.c. injections of U-47700 HCl (0.3, 1.0 or 3.0 mg/kg) or saline, and blood samples (0.3 mL) were withdrawn via i.v. catheters at 15, 30, 60, 120, 240, 480 min post-injection. Pharmacodynamic effects were assessed at each blood withdrawal, and plasma was assayed for U-47700 and its metabolites by liquid chromatography tandem mass spectrometry. U-47700 induced dose-related increases in hot plate latency (ED50 = 0.5 mg/kg) and catalepsy (ED50 = 1.7 mg/kg), while the 3.0 mg/kg dose also caused hypothermia. Plasma levels of U-47700 rose linearly as dose increased, with maximal concentration (Cmax) achieved by 15-38 min. Cmax values for N-desmethyl-U-47700 and N,N-didesmethyl-U-47700 were delayed but reached levels in the same range as the parent compound. Pharmacodynamic effects were correlated with plasma U-47700 and its N-desmethyl metabolite. Using radioligand binding assays, U-47700 displayed high affinity for μ-opioid receptors (Ki = 11.1 nM) whereas metabolites were more than 18-fold weaker. Our data reveal that U-47700 induces typical μ-opioid effects which are related to plasma concentrations of the parent compound. Given its high potency, U-47700 poses substantial risk to humans who are inadvertently exposed to the drug.
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Affiliation(s)
- Michael T Truver
- Department of Forensic Science, College of Criminal Justice, Sam Houston State University, Huntsville, TX, USA
| | - Christina R Smith
- Department of Forensic Science, College of Criminal Justice, Sam Houston State University, Huntsville, TX, USA
| | - Nancy Garibay
- Designer Drug Research Unit, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA
| | - Theresa A Kopajtic
- Biobehavioral Imaging and Molecular Neuropsychopharmacology Unit, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA
| | - Madeleine J Swortwood
- Department of Forensic Science, College of Criminal Justice, Sam Houston State University, Huntsville, TX, USA.
| | - Michael H Baumann
- Designer Drug Research Unit, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD, USA.
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Torralva R, Eshleman AJ, Swanson TL, Schmachtenberg JL, Schutzer WE, Bloom SH, Wolfrum KM, Reed JF, Janowsky A. Fentanyl but not Morphine Interacts with Nonopioid Recombinant Human Neurotransmitter Receptors and Transporters. J Pharmacol Exp Ther 2020; 374:376-391. [PMID: 32513839 DOI: 10.1124/jpet.120.265561] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 06/01/2020] [Indexed: 12/13/2022] Open
Abstract
Synthetic opioids, including fentanyl and its analogs, have therapeutic efficacy in analgesia and anesthesia. However, their illicit use in the United States has increased and contributed to the number one cause of death for adults 18-50 years old. Fentanyl and the heroin metabolite morphine induce respiratory depression that can be treated with the μ opioid receptor (MOR) antagonist naloxone. With higher or more rapid dosing, fentanyl, more than morphine, causes chest wall rigidity and can also induce rapid onset laryngospasm. Because non-MORs could mediate differing clinical manifestations, we examined the interactions of fentanyl and morphine at recombinant human neurotransmitter transporters, G protein-coupled receptors, and the N-methyl-D-aspartate glutamate receptor. Both drugs were agonists at MOR, κ, and δ opioid receptors. Morphine had little or no affinity at other human receptors and transporters (K i or IC50 value >100 µM). However, fentanyl had K i values of 1407 and 1100 nM at α 1A and α 1B adrenoceptor subtypes, respectively, and K i values of 1049 and 1670 nM at dopamine D4.4 and D1 receptor subtypes, respectively; it also blocked [3H]neurotransmitter uptake by the vesicular monoamine transporter 2 (IC50 = 911 nM). Pharmacokinetic models indicate that these Ki and IC50 values are pharmacologically relevant. Fentanyl had little affinity for other receptors or transporters. Thus, noradrenergic disposition at specific receptor subtypes in relevant organs may play a role in respiratory and cardiothoracic effects of fentanyl. Data suggest that less selective fentanyl receptor pharmacology could play a role in the different clinical effects of morphine compared with fentanyl, including fentanyl-induced deaths after illicit use. SIGNIFICANCE STATEMENT: The synthetic opioid fentanyl induces different clinical effects, including rapid onset muscular rigidity, vocal cord closure, and rapid death, than the heroin metabolite morphine. Our data indicate for the first time that the two drugs have very different effects at recombinant human neurotransmitter receptors and transporters that might explain those clinical differences.
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Affiliation(s)
- Randy Torralva
- Research Service, VA Portland Health Care System, Portland, Oregon (R.T., A.J.E., T.L.S., J.L.S., W.E.S., S.H.B., K.M.W., J.F.R., A.J.); Coda Research, Portland, Oregon (R.T.); Departments of Psychiatry (R.T., A.J.E., T.L.S., J.L.S., W.E.S., S.H.B., K.M.W., J.F.R., A.J.), Behavioral Neuroscience (A.J.E., A.J.), Oregon Health & Science University, Portland, Oregon; and The Methamphetamine Abuse Research Center, VA Portland Health Care System and Oregon Health & Science University, Portland, Oregon (W.E.S., A.J.)
| | - Amy J Eshleman
- Research Service, VA Portland Health Care System, Portland, Oregon (R.T., A.J.E., T.L.S., J.L.S., W.E.S., S.H.B., K.M.W., J.F.R., A.J.); Coda Research, Portland, Oregon (R.T.); Departments of Psychiatry (R.T., A.J.E., T.L.S., J.L.S., W.E.S., S.H.B., K.M.W., J.F.R., A.J.), Behavioral Neuroscience (A.J.E., A.J.), Oregon Health & Science University, Portland, Oregon; and The Methamphetamine Abuse Research Center, VA Portland Health Care System and Oregon Health & Science University, Portland, Oregon (W.E.S., A.J.)
| | - Tracy L Swanson
- Research Service, VA Portland Health Care System, Portland, Oregon (R.T., A.J.E., T.L.S., J.L.S., W.E.S., S.H.B., K.M.W., J.F.R., A.J.); Coda Research, Portland, Oregon (R.T.); Departments of Psychiatry (R.T., A.J.E., T.L.S., J.L.S., W.E.S., S.H.B., K.M.W., J.F.R., A.J.), Behavioral Neuroscience (A.J.E., A.J.), Oregon Health & Science University, Portland, Oregon; and The Methamphetamine Abuse Research Center, VA Portland Health Care System and Oregon Health & Science University, Portland, Oregon (W.E.S., A.J.)
| | - Jennifer L Schmachtenberg
- Research Service, VA Portland Health Care System, Portland, Oregon (R.T., A.J.E., T.L.S., J.L.S., W.E.S., S.H.B., K.M.W., J.F.R., A.J.); Coda Research, Portland, Oregon (R.T.); Departments of Psychiatry (R.T., A.J.E., T.L.S., J.L.S., W.E.S., S.H.B., K.M.W., J.F.R., A.J.), Behavioral Neuroscience (A.J.E., A.J.), Oregon Health & Science University, Portland, Oregon; and The Methamphetamine Abuse Research Center, VA Portland Health Care System and Oregon Health & Science University, Portland, Oregon (W.E.S., A.J.)
| | - William E Schutzer
- Research Service, VA Portland Health Care System, Portland, Oregon (R.T., A.J.E., T.L.S., J.L.S., W.E.S., S.H.B., K.M.W., J.F.R., A.J.); Coda Research, Portland, Oregon (R.T.); Departments of Psychiatry (R.T., A.J.E., T.L.S., J.L.S., W.E.S., S.H.B., K.M.W., J.F.R., A.J.), Behavioral Neuroscience (A.J.E., A.J.), Oregon Health & Science University, Portland, Oregon; and The Methamphetamine Abuse Research Center, VA Portland Health Care System and Oregon Health & Science University, Portland, Oregon (W.E.S., A.J.)
| | - Shelley H Bloom
- Research Service, VA Portland Health Care System, Portland, Oregon (R.T., A.J.E., T.L.S., J.L.S., W.E.S., S.H.B., K.M.W., J.F.R., A.J.); Coda Research, Portland, Oregon (R.T.); Departments of Psychiatry (R.T., A.J.E., T.L.S., J.L.S., W.E.S., S.H.B., K.M.W., J.F.R., A.J.), Behavioral Neuroscience (A.J.E., A.J.), Oregon Health & Science University, Portland, Oregon; and The Methamphetamine Abuse Research Center, VA Portland Health Care System and Oregon Health & Science University, Portland, Oregon (W.E.S., A.J.)
| | - Katherine M Wolfrum
- Research Service, VA Portland Health Care System, Portland, Oregon (R.T., A.J.E., T.L.S., J.L.S., W.E.S., S.H.B., K.M.W., J.F.R., A.J.); Coda Research, Portland, Oregon (R.T.); Departments of Psychiatry (R.T., A.J.E., T.L.S., J.L.S., W.E.S., S.H.B., K.M.W., J.F.R., A.J.), Behavioral Neuroscience (A.J.E., A.J.), Oregon Health & Science University, Portland, Oregon; and The Methamphetamine Abuse Research Center, VA Portland Health Care System and Oregon Health & Science University, Portland, Oregon (W.E.S., A.J.)
| | - John F Reed
- Research Service, VA Portland Health Care System, Portland, Oregon (R.T., A.J.E., T.L.S., J.L.S., W.E.S., S.H.B., K.M.W., J.F.R., A.J.); Coda Research, Portland, Oregon (R.T.); Departments of Psychiatry (R.T., A.J.E., T.L.S., J.L.S., W.E.S., S.H.B., K.M.W., J.F.R., A.J.), Behavioral Neuroscience (A.J.E., A.J.), Oregon Health & Science University, Portland, Oregon; and The Methamphetamine Abuse Research Center, VA Portland Health Care System and Oregon Health & Science University, Portland, Oregon (W.E.S., A.J.)
| | - Aaron Janowsky
- Research Service, VA Portland Health Care System, Portland, Oregon (R.T., A.J.E., T.L.S., J.L.S., W.E.S., S.H.B., K.M.W., J.F.R., A.J.); Coda Research, Portland, Oregon (R.T.); Departments of Psychiatry (R.T., A.J.E., T.L.S., J.L.S., W.E.S., S.H.B., K.M.W., J.F.R., A.J.), Behavioral Neuroscience (A.J.E., A.J.), Oregon Health & Science University, Portland, Oregon; and The Methamphetamine Abuse Research Center, VA Portland Health Care System and Oregon Health & Science University, Portland, Oregon (W.E.S., A.J.)
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78
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Gundersen POM, Broecker S, Slørdal L, Spigset O, Josefsson M. Retrospective screening of synthetic cannabinoids, synthetic opioids and designer benzodiazepines in data files from forensic post mortem samples analysed by UHPLC-QTOF-MS from 2014 to 2018. Forensic Sci Int 2020; 311:110274. [DOI: 10.1016/j.forsciint.2020.110274] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 03/19/2020] [Accepted: 03/25/2020] [Indexed: 12/16/2022]
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79
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Analytical findings in used syringes from a syringe exchange program. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 81:102770. [PMID: 32442881 DOI: 10.1016/j.drugpo.2020.102770] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/19/2020] [Accepted: 04/22/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Since it's first implementatation in 1984, Syringe Exchange Programs (SEP) are a critical component of harm reduction interventions among people who inject drugs.. The aim of this work was to use a scientific analytical approach to obtain drug use information through the analysis of the content of used syringes. METHODS 357 syringes were collected in New York City and submitted to qualitative analysis. Screening analysis was performed by gas chromatography mass spectrometry (GC-MS) and confirmatory analysis by liquid chromatography quadrupole time of flight mass spectrometry (LC-QTOF). RESULTS Of the 357 syringes analyzed, 275 (77.0%) were positive for one or more substances. The most common drug of abuse identified was heroin/related substances (72.0%), followed by cocaine/related substance (34.9%), fentanyl/related substance (13.5%), methamphetamine/related substance (7.6%) and furanylfentanyl (3.6%). Quinine/quinidine (18.5%) was the most common cutting agent detected, followed by levamisole (12.0%), caffeine (11.6%), lidocaine (11.6%), and phenacetin (6.9%). CONCLUSION Analysis of samples collected from a drug street scenario allows the identification of new substances being injected and provides information to harm reduction programs to identify strategies to reduce drug abuse.
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80
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Galaj E, Newman AH, Xi ZX. Dopamine D3 receptor-based medication development for the treatment of opioid use disorder: Rationale, progress, and challenges. Neurosci Biobehav Rev 2020; 114:38-52. [PMID: 32376243 PMCID: PMC7252042 DOI: 10.1016/j.neubiorev.2020.04.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 04/28/2020] [Indexed: 01/11/2023]
Abstract
Opioid abuse and overdose have become a national crisis in the USA. Although several opioid-based pharmacotherapies are available, they are ineffective in long-term relapse prevention. National Institute on Drug Abuse has listed dopamine D3 receptor antagonists as high priority for anti-opioid medication development. The novel D3 receptor antagonists (VK4-116, VK4-40) are effective in reducing opioid reward and relapse as well as potentiate opioid analgesia. D3 receptor antagonists deserve further studies as new pharmacotherapies for pain and of opioid use disorder.
Opioid abuse and related overdose deaths continue to rise in the United States, contributing to the current national opioid crisis. Although several opioid-based pharmacotherapies are available (e.g., methadone, buprenorphine, naloxone), they show limited effectiveness in long-term relapse prevention. In response to the opioid crisis, the National Institute on Drug Abuse proposed a list of pharmacological targets of highest priority for medication development for the treatment of opioid use disorders (OUD). Among these are antagonists of dopamine D3 receptors (D3R). In this review, we first review recent progress in research of the dopamine hypothesis of opioid reward and abuse and then describe the rationale and recent development of D3R ligands for the treatment of OUD. Herein, an emphasis is placed on the effectiveness of newly developed D3R antagonists in the animal models of OUD. These new drug candidates may also potentiate the analgesic effects of clinically used opioids, making them attractive as adjunctive medications for pain management and treatment of OUD.
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Affiliation(s)
- Ewa Galaj
- Molecular Targets and Medication Discovery Branch, National Institute on Drug Abuse, Intramural Research Program, Baltimore, MD, United States
| | - Amy Hauck Newman
- Molecular Targets and Medication Discovery Branch, National Institute on Drug Abuse, Intramural Research Program, Baltimore, MD, United States
| | - Zheng-Xiong Xi
- Molecular Targets and Medication Discovery Branch, National Institute on Drug Abuse, Intramural Research Program, Baltimore, MD, United States.
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81
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Budelier MM, Franks CE, Logsdon N, Jannetto PJ, Scott MG, Roper SM, Farnsworth CW. Comparison of Two Commercially Available Fentanyl Screening Immunoassays for Clinical Use. J Appl Lab Med 2020; 5:1277-1286. [PMID: 32674121 DOI: 10.1093/jalm/jfaa048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 02/14/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Fentanyl is a synthetic opioid associated with illicit drug use and overdose deaths. The SEFRIA Immunalysis (IAL) and ARK fentanyl assays are both FDA-cleared, open channel immunoassays for fentanyl detection in urine. However, limited data are available in the literature comparing these assays. The objective of this study was to perform a direct comparison of these two fentanyl immunoassays. METHODS IAL and ARK fentanyl immunoassays were performed on a Roche Cobas e602 automated chemistry analyzer. Repeatability and total imprecision were compared by diluting fentanyl into urine at concentrations above, below, and at the manufacturers' cutoffs of 1.0 ng/mL. Cross-reactivity was assessed for norfentanyl and the fentanyl analogs acetylfentanyl, acrylfentanyl, and furanylfentanyl. Concordance was assessed in 90 patient samples using liquid chromatography-tandem mass spectrometry (LC-MS/MS) as the gold standard. RESULTS Repeatability varied from 11.4%-17.8% on the IAL assay and 2.8%-5.5% on the ARK assay. Total imprecision was 18.9%-40.7% on the IAL assay and 2.9%-6.4% on the ARK assay. Both assays cross-reacted with acetylfentanyl (∼100%), acrylfentanyl (∼100%), and furanylfentanyl (∼20%), but only the ARK assay cross-reacted with norfentanyl (∼3%). An admixture of 0.5 ng/mL fentanyl and 6 ng/mL norfentanyl produced a positive result on the ARK assay. Total concordance between IAL and ARK for 90 tested patient samples was 93% (kappa = 0.85). Relative to LC-MS/MS, the IAL assay had a concordance of 90% (kappa = 0.79) and the ARK assay had a concordance of 94% (kappa = 0.88). Including norfentanyl in the LC-MS/MS confirmation increased the concordance of the ARK to 96% (kappa = 0.90). CONCLUSIONS The ARK assay recognized the metabolite norfentanyl, demonstrated superior precision, and had better concordance with LC-MS/MS compared to the IAL assay.
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Affiliation(s)
- Melissa M Budelier
- Department of Pathology and Immunology, Division of Laboratory and Genomic Medicine, Washington University, St. Louis, MO
| | - Caroline E Franks
- Department of Pathology and Immunology, Division of Laboratory and Genomic Medicine, Washington University, St. Louis, MO
| | - Nicole Logsdon
- Department of Pathology and Immunology, Division of Laboratory and Genomic Medicine, Washington University, St. Louis, MO
| | - Paul J Jannetto
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Mitchell G Scott
- Department of Pathology and Immunology, Division of Laboratory and Genomic Medicine, Washington University, St. Louis, MO
| | - Stephen M Roper
- Department of Pathology and Immunology, Division of Laboratory and Genomic Medicine, Washington University, St. Louis, MO
| | - Christopher W Farnsworth
- Department of Pathology and Immunology, Division of Laboratory and Genomic Medicine, Washington University, St. Louis, MO
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82
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Assessment of structure-activity relationships and biased agonism at the Mu opioid receptor of novel synthetic opioids using a novel, stable bio-assay platform. Biochem Pharmacol 2020; 177:113910. [PMID: 32179045 DOI: 10.1016/j.bcp.2020.113910] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 03/10/2020] [Indexed: 11/20/2022]
Abstract
Fentanyl and morphine are agonists of the Mu opioid receptor (MOR), which is a member of the GPCR family. Their analgesic effects are associated with unwanted side effects. On a signaling level downstream from MOR, it has been hypothesized that analgesia may be mediated through the G protein pathway, whereas the undesirable effects of opioids have been linked to the β-arrestin (βarr) pathway. Despite being an increasingly debated subject, little is known about a potential 'bias' (i.e. the preferential activation of one pathway over the other) of the novel synthetic opioids (NSO) - including fentanyl analogs - that have emerged on the illegal drug market. We have therefore developed and applied a novel, robust bio-assay platform to study the activity of 21 NSO, to evaluate to what extent these MOR agonists show biased agonism and to investigate the potential correlation with their structure. In addition, we evaluated the functional selectivity of TRV130, a purported G protein-biased agonist. We applied newly established stable bio-assays in HEK293T cells, based on the principle of functional complementation of a split nanoluciferase, to assess MOR activation via recruitment of a mini-Gi protein (GTPase domain of Gαi subunit) or βarr2. All but two of the tested NSO demonstrated a concentration-dependent response at MOR in both bio-assays. The developed bio-assays allow to gain insight into the βarr2 or G protein recruitment potential of NSO, which may eventually help to better understand why certain opioids are associated with higher toxicity. Adding to the recent discussion about the relevance of the biased agonism concept for opioids, we did not observe a significant bias for any of the evaluated compounds, including TRV130.
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83
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Krotulski AJ, Papsun DM, Kacinko SL, Logan BK. Isotonitazene Quantitation and Metabolite Discovery in Authentic Forensic Casework. J Anal Toxicol 2020; 44:521-530. [DOI: 10.1093/jat/bkaa016] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Abstract
The synthetic opioid landscape continues to change as non-fentanyl-related substances appear in forensic toxicology casework. Among the newest synthetic opioids to emerge is isotonitazene, an analogue of a benzimidazole class of analgesic compounds. Isotonitazene is an active and potent synthetic opioid, but the extent to which this compound is causing toxicity among drug users was previously unknown. This report describes the confirmation and quantitation of isotonitazene in blood, urine and vitreous fluid through standard addition, as well as in vivo metabolic profile determination in drug users. Quantitative analysis was performed using liquid chromatography tandem mass spectrometry (LC–MS/MS), and metabolite discovery was performed using liquid chromatography quadrupole time-of-flight mass spectrometry (LC-QTOF-MS). In total, 18 cases were confirmed positive for isotonitazene, nine of which were previously negative for any opioid. The average isotonitazene concentration in blood was 2.2 ± 2.1 ng/mL (median 1.75 ng/mL, range 0.4–9.5 ng/mL), and the average isotonitazene concentration in urine was 2.4 ± 1.4 ng/mL (median 2.7 ng/mL, range 0.6–4.0 ng/mL). The lowest concentration of isotonitazene in blood was 0.4 ng/mL (two cases) with no other opioids present; findings in death investigations. Four metabolites of isotonitazene were detected in vivo. N- and O-dealkylation products were determined to be the most prominent urinary biomarkers, while 5-amino-isotonitazene was identified in most blood samples. The prevalence and popularity of isotonitazene continue to increase in the United States in early 2020. Toxicologists, medical examiners and coroners should be aware of novel opioids outside the standard scope of testing, especially in medicolegal death investigations. Forensic scientists should add isotonitazene to testing procedures, and public health officials should counsel about potent new drugs and the dangers of opioid use.
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Affiliation(s)
- Alex J Krotulski
- Center for Forensic Science Research and Education at the Fredric Rieders Family Foundation, 2300 Stratford Ave, Willow Grove, PA 19090, USA
| | - Donna M Papsun
- Toxicology Department, NMS Labs, 200 Welsh Rd, Horsham, PA 19044, USA
| | - Sherri L Kacinko
- Toxicology Department, NMS Labs, 200 Welsh Rd, Horsham, PA 19044, USA
| | - Barry K Logan
- Center for Forensic Science Research and Education at the Fredric Rieders Family Foundation, 2300 Stratford Ave, Willow Grove, PA 19090, USA
- Toxicology Department, NMS Labs, 200 Welsh Rd, Horsham, PA 19044, USA
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84
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Blackard JT, Brown JL, Lyons MS. Synthetic Opioid Use and Common Injection-associated Viruses: Expanding the Translational Research Agenda. Curr HIV Res 2020; 17:94-101. [PMID: 31210115 DOI: 10.2174/1570162x17666190618154534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 05/29/2019] [Accepted: 06/11/2019] [Indexed: 01/20/2023]
Abstract
The US is in the midst of a major epidemic of opioid addiction and related comorbidities. People with opioid use disorder (OUD) are at significant risk for transmission of several blood-borne pathogens including the human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). Commonly abused opioids and their receptors promote viral replication and virus-mediated pathology. However, most studies demonstrating an adverse effect of drugs of abuse have been conducted in vitro, the specific effects of synthetic opioids on viral replication have been poorly characterized, and the evaluation of opioid-virus interactions in clinically relevant populations is rare. Rigorous characterization of the interactions among synthetic opioids, host cells, and common injection-associated viral infections will require an interdisciplinary research approach and translational studies conducted on humans. Such research promises to improve clinical management paradigms for difficult-to-treat populations, facilitate rational public health policies given severely strained resources, and reveal additional pathways for novel target-specific therapeutic interventions. This mini-review examines the published literature on the effects of opioids on HIV, HBV, and HCV pathogenesis and proposes a series of scientific questions and considerations to establish a translational research agenda focused on opioid-virus interactions.
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Affiliation(s)
- Jason T Blackard
- Division of Digestive Diseases, Department of Internal Medicine, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH 45267, United States
| | - Jennifer L Brown
- Addiction Sciences Division, Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH 45267, United States
| | - Michael S Lyons
- Department of Emergency Medicine, University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH 45267, United States
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Gilbert N, Antonides LH, Schofield CJ, Costello A, Kilkelly B, Cain AR, Dalziel PR, Horner K, Mewis RE, Sutcliffe OB. Hitting the Jackpot – development of gas chromatography–mass spectrometry (GC–MS) and other rapid screening methods for the analysis of 18 fentanyl‐derived synthetic opioids. Drug Test Anal 2020; 12:798-811. [DOI: 10.1002/dta.2771] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 01/03/2023]
Affiliation(s)
- Nicolas Gilbert
- Faculty of Science and Engineering, Department of Natural SciencesManchester Metropolitan University Manchester UK
- MANchester DRug Analysis & Knowledge Exchange (MANDRAKE)Manchester Metropolitan University Manchester UK
| | - Lysbeth H. Antonides
- Faculty of Science and Engineering, Department of Natural SciencesManchester Metropolitan University Manchester UK
- Present address: Leverhulme Research Centre for Forensic ScienceUniversity of Dundee Dundee DD1 5EH, UK
| | - Christopher J. Schofield
- MANchester DRug Analysis & Knowledge Exchange (MANDRAKE)Manchester Metropolitan University Manchester UK
- Greater Manchester Police, Openshaw Complex, Manchester UK
| | - Andrew Costello
- MANchester DRug Analysis & Knowledge Exchange (MANDRAKE)Manchester Metropolitan University Manchester UK
- Greater Manchester Police, Openshaw Complex, Manchester UK
| | - Brenda Kilkelly
- Faculty of Science and Engineering, Department of Natural SciencesManchester Metropolitan University Manchester UK
| | - Alan R. Cain
- MANchester DRug Analysis & Knowledge Exchange (MANDRAKE)Manchester Metropolitan University Manchester UK
- Security & Business ContinuityManchester Metropolitan University Manchester UK
- Present address: NHS Manchester CCG Parkway 3, Parkway Business Centre, Princess Road Manchester M14 7LU UK
| | - Paula R.V. Dalziel
- Residential ServicesManchester Metropolitan University Business School Manchester UK
| | - Karen Horner
- Residential ServicesManchester Metropolitan University Business School Manchester UK
| | - Ryan E. Mewis
- Faculty of Science and Engineering, Department of Natural SciencesManchester Metropolitan University Manchester UK
| | - Oliver B. Sutcliffe
- Faculty of Science and Engineering, Department of Natural SciencesManchester Metropolitan University Manchester UK
- MANchester DRug Analysis & Knowledge Exchange (MANDRAKE)Manchester Metropolitan University Manchester UK
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Nan Q, Hejian W, Ping X, Baohua S, Junbo Z, Hongxiao D, Huosheng Q, Fenyun S, Yan S. Investigation of Fragmentation Pathways of Fentanyl Analogues and Novel Synthetic Opioids by Electron Ionization High-Resolution Mass Spectrometry and Electrospray Ionization High-Resolution Tandem Mass Spectrometry. JOURNAL OF THE AMERICAN SOCIETY FOR MASS SPECTROMETRY 2020; 31:277-291. [PMID: 31939667 DOI: 10.1021/jasms.9b00112] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The global drug market is characterized by the fast development of new psychoactive substances such as fentanyl analogues and novel synthetic opioids, the detection of which is complicated by the lack of appropriate quality control procedures and references. Herein, we analyze the fragmentation pathways and characteristic ions of 25 novel fentanyl analogues and 5 novel synthetic opioids by electron ionization (EI) and electrospray ionization (ESI) high-resolution mass spectrometry to provide a reference for the identification of these species. In the ESI mode, fentanyl analogues mainly undergo piperidine ring degradation, phenethyl and piperidine ring dissociation, and piperidine ring and amide moiety cleavage, while piperidine ring degradation and phenethyl and piperidine ring dissociation are the major pathways in the EI mode. The five novel synthetic opioids largely undergo amide group dissociation and N-cyclohexyl bond cleavage in the ESI mode. Thus, this work facilitates the detection and quantitation of fentanyl analogues and novel synthetic opioids or other substances with similar structures in forensic laboratories.
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Affiliation(s)
- Qin Nan
- Department of Forensic Toxicology, Shanghai Key Laboratory of Forensic Medicine , Shanghai Forensic Science Platform, Academy of Forensic Science , Shanghai 200063 , China
- School of Pharmacy , Guangdong Pharmaceutical University , Guangzhou 510006 , China
| | - Wu Hejian
- Department of Forensic Toxicology, Shanghai Key Laboratory of Forensic Medicine , Shanghai Forensic Science Platform, Academy of Forensic Science , Shanghai 200063 , China
| | - Xiang Ping
- Department of Forensic Toxicology, Shanghai Key Laboratory of Forensic Medicine , Shanghai Forensic Science Platform, Academy of Forensic Science , Shanghai 200063 , China
| | - Shen Baohua
- Department of Forensic Toxicology, Shanghai Key Laboratory of Forensic Medicine , Shanghai Forensic Science Platform, Academy of Forensic Science , Shanghai 200063 , China
| | - Zhao Junbo
- Department of Forensic Toxicology, Shanghai Key Laboratory of Forensic Medicine , Shanghai Forensic Science Platform, Academy of Forensic Science , Shanghai 200063 , China
| | - Deng Hongxiao
- Department of Forensic Toxicology, Shanghai Key Laboratory of Forensic Medicine , Shanghai Forensic Science Platform, Academy of Forensic Science , Shanghai 200063 , China
| | - Qiang Huosheng
- Department of Forensic Toxicology, Shanghai Key Laboratory of Forensic Medicine , Shanghai Forensic Science Platform, Academy of Forensic Science , Shanghai 200063 , China
| | - Song Fenyun
- School of Pharmacy , Guangdong Pharmaceutical University , Guangzhou 510006 , China
| | - Shi Yan
- Department of Forensic Toxicology, Shanghai Key Laboratory of Forensic Medicine , Shanghai Forensic Science Platform, Academy of Forensic Science , Shanghai 200063 , China
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87
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Gjerde H, Bretteville-Jensen AL, Furuhaugen H, Bache-Andreassen L, Bergh MSS, Vindenes V. Determination of drug residues in used syringe needles. Drug Test Anal 2020; 12:410-416. [PMID: 31899604 DOI: 10.1002/dta.2759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 12/02/2019] [Accepted: 12/28/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Hallvard Gjerde
- Section of Drug Abuse Research, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
| | | | - Håvard Furuhaugen
- Section of Drug Abuse Research, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
| | - Lihn Bache-Andreassen
- Section of Drug Abuse Research, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
| | - Marianne Skov-Skov Bergh
- Section of Drug Abuse Research, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
| | - Vigdis Vindenes
- Section of Drug Abuse Research, Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway.,University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
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88
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Shafi A, Berry AJ, Sumnall H, Wood DM, Tracy DK. New psychoactive substances: a review and updates. Ther Adv Psychopharmacol 2020; 10:2045125320967197. [PMID: 33414905 PMCID: PMC7750892 DOI: 10.1177/2045125320967197] [Citation(s) in RCA: 108] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/26/2020] [Indexed: 12/19/2022] Open
Abstract
New psychoactive substances (NPS) are a heterogeneous group of substances. They are associated with a number of health and social harms on an individual and societal level. NPS toxicity and dependence syndromes are recognised in primary care, emergency departments, psychiatric inpatient and community care settings. One pragmatic classification system is to divide NPS into one of four groups: synthetic stimulants, synthetic cannabinoids, synthetic hallucinogens and synthetic depressants (which include synthetic opioids and benzodiazepines). We review these four classes of NPS, including their chemical structures, mechanism of action, modes of use, intended intoxicant effects, and their associated physical and mental health harms. The current challenges faced by laboratory testing for NPS are also explored, in the context of the diverse range of NPS currently available, rate of production and emergence of new substances, the different formulations, and methods of acquisition and distribution.
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Affiliation(s)
- Abu Shafi
- East London Foundation Trust, London, UK
| | - Alex J Berry
- Division of Psychiatry, University College London, UK
| | | | - David M Wood
- Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Derek K Tracy
- Consultant Psychiatrist, Oxleas NHS Foundation Trust, London, UK
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Bán EG, Brassai A, Vizi ES. The role of the endogenous neurotransmitters associated with neuropathic pain and in the opioid crisis: The innate pain-relieving system. Brain Res Bull 2019; 155:129-136. [PMID: 31816407 DOI: 10.1016/j.brainresbull.2019.12.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 11/22/2019] [Accepted: 12/02/2019] [Indexed: 12/28/2022]
Abstract
Neuropathic pain is a chronic pain caused by central and peripheral nerve injury, long-term diabetes or treatment with chemotherapy drugs, and it is dissimilar to other chronic pain conditions. Chronic pain usually seriously affects the quality of life, and its drug treatment may result in increased costs of social and medical care. As in the USA and Canada, in Europe, the demand for pain-relieving medicines used in chronic pain has also significantly increased, but most European countries are not experiencing an opioid crisis. In this review, the role of various endogenous transmitters (noradrenaline, dopamine, serotonin, met- and leu-enkephalins, β-endorphin, dynorphins, cannabinoids, ATP) and various receptors (α2, μ, etc.) in the innate pain-relieving system will be discussed. Furthermore, the modulation of pain processing pathways by transmitters, focusing on neuropathic pain and the role of the sympathetic nervous system in the side effects of excessive opioid treatment, will be explained.
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Affiliation(s)
- E Gy Bán
- Dept. ME1, Faculty of Medicine in English, "George Emil Palade" University of Medicine, Pharmacy, Science and Technology of Târgu-Mureș, Marosvásárhely, Romania
| | - A Brassai
- Dept. ME1, Faculty of Medicine in English, "George Emil Palade" University of Medicine, Pharmacy, Science and Technology of Târgu-Mureș, Marosvásárhely, Romania
| | - E S Vizi
- Institute of Experimental Medicine, Budapest, Hungary; Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary.
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90
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91
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Greenblatt DJ. Public Health Risk of Designer Psychotropic Drugs: Should PHASE Be Phased In? Clin Pharmacol Ther 2019; 106:1175-1176. [DOI: 10.1002/cpt.1578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 06/20/2019] [Indexed: 11/06/2022]
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92
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Therapeutic efficacy of environmental enrichment for substance use disorders. Pharmacol Biochem Behav 2019; 188:172829. [PMID: 31778722 DOI: 10.1016/j.pbb.2019.172829] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 11/13/2019] [Accepted: 11/15/2019] [Indexed: 12/18/2022]
Abstract
Addiction to drug and alcohol is regarded as a major health problem worldwide for which available treatments show limited effectiveness. The biggest challenge remains to enhance the capacities of interventions to reduce craving, prevent relapse and promote long-term recovery. New strategies to meet these challenges are being explored. Findings from preclinical work suggest that environmental enrichment (EE) holds therapeutic potential for the treatment of substance use disorders, as demonstrated in a number of animal models of drug abuse. The EE intervention introduced after drug exposure leads to attenuation of compulsive drug taking, attenuation of the rewarding (and reinforcing) effects of drugs, reductions in control of behavior by drug cues, and, very importantly, relapse prevention. Clinical work also suggests that multidimensional EE interventions (involving physical activity, social interaction, vocational training, recreational and community involvement) might produce similar therapeutic effects, if implemented continuously and rigorously. In this review we survey preclinical and clinical studies assessing the efficacy of EE as a behavioral intervention for substance use disorders and address related challenges. We also review work providing empirical evidence for EE-induced neuroplasticity within the mesocorticolimbic system that is believed to contribute to the seemingly therapeutic effects of EE on drug and alcohol-related behaviors.
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93
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Lister JJ, Ellis JD, Yoon M. Opioid prescribing and opioid-overdose deaths in Michigan: Urban-rural comparisons and changes across 2013-2017. Addict Behav Rep 2019; 11:100234. [PMID: 32467830 PMCID: PMC7244930 DOI: 10.1016/j.abrep.2019.100234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 11/12/2019] [Accepted: 11/12/2019] [Indexed: 01/17/2023] Open
Abstract
Examined opioid prescribing and opioid-overdose death rates in Michigan counties. Conducted urban-rural county comparisons and tested for changes across 2013–2017. Higher rates of overdose deaths in urban, and higher rates of prescribing in rural. Opioid-overdose death rates rose in both urban and rural counties across 2013–2017. Opioid prescribing rates did not change in urban or rural counties across 2013–2017.
Background Opioid-overdose deaths and opioid prescriptions have increased substantially within the past decade, leading to examinations of urban-rural differences for these opioid-related outcomes, and whether annual trends differ by urban-rural status. Most investigations have examined differences using national data, whereas few studies have identified patterns in hard-hit regions. Therefore, we examined urban-rural differences for opioid-related outcomes in Michigan, a state with overdose death and prescribing rates above the national average. Methods This study used county-level public data on opioid prescribing and opioid-overdose death rates in Michigan. Bivariate and joinpoint regression analyses tested for annual differences and annual changes in opioid-related outcomes across 2013–2017. Rural Urban Continuum Codes classified urban-rural county status. Results Bivariate analyses demonstrated that urban counties had consistently higher opioid-overdose death rates than rural, whereas rural counties had consistently higher opioid prescribing rates than urban. Joinpoint regression (2013–2017) revealed opioid-overdose death rates increased in urban (Annual Percent Change = 25.0%, p = .001) and rural counties (Annual Percent Change = 21.7%, p = .002), though no changes for opioid prescribing rates were observed among urban or rural counties. Conclusions Our study highlights nuanced urban-rural patterns in Michigan, a hard-hit state, compared to trends in national data. Both urban and rural counties experienced rising rates of opioid-overdose deaths, and rural counties experienced higher opioid prescribing rates than urban. Though urban counties experienced higher opioid-overdose death rates than rural, the rise in both county types was similar. Future research directions, implications for public health, and healthcare policy recommendations are discussed.
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Affiliation(s)
- Jamey J Lister
- Rutgers, The State University of New Jersey, School of Social Work, USA.,Wayne State University, School of Medicine, Department of Psychiatry and Behavioral Neurosciences, USA
| | - Jennifer D Ellis
- Wayne State University, School of Medicine, Department of Psychiatry and Behavioral Neurosciences, USA.,Wayne State University, Department of Psychology, USA
| | - Miyoung Yoon
- Case Western Reserve University, Jack, Joseph and Morton Mandel School of Applied Social Sciences, USA
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94
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Single-calibrant quantification of seized synthetic opioids by liquid chromatography-chemiluminescence nitrogen detection. Forensic Sci Int 2019; 305:110001. [PMID: 31704516 DOI: 10.1016/j.forsciint.2019.110001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/06/2019] [Accepted: 10/20/2019] [Indexed: 11/22/2022]
Abstract
Drug seizures involving a wide variety of emerging new psychoactive substances (NPS) call for new approaches for instant quantification and valuation. Liquid chromatography-chemiluminescence nitrogen detection (LC-CLND) was used in the quantification of opioids with a single secondary standard (caffeine), utilizing the detector's equimolar response to nitrogen. The mean N-equimolarity of CLND for ten fentanyl derivatives and U-47700 by the present LC-CLND method was 96.4% (range 91-101%). The furanylfentanyl samples consisted of 112 powdery samples with a mean (median, range) hydrochloride purity of 13% (4.9%, 0.08-100%). The purity distribution of the furanylfentanyl samples was distinctly bipartite, showing only lower than 9% (N=98) and higher than 60% (N=14) purities. The carfentanil samples consisted of eight brownish sticky samples with a mean (median, range) hydrochloride purity of 0.064% (0.063%, 0.052-0.092%). The U-47700 samples consisted of seven powdery samples with a mean (median, range) hydrochloride purity of 89.0% (100%, 51-100%). The present application to synthetic opioid analysis widens the scope of the established LC-CLND method, previously found useful for single-calibrant quantification of stimulant/hallucinogenic and cannabinoid type of NPS.
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95
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Pilot Study on Risk Perceptions and Knowledge of Fentanyl Exposure Among New York State First Responders. Disaster Med Public Health Prep 2019; 14:437-441. [PMID: 31571559 DOI: 10.1017/dmp.2019.95] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The present opioid epidemic and abuse of fentanyl in the United States has led to an increased risk of exposure to first responders. Law enforcement, fire, and emergency medical services are receiving misinformation on fentanyl health and safety risks and this has led to miscommunication. Understanding the risk perceptions and knowledge of first responders regarding fentanyl can help identify training gaps. METHODS A 15-item 6-point Likert scale online questionnaire was developed and distributed to firefighters, police officers, and emergency medical technicians, regarding perceptions of fentanyl exposure, and additional questions concerning knowledge. The online questionnaire was sent to 15 associations of national and New York State first responders with 3 associations acknowledging and distributing the survey. RESULTS Of the 247 participants, 187 served New York State; 92 worked in law enforcement; and the other 95 worked in either fire, emergency medical service, or both. New York State first responders generally agreed with expert risk perceptions and knowledge of fentanyl exposure in the pilot study. Items pertaining to using hand sanitizer, selecting glove type, and dermal exposure to fentanyl had lower agreement with expert beliefs. CONCLUSIONS Risk perceptions and knowledge could be used to evaluate fentanyl response training among first responders.
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96
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Torralva R, Janowsky A. Noradrenergic Mechanisms in Fentanyl-Mediated Rapid Death Explain Failure of Naloxone in the Opioid Crisis. J Pharmacol Exp Ther 2019; 371:453-475. [PMID: 31492824 DOI: 10.1124/jpet.119.258566] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 09/03/2019] [Indexed: 12/25/2022] Open
Abstract
In December 2018, the Centers for Disease Control declared fentanyl the deadliest drug in America. Opioid overdose is the single greatest cause of death in the United States adult population (ages 18-50), and fentanyl and its analogs [fentanyl/fentanyl analogs (F/FAs)] are currently involved in >50% of these deaths. Anesthesiologists in the United States were introduced to fentanyl in the early 1970s when it revolutionized surgical anesthesia by combining profound analgesia with hemodynamic stability. However, they quickly had to master its unique side effect. F/FAs can produce profound rigidity in the diaphragm, chest wall and upper airway within an extremely narrow dosing range. This clinical effect was called wooden chest syndrome (WCS) by anesthesiologists and is not commonly known outside of anesthesiology or to clinicians or researchers in addiction research/medicine. WCS is almost routinely fatal without expert airway management. This review provides relevant clinical human pharmacology and animal data demonstrating that the significant increase in the number of F/FA-induced deaths may involve α-adrenergic and cholinergic receptor-mediated mechanical failure of the respiratory and cardiovascular systems with rapid development of rigidity and airway closure. Although morphine and its prodrug, heroin, can cause mild rigidity in abdominal muscles at high doses, neither presents with the distinct and rapid respiratory failure seen with F/FA-induced WCS, separating F/FA overdose from the slower onset of respiratory depression caused by morphine-derived alkaloids. This distinction has significant consequences for the design and implementation of new pharmacologic strategies to effectively prevent F/FA-induced death. SIGNIFICANCE STATEMENT: Deaths from fentanyl and F/FAs are increasing in spite of availability and awareness of the opioid reversal drug naloxone. This article reviews literature suggesting that naloxone may be ineffective against centrally mediated noradrenergic and cholinergic effects of F/FAs, which clinically manifest as severe muscle rigidity and airway compromise (e.g., wooden chest syndrome) that is rapid and distinct from respiratory depression seen with morphine-derived alkaloids. A physiologic model is proposed and implications for new drug development and treatment are discussed.
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Affiliation(s)
- Randy Torralva
- CODA Inc., Research Department, Portland, Oregon (R.T.); Research Service, VA Portland Health Care System, Portland, Oregon (R.T., A.J.); and Department of Psychiatry, Oregon Health & Science University, Portland, Oregon (R.T., A.J.)
| | - Aaron Janowsky
- CODA Inc., Research Department, Portland, Oregon (R.T.); Research Service, VA Portland Health Care System, Portland, Oregon (R.T., A.J.); and Department of Psychiatry, Oregon Health & Science University, Portland, Oregon (R.T., A.J.)
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Utility of fentanyl vaccines: unique challenges posed by preventing opioid overdose and treating opioid use disorder. Neuropsychopharmacology 2019; 44:1675-1676. [PMID: 31127167 PMCID: PMC6785139 DOI: 10.1038/s41386-019-0418-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 04/29/2019] [Indexed: 01/08/2023]
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98
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Kim HK, Connors NJ, Mazer-Amirshahi ME. The role of take-home naloxone in the epidemic of opioid overdose involving illicitly manufactured fentanyl and its analogs. Expert Opin Drug Saf 2019; 18:465-475. [DOI: 10.1080/14740338.2019.1613372] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Hong K. Kim
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Nicholas J. Connors
- Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Maryann E. Mazer-Amirshahi
- Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC, USA
- School of Medicine, Georgetown University, Washington, DC, USA
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Vohra V, Hodgman M, Marraffa J, Barba K, Stoppacher R. Fentanyl- and fentanyl analog-related deaths across five counties in Central New York between 2013 and 2017. Clin Toxicol (Phila) 2019; 58:112-116. [DOI: 10.1080/15563650.2019.1613548] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Varun Vohra
- Upstate NY Poison Center, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Michael Hodgman
- Upstate NY Poison Center, SUNY Upstate Medical University, Syracuse, NY, USA
- Department of Emergency Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Jeanna Marraffa
- Upstate NY Poison Center, SUNY Upstate Medical University, Syracuse, NY, USA
- Department of Emergency Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Kristie Barba
- Onondaga County Medical Examiner’s Office, Syracuse, NY, USA
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100
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Evidence for nonlinear accumulation of the ultrapotent fentanyl analog, carfentanil, after systemic administration to male rats. Neuropharmacology 2019; 158:107596. [PMID: 30965021 DOI: 10.1016/j.neuropharm.2019.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/03/2019] [Accepted: 04/03/2019] [Indexed: 11/21/2022]
Abstract
The current opioid overdose crisis is being exacerbated by illicitly manufactured fentanyl and its analogs. Carfentanil is a fentanyl analog that is 10,000-times more potent than morphine, but limited information is available about its pharmacology. The present study had two aims: 1) to validate a method for quantifying carfentanil and its metabolite norcarfentanil in small-volume samples, and 2) to use the method for examining pharmacodynamic-pharmacokinetic relationships in rats. The analytical method involved liquid-liquid extraction of plasma samples followed by quantitation of carfentanil and norcarfentanil using ultra-high-performance liquid chromatography coupled to tandem mass spectrometry (UHPLC-MS/MS). The method was validated following SWGTOX guidelines, and both analytes displayed limits of detection and quantification at 7.5 and 15 pg/mL, respectively. Male Sprague-Dawley rats fitted with jugular catheters and temperature transponders received subcutaneous carfentanil (1, 3 and 10 μg/kg) or saline. Repeated blood specimens were obtained over 8 h, along with pharmacodynamic measures including core temperature and catalepsy scores. Carfentanil produced dose-related hypothermia and catalepsy that lasted up to 8 h. Carfentanil Cmax occurred at 15 min whereas metabolite Cmax was at 1-2 h. Concentrations of both analytes increased in a dose-related fashion, but area-under-the-curve values were much greater than predicted after 10 μg/kg. Plasma half-life for carfentanil increased at higher doses. Our findings reveal that carfentanil produces marked hypothermia and catalepsy, which is accompanied by nonlinear accumulation of the drug at high doses. We hypothesize that impaired clearance of carfentanil in humans could contribute to life-threatening effects of this ultrapotent opioid agonist. This article is part of the Special Issue entitled 'New Vistas in Opioid Pharmacology'.
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