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Skryabin VY, Vinnikova MA. Clinical characteristics of synthetic cannabinoid-induced psychotic disorders: a single-center analysis of hospitalized patients. J Addict Dis 2019; 37:135-141. [PMID: 31272306 DOI: 10.1080/10550887.2019.1627635] [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] [Indexed: 10/26/2022]
Abstract
This study was designed to evaluate synthetic cannabinoid (SC)-induced psychotic disorders in terms of their structure and clinical characteristics among hospitalized patients in Russia. It was a longitudinal, observational cohort study which included a total of 46 male patients who underwent the inpatient treatment in the intensive care unit or emergency department due to the SC-induced psychoses. Data on sociodemographic and disease-related characteristics, psychometric assessment scales obtained in face-to-face interviews, were recorded in all patients. The duration of catamnestic follow-up period was 2 years, with the major focus on manifestation of the schizophrenic process. Mean (SD) age of the patients with psychotic disorders induced by the SC use was 23.2 (3.5) years. Among 46 patients, 29 (63%) were SC-dependent and 17 (37%) were diagnosed with SC abuse. Average age at onset was 16.4 for psychoactive substances and 19.7 years for SC use. Marijuana was the most common first used substance. Based on our observations, we identified four clinical variants of the SC-induced psychoses. Our findings revealed that psychotic disorders are typical for the SC intoxication and most commonly influence young adults. Based on our observations, we identified four clinical variants of the SC-induced psychoses and revealed the signs which may indicate them. This study emphasizes the role of appropriate psychiatric management of SC-induced psychoses, since often only catamnestic long-term follow-up enables clinicians to determine the correct diagnosis and reveal the manifestation of the schizophrenic process.
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Affiliation(s)
- V Yu Skryabin
- Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia
| | - M A Vinnikova
- Moscow Research and Practical Centre on Addictions of the Moscow Department of Healthcare, Moscow, Russia.,I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
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Krotulski AJ, Mohr AL, Kacinko SL, Fogarty MF, Shuda SA, Diamond FX, Kinney WA, Menendez M, Logan BK. 4F‐MDMB‐BINACA: A New Synthetic Cannabinoid Widely Implicated in Forensic Casework. J Forensic Sci 2019; 64:1451-1461. [DOI: 10.1111/1556-4029.14101] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 05/17/2019] [Accepted: 05/20/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Alex J. Krotulski
- Center for Forensic Science Research and Education (CFSRE) Fredric Rieders Family Foundation 2300 Stratford Avenue Willow Grove PA
| | - Amanda L.A. Mohr
- Center for Forensic Science Research and Education (CFSRE) Fredric Rieders Family Foundation 2300 Stratford Avenue Willow Grove PA
| | | | - Melissa F. Fogarty
- Center for Forensic Science Research and Education (CFSRE) Fredric Rieders Family Foundation 2300 Stratford Avenue Willow Grove PA
| | - Sarah A. Shuda
- Center for Forensic Science Research and Education (CFSRE) Fredric Rieders Family Foundation 2300 Stratford Avenue Willow Grove PA
| | - Francis X. Diamond
- Center for Forensic Science Research and Education (CFSRE) Fredric Rieders Family Foundation 2300 Stratford Avenue Willow Grove PA
| | | | - M.J. Menendez
- Organized Crime Drug Enforcement Task Force (OCDETF) U.S. Department of Justice 950 Pennsylvania Avenue NW Washington DC
| | - Barry K. Logan
- Center for Forensic Science Research and Education (CFSRE) Fredric Rieders Family Foundation 2300 Stratford Avenue Willow Grove PA
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Sharma KK, Hales TG, Rao VJ, NicDaeid N, McKenzie C. The search for the "next" euphoric non-fentanil novel synthetic opioids on the illicit drugs market: current status and horizon scanning. Forensic Toxicol 2018; 37:1-16. [PMID: 30636980 PMCID: PMC6314991 DOI: 10.1007/s11419-018-0454-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 11/11/2018] [Indexed: 12/02/2022]
Abstract
PURPOSE A detailed review on the chemistry and pharmacology of non-fentanil novel synthetic opioid receptor agonists, particularly N-substituted benzamides and acetamides (known colloquially as U-drugs) and 4-aminocyclohexanols, developed at the Upjohn Company in the 1970s and 1980s is presented. METHOD Peer-reviewed literature, patents, professional literature, data from international early warning systems and drug user fora discussion threads have been used to track their emergence as substances of abuse. RESULTS In terms of impact on drug markets, prevalence and harm, the most significant compound of this class to date has been U-47700 (trans-3,4-dichloro-N-[2-(dimethylamino)cyclohexyl]-N-methylbenzamide), reported by users to give short-lasting euphoric effects and a desire to re-dose. Since U-47700 was internationally controlled in 2017, a range of related compounds with similar chemical structures, adapted from the original patented compounds, have appeared on the illicit drugs market. Interest in a structurally unrelated opioid developed by the Upjohn Company and now known as BDPC/bromadol appears to be increasing and should be closely monitored. CONCLUSIONS International early warning systems are an essential part of tracking emerging psychoactive substances and allow responsive action to be taken to facilitate the gathering of relevant data for detailed risk assessments. Pre-emptive research on the most likely compounds to emerge next, so providing drug metabolism and pharmacokinetic data to ensure that new substances are detected early in toxicological samples is recommended. As these compounds are chiral compounds and stereochemistry has a large effect on their potency, it is recommended that detection methods consider the determination of configuration.
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Affiliation(s)
- Kirti Kumari Sharma
- Fluoro Agro Chemicals Division, CSIR-Indian Institute of Chemical Technology, Hyderabad, 500007 India
- AcSIR-IICT, CSIR-Indian Institute of Chemical Technology, Hyderabad, 500007 India
| | - Tim G. Hales
- Division of Systems Medicine, School of Medicine, Ninewells Hospital University of Dundee, Dundee, UK
| | - Vaidya Jayathirtha Rao
- Fluoro Agro Chemicals Division, CSIR-Indian Institute of Chemical Technology, Hyderabad, 500007 India
- AcSIR-IICT, CSIR-Indian Institute of Chemical Technology, Hyderabad, 500007 India
| | - Niamh NicDaeid
- Forensic Drug Research Group, Centre for Anatomy and Human Identification, School of Science and Engineering, University of Dundee, Dundee, UK
- Leverhulme Research Centre for Forensic Science, School of Science and Engineering, University of Dundee, Dundee, UK
| | - Craig McKenzie
- Forensic Drug Research Group, Centre for Anatomy and Human Identification, School of Science and Engineering, University of Dundee, Dundee, UK
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Richeval C, Gaulier JM, Romeuf L, Allorge D, Gaillard Y. Case report: relevance of metabolite identification to detect new synthetic opioid intoxications illustrated by U-47700. Int J Legal Med 2018; 133:133-142. [PMID: 30443678 DOI: 10.1007/s00414-018-1969-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 11/09/2018] [Indexed: 01/11/2023]
Abstract
Today, new psychoactive substances (NPS) producers increasingly appear to be targeting new synthetic opioids (NSOs), and the recent emergence of NSOs is causing considerable concern in North America and in Europe. For toxicologists, NSO detection in a forensic context presents three additional difficulties to the general NPS analytical detection challenge: (i) high frequency of new products, (ii) low concentrations (in μg/L range and under) in biological samples related to their high opioid potency, and (iii) extensive metabolism. In this context, the present work aims to highlight the relevance of NSO metabolite detection in potential intoxication cases. Illustration is given with U-47700, an emerging NSO, (i) that was identified in a powder recently collected in France and in a fatality case, (ii) whose metabolites were in vitro produced using human liver microsomes and their mass spectra (MS) added in our MS/MS and HRMS libraries, and (iii) for which metabolism data were compared to those of the literature: U-47700 was identified in the powder and at 3040 μg/L in peripheral blood in the fatality case. In addition, high amounts of several U-47700 metabolites, especially N-desmethyl-U-47700, were observed in urine. Even if metabolite formation may largely depend on the enzymatic activity as well as on the length of the survival time, confrontation of these results to data found in the literature strongly suggests that this metabolite is regularly a better blood and (mainly) urine biomarker of U-47700 intake than U-47700 itself. Indeed, in this fatality and in other previous reports, N-desmethyl-U-47700 produced the main observed chromatographic signal (i) systematically in vitro and (ii) commonly in vivo, especially in urines. N,N-Didesmethyl-U-47700 is also sometimes a better biomarker of U-47700 intake than U-47700 itself. Accordingly, we suggest adding N-desmethyl-U-47700 (and N,N-didesmethyl-U-47700) in mass spectrum databases used for toxicological screening in order to reduce the risk of false-negative results in intoxication cases involving U-47700.
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Affiliation(s)
- Camille Richeval
- Unité Fonctionnelle de Toxicologie, CHU Lille, 59000, Lille, France.,EA 4483 - IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, University of Lille, 59000, Lille, France
| | - Jean-Michel Gaulier
- Unité Fonctionnelle de Toxicologie, CHU Lille, 59000, Lille, France. .,EA 4483 - IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, University of Lille, 59000, Lille, France.
| | | | - Delphine Allorge
- Unité Fonctionnelle de Toxicologie, CHU Lille, 59000, Lille, France.,EA 4483 - IMPECS - IMPact de l'Environnement Chimique sur la Santé humaine, University of Lille, 59000, Lille, France
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Concheiro M, Chesser R, Pardi J, Cooper G. Postmortem Toxicology of New Synthetic Opioids. Front Pharmacol 2018; 9:1210. [PMID: 30416445 PMCID: PMC6212520 DOI: 10.3389/fphar.2018.01210] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 10/04/2018] [Indexed: 01/09/2023] Open
Abstract
One hundred fifteen Americans die every day from opioid overdose. These overdose fatalities have been augmented by the increased availability of potent synthetic opioids, such as fentanyl and its derivatives. The death rate of synthetic opioids, other than methadone, increased by 72.2% from 2014 to 2015, and doubled from 2015 to 2016, situating the USA in the midst of an opioid overdose epidemic. The analytical identification of these opioids in postmortem samples and the correct toxicological data interpretation is critical to identify and implement preventive strategies. This article reviews the current knowledge of postmortem toxicology of synthetic opioids and the chemical and pharmacological factors that may affect drug concentrations in the different postmortem matrices and therefore, their interpretation. These factors include key chemical properties, essential pharmacokinetics parameters (metabolism), postmortem redistribution and stability data in postmortem samples. Range and ratios of concentrations reported in traditional and non-traditional postmortem specimens, blood, urine, vitreous humor, liver and brain, are summarized in tables. The review is focused on fentanyl and derivatives (e.g., acetyl fentanyl, butyryl fentanyl, carfentanil, furanyl fentanyl, 4-methoxybutyrylfentanyl, 4-fluorobutyrylfentanyl, ocfentanil) and non-traditional opioid agonists (e.g., AH-7921, MT-45, U-47700). All of these data are critically compared to postmortem data, and chemical and pharmacological properties of natural opioids (morphine), semi-synthetic (oxycodone, hydrocodone, hydromorphone, and oxymorphone), and synthetic opioids (methadone and buprenorphine). The interpretation of drug intoxication in death investigation is based on the available published literature. This review serves to facilitate the evaluation of cases where synthetic opioids may be implicated in a fatality through the critical review of peer reviewed published case reports and research articles.
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Affiliation(s)
- Marta Concheiro
- Department of Sciences, John Jay College of Criminal Justice, City University of New York, New York, NY, United States
| | - Rachel Chesser
- Department of Sciences, John Jay College of Criminal Justice, City University of New York, New York, NY, United States
| | - Justine Pardi
- Department of Forensic Toxicology, New York Office of the Chief Medical Examiner, New York, NY, United States
| | - Gail Cooper
- Department of Forensic Toxicology, New York Office of the Chief Medical Examiner, New York, NY, United States
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