n-(1-phenethylpiperidin-4-yl)-n-phenylacetamide and Drug-Overdose

The detection of fentanyl (FEN) and FEN analogs has been widely communicated throughout the scientific community. While most of the reporting has been in relation to overdose deaths, these drugs are commonly detected in impaired driving cases. A retrospective study of impaired driving cases analyzed between 2017 and 2019 produced 270 cases positive for FEN, carfentanil (CFEN) and/or acetylfentanyl (AFEN). FEN was the predominant drug found in these 270 cases (65.5%) with concentrations ranging from less than 1.0 to 64 ng/mL. CFEN was found alone in 6.6% cases with three concentrations above 1.0 ng/mL. AFEN was always found when FEN was positive with concentrations ranging from <1.0 to 9.2 ng/mL. Detailed case histories are provided with corresponding toxicology results. Toxicology results show impaired drivers using multiple drugs with a wide range of observed behaviors. The inclusion of these drugs in routine impaired driver toxicology testing is extremely important when attempting to determine their overall prevalence.

Topics: Analgesics, Opioid; Drug Overdose; Fentanyl; Humans; Retrospective Studies; Substance Abuse Detection

Synthetic opioids are compounds that were created to act on the opioid receptors. Novel synthetic opioids include various analogs of fentanyl (e.g., acetylfentanyl, acryloylfentanyl, carfentanil, furanylfentanyl, 4-fluorobutyrylfentanyl or ocfentanil) and newly emerging non-fentanyl compounds with different chemical structures, such as AH-7921, MT-45, and U-47700. In the last years, these drugs have rapidly emerged on the recreational drug market, and their abuse has been increasing worldwide. Due to the high potency and the low dose required to produce desired effects, the risk of overdose for these compounds including severe health implications, is quite high. Several fatal intoxication cases related to the abuse of synthetic opioids have recently been reported in the literature.. As a consequence, the detection of these compounds in biological samples is crucial in order to get a better understanding of their concentration and distribution in body fluids. We overviewed the analytical approaches for the investigation of synthetic opioids in postmortem samples reported in the literature, with special emphasis given to cases of lethal intoxication.

Topics: Analgesics, Opioid; Benzamides; Drug Overdose; Fentanyl; Humans; Illicit Drugs; Piperidines

Acetyl fentanyl (AF) is a Schedule I fentanyl analog that has been increasingly seen in heroin and fentanyl polydrug toxicity overdoses in Michigan (MI). Drug users are often unaware of the presence of AF in their drugs because it is often sold mixed into or disguised as heroin. High levels of AF in heroin drug products can cause increased incidence of overdose. This article describes data from a longitudinal opioid surveillance program and details 102 decedents in MI who were found to have evidence of heroin in their postmortem blood. A large portion of these decedents were also found to have evidence of fentanyl and AF. Our data further show significant overlap in incidence rates of AF and heroin-related overdose deaths in several MI counties, suggesting that AF is becoming enmeshed in heroin trafficking. Furthermore, we report unprecedented high incidence rates of AF and heroin-related overdose deaths in Calhoun county, and we propose that it is a high-intensity drug trafficking area. Highways US-131 and US-31 are likely used to transport these drugs. More study is needed into the drug trafficking trends in MI to ascertain drug sources and monitor the ever developing and dangerous polydrug heroin combinations.

Topics: Adult; Analgesics, Opioid; Chromatography, Liquid; Drug Overdose; Drug Trafficking; Female; Fentanyl; Forensic Toxicology; Heroin; Heroin Dependence; Humans; Illicit Drugs; Male; Michigan; Middle Aged; Population Surveillance; Substance Abuse Detection; Tandem Mass Spectrometry

Acetyl fentanyl (N-[1-phenethylpiperidin-4-yl]-N-phenylacetamide) is a potent opioid analgesic with no medicinal uses. We report deaths between 2016 and 2017 at the Medical Examiner's Office in Detroit, MI where acetyl fentanyl was found in the decedent's blood and compare them to previously published deaths between 2015 and 2016. The recent cases (cohort B) had a mean acetyl fentanyl concentration of 0.9 ng/mL (range: 0.1-5.3 ng/mL) and an associated higher concentration of fentanyl along with multiple other drugs present. The older cases (cohort A) had higher concentrations of acetyl fentanyl (mean: 8.9 ng/mL; range: 0.28-37 ng/mL) with lower, yet still toxic, concentrations of fentanyl. We conclude that the cause of death in these recent cases was likely multiple drug toxicity with fentanyl and that the consistently observed lower peripheral blood concentrations of acetyl fentanyl are most likely an artifact in the manufacture of the consumed illicit fentanyl.

Topics: Adult; Analgesics, Opioid; Benzodiazepines; Central Nervous System Depressants; Chromatography, Liquid; Cocaine; Cohort Studies; Coroners and Medical Examiners; Drug Overdose; Ethanol; Female; Fentanyl; Heroin; Humans; Illicit Drugs; Male; Mass Spectrometry; Michigan; Opioid-Related Disorders; Racial Groups; Urban Population

Acetyl fentanyl is a Schedule I controlled synthetic opioid that is becoming an increasingly detected "designer drug." Routine drug screening procedures in local forensic toxicology laboratories identified a total of 41 overdose deaths associated with acetyl fentanyl within multiple counties of the southwestern region of the state of Pennsylvania. The range, median, mean, and standard deviation of blood acetyl fentanyl concentrations for these 41 cases were 0.13-2100 ng/mL, 11 ng/mL, 169.3 ng/mL, and 405.3 ng/mL, respectively. Thirty-six individuals (88%) had a confirmed history of substance abuse, and all but one case (96%) were ruled multiple drug toxicities. This report characterizes this localized trend of overdose deaths associated with acetyl fentanyl and provides further evidence supporting an alarmingly concentrated opiate and opioid epidemic of both traditional and novel drugs within this region of the United States.

Topics: Adult; Analgesics, Opioid; Designer Drugs; Drug Overdose; Female; Fentanyl; Gas Chromatography-Mass Spectrometry; Humans; Male; Middle Aged; Opioid-Related Disorders; Pennsylvania; Young Adult

In this case report, we present an evaluation of the distribution of postmortem concentrations of butyr-fentanyl in a fatality attributed principally to the drug. A man who had a history of intravenous drug abuse was found unresponsive on the bathroom floor of his home. Drug paraphernalia was located on the bathroom counter. Toxicology testing, which initially screened positive for fentanyl by enzyme-linked immunosorbent assay, subsequently confirmed butyr-fentanyl, which was then quantitated by gas chromatography-mass spectrometry-specific ion monitoring (GC-MS SIM) analysis following liquid-liquid extraction. The butyr-fentanyl peripheral blood concentration was quantitated at 58 ng/mL compared with the central blood concentration of 97 ng/mL. The liver concentration was 320 ng/g, the vitreous was 40 ng/mL, the urine was 670 ng/mL and the gastric contained 170 mg. Acetyl-fentanyl was also detected in all biological specimens tested. Peripheral blood concentration was quantitated at 38 ng/mL compared with the central blood concentration of 32 ng/mL. The liver concentration was 110 ng/g, the vitreous was 38 ng/mL, the urine was 540 ng/mL and the gastric contained <70 mg. The only other drug detected was a relatively low concentration of benzoylecgonine. The cause of death was certified as acute butyr-fentanyl, acetyl-fentanyl and cocaine intoxication, and the manner of death was certified as accident.

Topics: Adult; Analgesics, Opioid; Cocaine; Drug Overdose; Enzyme-Linked Immunosorbent Assay; Fatal Outcome; Fentanyl; Forensic Toxicology; Gas Chromatography-Mass Spectrometry; Humans; Liquid-Liquid Extraction; Male; Opioid-Related Disorders; Substance Abuse, Intravenous

We present a fatal case of intoxication due to insufflation of acetyl fentanyl. His blood concentration of acetyl fentanyl was 270ng/mL, and the manner of death was classified as an accident. This is the first report of an autopsy case of acetyl fentanyl delivered by insufflation, rather than intravenous administration. He had been snoring loudly for at least 12h prior to death, and transport to a hospital during this time and treatment with naloxone may have saved his life. In this sense, it can be said that his death was preventable. This case reemphasizes the risk of death associated with drug overdose and the narrow range of acetyl fentanyl between the effective dose (ED50) and lethal dose (LD50). The case should also raise awareness among medical professionals of the effectiveness of naloxone and the need to establish a comprehensive system for toxicological analysis while keeping the possibility of use of 'designer drugs' in mind.

Topics: Adult; Autopsy; Designer Drugs; Drug Overdose; Fentanyl; Forensic Toxicology; Humans; Insufflation; Male

Topics: Adult; Aged; Analgesics, Opioid; Databases, Factual; Drug Overdose; Enzyme-Linked Immunosorbent Assay; Female; Fentanyl; Gas Chromatography-Mass Spectrometry; Humans; Male; Middle Aged; Needles; Rhode Island; Risk Factors; Socioeconomic Factors; Young Adult

Topics: Analgesics, Opioid; Drug and Narcotic Control; Drug Contamination; Drug Overdose; Fentanyl; Heroin; Humans; Illicit Drugs