Bäckberg Matilda, Beck Olof, Jönsson Karl-Henrik, Helander Anders
Swedish Poisons Information Centre , Stockholm , Sweden.
Clin Toxicol (Phila). 2015;53(7):609-17. doi: 10.3109/15563650.2015.1054505. Epub 2015 Jun 17.
The supply of unregulated "new psychoactive substances" (NPS) has shown a steady increase over the past six years. This report from the Swedish STRIDA project describes analytically confirmed non-fatal intoxications involving butyrfentanyl (butyrylfentanyl) or 4-fluorobutyrfentanyl (para-fluorobutyrfentanyl), two fentanyl analogues recently introduced as NPS opioids.
Observational case series of consecutive patients with suspected acute NPS exposure and requiring hospital care from all over Sweden.
From May 2014 to January 2015, blood and urine samples were obtained from four intoxication cases involving butyrfentanyl and one case involving 4-fluorobutyrfentanyl (men, 19-30 years) presenting in emergency departments (ED) or intensive care units (ICU). Laboratory analysis of serum and/or urine samples was performed by multi-component liquid chromatography-mass spectrometry methods. Data on clinical features were collected during consultations with the Poisons Information Centre and retrieved from medical records.
Of the five patients, two were discharged home from the ED and three were admitted to the ICU, of whom two required intubation and mechanical ventilation. Clinical features included typical opioid symptoms such as unconsciousness, respiratory depression, and apnea. In one case, naloxone successfully countered the effects. All patients were discharged the same or the following day. Butyrfentanyl was detected in two serum (0.6 and 0.9 ng/mL) and three urine (2.0-65.6 ng/mL) samples from three of four cases; three cases also contained fentanyl. In the 4-fluorobutyrfentanyl case, the substance was detected in serum (∼15 ng/mL) and urine (∼10 ng/mL). In four cases, other NPS and/or classical drugs were also detected. Analysis of two "butyrfentanyl" NPS products (nasal spray and powder) brought to hospital by patients showed that the 10-fold more potent fentanyl was the main active ingredient (∼7.5-10-fold higher amount) in both.
Typical and potentially life-threatening opioid toxicity was seen in acute intoxications involving butyrfentanyl, 4F-butyrfentanyl, and fentanyl. The incorrect labelling of butyrfentanyl NPS products which instead mainly contained fentanyl is alarming, given the narrow range between a safe and a lethal dose for opioids.
在过去六年中，不受管制的“新型精神活性物质”（NPS）供应呈稳步增长态势。这份来自瑞典STRIDA项目的报告分析了经证实的非致命性中毒案例，这些案例涉及丁酰芬太尼（丁酰基芬太尼）或4-氟丁酰芬太尼（对氟丁酰芬太尼），这两种芬太尼类似物最近作为NPS阿片类药物被引入。
对来自瑞典各地疑似急性NPS暴露且需要住院治疗的连续患者进行观察性病例系列研究。
2014年5月至2015年1月，从急诊科（ED）或重症监护病房（ICU）收治的4例涉及丁酰芬太尼中毒病例和1例涉及4-氟丁酰芬太尼中毒病例（年龄19 - 30岁男性）中采集血液和尿液样本。采用多组分液相色谱 - 质谱法对血清和/或尿液样本进行实验室分析。在与毒物信息中心会诊期间收集临床特征数据，并从医疗记录中获取。
5例患者中，2例从急诊科出院回家，3例收入重症监护病房，其中2例需要插管和机械通气。临床特征包括典型的阿片类症状，如意识丧失、呼吸抑制和呼吸暂停。有1例中，纳洛酮成功对抗了中毒效应。所有患者均在当天或次日出院。在4例中的3例患者的两份血清样本（0.6和0.9 ng/mL）和三份尿液样本（2.0 - 65.6 ng/mL）中检测到丁酰芬太尼；3例还含有芬太尼。在4-氟丁酰芬太尼中毒病例中，该物质在血清（约15 ng/mL）和尿液（约10 ng/mL）中被检测到。4例中还检测到其他NPS和/或传统药物。对患者带到医院的两种“丁酰芬太尼”NPS产品（鼻喷雾剂和粉末）的分析表明，效力强10倍的芬太尼是两者的主要活性成分（含量高约7.5 - 10倍）。
在涉及丁酰芬太尼、4F-丁酰芬太尼和芬太尼的急性中毒中观察到典型的、可能危及生命的阿片类毒性。鉴于阿片类药物安全剂量和致死剂量之间的范围很窄，丁酰芬太尼NPS产品标签错误且主要成分实为芬太尼的情况令人担忧。
