Helander Anders, Bäckberg Matilda, Beck Olof
a Department of Laboratory Medicine , Karolinska Institutet , Stockholm , Sweden ;
b Department of Clinical Pharmacology , Karolinska University Laboratory , Stockholm , Sweden ;
Clin Toxicol (Phila). 2016;54(4):324-32. doi: 10.3109/15563650.2016.1139715. Epub 2016 Feb 5.
Potent and potentially harmful new psychoactive substances (NPS) are continuously introduced on the recreational drugs market. This report from the Swedish STRIDA project describes analytically confirmed cases of intoxication involving the fentanyl analogs acetylfentanyl, 4-methoxybutyrfentanyl, and furanylfentanyl.
Patients with suspected NPS exposure presenting in emergency departments and intensive care units in Sweden and requiring hospital care are invited to the STRIDA project. Toxicological analysis of serum and urine samples was performed by multi-component liquid chromatographic-mass spectrometric methods. Data on clinical features were retrieved from telephone consultations with the Swedish Poisons Information Centre and from medical records.
Between April and November 2015, 14 analytically confirmed intoxications involving acetylfentanyl (nine cases), 4-methoxybutyrfentanyl (3), furanylfentanyl (1), and 4-methoxybutyrfentanyl together with furanylfentanyl (1) were identified. The patients were aged 20-40 (mean 28.5) years and 86% were men. Twelve patients (86%) were admitted to intensive care, where two required intubation and mechanical ventilation. Typical clinical features were decreased consciousness, respiratory depression, and miosis. In eight cases, the antidote naloxone was administered to counter the effects. The serum acetylfentanyl concentration (N = 7) was 0.6-51.6 (mean 18.3 and median 14.8) ng/mL, and in urine (N = 8) 0.1-686 (mean 155 and median 66.6) ng/mmol creatinine. The serum 4-methoxybutyrfentanyl concentration (N = 2) was 1.3 and 3.1 ng/mL, and 5.1-51.3 ng/mmol creatinine in urine (N = 3). For furanylfentanyl, the serum concentrations were 4.4 and 148 ng/mL and in urine 9.2 and 85 ng/mmol creatinine, respectively. In 13 cases (93%), other NPS and/or classical drugs were also detected. Drug products brought to hospital by patients contained acetylfentanyl (nasal spray and pink tablet), 4-methoxybutyrfentanyl (green tablet), furanylfentanyl/traces of 4-methoxybutyrfentanyl (nasal spray), and 4-fluorobutyrfentanyl (purple tablet).
Potentially life-threatening opioid toxicity was seen in acute intoxications involving acetylfentanyl, 4-methoxybutyrfentanyl, and furanylfentanyl. Intensive care treatment for one month was necessary in one acetylfentanyl case and one acetylfentanyl patient died from cerebral hemorrhage.
强效且可能有害的新型精神活性物质（NPS）不断涌入娱乐性毒品市场。这份来自瑞典STRIDA项目的报告描述了经分析确认的涉及芬太尼类似物乙酰芬太尼、4-甲氧基丁酰芬太尼和呋喃芬太尼中毒案例。
邀请在瑞典急诊科和重症监护病房就诊且疑似接触NPS并需要住院治疗的患者参与STRIDA项目。采用多组分液相色谱 - 质谱法对血清和尿液样本进行毒理学分析。临床特征数据通过与瑞典毒物信息中心的电话咨询以及病历获取。
在2015年4月至11月期间，共确认了14例经分析证实的中毒案例，其中涉及乙酰芬太尼（9例）、4-甲氧基丁酰芬太尼（3例）、呋喃芬太尼（1例）以及4-甲氧基丁酰芬太尼与呋喃芬太尼同时存在的情况（1例）。患者年龄在20 - 40岁（平均28.5岁），86%为男性。12名患者（86%）被收入重症监护病房，其中2人需要插管和机械通气。典型的临床特征为意识减退、呼吸抑制和瞳孔缩小。8例患者使用了解毒药纳洛酮来对抗中毒效果。血清中乙酰芬太尼浓度（N = 7）为0.6 - 51.6（平均18.3，中位数14.8）ng/mL，尿液中（N = 8）为0.1 - 686（平均155，中位数66.6）ng/mmol肌酐。血清中4-甲氧基丁酰芬太尼浓度（N = 2）为1.3和3.1 ng/mL，尿液中（N = 3）为5.1 - 51.3 ng/mmol肌酐。对于呋喃芬太尼，血清浓度分别为4.4和148 ng/mL，尿液中分别为9.2和85 ng/mmol肌酐。13例（93%）患者还检测出其他NPS和/或传统药物。患者带到医院的毒品制剂包含乙酰芬太尼（鼻喷雾剂和粉色片剂）、4-甲氧基丁酰芬太尼（绿色片剂）、呋喃芬太尼/微量4-甲氧基丁酰芬太尼（鼻喷雾剂）以及4-氟丁酰芬太尼（紫色片剂）。
在涉及乙酰芬太尼、4-甲氧基丁酰芬太尼和呋喃芬太尼的急性中毒中可见潜在危及生命的阿片类毒性。1例乙酰芬太尼中毒患者需要重症监护治疗1个月，1例乙酰芬太尼中毒患者死于脑出血。
