Rutgers New Jersey Medical School, Newark, NJ, USA.
American College of Medical Toxicology, Phoenix, AZ, USA.
Clin Toxicol (Phila). 2022 Sep;60(9):1067-1069. doi: 10.1080/15563650.2022.2084406. Epub 2022 Jun 16.
Novel opioids in the illicit drug supply, such as the "nitazene" group of synthetic opioids, present an ongoing public health problem due to high potency and respiratory depressant effects. We describe three patients in whom -piperidinyl etonitazene, a compound not previously reported in human exposure, was detected after suspected opioid overdose. Other substances that these patients tested for included fentanyl, cocaine, levamisole, phenacetin, benzoylecgonine, -fluorofentanyl, presumptive heroin (tested as 6-monoacetylmorphine (6-MAM), morphine, and codeine), and tramadol.
This is a case series of patients with acute opioid overdose enrolled in an ongoing multicenter prospective cohort study. Data collected included reported substance use, clinical course, naloxone dose and response, outcome, and analytes detected in biological samples.
Between October 6, 2020 and October 31, 2021, 1006 patients were screened and 412 met inclusion criteria. Of these, three patients (age 33-55) tested positive for -piperidinyl etonitazene at one site in New Jersey over a period of three days in July 2021. Two patients reported the use of cocaine; one reported the use of heroin and alprazolam. All three patients received naloxone with improvement in their mental status (2 milligrams (mg) intranasally (IN); 8 mg IN; 0.08 mg intravenous (IV)). Two of three received subsequent doses for recurrence of opioid toxicity (0.4-0.6 mg IV). One patient was diagnosed with pneumonia and admitted to the intensive care unit, one was discharged from the Emergency Department (ED), and one used additional drug while in the ED and required admission for a naloxone infusion. None developed organ damage or sequelae.
These cases represent a local outbreak of a novel "nitazene" opioid. Public health toxicosurveillance should incorporate routine testing of this emerging class of synthetic compounds in the illicit drug supply.
非法药物供应中的新型阿片类药物，如“硝甲西泮”类合成阿片类药物，由于其高效力和呼吸抑制作用，构成了持续存在的公共卫生问题。我们描述了三例疑似阿片类药物过量后检测到 -哌啶基依他佐辛的患者，这是一种以前未在人体暴露中报告过的化合物。这些患者还检测了其他物质，包括芬太尼、可卡因、左旋咪唑、非那西汀、苯甲酰可卡因而、-氟芬太尼、推定海洛因（检测为 6-单乙酰吗啡（6-MAM）、吗啡和可待因）以及曲马多。
这是一项在一项正在进行的多中心前瞻性队列研究中纳入的急性阿片类药物过量患者的病例系列研究。收集的数据包括报告的药物使用、临床过程、纳洛酮剂量和反应、结局以及生物样本中检测到的分析物。
2020 年 10 月 6 日至 2021 年 10 月 31 日，筛选了 1006 名患者，其中 412 名符合纳入标准。在 2021 年 7 月的三天内，新泽西州的一个地点有三名患者（年龄 33-55 岁）检测出 -哌啶基依他佐辛呈阳性。两名患者报告使用可卡因；一名报告使用海洛因和阿普唑仑。所有三名患者均接受了纳洛酮治疗，精神状态有所改善（2 毫克（mg）经鼻（IN）；8mg IN；0.08mg 静脉（IV））。其中两名患者因阿片类药物毒性复发而接受了后续剂量（0.4-0.6mg IV）。一名患者被诊断为肺炎并收入重症监护病房，一名患者从急诊部（ED）出院，一名患者在 ED 期间使用了其他药物，并需要入院接受纳洛酮输注。没有患者出现器官损伤或后遗症。
这些病例代表了一种新型“硝甲西泮”类阿片类药物的局部爆发。公共卫生毒理学监测应将常规检测这种新出现的非法药物供应中的合成化合物纳入其中。
