Office of the Chief Medical Examiner, San Francisco, CA 94124, United States.
Department of Laboratory Medicine, University of California, San Francisco, CA 94143, United States.
J Anal Toxicol. 2024 Oct 28;48(8):573-581. doi: 10.1093/jat/bkae062.
One of the quickest-growing subclasses of novel psychoactive substances is novel synthetic opioids (NSOs), which are categorized as fentanyl analogs (fentalogs) or nonfentanyl opioids that bind to the mu-opioid receptor. Increased detections of NSOs have been observed in the USA. However, limited information on their prevalence outside of the East Coast is available. This study details the prevalence of NSOs, specifically fluorofentanyl, in the biological and drug paraphernalia specimens of accidental overdose deaths in San Francisco in 2022. A recently developed and validated liquid chromatography with tandem mass spectrometry method was utilized for the analysis of >250 NSOs. Out of the 649 accidental overdose deaths in 2022, 617 cases were available for blood analysis, with at least 1 NSO detected in 48 cases (7.8%). Fentalogs were detected in all 48 cases, with fluorofentanyl being detected in 40 cases. In postmortem femoral blood, estimated concentrations of fluorofentanyl ranged from 0.1 to 8.9 ng/mL, and 0.05 to 85 ng/mL in urine. Polysubstance use with NSO was seen with fentanyl (89.6%), methamphetamine (70.8%), cocaine (33.3%), and heroin (18.8%). NSOs, mainly fluorofentanyl, were observed in matched drug paraphernalia. This report documents the migration of fluorofentanyl to the West Coast, specifically California.
新型精神活性物质中增长最快的子类之一是新型合成阿片类物质（NSO），它们被归类为芬太尼类似物（fentalogs）或非芬太尼类阿片类物质，与μ-阿片受体结合。美国已经观察到 NSO 的检测数量有所增加。然而，关于它们在东海岸以外地区的流行程度的信息有限。本研究详细介绍了 2022 年在旧金山意外过量死亡的生物和药物用具样本中新型合成阿片类物质（NSO），特别是氟芬太尼的流行情况。一种最近开发并验证的液相色谱-串联质谱法用于分析>250 种 NSO。在 2022 年的 649 例意外过量死亡中，有 617 例可进行血液分析，其中 48 例（7.8%）至少检测到 1 种 NSO。在所有 48 例中均检测到芬太尼类似物，其中 40 例检测到氟芬太尼。在死后股骨血中，氟芬太尼的估计浓度范围为 0.1 至 8.9ng/ml，在尿液中为 0.05 至 85ng/ml。在与 NSO 一起使用的多种物质中，芬太尼（89.6%）、甲基苯丙胺（70.8%）、可卡因（33.3%）和海洛因（18.8%）最为常见。在匹配的药物用具中观察到 NSO，主要是氟芬太尼。本报告记录了氟芬太尼向西海岸，特别是加利福尼亚的迁移。
