Sacco Matteo Antonio, Gualtieri Saverio, Tarallo Alessandro Pasquale, Tarda Lucia, Verrina Maria Cristina, Costa Andrea, Aquila Isabella
Institute of Legal Medicine, Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Viale Europa, Loc. Germaneto, 88100 Catanzaro, Italy.
Toxics. 2024 Jul 24;12(8):534. doi: 10.3390/toxics12080534.
Fentanyl is an opioid with powerful analgesic effects and a high speed of action. Due to its pharmacological properties, this molecule has therapeutic application as an anesthetic in surgery or as palliative therapy for cancer patients. Unfortunately, in recent years, the easy availability of this substance, the low cost and the illegal online market have favored the large-scale diffusion of fentanyl. Fentanyl is available in different forms, including nasal spray, oral patches, soluble capsules, aerosol or the new version of fentanyl mixed with other drugs, making its use very widespread. Subjects of various ages are involved in fentanyl consumption, including minors that have not yet reached adolescence. In this work, we performed a literature review using the search engines PubMed NCBI and SCOPUS regarding episodes of acute fentanyl intoxication occurring in those of a pediatric age using the Mesh Terms "fentanyl" AND "overdose" AND "children". The inclusion criteria were English papers published in the last 10 years regarding the cases of children under the age of 10. We evaluated the most frequent methods of intake and the circumstances of such episodes. In cases of death, we analyzed the autopsy, the toxicological findings and the investigations carried out. The review results show that in this age group (under < 10 y.o. s), it is possible to identify the risk factors for fentanyl intake, such as the presence of this molecule within the family unit due to drug addiction or medical therapy. The results also demonstrate a significant risk of underestimation of this phenomenon, since the molecule is often not investigated through adequate toxicological analysis. These results, therefore, suggest always carrying out toxicological investigations in the case of suspected fentanyl intoxication, both on patients or cadavers. The investigations must always include a urinary screening for opiates, and the request for a second level analysis with molecule dosage in cases of positivity or in cases of strong suspicion for assumption. In cases of intoxication in a family context of drug addiction, it is necessary to investigate the chronicity of the intake through hair analysis and evaluate the possible co-administration of other drugs. In conclusion, we suggest a protocol, applicable both on patients or cadavers, which can be useful for physicians and forensic pathologists in order to promptly identify these cases and allow for the reporting of them to the judicial authorities with the adoption of strict prevention and control measures.
芬太尼是一种具有强大镇痛作用且起效迅速的阿片类药物。由于其药理特性，该分子在外科手术中作为麻醉剂或作为癌症患者的姑息治疗具有治疗应用。不幸的是，近年来，这种物质的容易获取、低成本以及非法在线市场助长了芬太尼的大规模传播。芬太尼有不同形式，包括鼻喷雾剂、口服贴片、可溶性胶囊、气雾剂或与其他药物混合的新型芬太尼，使其使用非常广泛。各个年龄段的人都参与芬太尼消费，包括尚未达到青春期的未成年人。在这项工作中，我们使用搜索引擎PubMed NCBI和SCOPUS，以“芬太尼”、“过量”和“儿童”作为医学主题词，对儿科年龄人群中发生的急性芬太尼中毒事件进行了文献综述。纳入标准是过去10年发表的关于10岁以下儿童病例的英文论文。我们评估了最常见的摄入方法以及此类事件的情况。在死亡病例中，我们分析了尸检、毒理学发现以及所进行的调查。综述结果表明，在这个年龄组（10岁以下），可以识别出芬太尼摄入的风险因素，例如由于药物成瘾或医疗治疗而在家庭单位中存在这种分子。结果还表明存在对这一现象低估的重大风险，因为该分子常常未通过充分的毒理学分析进行调查。因此，这些结果表明，在疑似芬太尼中毒的情况下，无论是对患者还是尸体，都应始终进行毒理学调查。调查必须始终包括对鸦片类药物的尿液筛查，在呈阳性或强烈怀疑摄入的情况下要求进行分子剂量的二级分析。在药物成瘾的家庭环境中毒的情况下，有必要通过毛发分析调查摄入的慢性情况，并评估是否可能同时使用了其他药物。总之，我们建议一种适用于患者或尸体的方案，这对医生和法医病理学家可能有用，以便迅速识别这些病例，并通过采取严格的预防和控制措施将其报告给司法当局。
