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Patocka J, Wu W, Oleksak P, Jelinkova R, Nepovimova E, Spicanova L, Springerova P, Alomar S, Long M, Kuca K. Fentanyl and its derivatives: Pain-killers or man-killers? Heliyon 2024; 10:e28795. [PMID: 38644874 PMCID: PMC11031787 DOI: 10.1016/j.heliyon.2024.e28795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 04/23/2024] Open
Abstract
Fentanyl is a synthetic μ-opioid receptor agonist approved to treat severe to moderate pain with faster onset of action and about 100 times more potent than morphine. Over last two decades, abuse of fentanyl and its derivatives has an increased trend, globally. Currently, the United States (US) faces the most serious situation related to fentanyl overdose, commonly referred to as the opioid epidemic. Nowadays, fentanyl is considered as the number one cause of death for adults aged 18-45 in the US. Synthesis and derivatization of fentanyl is inexpensive to manufacture and easily achievable. Indeed, more than 1400 fentanyl derivatives have been described in the scientific literature and patents. In addition, accessibility and efficacy of fentanyl and its derivatives can play a potential role in misuse of these compounds as a chemical weapon. In this review, the properties, general pharmacology, and overdose death cases associated with fentanyl and selected derivatives are presented. Moreover, current opioid epidemic in the US, Moscow theatre hostage crisis, and potential misuse of fentanyl and its derivatives as a chemical weapon are disclosed.
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Affiliation(s)
- Jiri Patocka
- Department of Chemistry, Faculty of Science, University of Hradec Kralove, 50003 Hradec Kralove, Czech Republic
| | - Wenda Wu
- Department of Chemistry, Faculty of Science, University of Hradec Kralove, 50003 Hradec Kralove, Czech Republic
- School of Food and Biological Engineering, Hefei University of Technology, Hefei 230009, China
| | - Patrik Oleksak
- Department of Chemistry, Faculty of Science, University of Hradec Kralove, 50003 Hradec Kralove, Czech Republic
| | - Romana Jelinkova
- NBC Defence Institute, University of Defence, 68201 Vyskov, Czech Republic
| | - Eugenie Nepovimova
- Department of Chemistry, Faculty of Science, University of Hradec Kralove, 50003 Hradec Kralove, Czech Republic
| | - Lenka Spicanova
- Philosophical Faculty, University of Hradec Kralove, 50003 Hradec Kralove, Czech Republic
| | - Pavlina Springerova
- Philosophical Faculty, University of Hradec Kralove, 50003 Hradec Kralove, Czech Republic
| | - Suliman Alomar
- Doping Research Chair, Zoology Department, College of Science, King Saud University, Riyadh-11451, Kingdom of Saudi Arabia
| | - Miao Long
- Key Laboratory of Zoonosis of Liaoning Province, College of Animal Science & Veterinary Medicine, Shenyang Agricultural University, Shenyang 110866, China
| | - Kamil Kuca
- Department of Chemistry, Faculty of Science, University of Hradec Kralove, 50003 Hradec Kralove, Czech Republic
- Biomedical Research Centre, University Hospital in Hradec Kralove, Sokolska 581, 50005 Hradec Kralove, Czech Republic
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Tsang VWL, Wong JS, Westenberg JN, Ramadhan NH, Fadakar H, Nikoo M, Li VW, Mathew N, Azar P, Jang KL, Krausz RM. Systematic review on intentional non-medical fentanyl use among people who use drugs. Front Psychiatry 2024; 15:1347678. [PMID: 38414500 PMCID: PMC10896833 DOI: 10.3389/fpsyt.2024.1347678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/18/2024] [Indexed: 02/29/2024] Open
Abstract
Objectives Fentanyl is a highly potent opioid and has, until recently, been considered an unwanted contaminant in the street drug supply among people who use drugs (PWUD). However, it has become a drug of choice for an increasing number of individuals. This systematic review evaluated intentional non-medical fentanyl use among PWUD, specifically by summarizing demographic variance, reasons for use, and resulting patterns of use. Methods The search strategy was developed with a combination of free text keywords and MeSH and non-MeSH keywords, and adapted with database-specific filters to Ovid MEDLINE, Embase, Web of Science, and PsychINFO. Studies included were human studies with intentional use of non-medical fentanyl or analogues in individuals older than 13. Only peer-reviewed original articles available in English were included. Results The search resulted in 4437 studies after de-duplication, of which 132 were selected for full-text review. Out of 41 papers included, it was found that individuals who use fentanyl intentionally were more likely to be young, male, and White. They were also more likely to have experienced overdoses, and report injection drug use. There is evidence that fentanyl seeking behaviours are motivated by greater potency, delay of withdrawal, lower cost, and greater availability. Conclusions Among PWUD, individuals who intentionally use fentanyl have severe substance use patterns, precarious living situations, and extensive overdose history. In response to the increasing number of individuals who use fentanyl, alternative treatment approaches need to be developed for more effective management of withdrawal and opioid use disorder. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier CRD42021272111.
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Affiliation(s)
- Vivian W. L. Tsang
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - James S.H. Wong
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Complex Pain and Addiction Service, Vancouver General Hospital, Vancouver, BC, Canada
| | - Jean N. Westenberg
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Noor H. Ramadhan
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Hasti Fadakar
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Mohammadali Nikoo
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Complex Pain and Addiction Service, Vancouver General Hospital, Vancouver, BC, Canada
| | - Victor W. Li
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Complex Pain and Addiction Service, Vancouver General Hospital, Vancouver, BC, Canada
| | - Nick Mathew
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- BC Mental Health & Substance Use Services, Provincial Health Services Authority, Burnaby, BC, Canada
| | - Pouya Azar
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Complex Pain and Addiction Service, Vancouver General Hospital, Vancouver, BC, Canada
| | - Kerry L. Jang
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Reinhard M. Krausz
- Department of Psychiatry, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
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Vasiukhina A, Gad SF, Wellington EN, Wilmes DM, Yeo Y, Solorio L. PLA-PCL microsphere formulation to deter abuse of prescription opioids by smoking. Int J Pharm 2022; 626:122151. [PMID: 36037985 PMCID: PMC10729914 DOI: 10.1016/j.ijpharm.2022.122151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/15/2022] [Accepted: 08/23/2022] [Indexed: 11/17/2022]
Abstract
Opioids are commonly prescribed across the United States (US) for pain relief, despite their highly addictive nature that often leads to abuse and overdose deaths. Abuse deterrent formulations (ADFs) for prescription opioids make the non-therapeutic use of these drugs more difficult and less satisfying. Although approximately one-third of surveyed abusers in the US reported smoking opioids, to our knowledge, no commercialized ADF effectively prevents opioid smoking. Here, we report a novel approach to deter smoking of a model prescription opioid drug, thebaine (THB), by using polymer blend microspheres (MS) comprising polylactic acid (PLA) and polycaprolactone (PCL). We utilized high-performance liquid chromatography (HPLC) and thermogravimetric analysis (TGA) to test the ability of PLA-PCL MS to limit the escape of vaporized THB. Additionally, we compared the abuse-deterrent potential of PLA-PCL MS to that of activated carbon (AC) and mesoporous silica (MPS), two materials with excellent drug-adsorbing properties. Our MS formulation was effective in reducing the amount of both active drug and thermal degradation products in the vapor generated upon heating of THB. These results support that PLA-PCL microspheres can be co-formulated in a tablet with common prescription opioids to deter their abuse via the smoking route.
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Affiliation(s)
- Anastasiia Vasiukhina
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, USA
| | - Sheryhan F Gad
- Department of Industrial and Physical Pharmacy, Purdue University, West Lafayette, IN 47907, USA; Department of Pharmaceutics, Faculty of Pharmacy, Assiut University, Assiut, Egypt
| | - Elyssia N Wellington
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, USA
| | - Danielle M Wilmes
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, USA
| | - Yoon Yeo
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, USA; Department of Industrial and Physical Pharmacy, Purdue University, West Lafayette, IN 47907, USA
| | - Luis Solorio
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN 47907, USA; Center for Cancer Research, Purdue University, West Lafayette, IN 47907, USA
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Guliyev C, Tuna ZO, Ögel K. Fentanyl use disorder characterized by unprescribed use of transdermal patches: a case report. J Addict Dis 2021; 40:285-290. [PMID: 34445944 DOI: 10.1080/10550887.2021.1971940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Fentanyl is a synthetic opioid with analgesic potency 75-100 times higher than that of morphine, and its analgesic effect is used for pain treatment, mostly in cancer patients. Using fentanyl patches may reduce misuse potential due to the transdermal route of administration, long-acting action, sustained release delivery property, and maintenance of steady-state serum concentration of the drug. Although there have been reports of transdermal fentanyl patches (TFPs) misuse via transmucosal, trans-nasal, intravenous, and oral routes of administration, fentanyl use disorder via the transdermal route is very rare. CASE In this case report, we present a patient with a history of substance use disorder who developed fentanyl use disorder via transdermal route after using unprescribed TFP in order to quit opium gum. The CARE guidance was followed in the preparation of this case report. CONCLUSION The risk of use disorder may be higher, especially in individuals with a history of substance use disorders. This risk should be taken into account when clinicians prescribe this medication.
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Affiliation(s)
- Cavid Guliyev
- Alcohol and Substance Treatment Center, Moodist Hospital, Istanbul, Turkey
| | - Zehra Olcay Tuna
- Alcohol and Substance Treatment Center, Moodist Hospital, Istanbul, Turkey
| | - Kültegin Ögel
- Alcohol and Substance Treatment Center, Moodist Hospital, Istanbul, Turkey
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Kimergård A, Parkin S, Jennings S, Brobbin E, Deluca P. Identification of factors influencing tampering of codeine-containing medicines in England: a qualitative study. Harm Reduct J 2020; 17:63. [PMID: 32917213 PMCID: PMC7488478 DOI: 10.1186/s12954-020-00408-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 08/26/2020] [Indexed: 12/16/2022] Open
Abstract
Background Tampering of psychoactive medicines presents challenges to regulation and public health. However, little is currently known about what influences the decisions to treat codeine-containing medicines (CCM) with cold water extraction (CWE) from the perspective of individuals employing these techniques. The article identifies factors influencing utilisation of CWE to separate codeine from compounded analgesics, such as paracetamol and ibuprofen, found in CCM. Methods Purposive sampling of 27 participants residing in England who took part in a qualitative interview. Of these, 14 individuals (11 males and 3 females) reported tampering of psychoactive medicines, and the relevant transcripts were included in the analyses for the study. Participants were recruited from one addiction treatment service and from an online survey. The mean age of the participants was 31.5 years (range = 18–42 years). Qualitative data analysis followed the processes of iterative categorization (IC). The codes ‘harm reduction’, ‘information sources’ and ‘changes on the drug markets’ were grouped and summarised. The coding of the data was done in a Microsoft® Word document. Results Two groups of participants were identified in the data analysis: (i) individuals who used CCM (n = 5), and (ii) individuals who used CCM and heroin (n = 9). Participants in both groups used CWE due to concerns of paracetamol overdose from the use of excessive dosages of CCM. For both of them, information obtained from the internet encouraged the use of CWE. Participants using CCM described how the many steps involved in conducting CWE, including sourcing codeine boxes from pharmacies (over the counter), presented a barrier against using CWE. Participants using CCM and heroin explained how reduced availability in the local heroin supply influenced utilisation of CWE techniques to maintain their use of opioids and avoid withdrawal. Withdrawal symptoms and cravings outweighed the concerns about the quality of the extracted codeine mixtures in this participant group, especially the ability of CWE to remove paracetamol and tablet fillers. Conclusions Utilisation of CWE of codeine was influenced by several factors including drug market supply, the availability of detailed information on the internet about CWE and restrictions on codeine sourcing in pharmacies. Risks identified with CWE include consumption of unknown doses of paracetamol if the CWE techniques are not used correctly. Attempts at extracting codeine from CCM should be considered in risk assessments of opioid medicines.
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Affiliation(s)
- Andreas Kimergård
- Addictions Department, King's College London, 4 Windsor Walk, London, SE5 8BB, UK.
| | - Stephen Parkin
- Addictions Department, King's College London, 4 Windsor Walk, London, SE5 8BB, UK
| | - Stacey Jennings
- Centre for Psychiatry, Queen Mary University of London, Old Anatomy Building, London, EC1M 6BQ, UK
| | - Eileen Brobbin
- Addictions Department, King's College London, 4 Windsor Walk, London, SE5 8BB, UK
| | - Paolo Deluca
- Addictions Department, King's College London, 4 Windsor Walk, London, SE5 8BB, UK
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Post-mortem analysis of prescription opioids—A follow-up examination by LC–MS/MS with focus on fentanyl. Forensic Sci Int 2019; 305:109970. [DOI: 10.1016/j.forsciint.2019.109970] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 09/26/2019] [Accepted: 09/27/2019] [Indexed: 11/17/2022]
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Kuczyńska K, Grzonkowski P, Kacprzak Ł, Zawilska JB. Abuse of fentanyl: An emerging problem to face. Forensic Sci Int 2018; 289:207-214. [DOI: 10.1016/j.forsciint.2018.05.042] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/22/2018] [Accepted: 05/26/2018] [Indexed: 01/02/2023]
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