A case of U-47700 overdose with laboratory confirmation and metabolite identification

@article{Jones2017ACO,
  title={A case of U-47700 overdose with laboratory confirmation and metabolite identification},
  author={Matthew J. Jones and Bradley S Hernandez and Gregory C. Janis and Samuel J. Stellpflug},
  journal={Clinical Toxicology},
  year={2017},
  volume={55},
  pages={55 - 59}
}
Abstract Context: The opioid epidemic has included use of traditional drugs and recently newer synthetics. It is critically important to recognize and identify these new drugs both clinically and through appropriately designed toxicology testing. There is little available information on a synthetic gaining popularity, U-47700. Case details: A 23-year-old female presented after using “U4” by nasal insufflation and injection. She was cyanotic with respiratory depression and responded to naloxone… 

Quantification of U-47700 and its metabolites in plasma by LC-MS/MS.

Analysis of U-47700, a Novel Synthetic Opioid, in Human Urine by LC-MS-MS and LC-QToF.

TLDR
Findings suggest that U-47700 drug may cause significant morbidity and mortality within the United States as an emerging drug threat.

Another fatal case related to the recreational abuse of U-47700

TLDR
A non-targeted liquid chromatography/mass spectrometry (LC/MS)-based screening approach of urine and cerebrospinal fluid samples after intravenous injection of trans-3,4-dichloro-N-(2-(dimethylamino)cyclohexyl)-N-methylbenzamide (U-47700) shows that the powder had a relatively high purity and was adulterated to a low degree.

Metabolism of novel opioid agonists U-47700 and U-49900 using human liver microsomes with confirmation in authentic urine specimens from drug users.

TLDR
This study is the first to map the metabolic profiles of U-47700 and U-49900 using human liver microsomes, as well as theFirst to report any literature involving U- 49900 and analysis of case specimens.

Case report: relevance of metabolite identification to detect new synthetic opioid intoxications illustrated by U-47700

TLDR
Adding N-desmethyl-U-47700 (and N,N-didesmethyl- U- 47700) in mass spectrum databases used for toxicological screening in order to reduce the risk of false-negative results in intoxication cases involving U-47 700 is suggested.

A Case Study Involving U-47700, Diclazepam and Flubromazepam-Application of Retrospective Analysis of HRMS Data.

TLDR
The coronial case reported here illustrates the application of retrospective processing of HRMS data in the detection of emerging NPS, revealing the presence of designer benzodiazepines, diclazepam and flubromazep am as well as the psychedelic drug 2,5-dimethoxy-4-chloroamphetamine.

Quantification of U-47700 and its metabolites: N-desmethyl-U-47700 and N,N-didesmethyl-U-47700 in 12 autopsy blood samples employing SPE/LC–ESI-MS-MS

PurposeThe paper presents a report on the comprehensive assessment of a novel synthetic opioid (NSO) termed U-47700, and its two metabolites: N-desmethyl-U-47700 and N,N-didesmethyl-U-47700 in

U-47700 and Its Analogs: Non-Fentanyl Synthetic Opioids Impacting the Recreational Drug Market

TLDR
The evidence demonstrates that U-47700 is a potent μ-opioid receptor agonist, which poses a serious risk for overdosing and death, however, most analogs of U- 47700 appear to be less potent and have been detected infrequently in forensic specimens.
...

References

SHOWING 1-10 OF 15 REFERENCES

Revisiting opioid overdose induced acute respiratory distress syndrome

  • H. BhardwajB. BhardwajA. Awab
  • Medicine
    Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine
  • 2014
TLDR
Patients with opioid-induced NCPE and ARDS can have severe hypoxemia frequently needing invasive mechanical ventilation and an early orotracheal intubation should be considered in obtunded or severely hypoxemic patients.

Increases in Drug and Opioid Overdose Deaths—United States, 2000–2014

TLDR
Findings indicate that the opioid overdose epidemic is worsening and there is a need for continued action to prevent opioid abuse, dependence, and death, improve treatment capacity for opioid use disorders, and reduce the supply of illicit opioids, particularly heroin and illicit fentanyl.

Negative pressure pulmonary edema following naloxone administration in a patient with fentanyl-induced respiratory depression.

CDC Guideline for Prescribing Opioids for Chronic Pain - United States, 2016.

TLDR
This guideline is intended to improve communication between clinicians and patients about the risks and benefits of opioid therapy for chronic pain, improve the safety and effectiveness of pain treatment, and reduce the risks associated with long-term opioid therapy, including opioid use disorder, overdose, and death.

CDC Guideline for Prescribing Opioids for Chronic Pain--United States, 2016.

TLDR
This guideline is intended to improve communication about benefits and risks of opioids for chronic pain, improve safety and effectiveness of pain treatment, and reduce risks associated with long-term opioid therapy.

Factors affecting binding of trans-N-[2-(methylamino)cyclohexyl]benzamides at the primary morphine receptor.

In this paper, we describe the synthesis of a series of trans-N-[2-(methylamino)cyclohexyl]benzamides possessing morphine-like pharmacological properties. The affinity of the compounds for the

Synthetic opiate makers stay step ahead of US drug laws as overdose cases rise. The Guardian

  • Internet
  • 2016

Federal Register 21 CFR Part 1308

    Use of Synthetic Party Drug Puts Two North Texans in Hospital. The Dallas Morning News