Carfentanil: a narrative review of its pharmacology and public health concerns

@article{Leen2019CarfentanilAN,
  title={Carfentanil: a narrative review of its pharmacology and public health concerns},
  author={Jessica Leen and David N Juurlink},
  journal={Canadian Journal of Anesthesia/Journal canadien d'anesth{\'e}sie},
  year={2019},
  volume={66},
  pages={414-421}
}
  • J. Leen, D. Juurlink
  • Published 21 January 2019
  • Medicine
  • Canadian Journal of Anesthesia/Journal canadien d'anesthésie
Carfentanil is a synthetic fentanyl analogue approved for veterinary use. It is a mu-opioid receptor agonist with an estimated analgesic potency approximately 10,000 times that of morphine and 20-30 times that of fentanyl, based on animal studies. Since 2016, an increasing number of reports describe detection of carfentanil in the illicit drug supply. Little is known about the pharmacology of carfentanil in humans. Its high potency and presumed high lipophilicity, large volume of distribution… 
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References

SHOWING 1-10 OF 56 REFERENCES
The Pharmacokinetics and Pharmacodynamics of Carfentanil After Recreational Exposure: A Case Report
TLDR
A 34‐year‐old man admitted with depressed level of consciousness and in respiratory failure after recreational exposure to a white powder later inferred to contain carfentanil is described, the first pharmacokinetic and pharmacodynamic case report on the recreational use of carfENTanil.
Fatalities Involving Carfentanil and Furanyl Fentanyl: Two Case Reports.
TLDR
Due to the history, scene photos, toxicological findings in blood and urine and analysis of the drug paraphernalia on one of the cases which identified carfentanil and furanyl fentanyl, fentanyl analogues were suspected.
Fentanyls: Are we missing the signs? Highly potent and on the rise in Europe.
TLDR
Investigation from Estonia identified that in the European context, fentanyls are 'low use but high risk/harm' substances, and evidence shows that Estonia stands out as having an endemic problem, while the use of fENTanyls in other European countries appears to be geographically localised.
Recreational use of carfentanil – a case report with laboratory confirmation
The fentanyl derivative carfentanil, an animal tranquilizer, is one of the most potent opioids known (100 times more potent than fentanyl) [1]. Carfentanil obtained public attention related to its
Human health hazards of veterinary medications: information for emergency departments.
TLDR
There is a need for increased awareness of the potential hazards of veterinary medications within human medicine circles and timely reporting of veterinary medication hazards and their medical management may help to prepare the human medical community to deal with such exposures or abuses when time is of the essence.
Misuse of Novel Synthetic Opioids: A Deadly New Trend
TLDR
Novel synthetic opioids (NSOs) include various analogs of fentanyl and newly emerging non-fentanyl compounds and there is strong demand for their use, these drugs are being trafficked by organized crime.
Metabolism of Carfentanil, an Ultra-Potent Opioid, in Human Liver Microsomes and Human Hepatocytes by High-Resolution Mass Spectrometry
TLDR
While the human liver microsomal system demonstrated rapid clearance by CYP enzymes, the hepatocyte incubations showed much slower clearance, possibly providing some insight into the long duration of carfentanil’s effects.
Complications with the use of carfentanil citrate and xylazine hydrochloride to immobilize domestic horses.
TLDR
Analysis of the results more likely indicated that domestic and exotic horses may respond differently to carfentanil, and domestic horses may not be a good model for use in studies of carfENTanil.
Complications with the use of carfentanil citrate and xylazine hydrochloride to immobilize domestic horses.
TLDR
Analysis of the results more likely indicated that domestic and exotic horses may respond differently to carfentanil, and domestic horses may not be a good model for use in studies of carfENTanil.
Qualitative Identification of Fentanyl Analogs and Other Opioids in Postmortem Cases by UHPLC-Ion Trap-MSn.
TLDR
A method was developed and validated to identify 44 opioid-related and analgesic compounds in postmortem samples using ultra high performance liquid chromatography ion trap mass spectrometry with MSn capabilities, which continues to effectively assist the medical examiners in determining the cause and manner of death of decedents in Miami-Dade County.
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1
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3
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5
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