Near death from a novel synthetic opioid labeled U-47700: emergence of a new opioid class

@article{Schneir2017NearDF,
  title={Near death from a novel synthetic opioid labeled U-47700: emergence of a new opioid class},
  author={Aaron B. Schneir and Imir G. Metushi and Christian M Sloane and David J Benaron and Robert L. Fitzgerald},
  journal={Clinical Toxicology},
  year={2017},
  volume={55},
  pages={51 - 54}
}
Abstract Background: In the last decade there has been a worldwide surge in the recreational abuse of novel psychoactive substances, particularly amphetamine derivatives and synthetic cannabinoids. Synthetic opioids such as AH-7921, MT-45, and U-47700, with structures distinct from those ever used therapeutically or described recreationally, have also recently emerged. Case details: We report a patient who suffered respiratory failure and depressed level of consciousness after recreationally… 
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TLDR
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References

SHOWING 1-10 OF 23 REFERENCES
AH-7921: the list of new psychoactive opioids is expanded
TLDR
AH-7921 is a current public health risk, and better international collaboration, effective legislation and continuous community alertness are needed to tackle this current growing problem.
[MT-45--a dangerous and potentially ototoxic internet drug].
TLDR
Clinical data from 12 analytically confirmed hospital cases of MT-45 poisoning demonstrate thatMT-45, like other opioids, can induce potentially life threatening respiratory depression and loss of consciousness in users and that symptoms are usually reversed by standard doses of the opioid receptor antagonist naloxone.
Fatal intoxications associated with the designer opioid AH-7921.
TLDR
It is reasonable to assume that no sharp dividing line exists between lethal and non-lethal concentrations, and deaths with AH-7921 seem to occur both at low and high concentrations, probably a result of different tolerance to the drug.
The first reported fatality associated with the synthetic opioid 3,4-dichloro-N-[2-(dimethylamino)cyclohexyl]-N-methylbenzamide (U-47700) and implications for forensic analysis.
TLDR
The search for synthetic opioids as alternatives to opium-based derivatives has provided an important impulse to drug development around the globe, but the exploration of these important discoveries has also been increasingly mined by largescale producers of these materials, which are then offered for sale.
Lethal poisonings with AH-7921 in combination with other substances.
MT-45, a new psychoactive substance associated with hearing loss and unconsciousness
TLDR
MT-45 should be added to the growing list of harmful NPS causing life-threatening poisonings, and rapid actions taken to make it a controlled substance.
U-50,488 and the к receptor: A personalized account covering the period 1973 to 1990
TLDR
U-50,488 provided a succinct template for structural modifications and they are described for the period up to 1990 and a description of the structural classes of K agonists is provided including a summary of K recognition sites based on known agonists.
U-50,488 and the kappa receptor: a personalized account covering the period 1973 to 1990.
  • J. Szmuszkovicz
  • Biology
    Progress in drug research. Fortschritte der Arzneimittelforschung. Progres des recherches pharmaceutiques
  • 1999
TLDR
U-50,488 provided a succinct template for structural modifications and they are described for the period up to 1990 and a description of the structural classes of kappa agonists is provided including a summary ofKappa recognition sites based on known agonists.
...
...