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Review
. 2022 Jan;136(1):107-122.
doi: 10.1007/s00414-021-02729-2. Epub 2021 Oct 22.

Blood concentrations of new synthetic opioids

Piotr Adamowicz  1 , Karolina Nowak  2
Affiliations
Review

Blood concentrations of new synthetic opioids

Piotr Adamowicz et al. Int J Legal Med. 2022 Jan.

Abstract

Purpose: Over the last decade, there has been a significant growth in the market and number of new psychoactive substances (NPS). One of the NPS groups that has grown rapidly in recent years, bringing a new set of problems, consists of new synthetic opioids. The extreme potency of these compounds poses a high risk of acute poisoning, as an overdose can cause respiratory depression. Most of the information regarding human pharmacokinetics of new opioids is based on toxicological case reports and the data on concentrations of new opioids in human blood are scarce. The interpretation of results usually requires a comparison to previously published cases; therefore, a referenced compilation of previously published concentration data would be useful.

Methods: The data were collected by searching the PubMed and Scopus databases and by using the Google search engine. All the available data from articles and reports that measured new opioid concentrations in plasma, serum, or whole blood were included in the data analysis.

Results: The presented tables list the observed concentrations in fatal and nonfatal cases involving 37 novel synthetic opioids.

Conclusions: Blood levels of new opioids are extremely difficult to interpret. Low blood concentrations of these substances do not rule out acute poisoning as their high potency creates a risk of respiratory depression even at low doses. Opioid tolerance, frequent presence of other drugs, and additional diseases make it impossible to define concentration ranges, especially the minimum fatal concentrations. This report provides quick access to the source articles quantifying novel synthetic opioids.

Keywords: Blood concentrations; Fentanyl derivatives; Interpretation; New psychoactive substances; New synthetic opioids.

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