A cross-sectional analysis of fentanyl analog exposures among living patients
A cross-sectional analysis of fentanyl analog exposures among living patients
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DOI：
10.1080/00952990.2021.1891420
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发表时间：
2021-04-02
影响因子：
2.7
通讯作者：
Aks, Steven E.
中科院分区：
文献类型：
--
作者：
Chhabra, Neeraj;Rizvanolli, Lum;Aks, Steven E.
背景：合成阿片类药物，包括芬太尼类似物，导致阿片类药物相关死亡比例增加。高效类似物增加了致命过量的风险。芬太尼类似物暴露在已知阿片类药物暴露的患者中的患病率尚不清楚。Objective：本研究的目的是确定阿片类药物或芬太尼尿液筛查阳性的患者中芬太尼类似物的暴露患病率。这是一个横断面分析尿高效液相色谱/串联质谱图1是来自伊利诺伊州芝加哥的大型公共医疗系统中具有阿片类药物或芬太尼阳性尿液筛查的患者的HPLC-MS/MS结果。结果：2018年和2019年共对219份芬太尼或阿片类药物筛查阳性的尿样进行了HPLC-MS/MS检测。65.3%（n = 143）的样本中检测到至少一种芬太尼类似物，其中26.0%（n = 57）的样本对多种类似物检测呈阳性。最常见的类似物、中间体或代谢物为：4-ANPP（n = 131）; 2-呋喃基芬太尼（n = 22）;丙烯酰基芬太尼（n = 21）;丁酰基芬太尼（n = 15）;环丙基芬太尼（n = 15）;和卡芬太尼（n = 13）。在芬太尼筛查阳性的样本（n = 188）中，70.2%（132）至少对一种芬太尼类似物检测呈阳性。在芬太尼筛查阴性但阿片类药物筛查阳性的样本（n = 31）中，35.5%（n = 11）的芬太尼类似物检测阳性。结论：芬太尼类似物暴露在芬太尼或阿片类药物尿液筛查阳性的患者中很常见。对活体患者样本进行合成类阿片筛查具有未来毒理学监测的意义，这些数据强调了非法使用类阿片的风险增加。
Background: Synthetic opioids, including fentanyl analogs, contribute to an increasing proportion of opioid-related deaths. Highly potent analogs pose an increased risk for fatal overdose. The prevalence of fentanyl analog exposures in patients with known opioid exposure is unknown.Objective: The purpose of this study was to determine the exposure prevalence for fentanyl analogs in living patients with positive urine screens for opiates or fentanyl.Methods: This was a cross-sectional analysis of urine high performance liquid chromatography/tandem mass spectroscopy (HPLC-MS/MS) results from patients with a positive urine screen for opiates or fentanyl at a large public healthcare system in Chicago, Illinois. Samples with positive screens were non-continuously tested by HPLC-MS/MS for 5 selected months in 2018 and 2019.Results: A total of 219 urine samples which screened positive for fentanyl or opiates underwent HPLC-MS/MS testing. At least one fentanyl analog was detected in 65.3% (n = 143) of samples with 26.0% (n = 57) testing positive for multiple analogs. The most common analogs, intermediates, or metabolites were: 4-ANPP (n = 131); 2-furanylfentanyl (n = 22); acryl fentanyl (n = 21); butyrylfentanyl (n = 15); cyclopropylfentanyl (n = 15); and carfentanil (n = 13). Of samples which screened positive for fentanyl (n = 188), 70.2% (132) tested positive for at least one fentanyl analog. Of samples which screened negative for fentanyl but positive for opiates (n = 31), 35.5% (n = 11) tested positive for fentanyl analogsConclusion: Fentanyl analog exposure is common in patients with positive urine screens for fentanyl or opiates. Screening living patient samples for synthetic opioids has future toxicosurveillance implications and these data underscore the increased risks from illicit opioid use.