Protonitazene detection in two cases of opioid toxicity following the use of tetrahydrocannabinol vape products in Australia.

IF 3 3区 医学 Q2 TOXICOLOGY
Clinical Toxicology Pub Date : 2024-08-01 Epub Date: 2024-07-30 DOI:10.1080/15563650.2024.2383692
Rebekka Syrjanen, Jennifer L Schumann, Jared W Castle, Lesley Sharp, Andrew Griffiths, Karen Blakey, Martin Dutch, Jacqueline Maplesden, Shaun L Greene
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引用次数: 0

Abstract

Introduction: Protonitazene is an opioid belonging to the 2-benzylbenzimidazole structural class. We describe two cases of opioid toxicity involving the reported inhalation of a delta-9-tetrahydrocannabinol vape product in which protonitazene was detected.

Case reports: Case 1 was a young male found unconscious after the reported use of a delta-9-tetrahydrocannabinol vape. He suffered two subsequent apnoeic episodes requiring bag-valve-mask ventilation before eventual recovery. Only protonitazene was detected in blood at a concentration of 0.74 µg/L. Case 2 was a young male who died shortly after being found unresponsive. The postmortem femoral blood concentrations of protonitazene and delta-9-tetrahydrocannabinol were 0.33 µg/L and 2 µg/L, respectively. Analysis of a pod vaping device found in the decedent's hand and a separate e-liquid bottle labelled as delta-9-tetrahydrocannabinol showed a mixture of protonitazene and delta-9-tetrahydrocannabinol.

Discussion: The opioid effects of protonitazene are mediated through β-arrestin2 and mu opioid receptor signalling pathways. Benzimidazole opioids are lipophilic and, when mixed with a suitable solvent, can be used in a vape device. It is anticipated that naloxone would have provided effective reversal of toxicity in our cases.

Conclusions: Novel routes of opioid administration, like vaping, may appear relatively innocuous in comparison to intravenous administration, but opioids may still be absorbed at high concentrations, resulting in severe opioid toxicity or death.

澳大利亚两例使用四氢大麻酚汽化产品后阿片类药物中毒病例中的质子他嗪检测结果。
简介质子他嗪是一种属于 2-苄基苯并咪唑结构类别的阿片类药物。我们描述了两例因吸入δ-9-四氢大麻酚汽化产品而导致阿片类药物中毒的病例,其中检测到了质子氮烯:病例 1 是一名年轻男性,据报告他在吸食了一种 delta-9-tetrahydrocannabinol vape 后昏迷不醒。他随后出现两次呼吸暂停,需要进行袋阀面罩通气,最终才恢复正常。仅在血液中检测到 0.74 微克/升浓度的质子氮烯。病例 2 是一名年轻男性,在被发现无反应后不久死亡。死后股骨血液中质子他嗪和 delta-9-tetrahydrocannabinol 的浓度分别为 0.33 微克/升和 2 微克/升。对死者手中发现的一个豆荚吸食器和一个单独的标有δ-9-四氢大麻酚的电子液体瓶进行的分析表明,质子氮烯和δ-9-四氢大麻酚是混合物:讨论:质子他嗪的阿片效应是通过β-arrestin2和μ阿片受体信号通路介导的。苯并咪唑类阿片具有亲脂性,与合适的溶剂混合后可用于吸食装置。在我们的病例中,预计纳洛酮可有效逆转毒性:结论:与静脉注射相比,新的阿片类药物给药途径(如吸食)可能看起来相对无害,但阿片类药物仍有可能被高浓度吸收,从而导致严重的阿片类药物中毒或死亡。
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来源期刊
Clinical Toxicology
Clinical Toxicology 医学-毒理学
CiteScore
5.70
自引率
12.10%
发文量
148
审稿时长
4-8 weeks
期刊介绍: clinical Toxicology publishes peer-reviewed scientific research and clinical advances in clinical toxicology. The journal reflects the professional concerns and best scientific judgment of its sponsors, the American Academy of Clinical Toxicology, the European Association of Poisons Centres and Clinical Toxicologists, the American Association of Poison Control Centers and the Asia Pacific Association of Medical Toxicology and, as such, is the leading international journal in the specialty.
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