Acrylfentanyl is a highly lipophilic analog of the therapeutic drug fentanyl; its anti-nociceptive activity was reported to be more than 160 times higher than morphine, with an affinity for the μ-opioid receptor higher than fentanyl indeed, acrylfentanyl was shown to be more effective than fentanyl, inducing a longer lasting analgesia comparable with the duration of morphine effects .
According to the United Nation Office on Drugs and Crime, drug-related deaths are predominantly a consequence of the use of opioids; indeed, in Europe, opioid overdose is estimated to be the cause of death of 3.5% of all Europeans between 19 and 39 years old. Always in Europe, the northerly countries have the most elevated mortality rate due to drug-overdose, with Sweden mortality rate resulting fourth after Estonia, Scotland and Finland . In Sweden, between 2004 and 2014, opioids caused almost 3000 fatalities, with an average yearly increase of 18.1% .
. Popular synthetic opioids are, among others, methadone, buprenorphine, tramadol and fentanyl .
Fentanyl a prescription synthetic opioid, has been causing fatal intoxications in Sweden since 1994 recently, from the spring of 2015, a whole new set of fentanyl analogs have been pervading the market , causing more than a hundred deaths in the last two years alone, and being in response scheduled by the Swedish government as synthetic opioids . Among these analogs, particular interest was raised by acrylfentanyl , a synthetic opioid recently identified on the recreational drug market, first in Denmark and subsequently in Sweden.
Among opioids, a powerful class of NPS – synthetic opioids – has been significantly present on the European recreational drug market in general and on the Swedish one in particular. Indeed, reports show that in 11 countries in 2013, and in 18 countries in 2014, more than 10% of opioid patients were admitted for addiction to other opioids than heroin; some countries – e.g. Estonia, Finland and Czech Republic – reported that the more common cause for opioid treatment is due to non-heroin opioids.
Acrylfentanyl-price-per-gram is a highly lipophilic analog of the therapeutic drug fentanyl; its anti-nociceptive activity was reported to be more than 160 times higher than morphine, with an affinity for the μ-opioid receptor higher than fentanyl indeed, acrylfentanyl was shown to be more effective than fentanyl, inducing a longer lasting analgesia comparable with the duration of morphine effects. Regarding acrylfentanyl toxicity, no human studies have been conducted thus far, but given its similarity to fentanyl, it is worth keeping into consideration the average fentanyl lethal concentration of 3 ng/mL detected in series of lethal intoxications (serum) when approaching acrylfentanyl cases .The present report describes a series of forty fatal intoxications occurred in Sweden between April and October 2016, in which the presence of the synthetic opioid acrylfentanyl was determined to be either the main or a contributing cause of death. Subsequently, the report addresses the recreational drug scene in Sweden, with particular focus on fentanyl analog compounds.
Materials and methods
Analysis and quantification of acrylfentanyl in femoral blood were performed on an LC-30AD liquid chromatography system, (Shimadzu Scientific Instruments, Kyoto, Japan) equipped with a Triple QuadTM 4500 System (AB SCIEX Instruments, Concord, Ontario) mass spectrometer Mobile phase A (0.05% formic acid in 10 mM ammonium formate) and B (0.05% formic acid in Methanol) were used at a flow rate set to 0.8 mL/min; the linear gradient was set from 2% B to 100% B in 3.0 min. An Acquity UPLC® BEH Phenyl
Case reports
In the forty fatalities presented in this report, the examiner determined the cause of death to be fatal acrylfentanyl-price-per-gram intoxication, in single- or poly-drug scenario; the intoxications occurred over a 6-month-period, beginning in April 2016 and ending in October 2016. Six cases had a history of suicide attempts or presented clues of voluntary intoxication (cases 11, 19, 20, 24 31 and 38), raising the possibility that death was a suicide; all other cases were considered accidental overdoses.
Conclusions
The Western world is currently experiencing an opioid crisis, with a resurgence of the use of illegal opioids along with the widespread abuse of opioid medications. Synthetic opioids are a major problem that worsen the consequences of, and weaken the countermeasures against, such health hazard. Acrylfentanyl was one of the most problematic compounds to appear on the scene and – together with the previous fentanyl analogs – is a harsh remainder of the need for an ever more expedite
Founding sources
This research was conducted within the Strategic Research Area initiative established in the Swedish Government Bill on Research Policy in 2008.
