Near‐fatal Intoxication with the “New” Synthetic Opioid U‐47700: The First Reported Case in the Czech Republic

• Published in: Journal of forensic sciences Vol. 64; no. 2; pp. 647 - 650
• Main Authors: Židková, Monika, Horsley, Rachel, Hloch, Ondřej, Hložek, Tomáš
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.03.2019
• Subjects: 3,4‐ dichloro‐N‐(2‐(dimethylamino)cyclohexyl)‐N‐methylbenzamide; Chromatography; clonazolam; Drug abuse; forensic science; forensic toxicology; Gas chromatography; Intoxication; Liquid chromatography; Mass spectrometry; Metabolites; Methadone; Narcotics; novel benzodiazepine; novel psychoactive substance; Recreational use; Scientific imaging; Spectroscopy; synthetic opioid; U47700; Urine; Ventilation; Czech Republic; forensic toxicology; novel benzodiazepine; 3,4- dichloro-N-(2-(dimethylamino)cyclohexyl)-N-methylbenzamide; forensic science; synthetic opioid; clonazolam; U47700; novel psychoactive substance
• DOI: 10.1111/1556-4029.13903
• ISSN: 0022-1198; 1556-4029

Recreational use of the potent synthetic opioid 3,4‐ dichloro‐N‐(2‐(dimethylamino)cyclohexyl)‐N‐methylbenzamide (U‐47700) is rising, accompanied by increasingly frequent cases of serious intoxication. This article reports a case of near‐fatal U‐47700 intoxication. A man was found unconscious (with drug powder residues). After 40 h in hospital (including 12 h of supported ventilation), he recovered and was discharged. Liquid chromatography/high‐resolution mass spectrometry (LC/HRMS) or gas chromatography/mass spectrometry (GC/MS) were used to detect and quantify substances in powders, serum and urine. Powders contained U‐47700 and two synthetic cannabinoids. Serum and urine were positive for U‐47700 (351.0 ng/mL), citalopram (<LOQ), tetrahydrocannabinol (THC: 3.3 ng/mL), midazolam (<LOQ) and a novel benzodiazepine, clonazolam (6.8 ng/mL) and their metabolites but negative for synthetic cannabinoids. If potent synthetic opioids become cheaper and more easily obtainable than their classical counterparts (e.g., heroin), they will inevitably replace them and users may be exposed to elevated risks of addiction and overdose.