DOCSLIB.ORG

Fentanyls Continue to Replace Heroin in the Drug Arena: the Cases of Ocfentanil and Carfentanil

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Fentanyls Continue to Replace Heroin in the Drug Arena: the Cases of Ocfentanil and Carfentanil Forensic Toxicol DOI 10.1007/s11419-017-0379-4 REVIEW ARTICLE Fentanyls continue to replace heroin in the drug arena: the cases of ocfentanil and carfentanil 1 1 1 1 Nektaria Misailidi • Ioannis Papoutsis • Panagiota Nikolaou • Artemisia Dona • 1 1 Chara Spiliopoulou • Sotiris Athanaselis Received: 2 June 2017 / Accepted: 23 July 2017 Ó The Author(s) 2017. This article is an open access publication Abstract concern for public safety. The authorities should take the Purpose Ocfentanil and carfentanil are two potent syn- appropriate actions to avoid the expansion of this threat by thetic opioids that are analogues of fentanyl and are taking proper and prompt measures. actively involved in the recent fentanyl crisis. The aim of this review is to provide all the available information on Keywords Ocfentanil Á Carfentanil Á Synthetic opioids Á these two fentanyl analogues. Gray deaths Á Toxicology Á Legal status Methods All reviewed information was gathered through a detailed search of PubMed and the World Wide Web using relevant keywords. Introduction Results Like most of the members of the family of fen- tanyls, they are either sold as heroin to unsuspecting users New psychoactive substances (NPS) are a group of sub- or used extensively to lace heroin street samples. Despite stances that are sold in pure form or as a mixture with other the fact that ocfentanil was studied clinically in the early drugs of abuse and are widely abused. Most of these sub- 1990s, it did not manage to find its place in clinical prac- stances are not controlled under the 1961 Single Conven- tice. On the other hand, carfentanil is mainly used today as tion on Narcotic Drugs or the 1971 Single Convention on an anesthetic agent in large animals. Ocfentanil and car- Psychoactive Substances [1]. The rapid spread of NPS in fentanil are used and abused extensively, mainly in Europe the illegal drug market poses a significant risk for the and in the United States. As a result, they are the cause of public health and seems to present a serious matter of some verified intoxication cases and deaths worldwide. concern because of a high number of these drugs emerging This review provides information concerning chemistry, every year [2, 3]. Synthetic opioids hold a significant synthesis, prevalence, pharmacology, and toxicology, as position among NPS as they are highly potent drugs that well as the current legal status of these two fentanyl ana- are often sold as heroin to unsuspected drug users [3]. logues. Analytical methods developed for the determina- Among them, fentanyl is an important substance that is tion of ocfentanil and carfentanil in biological specimens used extensively as a powerful pain killer and is also and seized materials, as well as related intoxication and abused by a large number of drug addicts [4, 5]. More than lethal cases are also presented. 1400 fentanyl analogues have been synthesized over the Conclusions Ocfentanil and carfentanil are undeniably years in order to mimic fentanyl’s opioid effects and out- very dangerous opioid drugs and a very serious matter of smart the law because fentanyl is a controlled substance in most countries internationally [6, 7]. Two hundred of these analogues have been studied pharmacologically, 12 of & Panagiota Nikolaou which have entered the illegal drug market during the last 5 [email protected] years [6]. Ocfentanil is a short-acting fentanyl analogue that was 1 Department of Forensic Medicine and Toxicology, Faculty of Medicine, National and Kapodistrian University of Athens, firstly described in a US patent by Huang et al. [8]. It had 75 Mikras Asias, 115 27 Athens, Greece been studied for its analgesic activity and was found to be 123 Forensic Toxicol more potent than fentanyl and with fewer adverse effects, and Applied Chemistry (IUPAC) name is N-(2-fluo- regarding cardiovascular effects and respiratory depression rophenyl)-2-methoxy-N-[1-(2-phenylethyl)-piperidin-4-yl] [9]. The drug has also been studied as a supplement in acetamide, but it can also been found under the names 1-(2- general anesthesia [10]. Ocfentanil was the cause of some phenylethyl)-4-[N-(2-fluorophenyl)methoxyac- verified intoxication cases and deaths, mainly in Europe, etamido]piperidine hydrochloride, N-(2-fluorophenyl)-2- and threatens to be an imminent hazard to the public safety methoxy-N-[1-(2-phenylethyl)-4-piperidinyl]acetamide, [6, 11–15]. Some ocfentanil-related cases have been also ocfentanyl, ocfentanilo, UNII-MX52WBC8EV and A-3217 presented at different scientific conferences [16–18]. [53]. Ocfentanil is sold either as its base with the molecular Carfentanil is the most potent of the commercially formula C22H27FN2O2 (molecular weight 370.46 g/mol) or available fentanyl analogues [19, 20]. It was synthesized in as its hydrochloric acid salt C22H27FN2O2 HCl (molecular 1974 by a group of chemists at Janssen Pharmaceuticals, weight 406.9 g/mol) in a white or brown crystalline pow- and since then it has been used in veterinary medicine as a der form [50, 53, 54]. The Chemical Abstracts Service tranquilizer for the sedation of large animals [21–29]. (CAS) number of ocfentanil is 101343-69-5 [53–55]. It has Carfentanil has been pharmacologically studied mostly in a melting point of 183–184 °C, and there are no data animals, but also in humans [23, 28–39]. Some evidence regarding its boiling point [8, 54]. The drug is soluble in suggests that it has been used as a chemical weapon by the aqueous media at a pH below 7 (pKa = 7.82) and stable to Russian military, while attempting to subdue a terrorist moderate heat and light, if stored properly [10, 54]. siege of the Moscow Theater [40, 41]. Carfentanil is often used to adulterate heroin, fentanyl, and other drugs of Synthesis abuse [19, 42, 43]. During recent years, this fentanyl ana- logue has been responsible for a significant number of The synthesis of ocfentanil was first described in US patent accidental intoxication cases and deaths mostly in the number 4,584,303 by Huang et al. [8]. Initially 1-phe- United States [40, 44–46]. Intentional intake of carfentanil nethyl-4-piperidone reacts with 2-fluoro aniline. The does not seem to happen very often, because most drug resulting compound is a Schiff base that is reduced to the users are well informed about its potency and its harmful corresponding diamine, by sodium borohydride or lithium potential [47–49]. aluminum hydride. The acylation of the secondary amino The aim of this review is to provide all the available group with 2-methoxyacetyl chloride (methyl chlorofor- information on ocfentanil and carfentanil, regarding their mate) leads to the final product by yielding 1-(2-pheny- chemistry, synthesis, prevalence, pharmacology, toxicol- lethyl)-4-[N-(2-fluorophenyl)methoxyacetamido]piperi- ogy, and their current legal status. Analytical methods for dine. The whole synthetic route is presented in Fig. 2 the determination of ocfentanil and carfentanil in biological [8, 51]. specimens and seized materials, as well as related intoxi- cations and fatal cases are also presented. All the reviewed Prevalence and use information was gathered through a detailed search of PubMed and the World Wide Web using the keywords Despite the fact that ocfentanil had been studied clinically ‘‘ocfentanil’’, ‘‘carfentanil’’, ‘‘pharmacology’’, ‘‘toxicol- during early 1990s, it did not manage to find its place in ogy’’, ‘‘intoxications’’, ‘‘fatalities’’, ‘‘determination’’, ‘‘bi- clinical practice [10, 56–58]. As a drug of abuse, it ological fluids’’, and ‘‘legal status’’. emerged recently on the illegal drug market along with other fentanyl analogues [12–14, 59]. Ocfentanil was among the 81 NPS that were reported to the Early Warning Ocfentanil System (EWS) of European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) in 2013, after the drug Chemistry was identified in a seizure made by Dutch police, which might have been intended for sale as ‘‘synthetic heroin’’, in Ocfentanil is a synthetic analogue of fentanyl (Fig. 1) that October 2013. A related alert for ocfentanil was issued by possesses a methoxy group instead of a methyl group and a EMCDDA and Europol in the same year [44, 60]. fluorine atom on the ortho position of the aniline group According to the Early Warning Advisory (EWA) of the [50, 51]. Ocfentanil and ocfentanilum (in Latin) are the United Nations Office of Drugs and Crime (UNODC), proposed international nonproprietary names given by the ocfentanil is among the 14 fentanyl analogues that have World Health Organization (WHO) in accordance with been reported in Europe within 2012–2016 and it is among article 3 of the Procedure for the Selection of Recom- the 15 different synthetic opioids that have been reported to mended International Nonproprietary Names for Pharma- EMCDDA during 2009–2015 [6, 15]. The National Drug ceutical Substances [52]. Its International Union of Pure EWS (NDEWS) also issued an alert for ocfentanil among 123 Forensic Toxicol Fig. 1 Structures of fentanyl, ocfentanil, and carfentanil Fig. 2 Synthesis of ocfentanil according to Huang et al. [8] other fentanyl analogues [61]. It has been associated with acid [12, 13, 50, 59, 65, 69–71]. In many cases, ocfentanil is some intoxication cases and deaths mostly in Europe used to adulterate heroin; thus heroin users can be exposed to [6, 11–14, 62]. Ocfentanil has also been reported in Fin- ocfentanil without knowing it [12–14, 50, 59, 65, 68–71, 75]. land, France, Ireland, Luxembourg, Spain, Sweden, and the Cases in which fentanyls are sold under the guise of heroin United Kingdom [6, 59, 63–66]. The drug is also among are common worldwide [6]. In some, ocfentanil was labeled other synthetic opioids that are a current matter of concern and sold in the darknet as heroin or ‘‘synthetic heroin’’ in the United States and Canada [67, 68].
Load more

Recommended publications
  • Catawba Valley Community College Drug-Free Schools And
    Catawba Valley Community College Drug-Free Schools and Communities Act Introduction Catawba Valley Community College complies with The Federal Drug-Free Schools and Communities Act Regulations [EDGAR Part 86]. These regulations include the following: 1. Standards of conduct that clearly prohibit the unlawful possession, use, or distribution of illicit drugs and alcohol by students and employees on the school’s property or as part of the school’s activities; 2. A description of the sanctions under local, state, and federal law for unlawful possession, use, or distribution of illicit drugs and alcohol; 3. A description of the health risks associated with the use of illicit drugs and alcohol; 4. A description of any drug and alcohol counseling, treatment, or rehabilitation programs available to students and employees; and 5. A clear statement that the school will impose sanctions on students and employees for violations of the standards of conduct (consistent with local, state, and federal law) and a description of these sanctions, up to and including expulsion, termination, of employment, and referral for prosecution. The required information will be distributed to all students and employees by the following methods: All new curriculum students receive this information when they are admitted to the College. All curriculum students receive this information when they register for classes. All continuing education students will receive notification by USPS mail about where to find this information. This information is included in the Annual Security Report. This information is posted on the CVCC website on the Safety and Security page Catawba Valley Community College conducts a biannual review of this program in accordance with the regulations.
    [Show full text]
  • Pharmacy and Poisons (Third and Fourth Schedule Amendment) Order 2017
    Q UO N T FA R U T A F E BERMUDA PHARMACY AND POISONS (THIRD AND FOURTH SCHEDULE AMENDMENT) ORDER 2017 BR 111 / 2017 The Minister responsible for health, in exercise of the power conferred by section 48A(1) of the Pharmacy and Poisons Act 1979, makes the following Order: Citation 1 This Order may be cited as the Pharmacy and Poisons (Third and Fourth Schedule Amendment) Order 2017. Repeals and replaces the Third and Fourth Schedule of the Pharmacy and Poisons Act 1979 2 The Third and Fourth Schedules to the Pharmacy and Poisons Act 1979 are repealed and replaced with— “THIRD SCHEDULE (Sections 25(6); 27(1))) DRUGS OBTAINABLE ONLY ON PRESCRIPTION EXCEPT WHERE SPECIFIED IN THE FOURTH SCHEDULE (PART I AND PART II) Note: The following annotations used in this Schedule have the following meanings: md (maximum dose) i.e. the maximum quantity of the substance contained in the amount of a medicinal product which is recommended to be taken or administered at any one time. 1 PHARMACY AND POISONS (THIRD AND FOURTH SCHEDULE AMENDMENT) ORDER 2017 mdd (maximum daily dose) i.e. the maximum quantity of the substance that is contained in the amount of a medicinal product which is recommended to be taken or administered in any period of 24 hours. mg milligram ms (maximum strength) i.e. either or, if so specified, both of the following: (a) the maximum quantity of the substance by weight or volume that is contained in the dosage unit of a medicinal product; or (b) the maximum percentage of the substance contained in a medicinal product calculated in terms of w/w, w/v, v/w, or v/v, as appropriate.
    [Show full text]
  • Recommended Methods for the Identification and Analysis of Fentanyl and Its Analogues in Biological Specimens
    Recommended methods for the Identification and Analysis of Fentanyl and its Analogues in Biological Specimens MANUAL FOR USE BY NATIONAL DRUG ANALYSIS LABORATORIES Laboratory and Scientific Section UNITED NATIONS OFFICE ON DRUGS AND CRIME Vienna Recommended Methods for the Identification and Analysis of Fentanyl and its Analogues in Biological Specimens MANUAL FOR USE BY NATIONAL DRUG ANALYSIS LABORATORIES UNITED NATIONS Vienna, 2017 Note Operating and experimental conditions are reproduced from the original reference materials, including unpublished methods, validated and used in selected national laboratories as per the list of references. A number of alternative conditions and substitution of named commercial products may provide comparable results in many cases. However, any modification has to be validated before it is integrated into laboratory routines. ST/NAR/53 Original language: English © United Nations, November 2017. All rights reserved. The designations employed and the presentation of material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the United Nations concerning the legal status of any country, territory, city or area, or of its authorities, or concerning the delimitation of its frontiers or boundaries. Mention of names of firms and commercial products does not imply the endorse- ment of the United Nations. This publication has not been formally edited. Publishing production: English, Publishing and Library Section, United Nations Office at Vienna. Acknowledgements The Laboratory and Scientific Section of the UNODC (LSS, headed by Dr. Justice Tettey) wishes to express its appreciation and thanks to Dr. Barry Logan, Center for Forensic Science Research and Education, at the Fredric Rieders Family Founda- tion and NMS Labs, United States; Amanda L.A.
    [Show full text]
  • Understanding and Challenging the Drugs: Chemistry and Toxicology
    UNDERSTANDING AND CHALLENGING THE DRUGS: CHEMISTRY AND TOXICOLOGY Presenter: • Dr. Jasmine Drake, Graduate Program Director and Assistant Professor, Administration of Justice Department, Barbara Jordan-Mickey Leland School of Public Affairs, Texas Southern University NACDL Training Defending Drug Overdose Homicides in Pennsylvania Penn State Harrisburg, Middletown, PA November 6th, 2019 11:30- 12:45 p.m. Understanding & Challenging the Drugs: Chemistry & Toxicology Dr. Jasmine Drake, Forensic Science Learning Laboratory, Texas Southern University I. Opioid Drug Classifications A. Types of Opioids B. Classic vs. Synthetic C. Toxicology of Opioids 1) How opioids interact with the body 2) Addiction (psychological vs. physiological II. New Classes of Drugs A. Emerging Threats B. Potency III. National Trends in Opioid Overdose Deaths in the U.S. A. Based on State B. Ethnicity C. Drug-Type (prescription vs. fentanyl vs. heroin) IV. Trends of Opioid Overdose Deaths in Philadelphia A. Based on Ethnicity B. Drug Type (prescription vs. fentanyl vs. heroin) V. Legal Considerations to the Opioid Epidemic A. Punitive Measures vs. Rehabilitative Treatment B. Progressive Jurisdictions Nationwide C. New Legal Measures in Philadelphia VI. Toxicology Reports A. What’s in the report? B. Key Aspects of the Tox Report C. Terminology D. Evaluating and Interpreting the data? E. Questions and considerations. VII. Conclusion and Discussion A. Case Specific Examples B. Sample Toxicology Reports The Opioid Epidemic: What labs have to do with it? Ewa King, Ph.D. Associate Director of Health RIDOH State Health Laboratories Analysis. Answers. Action. www.aphl.org Overview • Overdose trends • Opioids and their effects • Analytical testing approaches • Toxicology laboratories Analysis. Answers. Action.
    [Show full text]
  • Stopping the Shipment of Synthetic Opioids: Oversight of U.S. Strategy to Combat Illicit Drugs MAY 25, 2017
    1 STATEMENT OF CHAIRMAN ROB PORTMAN U.S. SENATE PERMANENT SUBCOMMITTEE ON INVESTIGATIONS Stopping the Shipment of Synthetic Opioids: Oversight of U.S. Strategy to Combat Illicit Drugs MAY 25, 2017 This hearing will come to order. [gavel] I’ve called this hearing to address a crisis in our communities. And it’s getting worse, not better. Our country is gripped by an opioid epidemic. It’s a crisis that doesn’t discriminate and can be found in every corner of my state. Earlier this month, Police Officer Chris Green in East Liverpool, Ohio suffered a fentanyl overdose following a routine traffic stop. He noticed white powder in the car and took the necessary precaution of wearing a mask and gloves during the arrest. When he was back at the police station, he noticed a small amount of powder on his shirt and brushed it off with his bare hand. From that mere exposure to his fingers, he passed out from an overdose. Officer Green was given one dose of Narcan on the scene, which is a drug used to reverse the effects of opioid overdose. But Officer Green needed three more doses of Narcan at the hospital to revive him. Fentanyl is a powerful drug that is killing Americans and putting our first responders at risk. It is 30-50 times more powerful than heroin and 100 times stronger than morphine. A lethal dose of fentanyl can be as little as two milligrams. 2 The number of Americans overdosing on fentanyl and its analogues has increased dramatically over the past few years.
    [Show full text]
  • A Review of Cases of Marijuana and Violence
    Open Access Int. J. Environ. Res. Public Health 2020, 17(5), 1578; https://doi.org/10.3390/ijerph17051578 Review A Review of Cases of Marijuana and Violence by Redon Ipeku 3 and Thersilla Oberbarnscheidt 4 1 CEO of Health Advocates PLLC, East Lansing, MI 48823, USA 2 Department of Psychiatry Augusta University, Augusta, GA 30912, USA 3 College of Law, Michigan State University, East Lansing, MI 48823, USA 4 Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA * Author to whom correspondence should be addressed. Received: 9 December 2019 / Accepted: 25 February 2020 / Published: 29 February 2020 Download PDF Abstract : Marijuana is the most consumed illicit drug in the world, with over 192 million users. Due to the current legalization push of marijuana in the United States, there has been a lack of oversight regarding its public health policies, as marijuana advocates downplay the drug’s negative effects. This paper’s approach is from a public health perspective, focusing specifically on the cases of violence amongst some marijuana users. Here, we present 14 cases of violence with chronic marijuana users that highlight reoccurring consequences of: marijuana induced paranoia (exaggerated, unfounded distrust) and marijuana induced psychosis (radical personality change, loss of contact with reality). When individuals suffering from pre-existing medical conditions use marijuana in an attempt to alleviate their symptoms, ultimately this worsens their conditions over time. Although marijuana effects depend on the individual’s endocannabinoid receptors (which control behavioral functions, like aggression) and the potency level of tetrahydrocannabinol (THC) in the drug, scientifically documented links between certain marijuana users and violence do exist.
    [Show full text]
  • UCSF UC San Francisco Previously Published Works
    UCSF UC San Francisco Previously Published Works Title Fentanyl, fentanyl analogs and novel synthetic opioids: A comprehensive review Permalink https://escholarship.org/uc/item/8xh0s7nf Authors Armenian, Patil Vo, Kathy Barr-Walker, Jill et al. Publication Date 2017-10-01 Peer reviewed eScholarship.org Powered by the California Digital Library University of California Fentanyl, fentanyl analogs and novel synthetic opioids: A comprehensive review Patil Armenian, Kathy Vo, Jill Barr-Walker, Kara Lynch University of California, San Francisco-Fresno and University of California, San Francisco Keywords: opioid, synthetic opioids, fentanyl, fentanyl analog, carfentanil, naloxone Abbreviations: 4-ANPP: 4-anilino-N-phenethyl-4-piperidine; ANPP 4Cl-iBF: 4-chloroisobutyryfentanyl 4F-iBF: 4-fluoroisobutyrfentanyl AEI: Advanced electronic information AMF: alpha-methylfentanyl CBP: US Customs and Border Protection CDC: Centers for Disease Control CDSA: Controlled Drug and Substance Act (Canada) CNS: central nervous system DEA: US Drug Enforcement Agency DTO: Drug trafficking organization ED: Emergency department ELISA: enzyme-linked immunosorbent assay EMCDDA: European Monitoring Centre for Drug and Drug Addiction FDA: US Food and Drug Administration GC-MS: gas chromatography mass spectrometry ICU: intensive care unit IN: intranasal IV: intravenous LC-HRMS: liquid chromatography high resolution mass spectrometry LC-MS/MS: liquid chromatography tandem mass spectrometry MDA: United Kingdom Misuse of Drugs Act NPF: non-pharmaceutical fentanyl THF-F: tetrahydrofuranfentanyl US: United States USPS: US Postal Service UNODC: United Nations office on drugs and crime 1. Introduction The death rate due to opioid analgesics nearly quadrupled in the US from 1999 to 2011 and was responsible for 33,091 deaths in 2015 (CDC, 2014; Rudd et al., 2016).
    [Show full text]
  • Staying Safe on Prescription Opioids Together We Can
    Staying Safe on Prescription Opioids Together We Can. Suicide Prevention Information for Veterans, Their Families, and Caregivers Understanding Opioid Use Opioids are drugs a doctor might prescribe for pain relief. For example, your doctor might give you a How to Stay Safe on Prescription Opioids medication with codeine, hydrocodone, morphine, You can do several things to protect yourself and others from the or oxycodone to relieve pain from an injury or after risks associated with prescription opioids: a surgery. Some brand names for these medications include OxyContin, Percocet, and Vicodin. But there are Before you are prescribed opioids, tell your health care many more. provider about all other medications and supplements you are taking. Opioids are highly addictive. This means you could lose control over your use of them and feel sick without Tell your health care provider if you or your family has a them. That’s why they should only be taken under the history of alcohol or drug addiction. There are other pain care and guidance of a medical professional. Opioid treatment options that are equally as effective as (or more misuse can lead to both addiction and overdose. effective than) opioids and don’t carry the same risks for addiction and overdose. An opioid overdose is when a person takes more than the body can handle. It causes difficulty breathing Only take opioids prescribed to you and as directed by your and can result in suffocation and death. Overdose is health care provider. Never accept opioids from anyone else. especially likely with the use of heroin, fentanyl, and other illegal opioids obtainable on the street or online.
    [Show full text]
  • (12) United States Patent (10) Patent No.: US 8,357,723 B2 Satyam (45) Date of Patent: Jan
    US008357723B2 (12) United States Patent (10) Patent No.: US 8,357,723 B2 Satyam (45) Date of Patent: Jan. 22, 2013 (54) PRODRUGS CONTAINING NOVEL "Nitric Oxide Donors and Cardiovascular Agents Modulating the BO-CLEAVABLE LINKERS Bioactivity of Nitric Oxide: An Overview” by Louis J. Ignarro, et al., Circulation Research, vol. 90, No. 1, pp. 21-22 (Jan. 11, 002). (75) Inventor: Apparao Satyam, Mumbai (IN) “Bis3-(4-substituted phenyl)prop-2-enedisulfides as a new class of (73) Assignee: Piramal Enterprises Limited and antihyperlipidemic compounds' by Meenakshi Sharma, et al., Apparao Satyam, Mumbai (IN) Bioorganic and Medicinal Chemistry Leters, vol. 14, No. 21, pp. (*) Notice: Subject to any disclaimer, the term of this 5347-5350 (Nov. 1, 2004). patent is extended or adjusted under 35 Abstract Only "Spectrophotometric determination of binary mix U.S.C. 154(b) by 0 days. tures of pseudoephedrine with some histamine H1-receptor antago nists using derivative radio spectrum method' by H. Mahgouh, et al., (21) Appl. No.: 12/977,929 J. Pham Biomed Anal, vol. 31, No. 4, pp. 801-809 Mar. 26, 2003. (22) Filed: Dec. 23, 2010 Peter D. Senter et al., Development of Drug-Release Strategy Based (65) Prior Publication Data on the Reductive Fragmentation pf Benzyl Carbamate Disulfides. Journal of Organic Chemistry, 1990, 55, 2975-2978. Published by US 2011 FO269709 A1 Nov. 3, 2011 American Chemical Society (USA). Related U.S. Application Data Vivekananda M. Virudhula et al., Reductively Activated Disulfide Prodrugs of Paclitaxel. Biorganic & Medicinal Chemistry Letters, (62) Division of application No. 1 1/213,396, filed on Aug.
    [Show full text]
  • Prescription Opioids Hydrocodone, Oxycodone, Oxymorphone, Morphine, Codeine, Fentanyl
    Recognizing Symptoms of Drugs of Abuse Maricel Dela Cruz DO, MPH, FAWM It is the policy of the Intensive Osteopathic Update (IOU) organizers that all individuals in a position to control content disclose any relationships with commercial interests upon nomination/invitation of participation. Disclosure documents are reviewed for potential conflict of interest (COI), and if identified, conflicts are resolved prior to confirmation of participation. Only those participants who had no conflict of interest or who agreed to an identified resolution process prior to their participation were involved in this CME activity. All faculty in a position to control content for this session have indicated they have no relevant financial relationships to disclose. The content of this material/presentation in this CME activity will not include discussion of unapproved or investigational uses of products or devices. Faculty Disclosure I have no relevant financial relationships to disclose. The content of this material/presentation in this CME activity will not include discussion of unapproved or investigational uses of products or devices. Learning Objectives • Define illicit and illegal drug abuse • List common drugs of abuse as identified by the National Institute on Drug Abuse • Describe evidence-based screening tools to recognize a history of drug abuse in the outpatient setting • Describe signs and symptoms of drug abuse associated with common drugs of abuse • Demonstrate the current recommendations regarding drug abuse screening as per the United States Preventive Services Task Force Definition The use of illegal drugs or the use of prescription or over-the-counter drugs for purposes other than those for which they are meant to be used, or in large amounts.
    [Show full text]
  • No Moral Panic: Public Health Responses to Illicit Fentanyls
    No Moral Panic: Public Health Responses to Illicit Fentanyls Testimony of Daniel Ciccarone, M.D., M.P.H. Professor, Department of Family and Community Medicine, University of California San Francisco Before the House Committee on the Judiciary, Subcommittee on Crime, Terrorism and Homeland Security United States House of Representatives Hearing: Fentanyl Analogues: Perspectives on Class Scheduling January 28, 2020 Chair Bass, Vice-Chair Demings, Ranking Member Ratcliffe and other distinguished members of the House Subcommittee on Crime, Terrorism and Homeland Security, thank you very much for the opportunity to testify before you today. It is indeed an honor to be here. My name is Dan Ciccarone. I am professor of family and community medicine at the University of California, San Francisco. I have been a clinician for over 30 years and an academic researcher in the area of substance use with a focus on the medical and public health consequences of heroin use for the past 20 years. I have been asked to speak on my perspective on the class scheduling of fentanyl analogues and how these regulations might work counter to the goals of public health. My research and that of my team is multidisciplinary and multi-level. We use the tools of epidemiology, anthropology, statistics, economics, clinical and basic sciences. I am appreciative of my funder, which is the National Institutes of Health, National Institute on Drug Abuse, as well as my team, which includes Dr. Jay Unick, University of Maryland, Dr. Sarah G. Mars, UCSF, Dr. Dan Rosenblum, Dalhousie University, and Dr. Georgiy Bobashev from RTI, North Carolina.
    [Show full text]
  • Basic Pharmacology
    Name ___________________________________________ Date _________ Score _________ CHAPTER 35 Basic Pharmacology CHAPTER PRE-TEST Perform this test without looking at your book. 1. The Physician’s Desk Reference contains which of the following information? a. Brand and generic names of medications b. Classification or category c. Product information d. All of the above 2. An agent that produces numbness is called an: a. Analgesic b. Anesthetic c. Anticoagulant d. Antidote 3. Ibuprofen is considered which classification of medications? a. Sedative b. Nonsteroidal anti-inflammatory c. Vasopressor d. Decongestant 4. A liquid preparation of a drug is one that has been: a. Dissolved b. Suspended c. Crushed d. a and b 5. Misuse or overuse of medications is termed: a. Medication error b. Diversion c. Abuse d. All of the above 369 03047_sg_ch35_ptg01_hr_369_380.indd 369 DESIGN SERVICES OF 30/05/13 3:03 PM # 110592 Cust: Cengage Au: Lindh Pg. No. 369 K S4-CARLISLE Title: Study Guide to accompany Delmar’s Comprehensive Medical Assisting: Server: Short / Normal / Long Publishing Services 370 Chapter 35 • Chapter Assignment Sheets 6. Hydromorphone, oxycodone, and morphine are Schedule drugs. a. I b. II c. III d. IV 7. A drug’s official name assigned by the U.S. Adopted Names Council is: a. The generic name b. The brand name c. The chemical name d. All of the above 8. Which of the following are the responsibilities of the medical assistant as they relate to controlled substances? a. Provide security for prescription pads b. Properly dispose of and document the disposal of expired drugs c. Maintain legal inventories of medications d.
    [Show full text]