In the last two decades, a large increase in opioid overdose death rates has been recorded in North America. This phenomenon, related to the misuse of prescription opioids, has been dubbed an "opioids crisis". Recent years have seen the entrance of novel synthetic opioids (NSO) on the market, compounding the fatal intoxications issue. This brings several challenges for forensic toxicology laboratories: an increased number of cases, a large number of novel structurally similar compounds to include in screening analytical methods, the low concentration of drugs in biological fluids, and the challenging interpretation in the absence of sufficient literature. Three cases of fatal intoxication highlighting those challenges are presented, complete with post-mortem concentrations in cardiac blood, femoral blood and urine. Toxicological screening and quantitative analyses were performed on the biological specimens. In the first and second cases, furanylfentanyl, U-47700 and 4-anilino-N-phenethylpiperidine (4-ANPP) were detected at similar concentrations in cardiac blood. In the third case, a total of seventeen different NSO were detected. All intoxications showed a combination of NSO and other drugs. These three cases appear to be the harbinger of an increased NSO prevalence in the province of Québec, Canada.

中文翻译：

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与三例致命中毒有关的多种新型合成阿片类药物相关的挑战。

在过去的二十年中，北美洲的阿片类药物过量死亡率有大幅增加。这种与滥用处方阿片类药物有关的现象被称为“阿片类药物危机”。近年来，新型合成阿片类药物（NSO）进入市场，加剧了致命的中毒问题。这给法医毒理学实验室带来了一些挑战：案件增加，筛选分析方法中要包括的大量新型结构相似的化合物，药物在生物液体中的浓度低以及在缺乏足够文献的情况下具有挑战性的解释。呈现了三例致命的中毒事件，突显了这些挑战，并附有心脏血液，股骨血液和尿液中的验尸浓度。对生物学标本进行了毒理学筛选和定量分析。在第一和第二种情况下，在心脏血液中检测到了相似浓度的呋喃基芬太尼，U-47700和4-苯胺基-N-苯乙基哌啶（4-ANPP）。在第三种情况下，总共检测到十七种不同的NSO。所有中毒均显示NSO和其他药物的组合。这三个案例似乎预示着加拿大魁北克省NSO患病率上升。