BACKGROUND Since 2016 an increase has been observed in the availability of new synthetic opioids (NSO) in Europe. Cyclopropylfentanyl is a very potent and selective μ-opioid agonist, which was reported for the first time in August 2017 in Europe. METHODS The case was included in a prospective observational study of patients treated in emergency departments after the intake of novel psychoactive substances (NPS). Clinical features were acquired using a structured questionnaire for physicians. Serum and/or urine samples of ED patients were analyzed using liquid chromatography-electrospray ionization-tandem mass spectrometry (LC-ESI-MS/MS) screening methods for NPS. CASE REPORT Within 10 minutes after intranasal intake of fentanyl, a 25-year-old male developed nausea, profuse sweating and dyspnoe. Because soon afterwards coma and respiratory insufficiency was noticed, the patient was admitted to hospital. After administration of naloxone (0.8 mg) breathing stabilized. However, the patient displayed recurrent decreases of oxygen saturation for 12 hours. The intake of cyclopropylfentanyl was analytically confirmed. CONCLUSION The constantly growing diversity of NSO still poses a high risk for drug users and can be a challenging task for clinicians and forensic toxicologists. Clinicians treating opioid overdoses should be aware of the potentially long lasting respiratory depression induced by fentanyl analogs.

中文翻译：

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环丙基芬太尼（一种新型合成阿片类药物）的急性严重中毒

背景 自 2016 年以来，欧洲新合成阿片类药物 (NSO) 的供应量有所增加。环丙基芬太尼是一种非常有效且选择性的 μ-阿片类激动剂，于 2017 年 8 月在欧洲首次报道。方法 该病例被纳入一项前瞻性观察研究，该研究对在急诊科接受新型精神活性物质 (NPS) 治疗的患者进行了研究。使用面向医生的结构化问卷获取临床特征。使用液相色谱-电喷雾电离-串联质谱 (LC-ESI-MS/MS) 筛选方法对 ED 患者的血清和/或尿液样本进行分析。病例报告 鼻内摄入芬太尼后 10 分钟内，一名 25 岁男性出现恶心、大量出汗和呼吸困难。由于不久后发现昏迷和呼吸功能不全，病人被送进了医院。服用纳洛酮 (0.8 mg) 后，呼吸稳定。然而，患者显示氧饱和度反复下降 12 小时。环丙基芬太尼的摄入量经分析证实。结论 NSO 不断增长的多样性仍然给吸毒者带来了高风险，对临床医生和法医毒理学家来说可能是一项具有挑战性的任务。治疗阿片类药物过量的临床医生应该意识到芬太尼类似物可能引起的长期持续呼吸抑制。环丙基芬太尼的摄入量经分析证实。结论 NSO 不断增长的多样性仍然给吸毒者带来高风险，对临床医生和法医毒理学家来说可能是一项具有挑战性的任务。治疗阿片类药物过量的临床医生应该意识到芬太尼类似物可能引起的长期持续呼吸抑制。环丙基芬太尼的摄入量经分析证实。结论 NSO 不断增长的多样性仍然给吸毒者带来高风险，对临床医生和法医毒理学家来说可能是一项具有挑战性的任务。治疗阿片类药物过量的临床医生应该意识到芬太尼类似物可能引起的长期持续呼吸抑制。