ABSTRACT
Synthetic opioids have been associated globally with adverse effects in drug users. The nitazene group of drugs is a relatively new addition to the synthetic opioid class emerging in Europe in 2019. Some nitazenes have been shown to be more potent than fentanyl. Overdose clusters in heroin users in Dublin (57 cases) and Cork (20 cases), Ireland, in November and December 2023, respectively, prompted a rapid response from a number of Irish laboratories to identify the substance(s) of concern. Light brown (tan) powders were obtained from cases associated with overdoses, and the results from these analyses by collaboration of four laboratories are reported here. The samples were found to contain N-pyrrolidino protonitazene (protonitazepyne), caffeine, paracetamol, benzoic acid and mannitol.
ABSTRACT
In February 2015, an outbreak of recently acquired HIV infections among people who inject drugs (PWID) was identified in Dublin, following similar outbreaks in Greece and Romania in 2011. We compared drug and risk behaviours among 15 HIV cases and 39 controls. Injecting a synthetic cathinone, snow blow, was associated with recent HIV infection (AOR: 49; p=0.003). Prevention and control efforts are underway among PWID in Dublin, but may also be needed elsewhere in Europe.
Subject(s)
Drug Users/statistics & numerical data , HIV Infections/diagnosis , Ill-Housed Persons , Psychotropic Drugs/administration & dosage , Pyrrolidines/administration & dosage , Substance Abuse, Intravenous/complications , Adult , Case-Control Studies , Chromatography, High Pressure Liquid , Designer Drugs/administration & dosage , Designer Drugs/analysis , Disease Outbreaks , Female , HIV Infections/epidemiology , HIV Infections/transmission , Humans , Incidence , Ireland/epidemiology , Male , Mass Spectrometry , Middle Aged , Psychotropic Drugs/urine , Pyrrolidines/urine , Risk Factors , Risk-Taking , Substance Abuse, Intravenous/epidemiologyABSTRACT
A rapid, reproducible and sensitive reversed phase liquid chromatography-mass spectrometry method was developed and validated for the identification and semi-quantitative confirmation of stimulants in urine. The method is capable of separating compounds such as cocaine and metabolites, amphetamines, substituted cathinones and other designer drugs, with a total run time of 11 min. The method was subsequently used to confirm the presence of these stimulants in the urine of patients attending the Drug Treatment Centre Board Ireland over the period in which legislation banning some named cathinones was introduced in Ireland. Substituted cathinones were the predominant drug of choice, outside of cocaine use. Mephedrone was the most widely detected cathinone in 2010, whereas 3,4-methylenedioxypyrrolidinobutyrophenone featured more prevalently in screenings in 2011. The appearance of adverse effects increases during multi-stimulant use related to synergistic pharmacological combinations, and this method has benefits in identifying multi-drug use between next generation designer drugs and commonly used stimulants.
