U-47700: An Emerging Threat (2024)

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  • Cureus
  • v.9(10); 2017 Oct
  • PMC5741271

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U-47700: An Emerging Threat (1)

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Monitoring Editor: Alexander Muacevic and John R Adler

Saeed K Alzghari,U-47700: An Emerging Threat (2)1 Steven W Fleming,2 Kerry Anne Rambaran,3 James E Long,1 Samantha Burkhart,1 Jie An,1 and Jakub Furmaga4

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Abstract

Illicit opioid use continues to be an ever-growing problem in the United States. The rise of synthetic opioids is an emerging threat that is beginning to draw attention over the past few years.Herein, we present an overview of the rise of a synthetic opioid known as U-47700.We describe U-47700's history, legal status, ease of obtainment, consequences of its use, and a proposal to increase the awareness of this synthetic opioid.

Keywords: u-47700, synthetic opioid, opioid toxidrome, drug abuse, novel psychoactive substance, opioids, opioid poisoning, opioid abuse

Editorial

The opioid epidemic in the United States continues to be a significant problem. The number of deaths associated with opioid overdose has increased markedly, from 28,647 deaths in 2014 to 33,091 deaths in 2015 [1]. With this growing problem, there is also a risein the occurrence of synthetic opioidsthat can be surprisingly easy to obtain, as opposed toheroin or prescription opioids, such as hydrocodone, oxycodone, and others.

U-47700 (Figure ​(Figure1)1) is a newsynthetic opioid that hasmade its way to the United States. The Upjohn Company created U-47700 in the 1970s, but it never received Food and Drug Administration (FDA) approval. At about 7.5 times the potency of morphine, it can produce a strong analgesic response [2]. Furthermore, U-47700 exhibits common adverse effects associated with an opioid toxidrome, such as respiratory depression, cyanosis, and pinpoint eyes (as documented in recent case reports), as well as tachycardia in patients that survived an overdose of this agent [3-4]. Immunoassays cannot detect U-47700, but a combination approach of untargetedfollowed bytargeted chromatographic and spectral techniques have been utilized to detect U-47700 [4].

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Figure 1

Structure of U-47700

The Drug Enforcement Administration (DEA) made U-47700 a schedule I substance in November 2016. At the time of publication, the DEA confirmed 46 deaths from six states (New Hampshire, New York, North Carolina, Ohio, Texas, and Wisconsin) due to U-47700 overdose [2]. In a recent clinical review published by Rambaran, et al., the age range of ten individuals that died from U-47700 overdose (all males) was from 20 to 46 years of age, with nine out of the 10 deaths being 30 years of age or younger [4].

After the scheduling of U-47700, the most striking aspect is the ease in obtaining this crystalline opioid online (Figure ​(Figure2).2). For instance, a brief search with “U-47700 for sale” on multiple search engines led to many companies abroad advertising the product for a few dollars per gram.

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Figure 2

Physical sample of U-47700

We propose three ways to increase awareness of this potentially dangerous agent. First, educational efforts through national platforms, such as the Centers for Disease Control (CDC) and the National Institutes of Health (NIH), need to mention synthetically made agents, such as U-47700 as an emerging threat in addition to heroin and prescription opioids. Since this agent is relatively new, education about U-47700 in its entirety (such as the history of the agent, adverse effects, and recent deaths) is the key to bringing awareness to the public and providers. Second, more laboratories should include U-47700 as part of their analysis. Confirmation testing is necessary, especially when a screening test cannot elucidate U-47700, as seen in recent case reports [4-5]. This process takes time especially if a laboratory is not equipped for testing this agent. Third, toxicologists, pathologists, and pharmacists need to be aware of U-47700, continue to report cases associated with this agent, report new methodologies for its screening, and provide continuing educationas an emerging topic of interest.

Providers need to be cognizant of the importance of U-47700 as more information is made available through the literature and media. Educating the public andgreater access to toxicology screenings, as well as practitioners taking a greater role in the understanding and dissemination of data associated with U-47700, are necessary for curbing the effects of this emerging synthetic opioid.

Notes

The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. Do not disregard or avoid professional medical advice due to content published within Cureus.

Footnotes

The authors have declared financial relationships, which are detailed in the next section.

Saeed K. Alzghari, Steven Fleming, Jie An, Samantha Burkhart, and James E. Long declare(s) employment from Gulfstream Diagnostics.

References

1. Increases in drug and opioid-involved overdose deaths - United States, 2010-2015. Rudd RA, Seth P, David F, Scholl L. MMWR Morb Mortal Wkly Rep. 2016;65:1445–1452. [PubMed] [Google Scholar]

2. Schedules of controlled substances: temporary placement of U-47700 into schedule I. Final order. Drug Enforcement Administration, Department of Justice. https://www.gpo.gov/fdsys/pkg/FR-2016-11-14/pdf/2016-27357.pdf. Fed Regist. 2016;81:79389–79393. [PubMed] [Google Scholar]

3. Two cases of intoxication with new synthetic opioid, U-47700. Domanski K, Kleinschmidt KC, Schulte JM, et al. Clin Toxicol (Phila) 2017;55:46–50. [PubMed] [Google Scholar]

4. U-47700: a clinical review of the literature. Rambaran KA, Fleming SW, An J, et al. J Emerg Med. 2017 [PubMed] [Google Scholar]

5. Analysis of U-47700, a novel synthetic opioid, in human urine by LC-MS-MS and LC-QToF. Fleming SW, Cooley JC, Johnson L, et al. J Anal Toxicol. 2017;41:173–180. [PubMed] [Google Scholar]

Articles from Cureus are provided here courtesy of Cureus Inc.

U-47700: An Emerging Threat (2024)

FAQs

What are the effects of U-47700? ›

Furthermore, U-47700 exhibits common adverse effects associated with an opioid toxidrome, such as respiratory depression, cyanosis, and pinpoint eyes (as documented in recent case reports), as well as tachycardia in patients that survived an overdose of this agent [3-4].

What is the half life of U-47700? ›

As noted previously, U-47700 is estimated to have an elimination half-life of 6 h in humans [48].

Is buprenorphine harmful to humans? ›

Various forms of buprenorphine, such as buccal film, transdermal patch, or immediate-release injection, expose patients and other users to the risks of opioid addiction and substance use and misuse, which can result in overdose and death.

Is Addnok bad for you? ›

Do not use the Addnok tablet with other pain medications, as they can cause serious adverse effects. It can also damage the liver. If you are using this medicine with other medicine like allergy medications, cough or cold medicines, muscle relaxants, sleeping pills, etc., it can cause extreme drowsiness.

What is the other name for U-47700? ›

U-47700, also known as U4, pink heroin, pinky, and pink, is an opioid analgesic drug developed by a team at Upjohn in the 1970s which has around 7.5 times the potency of morphine in animal models.

How long does transdermal buprenorphine last? ›

Transdermal buprenorphine comes as a patch to apply to the skin. The patch is usually applied to the skin once every 7 days. Change your patch at about the same time of day every time you change it.

Is U-47700 illegal in the US? ›

The Drug Enforcement Administration classifies U-47700 as a Schedule I controlled substance. This means it is illegal in the United States, is prone to abuse, addiction and dependence, and has no recognized medical use.

What are the side effects of ethylmorphine hydrochloride? ›

Side effects

Adverse effects are similar to other opioids and include drowsiness, constipation, vertigo, nausea, vomiting, and respiratory depression. Contraindications include asthma, respiratory insufficiency, and age under 8.

What is the effect of Secobarbital? ›

Common side effects of Secobarbital include: drowsiness, feeling tired. "hangover" effect (drowsiness the day after a dose). headache, dizziness.

What are the common side effects of opioids BNF? ›

A full dose of the opioid component (e.g. 60 mg codeine phosphate) in compound analgesic preparations effectively augments the analgesic activity but is associated with the full range of opioid side-effects (including nausea, vomiting, severe constipation, drowsiness, respiratory depression, and risk of dependence on ...

What are the effects of tussi? ›

Many people using this medication do not have serious side effects. Tell your doctor right away if you have any serious side effects, including: mental/mood changes (such as confusion, hallucinations), shaking (tremors), weakness, fast/slow/irregular heartbeat. A very serious allergic reaction to this drug is rare.

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