title: An epidemic of fatal 3-methylfentanyl poisoning in Estonia.
abstract: An exceptional epidemic of poisonings due to the highly potent opioid designer drug 3-methylfentanyl (TMF) was revealed among Estonian drug users in 2005-2006 by post-mortem forensic toxicology. Quantitative analysis of cis-TMF, trans-TMF, and fentanyl was performed by liquid chromatography-tandem mass spectrometry. Comprehensive toxicological analysis was performed using a multi-technique approach. The number of TMF-related fatal accidental poisonings identified was 46 and 71 for 2005 and 2006, respectively. The proportion of male victims was 91.5% and the mean age of all victims was 26 years at death. TMF was used predominantly by intravenous injection. There was no significant difference in the blood concentrations of cis-TMF and trans-TMF between pure TMF poisonings and mixed TMF poisonings. The mean combined concentration of TMF stereoisomers among pure TMF cases (1.9 microg/l) was more than ten times lower than the mean fentanyl concentration in fentanyl-related fatalities. Concomitant use of other drugs involved alcohol, amphetamines, benzodiazepines, and cannabis, but very rarely other opioids.
authors.affiliation: Department of Forensic Medicine, University of Helsinki, P.O. Box 40, 00014, Helsinki, Finland. ilkka.ojanpera@helsinki.fi.
authors.forename: Ilkka
authors.initials: I
authors.lastname: Ojanperä
authors.forename: Merja
authors.initials: M
authors.lastname: Gergov
authors.forename: Milana
authors.initials: M
authors.lastname: Liiv
authors.forename: Aime
authors.initials: A
authors.lastname: Riikoja
authors.forename: Erkki
authors.initials: E
authors.lastname: Vuori
mesh_terms: D000328:Adult; D000700:Analgesics / Q000032:analysis / Q000737:chemistry / Q000506:poisoning*; D002853:Chromatography, Liquid; D004196:Disease Outbreaks; D004957:Estonia / Q000453:epidemiology; D005260:Female; D005283:Fentanyl / Q000031:analogs & derivatives* / Q000032:analysis / Q000737:chemistry / Q000506:poisoning; D053593:Forensic Toxicology; D006801:Humans; D008297:Male; D015394:Molecular Structure; D011041:Poisoning / Q000453:epidemiology; D017678:Sex Distribution; D013237:Stereoisomerism; D019966:Substance-Related Disorders / Q000453:epidemiology; D053719:Tandem Mass Spectrometry
chemical_list: D000700:Analgesics; C030592:3-methylfentanyl; D005283:Fentanyl