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Various toxicities: 2 case report In a retrospective study of 211 patients admitted at the addiction (AD) or emergency departments (ED) of Nancy university hospital, France from March 2019 to September 2019, 2 patients (a 27-year-old woman and a 53-year-old man) were described; of whom a 27-year-old woman developed coma following deliberate overdose of fentanyl and a 53-year-old man developed nausea, vomiting and chronic abdominal pain following withdrawal of morphine. Additionally, the man had a medical prescription-induced addiction to fentanyl [not all routes stated, dosages, duration of treatments to reaction onset and outcomes not stated]. A 27-year-old woman (case 5) received fentanyl for sedation. She was admitted to the intensive care unit with coma following the deliberate overdose fentanyl. Her urine narcotics screening revealed positive result for tetrahydrocannabinol. A 53-year-old man (case 6) was hospitalised in 2012 for chronic chest pain and received morphine and ketamine for pain relief. However, he had progressive failure of pain relief. Morphine was discontinued; however, he developed morphine withdrawal syndrome including nausea, vomiting and chronic abdominal pain. He was prescribed oral fentanyl and intranasal fentanyl [Instanyl] for pain management. But six month later, he developed fentanyl addiction. He then received substitution therapy with methadone for pain management. He was then admitted to the addiction department of the hospital. He claimed that he stopped taking fentanyl three weeks ago but his urines were still positive for fentanyl and norfentanyl, which is not consistent with the pharmacokinetics of this molecule. Fentanyl misuse was suspected. He denied any further urinary tests. His blood screening after 2 weeks revealed negative results for synthetic opioids. Jung J, et al. Multiplex detection of 14 fentanyl analogues and U-47700 in biological samples: Application to a panel of French hospitalized patients. Forensic Science International 317: 1-7, Dec 2020. Available from: URL: http://doi.org/10.1016/j.forsciint.2020.110437 803515138

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Reactions 14 Nov 2020 No. 1830