Severe poisoning after smoking a mixture of 4-fluoroisobutyryl fentanyl (4-FiBF) and alpha-pyrolidinoisohexaphenone (α-PiHP)

Context: Intoxications after ingestion of new psychoactive substances are currently one of the most challenging issues in clinical toxicology. Synthetic cathinones represented the largest group of drugs seized in 2020, but the increasing distribution of fentanyl analogues is resulting in a growing global opioid crisis. In addition, synthetic opioids may be intentionally combined with psychostimulants by drug manufacturers to reduce depressive effects. We report a case of severe poisoning after smoking a mixture of 4-fluomisobutyryl fentanyl (4-FiBF) and alpha-pyrrolidinoisohexaphenone (alpha-PiHP). Case details: A 29-year-old male was found out of conscious in his apartment and taken to the Intensive Care Unit. Examinations revealed pinpoint pupils, slight respiratory acidosis, leukocytosis as well as body temperature of 39.4 degrees C and increased creatinine with decreased eGFR level. Toxicological analysis of biological samples revealed presence of 4-FiBF and alpha-PiHP in concentrations: 87.7 ng/mL and 5.0 ng/mL (blood) and 2291.0 ng/mL and 722.2 ng/mL (urine), respectively. After 4 days, the patient was discharged home. Discussion: Unique combination of clinical symptoms was a result of a simultaneous 4-FiBF and alpha-PiHP intoxication. To our knowledge, this is the first case of ingestion such unusual mixture of new psychoactive substances with a full description of medical treatment.

Automated summary

Intoxications from new psychoactive substances are a major concern in clinical toxicology. This case report presents a severe poisoning after smoking a mixture of 4-fluoromisobutyryl fentanyl and alpha-pyrrolidinoisohexaphenone. The unique combination of these substances resulted in specific clinical symptoms and required medical treatment.