Accidental protonitazene intoxication: clinical management and detection of a novel opioid

Abstract

We describe the management by a pre-hospital medical team of a typical opioid toxidrome in a young man after consumption of an unknown substance with complete reversion after injection of unusually high doses of naloxone. The initial toxicological screening was negative. The secondary identification of protonitazene was performed several months after the first intoxication, both in the substance consumed and in the patient's blood samples. Protonitazene is a morphine derivative representing an emerging drug whose consumption is underestimated, escaping conventional toxicological screening and detected for the first time in France. The implementation of rapid detection procedures by the Lyon toxicology laboratory and the testing of these procedures during a second intoxication of the same patient allowed for the diagnosis to be reached again in record time.