Abstract：
From 2019, in the United States and Europe, the synthetic opioid market has diversified with the appearance of the 2-benzylbenzimidazole family, commonly named \"nitazenes\". In vitro studies show that these synthetic opioids have much higher affinities on μ-opioid receptors: 100 times more than morphine, and slightly higher than fentanyl for isotonitazene, increasing the risk of overdose. In south of France, isotonitazene (IZN) was identified for the first time in March 2023. In this context, there were 9 reports concerning the use of IZN in the south of France over a short period (March-April 2023), with identification of IZN in 4 cases and suspicion in others. They concerned 6 men and 3 women, with a mean age of 44.9±2 years. When available (2 cases), the product had been purchased from a dealer. IZN was identified on sample in 2 cases of overdose. Isotonitazene was also identified in biological samples in 2 cases: 1 case of overdose and coma requiring hospitalization with a favorable outcome (urinary analysis), and a death with post-mortem identification. This was the first identification of this product in France. The immediate broadcast of the alert limited the risks for users and made it possible to quickly inform regional and national health authorities. IZN is under intensive surveillance by the EMCDDA and classified as a narcotic in France since 2021. The analysis of the literature made it possible to identify cases of overdoses requiring very high doses of naloxone and deaths. The emergence of these synthetic opioids constitutes an important signal, due to their superior effects to heroin, their incomplete response to naloxone and the current difficulty in identifying them (devices for analyzing products in the reduction of risks, toxicology laboratories).
摘要：
从2019年开始，在美国和欧洲，合成阿片类药物市场随着2-苄基苯并咪唑家族的出现而多样化，俗称“硝基苯”。体外研究表明，这些合成阿片类药物对μ阿片受体的亲和力要高得多：是吗啡的100倍，略高于芬太尼的等氮氮烯，增加过量的风险。在法国南部,2023年3月首次发现了异氮烯（IZN）。在这种情况下，有9份关于法国南部在短时间内（2023年3月至4月）使用IZN的报告，在4例病例中鉴定出IZN，在其他病例中怀疑。他们涉及6名男性和3名女性，平均年龄44.9±2岁。可用时（2例），该产品是从经销商处购买的。在2例过量的样品中鉴定了IZN。在2例中的生物样本中也鉴定出异烟氮烯：1例过量和昏迷需要住院治疗，结果良好（尿分析），还有一份验尸证明的死亡.这是该产品在法国的首次鉴定。警报的立即广播限制了用户的风险，并有可能迅速通知区域和国家卫生当局。自2021年以来，IZN一直受到EMCDDA的严密监视，并在法国被列为麻醉品。对文献的分析使识别需要非常高剂量的纳洛酮和死亡的过量病例成为可能。这些合成阿片类药物的出现构成了一个重要的信号，由于它们优于海洛因，它们对纳洛酮的反应不完全，目前难以识别它们(用于分析产品以降低风险的设备，毒理学实验室)。
