{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T14:52:06Z","timestamp":1778338326964,"version":"3.51.4"},"reference-count":16,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2025,3,19]],"date-time":"2025-03-19T00:00:00Z","timestamp":1742342400000},"content-version":"unspecified","delay-in-days":18,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,2,15]]},"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:p>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.<\/jats:p>\n               <jats:p>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\u2019s 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.<\/jats:p>\n               <jats:p>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.<\/jats:p>","DOI":"10.1136\/bcr-2024-261722","type":"journal-article","created":{"date-parts":[[2025,3,19]],"date-time":"2025-03-19T16:22:10Z","timestamp":1742401330000},"page":"e261722","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Accidental protonitazene intoxication: clinical management and detection of a novel opioid"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-3497-5969","authenticated-orcid":false,"given":"Jonathan","family":"Meltzer","sequence":"first","affiliation":[{"name":"Anesthesiology and Critical Care, Centre Hospitalier Lyon-Sud, Pierre-Benite, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandra","family":"Boucher","sequence":"additional","affiliation":[{"name":"Toxicology Lab, Centre Hospitalier Lyon-Sud, Pierre-Benite, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sabine","family":"Cohen","sequence":"additional","affiliation":[{"name":"Toxicology Lab, Centre Hospitalier Lyon-Sud, Pierre-Benite, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julia","family":"Morere","sequence":"additional","affiliation":[{"name":"Emergency Medicine, H\u00f4pital Edouard Herriot, Lyon, Rh\u00f4ne-Alpes, France"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,3,19]]},"reference":[{"key":"2025082803063847000_18.3.e261722.1","unstructured":"SINTES (Syst\u00e8me d\u2019Identification National des Toxiques Et des Substances) in a glimpse, Available: https:\/\/en.ofdt.fr\/BDD\/publications\/docs\/In_a_glimpse_Point_Sintes8_2002.pdf"},{"key":"2025082803063847000_18.3.e261722.2","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1093\/jat\/bkab117","article-title":"A Forward-Thinking Approach to Addressing the New Synthetic Opioid 2-Benzylbenzimidazole Nitazene Analogs by Liquid Chromatography-Tandem Quadrupole Mass Spectrometry (LC-QQQ-MS)","volume":"46","author":"Walton","year":"2022","journal-title":"J Anal Toxicol"},{"key":"2025082803063847000_18.3.e261722.3","unstructured":"Point SINTES 10, Available: https:\/\/www.ofdt.fr\/heroine-et-opioides-synthese-des-connaissances-1729"},{"key":"2025082803063847000_18.3.e261722.4","unstructured":"Expert Committee on Drug Dependence . Critical review report: protonitazene. WHO; 2022."},{"key":"2025082803063847000_18.3.e261722.5","unstructured":"DARK Classics in Chemical Neuroscience: Etonitazene and Related Benzimidazoles | ACS Chemical Neuroscience, Available: https:\/\/pubs.acs.org\/doi\/10.1021\/acschemneuro.1c00037 [Accessed 18 Dec 2023]."},{"key":"2025082803063847000_18.3.e261722.6","doi-asserted-by":"crossref","first-page":"4519","DOI":"10.1007\/s10072-023-07024-z","article-title":"Multifocal neuropathy and Horner\u2019s syndrome due to disseminated pyomyositis in an intravenous drug user","volume":"44","author":"de Souza","year":"2023","journal-title":"Neurol Sci"},{"key":"2025082803063847000_18.3.e261722.7","unstructured":"Syrjanen R . Protonitazene detection in a case of life-threatening opioid toxicity following use of a vape product in Australia, Available: https:\/\/www.tandfonline.com\/doi\/abs\/10.1080\/24734306.2023.2222509"},{"key":"2025082803063847000_18.3.e261722.8","doi-asserted-by":"publisher","DOI":"10.1093\/jat\/bkac062"},{"key":"2025082803063847000_18.3.e261722.9","unstructured":"Jackson M , Fisher E . An unintentional overdose on protonitazene: the dangers of benzimidazole opioids, 2022. Available: https:\/\/www.tandfonline.com\/doi\/abs\/10.1080\/15563650.2022.2107776 [Accessed 18 Dec 2023]."},{"key":"2025082803063847000_18.3.e261722.10","unstructured":"European Database on New Drugs, Available: https:\/\/ednd2.emcdda.europa.eu\/ednd"},{"key":"2025082803063847000_18.3.e261722.11","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1002\/dta.3415","article-title":"Analysis of highly potent synthetic opioid nitazene analogs and their positional isomers","volume":"15","author":"Kanamori","year":"2023","journal-title":"Drug Test Anal"},{"key":"2025082803063847000_18.3.e261722.12","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1097\/PAF.0000000000000787","article-title":"Proliferation of Novel Synthetic Opioids in Postmortem Investigations After Core-Structure Scheduling for Fentanyl-Related Substances","volume":"43","author":"Papsun","year":"2022","journal-title":"Am J Forensic Med Pathol"},{"key":"2025082803063847000_18.3.e261722.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.forsciint.2021.110686"},{"key":"2025082803063847000_18.3.e261722.14","unstructured":"Canadian recommendations with naloxone, Available: https:\/\/www.msss.gouv.qc.ca\/professionnels\/soins-et-services\/protocoles-tap-annexe-i-medicaments\/naloxone\/#pharmaco-voie-in-im"},{"key":"2025082803063847000_18.3.e261722.15","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2004.12.012"},{"key":"2025082803063847000_18.3.e261722.16","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1007\/s40122-023-00481-6","article-title":"New Synthetic Opioids: Clinical Considerations and Dangers","volume":"12","author":"Edinoff","year":"2023","journal-title":"Pain Ther"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2024-261722","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T10:06:47Z","timestamp":1756375607000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2024-261722"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3]]},"references-count":16,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,3,19]]},"published-print":{"date-parts":[[2025,3]]}},"alternative-id":["10.1136\/bcr-2024-261722"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2024-261722","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3]]}}}