Searching for Synthetic Opioid Rescue Agents. 2: Identification of an Ultra-Potent Synthetic Opioid Rescue Agent

Ultrapotent synthetic opioids (UPSO) have become increasingly prevalent today, from being implicated in a mass casualty event to contaminating illicit drug supply across the country. These UPSOs are different than semisynthetic and naturally derived opioids, in the sense that UPSOs have a much great...

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Main Author: Jocelyn Martin (18693398) (author)
Other Authors: Edem Onyameh (21527214) (author), Dan Luo (192943) (author), Joshua W. Powell (20980692) (author), Riya R. Trivedi (21527217) (author), Eric J. Woloshin (18693407) (author), Yating Zhang (218669) (author), Jakob D. Shaykin (18693404) (author), Emily D. Denehy (18693392) (author), Alexia R. Alsum (18693401) (author), Emily Prantzalos (11526775) (author), Qianru Jiang (18693416) (author), Tao Che (1372938) (author), Warren J. Alilain (16468158) (author), Jill R. Turner (3185361) (author), Michael T. Bardo (18693425) (author), Thomas E. Prisinzano (268174) (author)
Published: 2025
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Summary:Ultrapotent synthetic opioids (UPSO) have become increasingly prevalent today, from being implicated in a mass casualty event to contaminating illicit drug supply across the country. These UPSOs are different than semisynthetic and naturally derived opioids, in the sense that UPSOs have a much greater ability to cause opioid-induced respiratory depression (OIRD) and wooden chest syndrome (WCS), two medical phenomena that are essential in the lethality of UPS opioids. Here, we report the identification of a potential rescue agent (<b>9</b>) that is more potent than naloxone (NLX) <i>in vitro</i> and fully reverses fentanyl- and carfentanil-induced ventilatory depression and fentanyl-induced vocal cord closure in rats. Unlike naloxone, rescue agent <b>9</b> increases minute ventilation above normal in fentanyl- or carfentanil-treated rats and appears to have limited brain penetrance. Targeting peripheral opioid receptors offers a new strategy for reversing OIRD, and <b>9</b> offers a lead toward developing such an agent.