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The drug commonly known as Buy U47700 Powder is a strong μ-opioid agonist with an approximate potency 7.5 times higher than morphine. It has been available in Europe since 2014, where it is usually sold through the internet or black market as an abuse morphine-like substance. In the case reported here, a Caucasian man was found dead in his apartment. Next to the body, the police seized one transparent plastic bag containing a white powder and two amber glass bottles with nasal spray containing few milliliters of a transparent liquid. During the autopsy, no evidence of natural disease or trauma was found to account for the death. Blood, urine and pubic hair were collected and submitted for toxicological analysis. The content of the seized materials was also submitted to a general screening analysis in order to determine its composition. U-47700 for sale was detected in blood, urine and hair samples using an UHPLC/MS-MS method purposely developed. The blood and urine concentrations were 380 and 10,400 ng/mL, respectively. No other drugs of abuse nor ethanol were found in blood and urine specimens. Pubic hair analysis revealed a frequent past exposure to Buy U47700 Powder. Finally, U-47700 was identified as the main component of the powder and the liquids contained in the nasal spray bottles.

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The combined circumstantial elements and toxicological results of the case revealed the occurrence of an acute intoxication produced by Buy U47700 Powder abuse. To the best of our knowledge, this is the first fatal intoxication case reported on the Italian territory involving the synthetic opioid U-47700.

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Buy U47700 Powder (3,4-dichloro-N-[2-(dimethylamino)cyclohexyl]-N-methylbenzamide) is an opioid analgesic drug developed by the pharmaceutical company Upjohn in the 1970s and structurally related the earlier opioid AH-7921 (Belgian Early Warning System Drug, 2017). At the moment, it is controlled in 3 European countries (Sweden, Finland and United Kingdom) and in the USA. U-47700 is a strong μ-opioid receptor agonist, and reproduces all (or most of the) common effects of opiates such as morphine, including analgesia, pronounced euphoria, sedation and itching (Nikolaou et al., 2017). For these reasons, the compound is gaining popularity on drug user forums as a legal alternative to morphine/heroin (Zawilska, 2017). It is generally sold online as a research chemical, not for human consumption, as a white or slightly pinkish powder or fine crystals under different names, including “U4”, “Pink,” or “Pinky.” There is limited information available on the routes of administration and the doses of U-47700 for sale used. It is taken by oral, nasal, rectal routes, or by smoking, intravenous injection, or even by combinations of these routes (Nikolaou et al., 2017; Zawilska, 2017). Side effects, including overdose reactions, are presumed to be very similar to other opiates/opioids as well: depressed respiration (slow breathing), miosis (pinpoint pupils), constipation (World Health Organization, 2016; Baumann and Pasternak, 2018). Even if several cases of acute and lethal intoxication involving Buy U47700 Powder were reported and reviewed in the literature (Rambaran et al., 2017; Gerace et al., 2018), little is still known about the correlation between its blood concentration and the observed effects. In this investigation, we report a case of fatal intoxication after U-47700 for sale intake. The presence of the drug was confirmed in blood, urine and pubic hair specimens by means of mass spectrometry-based chromatographic methods.

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A Caucasian man, with the previous history of drug addiction, was found dead in his apartment, lay down on the floor. Two amber glass bottles with nasal spray, containing few mL of a transparent liquid, plus a plastic bag containing white powder was found on a table near the decedent. Moreover, a package containing a vial of naloxone hydrochloride 0.4 mg/mL was also found on the table. No evidence of violence was observed in the room. The death was reported to the Public Prosecutor who took jurisdiction of the case. To investigate the cause of death, he ordered a post-mortem examination and toxicological analysis.

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The findings were irrelevant, except for general pulmonary oedema. The body appeared well-nourished, and the internal examination presented no evidence of natural disease or trauma to account for his death. At the external examination of the body, no signs of injection were found. To execute the inherent toxicological analyses, heart blood, urine and pubic hair (length: 3 cm) specimens were collected during the post-mortem examination. Peripheral blood was not collected. All of the samples were stored at −20°C before the analysis.

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Experimental

Samples preparation for fluids and pubic hair

General screening analysis was executed according to a standard procedure employed in our laboratory (Gerace et al., 2014). Briefly, urine sample was extracted with tert-butyl methyl ether (TBME) at alkaline condition after a deconjugation with β-glucuronidase from E. coli. After mixing and centrifugation, the organic layer was separated and dried under a nitrogen flow. The residue was reconstituted with 50 μL of methanol and a 1 μL aliquot was injected into the gas chromatography/mass spectrometry (GC/MS) system. In addition, the blood sample was screened with a method for the detection of about ninety pharmaceutical drugs and metabolites routinely employed in our laboratory (Vincenti et al., 2013). For U-47700 for sale quantitation in blood, 50 μL of samples were added with the internal standard (fentanyl-d5) at final concentration of 50 ng/mL and added with 950 μL of acetonitrile/methanol 80:20 (v/v), previously stored at −20°C, and then incubated at −20°C for 15 min. For quantitation in urine 50 μL of samples were added with the internal standard (fentanyl-d5) at final concentration of 50 ng/mL and added with 950 μL of water with formic acid 5 mM/acetonitrile 95:5 (v/v). In both cases, the sample was centrifuged at 14,000 rpm for 5 min and 100 μL of the organic phase was transferred into a new vial. Finally, 1 μL aliquot was directly injected into the UHPLC-MS/MS system operating in selected reaction monitoring (SRM) mode.

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Pubic hair analysis was performed on the entire length of the hair lock (3 cm). Approximately 50 mg of hair was twice-washed with dichloromethane and methanol (3 mL each, vortex mixed for 3 min). After complete removal of the solvent wash, the hair was dried at room temperature by a gentle nitrogen flow and subsequently pulverized with a ball mill. For Buy U47700 Powder quantitation, the hair sample was fortified with 3 μL of a fentanyl-d5 dilute solution used as the internal standard at a final concentration of 0.3 ng/mg. After the addition of 1 mL of methanol, the sample was incubated at 55°C for 15 h without stirring. Finally, the vial was centrifuged once more at 14,000 rpm for 5 min and 1 μL aliquot was directly injected into the UHPLC-MS/MS system operating in SRM mode.

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The linear calibration model was checked by analyzing blank hair samples spiked with standard solutions at a final concentration of 0, 0.01, 0.025, 0.05, 0.1, and 0.25 ng/mg. Whenever the effective drug concentration exceeded the calibration range, the samples were diluted to fit the quantitation interval considered in the curve.

Moreover, qualitative and quantitative hair analyses for the detection of (i) the most common drugs of abuse, (ii) synthetic cannabinoids and (iii) synthetic cathinones were performed by means of analytical methods used in our laboratory and described elsewhere (Di Corcia et al., 2012; Salomone et al., 2014, 2016).

The liquids and the powder found on the scene were subjected to systematic analysis for the detection of drugs and toxic substances. A 100 μL aliquot of liquid and 100 mg of the powder were dissolved in 5 mL of methanol. After sonication in an ultrasound bath for 1 h at 55°C, a 1 μL aliquot of methanolic solution was injected into the GC/MS system with the mass spectrometer acquiring the spectra in the full scan mode (40–650 amu).

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Preliminary screening analyses for amphetamines, tricyclic antidepressants, barbiturates, benzodiazepines, cannabinoids, methadone, cocaine and opiates were performed on urine by the Enzyme Multiplied Immunoassay Technique (EMIT, Abbott Laboratories, IL, USA). The presence of ethanol in the blood was determined by headspace-GC-MS. Screening analysis for unknown substances was performed using a 6890N GC apparatus (Agilent Technologies, Milan, Italy) equipped with a HP−5 17 m fused-silica capillary column (J&W Scientific) with a 0.2-mm inner diameter and a 0.33–μm film thickness. Full scan spectra in the interval 40–650 amu were acquired using a 5,975 inert mass-selective detector (Agilent Technologies, Milan, Italy) operating in the EI mode at 70 eV. The qualitative identification of the underivatized compounds was performed by comparing the full scan spectra obtained with those recorded in the updated spectra libraries (PMWTox2, SWGDRUG version 3.0, AAFS2012, CaymanSpectraLib). For the U-47700 confirmation analysis, a dedicated UHPLC-MS/MS procedure was developed as follows. The chromatographic separation was performed using a Shimadzu LC-30A series system (Shimadzu, Duisburg, Germany) equipped with a CORTECS UPLC C18 column 1.6 μm × 2.1 mm × 100 mm (Waters Corporation, Italy). The elution solvents were water/formic acid 5 mM (solvent A) and acetonitrile/formic acid 5 mM (solvent B). After an initial isocratic condition at 95% A for 0.5 min, the mobile phase composition was varied by a linear gradient (A:B; v/v) from 95:5 to 45:55 in 4.0 min; followed by isocratic elution at 55% B for 0.5 min. The flow rate was 0.5 mL/min and the total run time was 6.0 min including re-equilibration at the initial conditions before each injection. Detection was carried out by an API 5500 triple quadrupole mass spectrometer (ABSCIEX, Foster City, CA, USA) equipped with turbo ion spray source, operating in the positive ionization mode. The SRM transitions used for the determination of Buy U47700 Powder were 330.9 → 286.1 (quantifier) and 330.9 → 204.1 (qualifier), while for the internal standard the transitions 342.2 → 188.2 was chosen.

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The method was validated by investigating the following parameters: selectivity, linearity, identification and quantitation limits (LOD and LOQ), precision, accuracy and matrix effect. The linear calibration model was checked by analyzing (three replicates) blank samples spiked with Buy U47700 Powder standard solution at final concentrations of 0, 10, 25, 50, 100, and 250 ng/mL. Whenever the effective drug concentration exceeded the calibration range, the extract was diluted in order to fit the quantitation interval considered in the curve. Ten different blank samples were prepared as previously described to test the selectivity of the whole analytical procedure. The occurrence of possible interferences from endogenous substances was checked by monitoring the signal to noise ratio (S/N) for the U-47700 for sale SRM transitions at the expected retention time. LOD values were estimated as the analyte concentration whose response provided a S/N value equal to 3, as determined from the least abundant transition. The S/N value at the lowest concentration was used to extrapolate the theoretical LOD. This calculated LOD was then experimentally confirmed by analyzing spiked samples at LOD concentration of U-47700 for sale. LOQ was calculated as three times the LOD. Within-batch precision (expressed as percent variation coefficient, CV%) and accuracy (expressed as bias %), were assessed by extracting and analyzing a series of ten blood samples fortified at 50 ng/mL. Matrix effect was evaluated by comparing the signal obtained when the analyte was added to the matrix extract with the response obtained from a methanolic solution containing the analyte at the same concentration. The per cent difference represented either matrix suppression (value below 100%) or matrix enhancement (value above 100%).

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The calibration plot showed good linearity in the range 0–250 ng/mL, with a determination coefficient of 0.998. The SRM chromatograms from ten negative samples of blood showed no interfering signals (i.e., S/N ratio lower than 3) at the retention time of Buy U47700 Powder, indicating that the method is selective and free from matrix interferences. The calculated LOD was 0.6 ng/mL and the LOQ was fixed at 2 ng/mL. The results show a satisfactory within-batch precision (CV%: 3.1) and accuracy (bias%: 11.7) at 50 ng/mL. No significant matrix effect was observed (matrix effect of 4.0%).

The presence of U-47700 for sale was confirmed in all specimens. Figure ​Figure11 depicts the SRM profiles obtained from the blood, urine and pubic hair samples for the detection of the target analyte. U-47700 was quantified at a concentration of 380 ng/mL in blood while a higher amount of the drug was detected in urine (10,300 ng/mL, creatinine 156 mg/dL). No other drugs nor ethanol were detected in the body fluids. Pubic hair analysis revealed past exposure to Buy U47700 Powder (5.7 ng/mg). Moreover, pubic hair turned out negative for the presence of traditional drugs of abuse, synthetic cathinones and synthetic cannabinoids. Buy U47700 Powder was also identified as the main component of the white powder (purity 99%) and of the liquid content of the nasal spray bottles (0.1 mg/ml). The presence of the substance in the nasal spray bottles together with the absence of injection signs on the body indicated that one of the consumption ways was presumably intranasal.

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