Misuse of Novel Synthetic Opioids: A Deadly New Trend

Abstract

Novel synthetic opioids (NSO) include various analogs of fentanyl and newly-emerging non-fentanyl compounds. Together with illicitly manufactured fentanyl (IMF), these drugs have caused a recent spike in overdose deaths, while deaths from prescription opioids have stabilized. NSO are used as stand-alone products, as adulterants in heroin, or as constituents of counterfeit prescription medications. During 2015 alone, there were 9,580 deaths from synthetic opioids other than methadone. Most of these fatalities were associated with IMF rather than diverted pharmaceutical fentanyl. In opioid overdose cases where the presence of fentanyl analogs was examined, analogs were implicated in 17% of fatalities. Recent data from law enforcement sources show increasing confiscation of acetylfentanyl, butyrylfentanyl and furanylfentanyl, in addition to non-fentanyl compounds such as U-47700. Since 2013, deaths from NSO in the United States are 52 for acetylfentanyl, 40 for butyrylfentanyl, 128 for furanylfentanyl and 46 for U-47700. All of these substances induce a classic opioid toxidrome which can be reversed with the competitive antagonist naloxone. However, due to the putative high potency of NSO and their growing prevalence, it is recommended to forgo the 0.4 mg initial dose of naloxone and start with 2 mg. Because NSO offer enormous profit potential, and there is strong demand for their use, these drugs are being trafficked by organized crime. NSO present major challenges for medical professionals, law enforcement agencies and policymakers. Resources must be distributed equitably to enhance harm reduction though public education, medication-assisted therapies and improved access to naloxone.

Being “hooked up” during a sharp increase in the availability of illicitly manufactured fentanyl: Adaptations of drug using practices among people who use drugs (PWUD) in New York City

“…These analogs ranged in potency from 1.5 to 10,000 times that of morphine (Prekupec et al, 2017; Suzuki & El-Haddad, 2017). Primarily manufactured in labs in China and brought into the US via mail or smuggled from Mexico (U.S.…”

Opioid Therapy in Acute and Chronic Pain

“…Coprescription of naloxone should be considered for patients who are on high doses of opioids, have children in the environment or home, are on formulations that increase the risk of overdose (eg, fentanyl patch, long‐acting formulations), have experienced an overdose, or have a diagnosis of substance use disorder but need to take opioids. Because of the recent increase of opioid overdose deaths due to synthetic opioids such as fentanyl and carfentanyl, the recommendation has been made to administer a standard initial intramuscular dose of naloxone 2 mg (rather than 0.4 mg) or 4 mg by intranasal administration . There are no safety concerns with the higher naloxone dose …”

Fast UHPLC–MS/MS method for analysis of furanylfentanyl in different seized blotter papers

“…6 Because fentanyl and its analogs are highly potent, doses as small as 1 mg can be lethal. 7,8 Recently, several fentanyl analogs, such as carfentanyl 7 (Figure 1D), acetylfentanyl 1,9,10 (Figure 1A), acrylfentanyl 9,[11][12][13] (Figure 1C), and furanylfentanyl 7,8,[14][15][16][17] (Figure 1F) have been associated with acute intoxications worldwide. In Europe, between November 2015 and February 2017, 23 deaths were reported where furanylfentanyl was detected post-mortem.…”