New synthetic opioids: Part of a new addiction landscape

Abstract

Synthetic opioids (SO) are a major risk for public health across the world. These drugs can be divided into 2 categories, pharmaceutical and non-pharmaceutical fentanyls. A new generation of SO has emerged on the drug market since 2010. North America is currently facing an opioid epidemic of morbi-mortality, caused by over-prescription of opioids, illegally diverted prescribed medicines, the increasing use of heroin and the emergence of SO. Furthermore, this opioid crisis is also seen in Europe. SO are new psychoactive substances characterized by different feature such as easy availability on the Internet, low price, purity, legality, and lack of detection in laboratory tests. They have not been approved or are not recommended for human use. Opioid misuse is associated with somatic and psychiatric complications. For many substances, limited pharmacological information is available, increasing the risk of harmful adverse events. Health actors and the general population need to be clearly informed of the potential risks and consequences of the diffusion and use of SO.

Repeated Administration of Clinical Doses of Tramadol and Tapentadol Causes Hepato- and Nephrotoxic Effects in Wistar Rats

“…Although tramadol and tapentadol are claimed to have better safety profiles than their opioid peers, several adverse events have been reported, including nausea, vomiting, dizziness, seizures, dyspnea, respiratory depression [ 1 , 2 , 14 , 47 , 48 , 49 , 50 , 51 ], and even fatal cases [ 10 , 42 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 ]. In the VigiBase™ World Health Organization (WHO) Global Database of Individual Case Safety Reports concerning 5-HT toxicity, tramadol ranks 1st and tapentadol ranks 3rd (with 647 and 115 cases out of 1641, respectively) as the only suspected cause or amongst other drugs, and 1st and 2nd (with 62 and 42 cases out of 147, respectively) as the only suspected cause [ 34 , 69 ].…”

Decreased Relative Cerebral Blood Flow in Unmedicated Heroin-Dependent Individuals

“…Mesolimbic system dysfunction is a hallmark change in drug addiction ( 32 , 33 ), including heroin addiction ( 34 – 36 ). By binding to the µ-opioid receptors on GABA neurons in the midbrain, heroin suppresses the inhibitory effects of GABA on dopamine neurons, which subsequently promotes the release of dopamine, leading to elevated reward effects ( 37 ).…”

Ten Years of Fentanyl-like Drugs: a Technical-analytical Review

“…2), also known as nonpharmaceutical fentanyls or designer fentanyls, have been developed, while causing a major health risks problem. [7][8][9] The first far-reaching illicit use of fentanyl analogues (identified with the street names of China White or Synthetic Heroin) was in California between 1979 and 1988. 10 The composition of China White is complex and non-standardizable.…”