Non-Medical Use of Novel Synthetic Opioids: A New Challenge to Public Health

Abstract

Background: In the last decade there has been a progressive increase in the use of new psychoactive substances (NPSs) that are not yet under international control. In particular, novel synthetic opioids (NSOs) have reappeared on the recreational drug market in the last few years. As a result, the use of NSOs has increased rapidly. This poses an emerging and demanding challenge to public health. Aim: To raise awareness among clinicians and other professionals about NPSs, especially NSOs, to summarize current knowledge about pharmacological properties, forms of NSO on the market, pattern of use, effects and consequences of use. Methods: An electronic search was carried out on the Medline/PubMed and Google Scholar databases to find selected search terms. Results: Some NPSs are already controlled, while others can be legally sold directly on the drug market (mainly via internet, less so by drug dealers) or be used as precursors for the synthesis of other designer drugs that mimic the psychoactive effects of controlled substances. Potential side-effects of NSOs include miosis, sedation, respiratory depression, hypothermia, inhibition of gastrointestinal propulsion, death (from opioid overdose). Conclusions: The severity of the opioid crisis has intensified with the introduction of highly potent NSOs on the drug market. As long as addicts are dying from overdose or similar causes, there is something more constructive to do than waiting for addicts to overdose on heroin at a place located near a remedy, as if to say, within reach of naloxone.

Novel Opioids: Systematic Web Crawling Within the e-Psychonauts’ Scenario

“…Furthermore, as highlighted using a molecular docking model, some substances are too structurally similar for the scoring function to distinguish between different analogs (Ellis et al, 2018(Ellis et al, , 2019. For some opioids, larger dosages of naloxone may be required to reverse the opioid toxidrome than needed in case of a typical heroin overdose (Armenian et al, 2018;Lovrecic et al, 2019). The greatest levels of concerns remain related to fentanyl analogs, because of their harmful potential (Schifano et al, 2019a), the continuous high incidence of emerging analogs on the markets over the last years (Schueler, 2017), and the difficulties in identifying them with analytical chemistry techniques (Gerace et al, 2018b;Morrow et al, 2019).…”

“…NSOs are frequently used with other illegal or prescribed drugs (Pichini et al, 2018;Pérez-Mañá et al, 2018). Owing to a range of reasons, the non-medical use of opioids such as fentanyl analogs and a range of remaining prescription/nonprescription substances is spreading worldwide (Prekupec et al, 2017;Lovrecic et al, 2019) and is affecting the entire life span, from youngsters to the elderly (Huhn et al, 2018;Kelley-Quon et al, 2019). Opioids are among the most powerful analgesic drugs, but they are burdened by unwanted adverse effects, in particular the abuse liability and the respiratory depression, with the last being the primary cause of death from overdose (Valentino and Volkow, 2018;Algera et al, 2019;Varga et al, 2020).…”

Club Drugs: Psychotropic Effects and Psychopathological Characteristics of a Sample of Inpatients

“…Nevertheless, growing evidence supports the possibility of significant psychiatric and physical consequences related to NPS consumption (13,14). Recently, researchers have reported that NPS consumption may be associated with the onset of a variety of psychiatric symptoms and conditions, including confusion, paranoid thoughts, auditory and visual hallucinations, dissociation (e.g., derealization and somatopsychic depersonalization), insomnia, chronic cognitive impairment and delusions of reference, persecution, grandeur and jealousy, as well as hypomanic states, aggressiveness and irritability, violence, and suicidal thoughts (15)(16)(17). These symptoms are often due to the increased potency of NPS compared to traditional substances, as well as to their action on a number of different neural pathways, including dopamine (DA) and serotonin (5-HT) receptors for psychedelic phenethylamines, tryptamines and synthetic cathinones, cannabinoid (CB) receptors for synthetic cannabinoids, and N-methyl-D-aspartate (NMDA) receptors for some dissociatives (12).…”

US national treatment admissions with opioids and benzodiazepines

“…The trend analysis demonstrated the growing importance of self‐reported heroin use among treatment admissions which parallels the increase in heroin‐involved deaths [2]. By contrast, the decrease in admissions among OPS that parallels the explosion in synthetic opioid‐involved deaths [30,31] suggests that, at the time of these admissions, people did not report seeking fentanyl. Even if fentanyl is the dominant opioid in an area and laboratory findings confirm that people are using fentanyl, admission coding is determined by self‐report combined with clinical judgement.…”