The hidden web and the fentanyl problem: Detection of ocfentanil as an adulterant in heroin

Abstract

We report the presence of a new substance detected in the hidden web as an adulterant of heroin, ocfentanil. It has short acting opioid-like effects, roughly the same potency as fentanyl, and can be injected, snorted or smoked. Severe side effects have been associated with its use, including one death. No discussion about this substance could be found in the Internet, which suggests this substance has not been sold as such. Available data about purities of drugs purchased in cryptomarkets suggest that adulteration is not a severe problem and this agrees with users' perceptions. However, this study suggests that adulteration is a real threat not only at the street level, but also for users that buy substances in cryptomarkets, and suggest the need for harm reduction initiatives in this setting.

Fatality involving ocfentanil documented by identification of metabolites

“…Fentanyl analogues are known to be added in small amounts to street heroin. The presence of OcF as an adulterant of heroin associated to severe side effects related to its use has already been reported . The content of OcF in this pink powder was similar to those observed in 2 previously reported fatalities (apart from heroin that was not detected in these powders) (Table ) …”

“…OcF exhibits analgesia and respiratory depression in a dose‐related manner, and a 3 μg/kg dose of OcF produced an equivalent level of analgesia to 5 μg/kg dose of fentanyl in humans . Since 2013, OcF has been identified in several seized powders (sniffed, smoked, or injected by users) across Europe: the Netherlands, Estonia, Sweden, France, Denmark, Germany, and Spain . Two fatalities were reported in 2016 in Belgium and Switzerland …”

Exposure to fentanyl-contaminated heroin and overdose risk among illicit opioid users in Rhode Island: A mixed methods study

“…If these statements are accurate, placing those dealers under arrest may put their clients directly at risk of fentanyl exposure, as they are now forced to purchase drugs from a new, less familiar, less trusted seller. This indicates that it may well be time for new approaches to reducing the risk in the drug supply, including supplier-based risk reduction (as opposed to public safety) interventions (Greenfield & Paoli, 2017; Latkin, Yang, Tobin, & German, 2013), drug checking services (Quintana et al, 2017), or the adaptation of anonymous notification services for those connected by dealer networks (Huffam et al, 2013; Tan et al, 2016), as current practices aimed at supply reduction may exacerbate opioid-related risks to public health and public safety at the local level.…”

An Expanding World of Novel Psychoactive Substances: Opioids

“…The drug has recently been detected in the hidden market as an adulterant of heroin (78). Deaths involving ocfentanil were reported in Belgium (65) and in Switzerland (66), and the cases are summarized in Table 3.…”