Novel synthetic opioids (NSOs) constitute of numerous analogues of fentanyl and recently emerging non-fentanyl combinations. Together with wrongful manufactured fentanyl (IMF), these narcotics have caused a recent surge in drug overdose casualties, whereas deaths from prescription opioids have stabilized. This artificial combination is used as stand-alone products, as adulterants in heroin, or as constituents of counterfeit prescription medications. During 2015 alone, there were 9580 deaths from synthetic opioids other than methadone. Most of these casualties were linked with the IMF rather than diverted pharmaceutical fentanyl. In opioids overdose cases, where the behavior of fentanyl analogues was examined, analogues were involved in 17% of fatalities.
Current data from law enforcement sources show increasing takeover of acetyl fentanyl, butyryl fentanyl, and furanyl fentanyl, in addition to non-fentanyl combinations such as U-47700. Since 2013, fatalities from NSOs in the United States were 52 for acetyl fentanyl, 40 for butyryl fentanyl, 128 for furanyl fentanyl, and 46 for U-47700. All of these substances provoke a classic opioid toxidrome, which can be overturned with the strong antagonist naloxone. However, due to the putative high strength of NSOs and their thriving prevalence, it is suggested to avoid the 0.4 mg initial dose of naloxone and start with 2 mg. Because NSOs offer enormous profit potential, and there is strong demand for their use, these drugs are being trafficked by crime syndicates.
NSOs are vital threats for its users as well as for medical professionals, policymakers. Resources must be distributed equitably to enhance harm reduction though public education, medication-assisted therapies, and regulated access to naloxone.
Synthetic combinations which have potential to health risks are interpreted as “substances of abuse, either in pure form or a preparation, exempted by the current drug policies. Psychotropic Substances may pose a public health threat. In the context of this definition, the term “new” does not necessarily refer to new chemical entities, but rather those compounds that have recently become available in the recreational drug market. Many NPS are created by modifying the chemical patterns of illegal drugs or prescribed medications to generate substances which bypass standing drug control laws. As governments pass legislation to render specific NPS illegal, new alternates are synthesized and marketed to stay 1 step ahead of regulators and law enforcement. In recent years, there has been explosive growth in the market for NPS, promoted by entrepreneurs and organized crime groups who have exploited both the manufacturing capacity in Asian countries and the emergence of globalized trade.
The non-medical use of synthetic opioids and the use of heroin in North America have escalated into a crisis of overdose deaths. The opioid market has become more diversified particularly in the United States, where it is comprised of a combination of internationally controlled substances (e.g. heroin) and prescription medicines, diverted from the legal market or produced as counterfeit medicines. These counterfeited medicines contain fentanyl and fentanyl analogues, as well as non-opioid substances such as derivatives of benzodiazepine and methylphenidate. Most of the fentanyl recently seized in the United States has been of non-pharmaceutical origin. The pills and powders containing such substances sold on the illicit market pose a threat to public health because of the variable quantity and potency of the active components, which in extreme cases, such as with carfentanil, maybe 10,000 times more potent than morphine. Such products can prove particularly dangerous when sold in the street together with heroin or as counterfeit prescription drugs, without the user’s knowledge. In the United States, fentanyl and its analogues have contributed to more In 2018, 67,367 drug overdose deaths occurred in the United States. The age-adjusted rate of overdose deaths decreased by 4.6% from 2017 (21.7 per 100,000) to 2018 (20.7 per 100,000). Opioids—mainly synthetic opioids are currently the main driver of drug overdose deaths.
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