Misuse of Novel Synthetic Opioids: A Deadly New Trend.

Study Author Michael Baumann

Reviews To Read – March 1, 2018.

The United States is experiencing an epidemic of opioid overdose deaths. A major factor in this crisis is the increasing availability of potent opioid drugs, including fentanyl and novel synthetic opioids (NSOs). NSOs include various analogs of fentanyl and newly-emerging non-fentanyl compounds which stimulate mu-opioid receptor proteins in the brain. NSOs are manufactured in Asian laboratories and trafficked via the Internet. They are found as standalone products, additives in illicit heroin or constituents of counterfeit pain pills, and most users are unaware of their exposure to the substances. Recent data from law enforcement sources show rising confiscation of acetylfentanyl, butyrylfentanyl, and furanylfentanyl, in addition to non-fentanyl compounds such as U-47700. These substances have been associated with many forensically-confirmed overdose deaths, but there is scant information about the biological effects of most NSOs. Here we describe the pharmacology, toxicology, clinical management, forensic detection, and regulatory issues associated with NSOs. Overall, NSOs 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.

Prekupec, Matthew P; Mansky, Peter A; Baumann, Michael H

Misuse of Novel Synthetic Opioids: A Deadly New Trend. Journal Article

In: J Addict Med, vol. 11, no. 7, pp. 256–265, 2017.

Abstract | Links

@article{Prekupec2017,

title = {Misuse of Novel Synthetic Opioids: A Deadly New Trend. },

author = {Matthew P Prekupec and Peter A Mansky and Michael H Baumann},

url = {https://www.ncbi.nlm.nih.gov/pubmed/28590391},

doi = {10.1097/ADM.0000000000000324},

year  = {2017},

date = {2017-07-15},

journal = {J Addict Med},

volume = {11},

number = {7},

pages = {256--265},

abstract = {Novel synthetic opioids (NSOs) 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, whereas deaths from prescription opioids have stabilized. NSOs are 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 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 NSOs in the United States were 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 NSOs and their growing prevalence, it is recommended to forgo 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 organized crime. NSOs 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.

},

keywords = {},

pubstate = {published},

tppubtype = {article}

}