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Publications: Synthetic Opioids - Key Resources
RAND Corporation, Santa Monica, Calif.
NPS synthetic opioids fentanyl USA opioid-related deaths
The future of fentanyl and other synthetic opioids

The number of opioid-related deaths in the United States is truly astounding. There were on the order of 50,000 opioid-involved overdose fatalities in 2018, which is roughly similar to the magnitude of deaths from HIV/AIDS at its peak in 1995 (Centers for Disease Control and Prevention, 2013; Ruhm, 2018; Ahmad et al., 2019). The rates of overdose fatalities involving heroin or other semisynthetic or natural opioids (which are mostly prescription drugs; see Appendix A for terms) have slowed in recent years and are now outnumbered two to one by overdoses involving synthetic opioids. Ciccarone (2017, p. 107) refers to a “triple wave epidemic:” The first wave was prescription opioids, the second wave was heroin, and the third—and ongoing—wave is synthetic opioids.

There are many different synthetic opioids, but analyses of death certificate records show that most synthetic opioid overdoses as of 2016 involve fentanyl (Hedegaard et al., 2018; Spencer et al., 2019). Similarly, drug seizure databases indicate a sharp rise in the number of exhibits containing fentanyl, from slightly fewer than 1,000 in 2013 to more than 59,000 in 2017 (U.S. Drug Enforcement Administration, 2018e), although some of that increase might be a function of greater law enforcement efforts aimed at detecting and seizing fentanyl and other synthetic opioids.

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European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)
fentanils synthetic cannabinoids NPS Early Warning System
Fentanils and synthetic cannabinoids: driving greater complexity into the drug situation

An update from the EU Early Warning System

New psychoactive substances are a broad range of drugs that are not controlled by the 1961 and 1971 United Nations drug control conventions but may pose similar threats to public health. Many of them are traded as ‘legal’ replacements to established controlled drugs such as cannabis, heroin, cocaine and MDMA. 

Over the last decade, there has been a large increase in these substances as globalisation and new technology have allowed production to shift from small-scale illicit laboratories in Europe to commercial chemical and pharmaceutical operations in China that are capable of making hundreds of different substances on an industrial scale. Once in Europe, they are sold openly in branded products advertised as ‘legal highs’, under the guise of being ‘research chemicals’, and as ‘food supplements’, in attempts to make these substances attractive to users. They are also sold on the illicit drug market, either under their own names or passed off as established controlled drugs to unsuspecting users. In parallel with the growth in the range of substances and products that are offered, the consumer base has also grown and includes recreational users, chronic and marginalised drug users, those who self-medicate, and people wanting to improve how they look or their performance at work or when studying. The growth in the market is also reflected in a large increase in the number of seizures reported by law enforcement as well as in poisonings.

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