Designer Drug Trends: Synthetic Opioids

Clinician Support

Over the past 25 years, the opioid crisis has undergone distinct phases, and with each step more potent and potentially deadly substances are making it into our communities. The progression started with prescription opioids then moved to heroin and, over the past 5 years, moved to fentanyl. In the past 3 years, a growing list of other synthetic opioids – some related to fentanyl (fentanyl analogues) and others that are distinct from fentanyl – have emerged.

To put it into context, opioids are typically rated by their relative potency to morphine. Heroin and oxycodone are approximately twice as potent as morphine; fentanyl is 50 times as potent as morphine and fentanyl analogues can be up to 100 – 1000 times as potent as morphine. Other synthetic opioids (such as isotonitazene or ISO) can be 500 times more potent than morphine – or even more.

Designer Drug Trends: Synthetic Opioids

What Are Synthetic Opioids

Synthetic opioids are a class of psychoactive drugs that are produced in laboratories with man-made ingredients that have similar effects to the naturally occurring drugs.

Current Synthetic Opioid Trends

In 2019, China banned fentanyl and fentanyl precursors – a major step in disrupting fentanyl distribution. Unfortunately, the illicit drug market often adapts and far outpaces regulatory efforts. In response, other synthetic opioids, such as etonitazene and isotonitazene (ISO) began to show up across Europe and the United States. The first reported overdose death involving ISO occurred in April 2019 and as of late last year, there were over 20 confirmed overdose deaths involving ISO in the US. Herein lies the major issue…

Counter Measures to Increasing Synthetic Opioid Use

Unfortunately, we do not systematically surveillance (ie. test) for synthetic opioids, or for that matter fentanyl, in a wide-spread way. Additionally, there is a lot of resistance to providing opiate users with harm reduction tools such a fentanyl test strips because some policy makers contend that this enables illicit drug use, despite many treatment providers arguing the opposite.

At Wellbridge, we believe that it is our responsibility as providers to work towards counter measures, such as raising awareness of emerging threats across our communities and among clinicians, develop and implement better testing methods for point of care testing and CLIA-waived options, expand overdose education and naloxone distribution, and expand access to addiction treatment.