Fentanyl is a highly potent synthetic piperidine opioid primarily used as an analgesic. It is 20 to 40 times more potent than heroin and 100 times more potent than morphine; its primary clinical utility is in pain management for cancer patients and those recovering from painful surgeries. Fentanyl is also used as a sedative. Depending on the method of delivery, fentanyl can be very fast acting and ingesting a relatively small quantity can cause overdose. Fentanyl works by activating μ-opioid receptors. Fentanyl is sold under the brand names Actiq, Duragesic and Sublimaze, among others.
A drug overdose is the ingestion or application of a drug or other substance in quantities much greater than are recommended. Typically it is used for cases when a risk to health will potentially result. An overdose may result in a toxic state or death.
Carfentanil or carfentanyl, sold under the brand name Wildnil, is an extremely potent opioid analgesic used in veterinary medicine to anesthetize large animals such as elephants and rhinoceroses. It is typically administered in this context by tranquilizer dart. Carfentanil has also been used in humans to image opioid receptors. It has additionally been used as a recreational drug, typically by injection, insufflation, or inhalation. Deaths have been reported in association with carfentanil.
Gray death is a slang term which refers to the dangers that emerged in 2017, when potent mixtures of synthetic opioids, for example benzimidazole opioids or fentanyl analogues, were often sold on the street misleadingly as "heroin". However, other substances such as cocaine have also been laced with opioids that resulted in illness and death.
Kolokol-1 is a synthetic opioid developed for use as an aerosolizable incapacitating agent. The exact chemical structure has not yet been revealed by the Russian government. It was originally thought by some sources to be a derivative of the potent opioid fentanyl, most probably 3-methylfentanyl dissolved in an inhalational anaesthetic as an organic solvent. However, independent analysis of residues on the Moscow theater hostage crisis hostages' clothing or in one hostage's urine found no fentanyl or 3-methylfentanyl. Two much more potent and shorter-acting agents, carfentanil and remifentanil, were found in the samples. They concluded that the agent used in the Moscow theater hostage crisis contained two fentanyl derivatives much stronger than fentanyl itself, sprayed in an aerosol mist.
Xylazine is a structural analog of clonidine and an alpha-2 adrenergic receptor agonist, sold under many trade names worldwide, most notably the Bayer brand name Rompun, as well as Anased, Sedazine and Chanazine.
The Tenderloin is a neighborhood in downtown San Francisco, in the flatlands on the southern slope of Nob Hill, situated between the Union Square shopping district to the northeast and the Civic Center office district to the southwest. Encompassing about 50 square blocks, it is historically bounded on the north by Geary Street, on the east by Mason Street, on the south by Market Street and on the west by Van Ness Avenue. The northern boundary with Lower Nob Hill has historically been set at Geary Boulevard.
Medetomidine is a veterinary anesthetic drug with potent sedative effects and emerging illicit drug adulterant.
An opioid overdose is toxicity due to excessive consumption of opioids, such as morphine, codeine, heroin, fentanyl, tramadol, and methadone. This preventable pathology can be fatal if it leads to respiratory depression, a lethal condition that can cause hypoxia from slow and shallow breathing. Other symptoms include small pupils and unconsciousness; however, its onset can depend on the method of ingestion, the dosage and individual risk factors. Although there were over 110,000 deaths in 2017 due to opioids, individuals who survived also faced adverse complications, including permanent brain damage.
The US federal government is an opponent of the illegal drug trade; however, state laws vary greatly and in some cases contradict federal laws.
U-47700, also known as U4, pink heroin, pinky, and pink, is an opioid analgesic drug developed by a team at Upjohn in the 1970s which has around 7.5 times the potency of morphine in animal models.
Acetylfentanyl is an opioid analgesic drug that is an analog of fentanyl. Studies have estimated acetylfentanyl to be 15 times more potent than morphine, which would mean that despite being somewhat weaker than fentanyl, it is nevertheless still several times stronger than pure heroin. It has never been licensed for medical use and instead has only been sold on the illicit drug market. Acetylfentanyl was discovered at the same time as fentanyl itself and had only rarely been encountered on the illicit market in the late 1980s. However, in 2013, Canadian police seized 3 kilograms of acetylfentanyl. As a μ-opioid receptor agonist, acetylfentanyl may serve as a direct substitute for oxycodone, heroin or other opioids. Common side effects of fentanyl analogs are similar to those of fentanyl itself, which include itching, nausea and potentially fatal respiratory depression. Fentanyl analogs have killed hundreds of people throughout Europe and the former Soviet republics since the most recent resurgence in use began in Estonia in the early 2000s, and novel derivatives continue to appear.
There is an ongoing opioid epidemic in the United States, originating out of both medical prescriptions and illegal sources. The epidemic began in the United States in the late 1990s, according to the Centers for Disease Control and Prevention (CDC), when opioids were increasingly prescribed for pain management, resulting in a rise in overall opioid use throughout subsequent years.
The opioid epidemic, also referred to as the opioid crisis, is the rapid increase in the overuse, misuse/abuse, and overdose deaths attributed either in part or in whole to the class of drugs called opiates/opioids since the 1990s. It includes the significant medical, social, psychological, demographic and economic consequences of the medical, non-medical, and recreational abuse of these medications.
The United States Centers for Disease Control and Prevention has data on drug overdose death rates and totals. Around 1,106,900 US residents died from drug overdoses from 1968 to 2020, around 932,400 from 1999 through 2020 and around 93,700 in 2020. Of every 100,000 people in 2020 in the US, drugs killed 28. Opioids were involved in around 80,400 of the around 109,200 deaths in 2021. Synthetic opioids other than methadone were involved with 70,601 deaths in 2021. Around 111,000 people died in 2022. Around 108,300 in 2023.
Harm reduction consists of a series of strategies aimed at reducing the negative impacts of drug use on users. It has been described as an alternative to the U.S.'s moral model and disease model of drug use and addiction. While the moral model treats drug use as a morally wrong action and the disease model treats it as a biological or genetic disease needing medical intervention, harm reduction takes a public health approach with a basis in pragmatism. Harm reduction provides an alternative to complete abstinence as a method for preventing and mitigating the negative consequences of drug use and addiction.
New Jersey's most recent revised policy was issued September 7, 2022 pursuant to P.L.2021, c.152 which authorized opioid antidotes to be dispensed without a prescription or fee. Its goal is to make opioid antidotes widely available, reducing mortality from overdose while decreasing morbidity in conjunction with sterile needle access, fentanyl test strips, and substance use treatment programs. A $67 million grant provided by the Department of Health and Human Services provides funding for naloxone as well as recovery services. This policy enables any person to distribute an opioid antidote to someone they deem at risk of an opioid overdose, alongside information regarding: opioid overdose prevention and recognition, the administration of naloxone, circumstances that warrant calling 911 for assistance with an opioid overdose, and contraindications of naloxone. Instructions on how to perform resuscitation and the appropriate care of an overdose victim after the administration of an opioid antidote should also be included. Community first aid squads, professional organizations, police departments, and emergency departments are required to "leave-behind" naloxone and information with every person who overdosed or is at risk of overdosing.
Beginning in 2022 and especially in 2023, the United States Congress has introduced and passed numerous pieces of legislation tackling opioids, fentanyl, and the opioid epidemic within America. Many of these bills have been introduced by members of the Republican Party, and some pieces of legislation have attracted bipartisan support from members of the Democratic Party. Most legislative efforts have arisen during the 117th and 118th Congresses.
In response to the surging opioid prescription rates by health care providers that contributed to the opioid epidemic in the United States, US states began passing legislation to stifle high-risk prescribing practices. These new laws fell primarily into one of the following four categories:
- Prescription Drug Monitoring Program (PDMP) enrollment laws: prescribers must enroll in their state's PDMP, an electronic database containing a record of all patients' controlled substance prescriptions
- PDMP query laws: prescribers must check the PDMP before prescribing an opioid
- Opioid prescribing cap laws: opioid prescriptions cannot exceed designated doses or durations
- Pill mill laws: pain clinics are closely regulated and monitored to minimize the prescription of opioids non-medically
Daniel Chretien Comeaux is an American federal agent who currently serves as Special Agent in Charge (SAC) of the Drug Enforcement Administration's (DEA) Houston Field Division since 2021.
