Fentanyl, much more deadly than heroin

In the United States, the number of deaths from using synthetic opioids has risen from 3,000 in 2013, to more than 30,000 in 2018. In fact, synthetic opioids such as fentanyl are now responsible for twice as many deaths as heroin.

In the USA, a book [1] offering a systematic assessment of the past, present, and possible future of synthetic opioids in the United States, has been released. The book is rooted in the analysis of secondary data, literature reviews, international case studies, and interviews with key informants. The goal is to provide decision-makers, researchers, the media, and members of the public with insights intended to improve their understanding of the synthetic-opioid problem and how to respond to it.

Main conclusions

Fentanyl and other synthetic opioids dominate some regional drug markets in Canada and the eastern United States.
The spread of Fentanyl can be explained more by supply-side factors than by an increase in demand. These issues include the online dissemination of new and more efficient synthesis methods, anonymous e-commerce operators, etc.

In some markets, fentanyl is replacing – not just altering or supplementing – heroin.
The spread of synthetic opioids is a result of supplier decisions rather than user demand.
Despite substantial differences in their drug policies and public health services, the problem in some parts of Canada is as acute as in the east of the United States.
Fentanyl’s spread is episodically quick and persistent.
The synthetic-opioid problem will likely get worse.
The synthetic-opioid problem in the USA has yet to reach a national scale. Some western regions of Mississippi have been less affected until now.


It’s imperative that efforts be made to prevent synthetic opioids from becoming entrenched in parts of the country that have been only moderately affected.
Policymakers must innovate in places where synthetic opioids are produced. New approaches to dealing with the crisis must be given serious consideration (for example, disrupting online transactions, supervised consumption locations, new evidence-based treatments such as heroin-based treatment, analysis of drug contents). The nature and scale of the challenge presented by synthetic opioids, which, in their current forms and distribution methods represent a departure from previous crisis, make these actions necessary. In fact, the solution to this crisis may lie in approaches and technologies that do not exist today.
Governments have a unique responsibility to fund data-collection and the monitoring of drug sales and usage.  The HIV / AIDS crisis prompted substantial investment in new data and monitoring systems, such as the National HIV Behavioral Surveillance System. The number of opioid-related deaths is roughly similar to that at the peak of the HIV / AIDS epidemic, but there has been no comparable investment in improving existing drug control systems.

[1] The future of Fentanyl and Other Synthetic Opioids by Bryce Pardo, Jirka Taylor, Jonathan P. Caulkins, Beau Kilmer, Peter Reuter, Bradley D. Stein.



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