Misuse of Novel Synthetic Opioids: A Deadly New Trend.
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ABSTRACT:
SUBMITTER: Prekupec MP
PROVIDER: S-EPMC5537029 | biostudies-other | 2017 Jul/Aug
REPOSITORIES: biostudies-other
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Project description:Background: In the last decade there has been a progressive increase in the use of new psychoactive substances (NPSs) that are not yet under international control. In particular, novel synthetic opioids (NSOs) have reappeared on the recreational drug market in the last few years. As a result, the use of NSOs has increased rapidly. This poses an emerging and demanding challenge to public health. Aim: To raise awareness among clinicians and other professionals about NPSs, especially NSOs, to summarize current knowledge about pharmacological properties, forms of NSO on the market, pattern of use, effects and consequences of use. Methods: An electronic search was carried out on the Medline/PubMed and Google Scholar databases to find selected search terms. Results: Some NPSs are already controlled, while others can be legally sold directly on the drug market (mainly via internet, less so by drug dealers) or be used as precursors for the synthesis of other designer drugs that mimic the psychoactive effects of controlled substances. Potential side-effects of NSOs include miosis, sedation, respiratory depression, hypothermia, inhibition of gastrointestinal propulsion, death (from opioid overdose). Conclusions: The severity of the opioid crisis has intensified with the introduction of highly potent NSOs on the drug market. As long as addicts are dying from overdose or similar causes, there is something more constructive to do than waiting for addicts to overdose on heroin at a place located near a remedy, as if to say, within reach of naloxone.
| S-EPMC6352208 | biostudies-literature
Project description:Over the past few years, there has been an emerging number of new psychoactive drugs. These drugs are frequently mentioned as "legal highs", "herbal highs", "bath salts" and "research chemicals". They are mostly sold and advertised on online forums and on the dark web. The emerging new psychoactive substances are designed to mimic the effects of psychoactive groups, which are often abused drugs. Novel synthetic opioids are a new trend in this context and represent an alarming threat to public health. Given the wide number of fatalities related to these compounds reported within the last few years, it is an important task to accurately identify these compounds in biologic matrices in order to administer an effective treatment and reverse the respiratory depression caused by opioid related substances. Clinicians dealing with fentanyl intoxication cases should consider that it could, in fact, be a fentanyl analogue. For this reason, it is a helpful recommendation to include synthetic opioids in the routine toxicological screening procedures, including analysis in alternative matrices, if available, to investigate poly-drug use and possible tolerance to opioids. To address this public health problem, better international collaboration, effective legislation, effective investigation, control of suspicious "research chemicals" online forums and continuous community alertness are required. This article aims to review diverse reported fatalities associated with new synthetic opioids describing them in terms of pharmacology, metabolism, posology, available forms, as well as their toxic effects, highlighting the sample procedures and analytical techniques available for their detection and quantification in biological matrices.
| S-EPMC6609355 | biostudies-literature
Project description:The recent re-emergence and the increasing popularity of nitazenes, a group of new synthetic opioids (NSO) that belong to the benzimidazole chemical class, has raised public health concerns. As a class of potential opioid analgesic agents whose development was discontinued in the 1960s due to their high potential for abuse, very little is known about their metabolism and physiologic disposition. In the current study, three nitazenes-butonitazene, isotonitazene and protonitaze were incubated in human liver microsomes (HLM), human S9 (HS9) fractions and recombinant cytochrome P450 enzymes. All three nitazenes were rapidly metabolized in both HLM and HS9 with over 95% depletion within 60 min. In HLM, butonitazene, isotonitazene and protonitazene had in vitro intrinsic clearance (CLint) (µL/min/mg protein) values of 309, 221 and 216 respectively compared to 150 of verapamil, the positive control. In HS9, CLint values were 217, 139, and 150 for butonitazene, isotonitazene and protonitazene respectively compared to only 35 for testosterone, the control probe substrate. Putative metabolite identified from this study include products of hydroxylation, desethylation, dealkylation, desethylation followed by dealkylation, and desethylation followed by hydroxylation. The metabolic phenotyping showed CYP2D6, CYP2B6 and CYP2C8 and the major hepatic enzymes responsible for the metabolism of nitazenes. Within 30 min of incubation, CYP2D6 depleted butonitazene (99%), isotonitazene (72%) and butonitazene (100%) significantly. The rapid metabolism of nitazenes may be an important factor in accurate and timely detections and quantitation of the unchanged drugs in human matrices following intoxication or in forensic analysis. The involvement of multiple polymorphic CYPs in their metabolism may play important roles in the susceptibility to intoxication and/or addiction, depending on the activity of the metabolites.
| S-EPMC11291330 | biostudies-literature
Project description:BackgroundSuccessfully combating the opioid crisis requires patients who misuse opioids to have access to affirming and effective health care. However, there is a shortage of physicians who are willing to work with these patients. We investigated novel predictors of what might be contributing to physicians' unwillingness to engage with this patient population to better identify and direct interventions to improve physician attitudes.Methods333 physicians who were board certified in the state of Ohio completed a survey about their willingness to work with patients who misuse opioids. The hypothesized relationships between the proposed predictors and willingness to work with this patient population were tested using multivariate regression, supplemented with qualitative analysis of open-text responses to questions about the causes of addiction.ResultsPerceptions of personal invulnerability to opioid misuse and addiction, opioid misuse and addiction controllability, and health care provider blame for the opioid crisis were negatively associated with physician willingness to work with patients who misuse opioids after controlling for known predictors of physician bias toward patients with substance use disorders. Physicians working in family and internal medicine, addiction medicine, and emergency medicine were also more willing to work with this patient population.ConclusionsDistancing oneself and health care professionals from opioid misuse and placing blame on those who misuse are negatively associated with treatment willingness. Interventions to improve physician willingness to work with patients who misuse opioids can target these beliefs as a way to improve physician attitudes and provide patients with needed health care resources.
| S-EPMC8147073 | biostudies-literature
Project description:BackgroundThe misuse of prescription opioids (MUPO) is a leading public health concern. Social media are playing an expanded role in public health research, but there are few methods for estimating established epidemiological metrics from social media. The purpose of this study was to demonstrate that the geographic variation of social media posts mentioning prescription opioid misuse strongly correlates with government estimates of MUPO in the last month.MethodsWe wrote software to acquire publicly available tweets from Twitter from 2012 to 2014 that contained at least one keyword related to prescription opioid use (n = 3,611,528). A medical toxicologist and emergency physician curated the list of keywords. We used the semantic distance (SemD) to automatically quantify the similarity of meaning between tweets and identify tweets that mentioned MUPO. We defined the SemD between two words as the shortest distance between the two corresponding word-centroids. Each word-centroid represented all recognized meanings of a word. We validated this automatic identification with manual curation. We used Twitter metadata to estimate the location of each tweet. We compared our estimated geographic distribution with the 2013-2015 National Surveys on Drug Usage and Health (NSDUH).ResultsTweets that mentioned MUPO formed a distinct cluster far away from semantically unrelated tweets. The state-by-state correlation between Twitter and NSDUH was highly significant across all NSDUH survey years. The correlation was strongest between Twitter and NSDUH data from those aged 18-25 (r = 0.94, p < 0.01 for 2012; r = 0.94, p < 0.01 for 2013; r = 0.71, p = 0.02 for 2014). The correlation was driven by discussions of opioid use, even after controlling for geographic variation in Twitter usage.ConclusionsMentions of MUPO on Twitter correlate strongly with state-by-state NSDUH estimates of MUPO. We have also demonstrated that a natural language processing can be used to analyze social media to provide insights for syndromic toxicosurveillance.
| S-EPMC5711756 | biostudies-literature
Project description:PurposeSince the appearance of fentanyl followed by its many kinds of analogues around 1988, North America has been exposed to fierce synthetic opioid pandemic resulting in more than 130,000 deaths due to their overdoses until May 2019, when China declared to prohibit the licit fentanyl analog production. However, the Chinese announcement did not go into force in USA due to the adroit strategies of tough traffickers. Thus, contrary to the expectation, the number of synthetic opioid products and their poisoning cases in USA has increased by about 30%; especially, various benzimidazole synthetic opioids have revived on the illicit drug market during a recent few years. In this article, the recent abrupt changes in the situations of illicit synthetic opioid market and their current abuses are described.MethodsVarious databases, such as SciFinder, Google, and Google Scholar, were utilized to collect relevant reports referring old but newly appearing synthetic opioids.ResultsAt the present time, there are several families of new synthetic opioids, which are not fentanyl derivatives; MT-45 and its analogs, benzamide and 2-phenylacetamide opioids (U-series opioids), and benzimidazole opioids. Most of the above substances had been developed in 1950s to 1970s, but had never been used as analgesic medicines, because of their severe adverse effects, such as respiratory depression, physical dependence, and resulting deaths. However, there is possibility that these drugs will become main illicit synthetic opioids in place of the fentanyl analogs during coming several years from this time.ConclusionsAll of the above non-fentanyl-derived families had been developed 50-70 years ago to establish them as analgesic medicines, but had been unsuccessful. These drugs largely appeared in the illicit drug markets in North America, Europe, and Australia, during recent years. Pharmacological, toxicological, and metabolic studies are insufficient for benzamide and 2-phenylacetamide opioids, and are very scant especially for benzimidazole opioids. This time we should start studying pharmacotoxicology of the newly emerging synthetic opioids to alert forensic toxicologists in the world and to suppress their rapid and wide spread in the world.Supplementary informationThe online version contains supplementary material available at 10.1007/s11419-022-00624-y.
| S-EPMC9052731 | biostudies-literature
Project description:BackgroundIncreasing naloxone awareness and carrying among individuals who misuse opioid analgesic medications (OAs) could reduce opioid overdose mortality. Methods: Self-report surveys were completed by 322 adults receiving residential addiction treatment who misused OAs in the past year. Descriptive analyses and prevalence ratios (using Poisson generalized estimating equations) examined whether illegal opioid (e.g., heroin) initiation was associated with naloxone awareness. Results: Among this sample of participants who misused OAs, naloxone awareness was lowest among those who never used illegal opioids (26%) and highest among those who transitioned from OAs to illegal opioid use over time (83%). Naloxone awareness remained higher among participants who had used illegal opioids after adjustment for sociodemographic and substance use characteristics. Those who used OAs before initiating illegal opioids were 2.3-fold (95% CI: 1.5-3.3) more likely to have naloxone awareness than those who had only misused OAs after adjustment. Half of participants who had only used OAs had experienced an overdose, 75% had witnessed an overdose, and 61% were prescribed OAs to treat pain in the past 6 months. Conclusions: Implementing overdose education and naloxone distribution programs during addiction treatment could bolster naloxone awareness among people who misuse OAs but who have not used illegal opioids.
| S-EPMC7854843 | biostudies-literature
Project description:BackgroundDrug classes are grouped based on their chemical and pharmacological properties, but prescription and illicit drugs differ in other important ways. Potential differences in genetic and environmental influences on the (mis)use of prescription and illicit drugs that are subsumed under the same class should be examined. Opioid and stimulant classes contain prescription and illicit forms differentially associated with salient risk factors (common route of administration, legality), making them useful comparators for addressing this etiological issue.MethodsA total of 2410 individual Australian twins [Mage = 31.77 (s.d. = 2.48); 67% women] were interviewed about prescription misuse and illicit use of opioids and stimulants. Univariate and bivariate biometric models partitioned variances and covariances into additive genetic, shared environmental, and unique environmental influences across drug types.ResultsVariation in the propensity to misuse prescription opioids was attributable to genes (41%) and unique environment (59%). Illicit opioid use was attributable to shared (71%) and unique (29%) environment. Prescription stimulant misuse was attributable to genes (79%) and unique environment (21%). Illicit stimulant use was attributable to genes (48%), shared environment (29%), and unique environment (23%). There was evidence for genetic influence common to both stimulant types, but limited evidence for genetic influence common to both opioid types. Bivariate correlations suggested that prescription opioid use may be more genetically similar to prescription stimulant use than to illicit opioid use.ConclusionsPrescription opioid misuse may share little genetic influence with illicit opioid use. Future research may consider avoiding unitary drug classifications, particularly when examining genetic influences.
| S-EPMC8286273 | biostudies-literature
Project description:A few new psychoactive substances (NPS) that mimic the effects of controlled neuropsychiatric and illicit drugs have been forensically identified in the U.S. Wastewater-based epidemiology (WBE) can provide a comprehensive and more cost- and time-effective method of determining the prevalence of NPSs in communities. In this study, an analytical method capable of simultaneous determination of trace-level 40 NPS residues (synthetic opioids, synthetic cannabinoids, synthetic cathinones, piperazines, indole, and amphetamine) in wastewater was developed and validated. The developed analytical method was utilized to determine the occurrence of NPSs in four rural communities in southern Illinois. Nine NPSs (carfentanil, furanyl fentanyl, methoxyacetyl fentanyl, MAB-CHMINACA, methcathinone, 4-methyl pentedrone, 2-methyl-4'-(methylthio)-2-morpholinopropiophenone (MMMP), 1-(3-chlorophenyl) piperazine (mCPP), and 5-(2-Aminopropyl) Indole (5IT) were quantified. Methcathinone was the most frequently detected NPS (detection frequency, df = 100%) followed closely by the MMMP and mCPP (df = 91%). The mass loading of methcathinone, mCPP, and 5-IT using ammoniacal nitrogen-based population were up to 21.1 ± 1.3 mg/d/1000 people, 15.0 ± 0.5 mg/d/1000 people, and 9.75 ± 2.72 mg/d/1000 people, respectively. This is the first study to determine the occurrence of NPSs including synthetic opioids, synthetic cannabinoids, synthetic cathinones, and piperazines in the U.S. communities.
| S-EPMC8014967 | biostudies-literature
Project description:The continual introduction of a large number of new psychoactive substances, along with the large turnover of these substances, necessitates the development of non-targeted detection strategies to keep pace with the ever-changing drug market. The production of certified reference materials often lags behind the introduction of new substances to the market, therefore these detection strategies need to be able to function without relying on reference materials or library spectra. Synthetic opioids have recently emerged as a drug class of particular concern due to the health issues caused by their incredibly high potency. A common method which has been used for non-targeted analysis in the past involves the identification of common product ions formed as a result of the fragmentation of the parent molecule. These common fragments can then potentially be used as markers to indicate the presence of a particular class of compounds within a sample. In this study, standards of a number of different synthetic opioids, including 14 fentanyl derivatives, 7 AH series opioids, 4 U series opioids, 4 W series opioids and MT-45, were subjected to collision-induced dissociation studies to determine how the compounds fragment. The spectra obtained from these studies included a number of diagnostic fragments common to the different opioid classes that, when used in combination, show potential for use as class predictors. By using simple data processing techniques, such as extracted ion chromatograms, these diagnostic product ions identified can be applied to a non-targeted screening workflow.
| S-EPMC6527801 | biostudies-literature