Fentanyl and its analogues

Fentanyl synthetic opiate, developed for medical purposes, is increasingly gaining popularity among synthetic drug sellers. This article will address the problem of new synthetic opiates and their analogues, as well as the legal aspects of this substance.

Fentanyl and its analogues are potent synthetic opioids that are prone to abuse. They are often sold under the guise of heroin or prescription drugs such as oxycodone, and this increases the risk of overdose and related fatal accidents. An increasing number of deaths are related to the use of fentanyl and its analogues, particularly in North America. The easy synthesis of a number of these substances, combined with the ease in obtaining the necessary precursor chemicals and equipment, has led to an increase in their underground production.

In recent years, there has been a sharp increase in the number of deaths associated with opioid overdose, mainly in North America and, to some extent, in Europe. While the problem posed by these deaths is complex, more evidence is emerging about the role of fentanyl and its analogues in the current crisis. Fentanyl itself is a potent analgesic opioid, occupying a steady position in medicine. However, there was always concern about his ability to cause abuse and dependence, and therefore he was placed under international control as far back as 1964. In the 1970s and 1980s, products containing fentanyl and its analogues appeared on the illicit drug market and became notorious due to accidental overdoses.1 The problem appears to have reappeared and the clandestine production of fentanyl has increased to an unprecedented scale. The necessary materials and equipment for production are readily available online, at low cost. This situation is exacerbated by the rapid emergence of new analogues of non-fentanyl series, which were not allowed for medical use.
The crisis of opioid overdose has had a particularly strong impact on the countries of North America. Although initially the sharp increase in overdose cases was attributed to heroin, the current crisis is mainly due to clandestine fentanyl and fentanyl analogues.

In addition, evidence of fatal cases associated with new fentanyl analogs in other regions of the world is accumulating. Tablets and powders containing such substances sold on the illicit drug market pose a threat to the health of the population due to the changing amount and action of the active ingredients, which in extreme cases, such as with carfentanil, can be 10,000 times more potent than morphine. Such products can be especially dangerous when they are sold as street heroin, along with heroin or as counterfeit prescription drugs, without the knowledge of the person using them.
This publication is intended to inform the growing complexity of the opioid market, in particular the fentanyl group, international control measures, changing consumption patterns and associated risks, global changes in the production and trafficking of fentanyl analogues and their precursors.
Good medications, bad
drugs?
Fentanyl belongs to the class of potent opioid analgesics, 4-anilidopiperidines. These synthetic opioids have a high affinity for μ-opioid receptors, which presents both advantages and disadvantages. On the one hand, the strong agonists of the μ-opioid receptors from the fentanyl family have excellent analgesic properties. On the other hand, such drugs are susceptible
methylthiofentanyl, hydroxyfentanil,
methylfentanyl, para-fluorofentanyl and thiofentanil).

Fentanyl and its analogs are under control in accordance with the Single Convention on Narcotic Drugs of 1961

International control of acetylfentanil was established in 2016, while WHO made recommendations to establish control over butyrfentanil.5 Carfentanil, which was first synthesized in 1974 and remains the most potent of commercially available opioids in the world, is not under international control.
Over the past five years, even more than a dozen fentanyl analogues have appeared on the market for banned opioids. Some of these analogues were reopened by drug traffickers on the basis of research work that was carried out between the 1960s and the 1990s.

These substances have been described in the scientific literature, but did not become pharmaceuticals. Examples include acetylenyl, butylpentyl, furylmethanol and Alfentanil. Other substances currently available on the market of illicit opioids is the newly developed analogs of fentanyl, such as acrylontrile and pair – personalisierter.
The myriad possibilities for creating new compounds by making small changes in the chemical structure represent increasing difficulties in the international fight against opioid trade. Between 2012 and 2016, seventeen fentanyl analogues from East Asia, Europe and North America were reported to the UNIP early warning web portal for NIPs. To date international control was installed only for one of them, azetilholinom.

Non-medical use of fentanyl and its analogues can have serious health consequences. Addiction and addiction develop very quickly and can reach extreme levels. First of all, each episode of non – medical use is associated with a high risk of overdose and death as a result of respiratory depression-a common side effect of opioids. Based on a report from the Sydney drug use room, it was determined that under medical supervision, the risk of overdose after parenteral administration of fentanyl is twice as high as after heroin injections and eight times higher than after injections of other prescription opioids.Six
Overdose can be effectively eliminated by naloxone, a drug that is an antagonist of the μ-opioid receptor.

Table 1: NIP – analogues of fentanyl, reported on the web portal of the United Nations UPN on early warning, 2012-2016

GENERALIZED NAME

3-Fluoropentanyl 4-fluorobutyrfentanyl
4-Methoxybutyrylpentanyl acetylpentanyl
acrylfenanil-beta-hydroxythiopentanyl
butyrfentanil
despropionylfentanyl
despropionyl-2-fluoropentanil
furanylfentanyl
isobutyrfentanil
an analogue of (iso) butyr-F-fentanyl-N-benzyl
methoxyacetylfentanyl octfentanil
p-fluoroisobutyrfentanyl tetrahydrofuranylfentanyl
valerylfentanil

It is important to note that to eliminate an overdose of fentanyl or its analogues often require very high doses of naloxone. In response to the growing need for treatment of overdose, some countries have introduced or expanded programmes to spread naloxone. In 2016, Canada allowed the sale of naloxone without a prescription, including nasal spray.Seven
Risky methods
Although the use of fentanyl in clinical observation is safe, for example, in hospital settings, the use of products containing fentanyl, in recreational purposes can easily be fatal with increasing the administered dose, or change method of administration (for example, the extraction of the drug from the transdermal patch into a liquid for the preparation of injection or nasal spray, inhalation of fentanyl vapors, or placement of transdermal patches on the mucous membranes of the oral cavity).
A study conducted in rural areas of Australia, came to the conclusion that persons who use drugs usually don’t go back to less potent opioids, becoming dependent on fentanyl, they are practicing unsafe methods of preparation and administration, and among them the risk of overdose is exacerbated by the misinformation circulating in their environment. The use of illegally produced fentanyl and its analogues increases the danger, due to the lack of quality control in the production of such products, as a rule, they are not divided into precise doses and can be deadly in small quantities due to the extreme content of active substances. Attempts to prepare a single dose by weighing without precision equipment are very risky. Another approach is to convert a larger amount of the drug into a solution, which is then proportionally divided into individual doses; however, errors in calculations can be fatal. Users experimenting with new fentanyl analogues whose action is not clearly defined increase the chances of making a fatal mistake.

Risk of exposure to fentanyl and its analogues
Overdose can occur as a result of the use of strong synthetic opioids without taking precautions that prevent inhalation or absorption of the substance through the skin or mucous membranes. Contact with fentanyl or its analogues is so dangerous that in Canada and the United States, cases of hospitalization of law enforcement officers who seized such chemicals were recorded. Management on struggle against drugs (DEA) of the United States recently issued a warning about the dangers of fentanyl and carfentanil, with recommendations for action in situations, which can have such drugs, including the immediate application of naloxone in the event of exposure.
Death by overdose
The non-medical use of fentanyl and its analogues has resulted in thousands of casualties worldwide. In North America, illegally produced fentanyl or fentanyl analogues led to a number of overdose deaths in the 1970s, and they are largely responsible for the current overdose epidemic in the region.

In the US, fentanyl and its analogues have led to more than 5,000 overdose deaths since the fall of 2013. In Canada, it was determined that fentanyl is the cause or a contributing factor in at least 655 deaths that occurred between 2009 and 2014,  In the European Union, the deaths of the group in connection with the substances of the group of fentanyl was first documented in the 1990-ies in Italy and Sweden, and reappeared in the early 2000-ies in Estonia (where the majority of registered deaths from overdose are associated with the use of fentanyl and 3-methyl фентанила), also recently reported in several other member States of the EU, including Finland, Germany, Greece and the United Kingdom. In Australia has witnessed the increasing occurrence of deaths due to the use of pharmaceutical fentanyl, redirected to the misuse, between 2000 and 2012 were reported in at least 123 deaths related to fentanyl.

Of deaths a result of the use of several patches with fentanyl has also been reported in Algeria and Morocco.
In recent years, several new synthetic opioids have been reported in serious cases of death and events.18 In 2016, a record of overdoses in the Midwest in the USA was associated with carfentanil, and in the canadianotkrovennie.
Markets for specific products
Products sold on the market for banned synthetic opioids are highly diversified and often specific to a particular region.

Fentanyl is extracted from pharmaceutical products (mainly transdermal), represents the primary form of non-medical use of fentanyl in Australia and Germany, reports of this also appeared in New Zealand. Clandestinely produced fentanyl or its analogues can be sold in solid or liquid form, like a drug which addicts prefer, as in the case of Estonia, where fentanyl and 3 – methylfentanyl are the most widely used opioids, and the main injecting drug.Twenty two
In North America, drugs from the fentanyl group containing or replacing heroin entered the illicit drug market as early as the 1970s under names such as “China White”, “Tango and Cash” or “synthetic heroin”. This trend is now returning. Illegally produced fentanyl is most often mixed with or sold as white heroin powder, but also as cocaine-containing products23 or “black resin” (heroin). The most recent development is the emergence of counterfeit pharmaceuticals containing illegally produced fentanyl and its analogues. Selling fake products to unsuspecting consumers increases the risk of overdose because they do not know what substances they consume and cannot determine the safe amount. It is important to note that clandestine manufacturers often do not have the capacity to ensure the uniform distribution of such potent substances in commercially available drugs such as tablets and powders. As a result, some tablets and powders may contain lethal doses. In a study conducted in California, an outbreak of poisoning caused by pills
Still continue to appear new types of fake pills, prescription, with content of synthetic opioids. there are also cases in Europe of sales of fentanyl and its analogues disguised as heroin. For example, as shown by the analysis of samples collected in Spain and France, Alfentanil sold in the “shadow Internet” as heroin.Twenty six
Production and trafficking
According to UBN, the existing fentanyl crisis in the US is largely fuelled by illegally produced fentanyl and its analogues, which are smuggled as such or synthesized from imported precursors. The materials and devices used in the synthesis and tableting of fentanyl are inexpensive and easy to obtain from suppliers on the Internet, and their synthesis does not require professional skills in the laboratory. It facilitates small-scale of drug-trafficking organizations output on small-scale production. The bulk of fentanyl recently seized in the US is non-pharmaceutical in origin and is synthesized using the so-called Siegfried method, which was first described in the 1980s and relatively easy to perform. precursor chemicals used in this method are N-phenethyl-4-piperidone (N – PP) or its derivative, 4-anilino-N – phenetilpiperidine (A-N-PP). Most analogues of fentanyl, reported in recent years in reference and information web portal UNODC early warning, including acetylphenyl, butylpentyl and furylmethanol, can be synthesized from N-phenethyl-4-piperidone or 4-anilino-N – finetipped according to the method of Siegfried.
Issue 17 However, international control of
most of the fentanyl analogues were installed between the 60s and 90s, and they don’t seem to be related to the existing opioid crisis in the US, they can’t be easily made from N-phenethyl-4-piperidone or 4 – anilino-N-phenetilpyperidine.
Data from reports to the United Nations HPD on liquidated fentanyl laboratories include: three cases in Canada (one laboratory in the kitchen, and one industrial facility in 2011, and one facility from medium to large scale in 2012), one laboratory in the kitchen in Slovakia (2011), three laboratories in the kitchen in the United States (one in 2013 and two in 2015), one laboratory in the kitchen in Germany (2015). and one case of 3-methylphentanyl manufacture in Russia (2014).Twenty nine
Because of their extremely strong action, fentanyl and its analogues are often present in trace amounts in available products, they may be present in drugs, illegally manufactured materials or in mixtures with, for example, heroin. This makes the detection of these substances extremely difficult in forensic laboratories and can lead to a decrease in the number of reports of the volumes in which these products appear on the market of illicit drugs.
with falsified
bought on the street hydrocodone/acetaminophen,
fentanyl in the analyzed tablets ranged from 600-6900 µg / tablet.