Abuse of fentanyl derivatives: History repeating itself.

Abstract

The lay and medical literature are replete with stories and articles that describe the current opioid epidemic in the United States.1–3 The opioid scourge has resulted in a nearly threefold increase in the number of overdose deaths from 1999 through 2014.2 While fatalities related to prescription opioids (e.g., oxycodone) remain high, death rates related to synthetic opioids are increasing dramatically. Methadone-related fatalities are common. Fentanyl is often substituted deliberately by drug dealers for heroin.4,5 More recently, synthetic opioid derivatives of fentanyl, such as carfentanil, have emerged as public health threats. Illicit fentanyl derivatives are often present in counterfeit prescription opioids or marketed as “super potent” heroin (heroin laced with carfentanil). However, the recent opioid plague with illicit fentanyl derivatives is not an issue that is unique just to the 21st century. Fentanyl was first synthesized by Dr. Peter Janssen in the 1960s. In 1979, fentanyl derivatives appeared as some of the first designer drugs in California, under the name “China white.”6 Regional epidemics of fatal overdoses with fentanyl derivatives became commonplace. In 1988, a corporate chemist in the Pittsburgh region synthesized and marketed 3-methyl fentanyl. Sold as China white and promoted as heroin, the use of this drug resulted in dozens of fatalities in unsuspecting heroin users who were unaware of the derivative’s super potency. A similar outbreak occurred in Philadelphia in 1992. This scenario has repeated itself a multitude of times leading up to the current epidemic.