Non-Medical Use of Novel Synthetic Opioids: A New Challenge to Public Health.

Barbara Lovrecic,Icro Maremmani,Angelo G I Maremmani,Branko Gabrovec,Mercedes Lovrecic,Matteo Pacini,Marco Carli

doi:10.3390/ijerph16020177

Abstract

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.

Highlights

New psychoactive substances (NPSs) are legally defined as new narcotic or psychotropic drugs, in pure form or in a preparation, which are not scheduled under the 1961 Single Convention on Narcotic Drugs or the 1971 Convention on Psychotropic Substances [1], but which may pose a public health threat comparable with classic illicit drugs, substances listed in conventions (Council of the European Union decision 2005/387)
The dynamic drug market of new psychoactive substances (NPSs), including novel synthetic opioids (NSOs), is continuously changing, while NSO users are usually unaware of the NSO content and their exposure to it, or they may know only a brand or street name
Indirect information could be obtained from data on acute clinical toxicity which are limited to retrospective analysis, surveys and case reports, and are mainly reported by poison centers, NSO-related mortality data and data about confiscated drug products [7]

Summary

Introduction

New psychoactive substances (NPSs) are legally defined as new narcotic or psychotropic drugs, in pure form or in a preparation, which are not scheduled under the 1961 Single Convention on Narcotic Drugs or the 1971 Convention on Psychotropic Substances [1], but which may pose a public health threat comparable with classic illicit drugs, substances listed in conventions (Council of the European Union decision 2005/387). 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. Novel synthetic opioids (NSOs) have reappeared on the recreational drug market in the last few years. The use of NSOs has increased rapidly. This poses an emerging and demanding challenge to public health. Methods: An electronic search was carried out on the Medline/PubMed and Google Scholar databases to find selected search terms

Objectives

Methods

Results

Discussion

Conclusion