Report: fentanyl's increasing flows fuel steep rise in overdose deaths

Increasing flows of fentanyl fuel a steep rise in overdose deaths. Image: UNODC6 March 2017 - UNODC launched today a report which sheds light on the rapidly unfolding public health threat posed by extremely potent synthetic opioids, such as fentanyl and its analogues. Information in the report suggests that it is twice as likely to overdose with fentanyl than with heroin. The study is part of the Global Synthetics Monitoring: Analyses, Reporting and Trends (SMART) Programme, designed to provide regular brief reports on emerging patterns and trends of the global synthetic drug situation.

"The Global SMART Update provides up-to-date information on the fast-changing synthetic opioid situation in the context of an escalating public health emergency, resulting in too many overdose deaths and human tragedy. The update looks into the evolving manufacturing, trafficking, and marketing patterns and suggests suitable policy measures", said Jean-Luc Lemahieu, UNODC's Director of Public Affairs.

The latest SMART update  - number 17, under the theme " Fentanyl and its analogues - 50 years on" - includes information on the growing complexity of the opioid market, in particular the fentanyl group, international controls, evolving patterns of use and associated risks, global developments in manufacture and trafficking of fentanyl analogues and their precursors.

Fentanyl is considered the strongest opioid available for medical use in humans, with about 100 times the potency of morphine. It is highly valued for its analgesic and sedative effects and widely used in the management of severe pain and anaesthesia. On the other hand, such drugs are liable to abuse and have high dependence producing properties. For instance, a report from a drug consumption room in Sydney, Australia, under medical surveillance, found that the risk of overdose upon injecting fentanyl was two times higher than upon injecting heroin, and eight times higher than upon injecting other prescription opioids.

In the 1970s and 1980s, products containing fentanyl and its analogues appeared on the illicit drug market and became notorious for accidental overdoses. The problem seems to have resurfaced, and the clandestine manufacturing of fentanyl has risen to unprecedented levels. The required materials and equipment for manufacture are readily available online, at a low cost. This situation is aggravated by the rapid emergence of novel non-fentanyl analogues which have not been approved for medical use.

North America is particularly affected by an opioid overdose crisis. While originally the sharp rise in overdoses was attributed to heroin, the current crisis is mainly attributed to illicitly manufactured fentanyl or fentanyl analogues which have caused several epidemics of overdose deaths since the 1970s. Since fall 2013, fentanyl and its analogues have contributed to more than 5000 overdose deaths.

Key research insights also included in the latest update delineate a complex market, whereby the sale of illicit opioids is entwined with the legitimate and underground supply of opioid pharmaceuticals, exposing users to the ruthless criminal practice of counterfeiting prescription medications. The report calls for special attention to the global developments in clandestine opioid manufacturing and trafficking, and associated international concerns.

The upcoming 60th Commission on Narcotic Drugs will consider the scheduling of two precursors of fentanyl and its analogues under the 1988 Convention, on 16th March 2017. This move should impact positively on efforts by Member States to disrupt the clandestine manufacture of these substances. In addition, an analogue of fentanyl, butyrfentanyl will be considered for control under the 1961 Convention at the same meeting.

Further Information:

Global SMART Update 17: Fentanyl and its analogues - 50 years on

UNODC's Global SMART Programme

60th Commission on Narcotic Drugs

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