Abstract
In 2016 in the USA, 19 547 fatal overdoses (about a third of all fatal overdoses) were attributed to synthetic opioids, primarily fentanyls. Fentanyl, almost always sold as or mixed with illicitly sourced opioids, sharply increases risk of overdose. Its potency (roughly 50 times that of heroin) makes accurate dosing and titration difficult. The duration of desired effects is shorter than that of other abused opioids, necessitating more frequent dosing. Each of these factors increases risk of overdose and the social damage caused by non-prescription opioid use. Additional interventions that take account of the increasing lethality of street drugs are needed.
Price, concealability, and accessibility make fentanyls attractive for drug dealers. In some North American street opioid markets, fentanyls have become ubiquitous. Insite, Vancouver’s drug consumption outreach service, tested 173 samples in July, 2016, and found that more than 90% of the drugs they tested that were reported to be heroin or mixtures containing heroin also contained fentanyls. According to the European Monitoring Center on Drugs and Drug Addiction, fentanyl has become the most commonly used opioid among injecting drug users in Estonia.