17 GLOBAL March S MART UPDATE VOLUME VOLUME Fentanyl and its analogues - 50 years on Research 2017 GLOBAL SMART UPDATE About the SMART Update Content Synthetic drugs constitute one of the most significant SPECIAL SEGMENT 3 drug problems worldwide. After cannabis, amphet- amine-type stimulants (ATS) are the second most widely used drugs across the globe, with use levels SHORT SEGMENTS 8 often exceeding those of heroin and/or cocaine. Along BEIJING, China – September 2015 with ATS, the continued growth of thenew psychoactive 8 substances (NPS) market over the last years has become BEIJING, China – May 2015 8 a policy challenge and a major international concern. A growing interplay between these new drugs and tra- TOKYO, Japan – August 2016 8 ditional illicit drug markets is being observed. By July 2016, the emergence of NPS had been reported from HELSINKI, Finland – June 2015 8 102 countries and territories. Trends on the synthetic drug market evolve quickly each year. STOCKHOLM, Sweden – August 2016 9 The UNODC Global Synthetics Monitoring: Analyses, Reporting and Trends (SMART) Programme enhances TALLINN, Estonia – July 2016 9 the capacity of Member States in priority regions to VIENNA, Austria – May 2016 generate, manage, analyse, report and use synthetic 9 drug information to design effective policy and pro- VIENNA, Austria – November 2016 9 gramme interventions. Launched in September 2008, the Global SMART Programme provides capacity building GENEVA, Switzerland – November 2016 10 to laboratory personnel, law enforcement and research officers in the Pacific, East and South-East Asia, South BRUSSELS, Belgium – 2015 10 Asia, the Near and Middle East, Africa and Latin America; and regularly reviews the global amphetamine-type DUBLIN, Ireland – 2016 10 stimulants andnew psychoactive substances situation. Its main products include online drug data collection, SÃO PAULO, Brazil – September 2016 10 situation reports, regional assessments and the UNODC Early Warning Advisory (EWA) on new psychoactive OTTAWA, Canada – September 2016 11 substances. The EWA is a webportal that offers regu- lar updates on new psychoactive substances, including LOS ANGELES, California – March 2016 11 trend data on emergence and persistence, chemical data, supporting documentation on laboratory analysis BRITISH COLUMBIA, Canada – June 2016 11 and national legislative responses (available at: www. WASHINGTON D.C., United States – 2016 11 unodc.org/NPS). The Global SMART Update (GSU) series is published twice a year in English, Spanish and Russian and provides information on emerging patterns and trends of the global synthetic drug situation in a concise format. Each issue of the Global SMART Update contains a special segment and short segments on the topic of interest.* Electronic copies of the Global SMART Updates and other publications are available at: www.unodc.org/ unodc/en/scientists/publications-smart.html. Past issues have covered topics such as UNGASS 2016 recommenda- tions, injecting use of synthetic drugs, legal responses to NPS, key facts about synthetic cannabinoids and regional patterns of methamphetamine manufacture. * The information and data contained within this report are from official Government reports, press releases, scientific journals or incidents confirmed by UNODC Field Offices. An asterisk (*) indicates that information is preliminary as it stems from ‘open sources’ where UNODC is waiting for official confir- mation. This report has not been formally edited. The contents of this publication do not necessarily reflect the views or policies of UNODC or contributory organizations and neither do they imply any endorsement. Suggested citation: UNODC, Global SMART Update Volume 17, March 2017. 2 Volume 17 Fentanyl and its analogues - 50 years on ABSTRACT Fentanyl is the strongest opioid Fentanyl and its analogues are potent synthetic opioids, which are available for medical use in humans, with about 100 times the potency of liable to abuse. They are often sold under the guise of heroin or morphine2. It is highly valued for its prescription medicines, such as oxycodone, and this exacerbates analgesic and sedative effects and the risk of overdose and associated fatalities. An increasing num- widely used in the management of ber of deaths have been associated with the use of fentanyl and severe pain and in anaesthesia. The its analogues, particularly in North America. The facile synthesis of three fentanyl analogues approved a number of these substances, coupled with the ease in obtaining for pharmaceutical use, sufentanil, alfentanil and remifentanil, have the required precursor chemicals and equipment, has led to an very short onset and duration of SEGMENT SPECIAL increase in clandestine manufacture. action, and their medical use is lim- ited to intravenous anaesthesia3. Introduction Carfentanil, estimated to be about 10,000 times more potent than Recent years have seen a sharp rise and fentanyl analogues. Evidence on morphine4, is intended only for vet- in opioid-related overdose deaths fatalities associated with emerging erinary use on large animals, and not mainly in North America, and to a fentanyl analogues is accumulating, approved for medical use in humans. certain extent, in Europe. While the also, in other regions of the world. challenge posed by these fatalities The pills and powders containing The liability of fentanyl and its is complex, more evidence is emerg- such substances sold on the illicit analogues to abuse and the depen- ing about the role fentanyl and its market pose a threat to public health dence-potential are reflected in the analogues play in the current crisis. because of the variable quantity and international legislative responses. Fentanyl itself is a powerful opioid potency of the active components, Fentanyl was first synthesized in analgesic, with an established place which in extreme cases, such as with 1959, and was placed under inter- national control as a Schedule 1 in medicine. Yet, there has always carfentanil, may be 10,000 times substance in 1964 under the Single been concern about its potential for more potent than morphine. Such Convention on Narcotic Drugs of abuse and dependence, and it was products can prove particularly dan- 1961. During the ensuing decades, therefore placed under international gerous when sold as street heroin, together with heroin or as counter- the list of scheduled substances control as far back as 1964. In the has grown to include all fentanyl 1970s and 1980s, products con- feit prescription drugs, without the user’s knowledge. analogues approved for human taining fentanyl and its analogues medical use (sufentanil in 1980, appeared on the illicit drug market, This publication aims to inform alfentanil in 1984, and remifentanil and became notorious for accidental about the growing complexity of the 1 in 1999), and several analogues overdoses. The problem seems to opioid market, in particular the fen- which have not been developed have resurfaced and the clandes- tanyl group, international controls, into pharmaceutical products tine manufacturing of fentanyl has evolving patterns of use and associ- (acetyl-alpha- methylfentanyl, alpha- risen to unprecedented levels. The ated risks, global developments in methylfentanyl and 3-methylfentanyl required materials and equipment manufacture and trafficking of fen- were placed under international for manufacture are readily available tanyl analogues and their precursors. control in 1988, and alpha-methyl- online, at low cost. This situation is thiofentanyl, beta-hydroxyfentanyl, aggravated by the rapid emergence Good medicines, beta-hydroxy-3-methylfentanyl, of novel fentanyl analogues which bad drugs? 3-methylthiofentanyl, para-fluoro- have not been approved for medi- Fentanyl belongs to a class of potent fentanyl and thiofentanyl in 1990). cal use. opioid analgesics, the 4-anilidopi- North America is particularly affected peridines. These synthetic opioids by an opioid overdose crisis. While have a high affinity for theµ -opioid originally, the sharp rise in over- receptor, which presents both bene- doses was attributed to heroin, the fits and drawbacks. On the one hand, current crisis is mainly attributed to strong µ-opioid receptor agonists 2 Chodoff P, Domino EF. Comparative phar- macology of drugs used in neuroleptanalge- clandestinely manufactured fentanyl from the fentanyl family have excel- sia. Anesthesia and Analgesia, 44 (5) (1965), lent pain-relieving properties. On the pp. 558–563 other hand, such drugs are liable to 3 Lemmens H. Pharmacokinetic-pharmaco- abuse and have high dependence- dynamic relationships for opioids in bal- producing properties. anced anaesthesia. Clin Pharmacokinet. 1 Henderson GL. Fentanyl-related deaths: 1995;29:231–242. demographics, circumstances, and toxicology 4 Janssen PA. Potent, new analgesics, tailor- of 112 cases. Journal of Forensic Science. made for different purposes. Acta Anaesthe- 1991 Mar 1;36(2):422-33. siol Scand. 1982 Jun;26(3):262-8. 3 GLOBAL SMART UPDATE Figure 1: International control of fentanyl and its analogues, 1964-2016 Fentan eport the UNODC Early Warning Advisory acrletanl para-fluoroisobutyrfentanyl 2016 butyrfentanyl, furanylfentanyl 2015 eletanl eletanl oetanl 2013 remetl 1999 1990 1988 alphamethloetanl beta-hydroxyfetanl beta-hydroxymethletanl methloetanl para-fluorofentanyl, thiofentanyl 1984 letl elalphamethletanl alphamethletanl methletanl 1980 uetl 1964 Fentan ontr fetanl 1961 Single Convention on Narcotic Drugs Acetylfentanyl was placed under