What Are Synthetic Opioids?
Synthetic opioids are a class of drug that are manufactured in laboratories and designed to have a chemical structure which is similar to opioids naturally derived from the opium poppy. Though the chemical makeup is similar between synthetic opioids and “natural” varieties (like many prescription opioids), the specific compounds that make up synthetic opioids are entirely man-made – typically in a pharmaceutical laboratory. This is different than natural or non-synthetic opioids like morphine and codeine, which are extracted from naturally-occurring chemicals in opium leaves, then refined and made into medication.
Frequently, synthetic opioids are used as cutting agents in other drugs (especially heroin and cocaine) or pressed into pill form and sold on the street as counterfeit painkillers. Because synthetic opioids are so powerful, accidental overdose is common.
One of the most common synthetic opioids in the U.S. is fentanyl. First discovered in 1974 by Paul Janssen, the powerful drug (50 to 100 times more potent than morphine) became one of the most widely used opioids in medicine by 2017. The drug is produced in high quantities by both pharmaceutical companies for legal, surgical purposes and illicit, street manufacturers for illegal distribution. Today, there are a number of fentanyl analogues, or slight variations with harsher effects on the body, being introduced with no prior or current medical use.
Other synthetic opioids include:
Carfentanil, in particular, is one of the strongest opioids; it is 10,000 times more powerful than morphine and was created to be an elephant tranquilizer. A powder form of the drug is being used as a deadly cutting agent in heroin. The rise in illicit use of synthetic opioids has further increased already record-high numbers of opioid overdose deaths in the US.
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Synthetic Opioids and the Opioid Epidemic
Between 2017 and 2018, fatal drug overdoses increased by 10% in the US, climbing to a total of over 72,000 Americans. The rise of even deadlier synthetic opioids make up a majority of the still-growing death toll. In 2016, fentanyl and other synthetic opioids overtook prescription opioids in involvement in overdose fatalities. A government survey by telephone revealed that 2.1 million Americans qualified as having an opioid use disorder (OUD) – startling, considering 4 of 5 heroin addictions began with prescription opioid abuse.
Deaths from prescription opioids began to level off in 2011, or even reverse, in many parts of the country. However, synthetic opioids have added fuel to the fire. In what is commonly considered the “Second Wave” of the opioid epidemic, drug trafficking organizations began using synthetic opioids to mimic other drugs. Fentanyl and drugs like it are typically sold on the street as a counterfeit for popular medications (usually oxycodone or hydrocodone). Addiction sufferers often believer they are purchasing OxyContin or Vicodin but are actually receiving much more powerful and fast-acting analogues with higher likelihoods of overdose.
Additionally, powder drugs like heroin and cocaine are being mixed (or “cut”) with fentanyl and carfentanil, increasing the risk of fatal overdose even among individuals with high opioid tolerances. In Cuyahoga County, home to Cleveland, the medical examiner’s office reported that 89.8% of heroin cases involved fentanyl. Cleveland law enforcement describe local heroin as a “mixture of brown and white powder” similar to powder chocolate milk mix.
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Synthetic Opioids’ Effect on the Body
Synthetic opioids’ effect on the body is similar to that of other opioids, from Percocet to Black Tar heroin. These drugs are opioid receptor agonists and act primarily on the brain and spinal cord. Legally prescribed opioids are regulated by the FDA, with pre-determined potencies and consistent effects on the body. However, illicit synthetic opioids are unregulated, and potency can vary from lab to lab and drug dealer to drug dealer.
Using synthetic opioids to seek stronger “highs” generally results in an escalation of symptoms with a potential for overdose. Whether administered orally through pills, sublingually (under the tongue), through nasal inhalation, smoked, or injected intravenously, the effects are much the same, although they may vary in intensity, time of onset, and method of administration.
Symptoms of opioid abuse include:
- Feelings of euphoria
- Pain relief
As newer, more potent synthetic opioids are created, standard detection tests that can distinguish between opioids have yet to become available to coroners, emergency medical personnel, or hospitals. Still, data does not yet demonstrate that synthetic opioids are any more or less addictive than other opioids.
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Synthetic Opioid Statistics
Synthetic opioids made up almost 50% of opioid-related deaths in 2016 (up from 14% in 2010).
Synthetic opioids contributed to over 19,413 deaths in 2016 (deaths commonly involve multiple opioids).
Synthetic Opioid Overdose
Typically, fatal opioid overdoses are caused by a lack of oxygen when a person stops breathing. Because synthetic opioids are so similar to “natural” opioids, the signs of dependency, addiction, and overdose to both are very similar. Fentanyl is a longer-acting opiate, like morphine, heroin, or oxycodone. The primary difference between overdose from oxycodone and fentanyl or carfentanil, is that the latter are exponentially stronger than the former and have greater risk of complications. Moreover, fentanyl’s ability to start affecting the body soon after ingestion can lead to overdose even faster.
Signs of overdose are more pronounced versions of symptoms the drug already produces – slowed breathing may stop entirely, reduced consciousness may become unconsciousness. Today, opioid overdose is more likely to be fatal because of high potency. However, it is possible to survive an opioid overdose if the victim is provided medical attention quickly enough.
To reverse an overdose, and allow an individual to begin breathing normally again, higher doses of naloxone is required. Naloxone, an opioid receptor antagonist, can block the effects of all opioids in a person’s system, reviving them and preventing them from getting any higher. The most common form of naloxone, Narcan, comes in a nasal spray in a 4 mg dose. Multiple doses may need to be administered to fully revive an individual.
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Get Help for a Synthetic Opioid Addiction
Regardless of the type of opioid, detoxing can be painful and in extreme cases, deadly. Medical professionals generally recommend individuals seek assistance from a drug rehab facility, as medical assistance increases the likelihood of success as well as comfortability. Followed by inpatient drug rehab or outpatient rehab, people can recover and maintain sobriety afterward through support groups or therapy.
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