RAND Corporation, Santa Monica, CA, USA.
Stever University Professor of Operations Research and Public Policy, Pittsburgh, PA, USA.
Addiction. 2021 Jun;116(6):1304-1312. doi: 10.1111/add.15222. Epub 2020 Aug 31.
Overdose deaths related to illegal drugs in North American markets are now dominated by potent synthetic opioids such as fentanyl, a circumstance foreshadowed by often-overlooked events in Estonia since the turn of the century. Market transitions generate important and far-reaching implications for drug policy.
The supplier-driven introduction of illegally manufactured synthetic opioids into street opioids is elevating the risk of fatal overdose. Using the most recent overdose mortality and drug seizure data in North America, we find that overdose deaths and seizures involving synthetic opioids are geographically concentrated, but this might be changing. Examination here suggests that in some places fentanyl and its analogues have virtually displaced traditional opioids, such as heroin. The concealing of synthetic opioids in powders sold as heroin or pressed into counterfeit medications substantially increases harms. The nature and scale of the challenge posed by synthetic opioids is unprecedented in recent drug policy history.
There is urgent need for policy and technological innovation to meet the challenges posed by illegally produced synthetic opioids. Novel interventions worth examining include supervising drug use, proactively deterring on-line distribution and new technologies aimed at improving transparency, such as point-of-use drug content testing. Continuing to approach this problem only with existing policies and available methods, such as naloxone, is unlikely to be enough and will result in many premature deaths.
如今，在北美市场，与非法药物相关的药物过量死亡事件主要由芬太尼等强效合成阿片类药物主导，而这一情况早在本世纪初就被爱沙尼亚经常被忽视的事件所预示。市场转型对毒品政策产生了重要而深远的影响。
供应商驱动的将非法制造的合成阿片类药物引入街头阿片类药物，正在增加致命药物过量的风险。我们使用北美最新的药物过量死亡率和药物缉获数据，发现涉及合成阿片类药物的药物过量死亡和缉获在地理上集中，但这种情况可能正在发生变化。在这里的检查表明，在某些地方，芬太尼及其类似物几乎已经取代了传统的阿片类药物，如海洛因。将合成阿片类药物隐藏在作为海洛因出售的粉末或压制成假冒药物中，大大增加了危害。合成阿片类药物所带来的挑战的性质和规模在最近的毒品政策历史上是前所未有的。
迫切需要政策和技术创新来应对非法生产的合成阿片类药物带来的挑战。值得研究的新型干预措施包括监督药物使用、积极阻止在线分销以及旨在提高透明度的新技术，例如即时药物含量检测。继续仅用现有的政策和现有的方法，如纳洛酮来解决这个问题是不够的，这将导致许多人过早死亡。
