Meyer Maximilian, Westenberg Jean N, Jang Kerry L, Choi Fiona, Schreiter Stefanie, Mathew Nickie, King Conor, Lang Undine E, Vogel Marc, Krausz R Michael
Department of Psychiatry, Faculty of Medicine, University of British Columbia, 5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada.
University Psychiatric Clinics Basel, University of Basel, Basel, Switzerland.
Int J Ment Health Syst. 2023 Oct 25;17(1):36. doi: 10.1186/s13033-023-00601-x.
Understanding drug market dynamics and their underlying driving factors is paramount to developing effective responses to the overdose crisis in North America. This paper summarises the distinct drug market trends observed locally and internationally over the past decade to extrapolate future drug market trajectories. The emergence of fentanyl on North American street markets from 2014 onwards led to a shift of street drug use patterns. Previously perceived as contaminants, novel synthetic opioids became the drugs of choice and a trend towards higher potency was observed across various substance classes. The diversification of distribution strategies as well as the regionalisation and industrialisation of production followed basic economic principles that were heavily influenced by prosecution and policy makers. Particularly, the trend towards higher potency is likely most indicative of what to expect from future illicit drug market developments. Nitazenes and fentanyl-analogues, several times more potent than fentanyl itself, are increasingly detected in toxicological testing and have the potential of becoming the drugs of choice in the future. The dynamic of drug import and local production is less clear and influenced by a multitude of factors like precursor availability, know-how, infrastructure, and the success of local drug enforcement strategies. Drug market dynamics and the current trajectory towards ultrapotent opioids need to be recognised by legislation, enforcement, and the health care system to prepare effective responses. Without significant improvements in treatment access, the implementation of preventative approaches and early warning systems, the mortality rate will continue to increase. Furthermore, there is no mechanism in place preventing the currently North American focused overdose crisis to spread to other parts of the globe, particularly Europe. A system of oversight, research, and treatment is needed to address mortality rates of historic proportions and prevent further harm.
了解毒品市场动态及其潜在驱动因素对于制定应对北美过量用药危机的有效措施至关重要。本文总结了过去十年在本地和国际上观察到的不同毒品市场趋势，以推断未来毒品市场的发展轨迹。2014年起，芬太尼在北美街头市场出现，导致街头毒品使用模式发生转变。新型合成阿片类药物此前被视为污染物，如今却成为了首选毒品，并且在各类毒品中都出现了药效增强的趋势。分销策略的多样化以及生产的区域化和工业化遵循了基本经济原则，这些原则受到执法部门和政策制定者的严重影响。特别是，药效增强的趋势很可能最能预示未来非法毒品市场的发展走向。在毒理学检测中，越来越多地检测到比芬太尼本身药效强几倍的氮杂环卡宾和芬太尼类似物，它们有可能在未来成为首选毒品。毒品进口和本地生产的动态情况尚不明朗，受到多种因素影响，如前体供应、专业知识、基础设施以及当地毒品执法策略的成效等。立法、执法和医疗系统需要认识到毒品市场动态以及当前向超强效阿片类药物发展的轨迹，以便做出有效的应对措施。如果在治疗可及性、预防方法和预警系统的实施方面没有显著改善，死亡率将继续上升。此外，目前没有机制可以防止当前集中在北美的过量用药危机蔓延到全球其他地区，尤其是欧洲。需要一个监督、研究和治疗体系来应对历史上前所未有的死亡率，并防止进一步的危害。
