A recently published report by the Advisory Council on the Misuse of Drugs has warned of the pharmacology and toxic effects of fentanyl and related analogues. The report says that it can be concluded that fentanyl and fentanyl-analogues present a significant ongoing risk to UK public health.
Episodes of fentanyl toxicity and deaths in the UK have been sporadic and have not approached the very high numbers seen in North America.
However, rates of registered deaths involving fentanyls have recently increased and may be under-estimated because sufficiently detailed forensic analysis of drug causes is sometimes not carried out. Consequently, the role of a fentanyl in the death may not be recognised.
The public health risk associated with the misuse of fentanyl and its analogues relates to the high potency of these substances a report has highlighted. Compared to morphine, the amount of fentanyl required to produce the same analgesic effects is 50-100 times lower.
Fentanyl and its analogues are potent compounds that therefore carry a high risk of accidental overdose that may be fatal.
The report warns of the ongoing risk of fentanyls and other new synthetic opioids increasingly infiltrating the UK heroin market and increasing rates of drug-related deaths.
The report makes a number of recommendations including the following:
- Research should be commissioned to study diversion and non-medical use of strong opioids to identify trends, drug products involved and populations at risk.
- Government departments should conduct a full review of international drug strategy approaches to fentanyl markets, in particular, the North American experience, and consider interdiction controls that can be applied to the UK situation.
- Toxicology analysis of samples of all deaths related to drug poisoning should include analysis for fentanyl and fentanyl analogues as nonsystematic screening hinders our capacity to understand trends in drug death.
- Toxicology reports from all deaths related to drug poisoning should include a clear statement as to whether fentanyl and/or its analogues were included in the testing. This would enable meaningful monitoring of trends in fentanyl-associated deaths.
- Research should be commissioned to monitor the local and national prevalence of fentanyl and fentanyl analogues in:
- Drug seizures, including heroin preparations and counterfeit medicines.
- Non-fatal episodes of heroin toxicity requiring hospital treatment.
- Increased funding should be made available to the Defence, Science and Technology Laboratory Forensic Early Warning System (DSTL FEWS) programme to increase capacity to analyse un-adopted police and border force seizures.
- Agencies with responsibilities relating to drugs of misuse should monitor the international situation and share available UK data. There should also be a comprehensive early warning system which has access to up to date consolidated UK-wide drug misuse data sets.
- If materials are encountered in the UK or Europe that retain potency but fall outside the UK generic control on fentanyls, a small amendment to that generic control should be applied to address these.
- Following a consultation with the research community the Home Office should expand the precursor controls to cover simple variants of ANPP, the immediate precursor to fentanyl (further details are included in this report).
You can read the full report below.