The Advisory Council for the Misuse of Drugs (ACMD) have published a comprehensive report on the synthetic opioid fentanyl and its analogues.
The ACMD produced the report after concerns were raised over increasing drug-related deaths rates and growing evidence from law enforcement agencies of fentanyls entering European drug markets.
It includes a literature review on the pharmacology and toxic effects of fentanyl and related analogues; details of the potential use of both pharmaceutical and illicitly manufactured fentanyl compounds, and, a summary of the associated harms as documented internationally and in the UK.
The report states that fentanyls present a significant ongoing risk to UK public health and current monitoring and surveillance systems should be adapted for accurate monitoring of this threat.
To summarise, the ACMD have drawn the following conclusions and recommendations from the evidence presented in this report:
Conclusions
- Fentanyls carry a high risk of accidental overdose that may be fatal. Infiltration of fentanyls into the heroin supply chain in the United States and Canada has been responsible for substantial increases in drug-related deaths.
- The risk to public health from fentanyls may be lower in the UK than in North America because there is a smaller population of people who have become habituated to strong opioids. There is, however, limited information available about diversion rates and use of pharmaceutical fentanyls in the UK.
- 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.
- There remains an ongoing risk of fentanyls increasingly infiltrating the UK heroin market and increasing rates of drug-related deaths. The long-standing UK generic control on fentanyls has proved to be robust and almost all ‘designer’ fentanyl variants being encountered are automatically controlled in the UK as Class A drugs.
Recommendations
- 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.
- Ensure that health professionals are trained in the appropriate therapeutic use of strong opioids, as described in the ‘Opioids Aware’ resource and the forthcoming NICE guidance on management of chronic pain.
- A) Toxicology analysis of samples of all deaths related to drug poisoning should include analysis for fentanyls as non-systematic screening hinders our capacity to understand trends in drug deaths.
B) Toxicology reports from all deaths related to drug poisoning should include a clear statement as to whether fentanyls were included in the testing. Importantly, it should be made explicit if fentanyls have not been tested for. 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: i) drug seizures, including heroin preparations and counterfeit medicines ii) non-fatal episodes of heroin toxicity requiring hospital treatment.
- Agencies with responsibilities relating to drug use 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 use data.