New drugs: high potency and harms
New psychoactive substances, including new synthetic opioids, synthetic cannabinoids and synthetic cathinones, are causing a range of serious harms in Europe.
Fentanyls are exceptionally potent opioids which, although playing a small role in Europe’s drug market, pose a serious threat to individual and public health. In part this stems from the increased risk of severe and fatal poisonings in users - often manifesting as outbreaks - as fentanyls cause rapid and profound respiratory depression. It is also because of the increased risk of accidental exposure resulting in poisoning in others; families and friends of users, as well as law enforcement, other emergency services, medical staff and those working in laboratories, may be at risk.
The use of protective equipment to reduce the risk of harm from accidental exposure may be necessary in some settings, such as customs facilities at Europe’s borders, where seizures of bulk fentanyl powders may be handled. Additionally, there is some evidence to suggest that fentanyls have been sold to unsuspecting users as established illicit drugs and fake pain medicines, potentially increasing the risk of severe and fatal poisoning in some user groups. In such circumstances, the availability of the antidote naloxone may need to be assessed. In addition to the acute risks of overdose, fentanyls also have high abuse liabilities and dependence-producing potentials, which could worsen public health and social problems commonly associated with high-risk opioid use.
During 2016, the EMCDDA and Europol launched special investigations into acryloylfentanyl and furanylfentanyl, after signals were detected through the EU Early Warning System. More than 50 deaths were reported, many of which were attributed directly to these substances. In addition, the EMCDDA also issued five alerts to its network across Europe related to these and other new fentanyls.
New psychoactive substances are causing a range of serious harms in Europe
The synthetic cannabinoids are another group of new substances that continued to cause problems in 2016. The EMCDDA issued alerts on three substances - MDMB-FUBINACA, MDMB-CHMICA and 5F-MDMB-PINACA - based on 45 serious adverse events, including 18 deaths and 27 non-fatal intoxications. In addition, the EMCDDA launched a procedure which led to a risk assessment of MDMB-CHMICA, which ultimately resulted in the substance being been subjected to control measures throughout Europe.
- Risk assessment of MDMB-CHMICA
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In July 2016, MDMB-CHMICA became the first synthetic cannabinoid to be risk-assessed by the EMCDDA. It was first reported to the EU Early Warning System in 2014 by Hungary, and was subsequently detected in 23 EU Member States, Turkey and Norway. The substance was involved in more than 20 serious poisonings and 28 deaths.
Bulk powders of MDMB-CHMICA are produced in China and imported into Europe, where they are processed and packaged into ‘herbal smoking mixtures’. It is thought that many of the adverse events caused by MDMB-CHMICA and other synthetic cannabinoids are related to the high potency of these substances and poor manufacturing practices. Evidence suggests that producers guess the quantities of substance to apply when manufacturing ‘smoking mixtures’. In addition, the crude manufacturing techniques used may not distribute the substance uniformly in the product. This may lead to some samples containing elevated amounts of the substance, resulting in high doses and an increased risk of severe poisoning and death.