Stronger Than Fentanyl: The Next Wave of Potent Opioids to Watch

Opioids have long played a significant role in pain management and, unfortunately, in the opioid crisis stemming from misuse. Fentanyl, recognized for its extreme potency, is a name that has garnered attention both in medical circles and the broader public. As we move further into the 21st century, several opioids, even more potent than fentanyl, are emerging. This post aims to shed light on these newer, stronger synthetic opioids, providing information to inform the reader about the next wave of substances making headlines.

Carfentanil

Carfentanil is a synthetic opioid initially developed for use in large animals, such as elephants. Chemically, it’s related to fentanyl, but its potency is on a different scale altogether. Carfentanil is estimated to be about 100 times stronger than fentanyl and up to 10,000 times more potent than morphine. This extreme potency means that even minute amounts can cause respiratory depression, a primary cause of opioid overdose deaths.

Its primary legitimate use is in veterinary medicine, particularly for tranquilizing large animals. In recent years, however, carfentanil has found its way into the illicit drug market, often mixed with other substances. This poses a significant danger to individuals unaware of its presence in a drug mixture.

Because of its extreme potency, exposure to even small amounts of carfentanil, whether ingested, inhaled, or absorbed through the skin, can be fatal to humans. Due to these dangers, first responders and medical professionals have had to adapt their protocols when encountering potential carfentanil-related incidents, ensuring safety while administering care.

Furanylfentanyl

Furanylfentanyl is one of several analogs of the synthetic opioid fentanyl. Originally developed for medical purposes, this compound has since found its way into the illicit drug market. Structurally, it’s slightly modified from fentanyl, but this small change results in a potency that is estimated to be seven times as strong as fentanyl. Furanylfentanyl often appears as a white powder and, like other opioids, carries significant risks of overdose.

Alarmingly, it’s also been detected in counterfeit pills meant to mimic other opioids, which means that individuals may consume it without realizing it, amplifying the risk of unintended overdose. Given its presence in the unregulated market and the inherent dangers associated with its potency, it has been classified as a Schedule I controlled substance in the U.S. This categorization indicates it has no approved medical use and a high potential for abuse. The Drug Enforcement Administration (DEA) considers furanylfentanyl to be a dangerous and potentially deadly drug that poses a significant public health risk. 

Nitazenes

Nitazenes, a prospective opioid analgesic developed in the 1950s, never received clinical approval. However, their recent appearance in the illicit drug market and association with numerous global overdose deaths has drawn considerable attention.

Nitazene compounds are found in a range of forms, from white or off-white solids to powders of varied colors and even as crystals, and are believed to be more potent than fentanyl. Since 2019, these substances have emerged in the unregulated drug supplies of Canada and the United States. Moreover, they often appear in drugs presumed to contain common opioids, like fentanyl or oxycodone tablets, catching individuals off-guard. Classified as a new psychoactive substance (NPS), nitazenes are part of a drug category that aims to replicate the effects of familiar illegal drugs, making the legal landscape around them intricate.

The link between nitazenes and overdose deaths in several states marks them as a growing challenge in the U.S. Notably, in Florida, nitazene compounds, sometimes referred to as “Frankenstein opioids,” have been categorized as Schedule I substances.

N-Desethyl Isotonitazene

N-desethyl isotonitazene is one of the novel synthetic opioids that has recently garnered the attention of medical and law enforcement communities. It belongs to the nitazene family and has recently emerged in the recreational drug supply in the United States. Most nitazene compounds encountered in the illicit drug supply retain opioid receptor activity and potency similar to or greater than fentanyl. N-desethyl isotonitazene, on the other hand, is estimated to be approximately 20 times more potent than fentanyl.

This compound often presents as a white or off-white powder, which can be easily mixed with other drugs, increasing the risk of accidental consumption. They can also be found as crystalline solids and in pill form. One of the main concerns with N-desethyl isotonitazene, as with other synthetic opioids, is the risk of deadly overdose, especially due to limited knowledge about its effects. Furthermore, detecting it can be difficult with current drug screening tests, emphasizing the need for updated testing methods to ensure public safety. 

Brorphine

Brorphine is a relatively new synthetic drug that has entered the illicit drug supply in the United States. It has a pharmacological profile similar to fentanyl and other schedule I and II synthetic opioids that act as mu-opioid receptor agonists. Brorphine, which is classified as a synthetic compound under the ‘piperidines’ category, is distinctive in that it has no known industrial or therapeutic applications. However, its detection in drug seizures signals its increasing distribution and potential for misuse.

The U.S. classifies brorphine as a Schedule I controlled substance. It’s been identified in drug concoctions that typically include fentanyl and flualprazolam, as well as in counterfeit prescription opioid pills. Various methods of consumption, such as oral intake, inhalation, or intravenous use, have been reported.

Much like other potent opioids, the principal threat posed by brorphine is the heightened potential for fatal overdose, especially when mixed with other recreational drugs. Given that many may be uninformed about its potency, the hazard of unintentional high-dose intake grows. Even with scant safety information, its distribution as a designer drug has been evident since at least 2019. The emergence of opioids like brorphine underlines the urgent need for robust monitoring, expanded research, and public awareness initiatives to ensure safety and deter misuse.

The Global Impact

The rise of synthetic opioids and their variants has had far-reaching consequences on a global scale. Understanding the breadth and depth of this impact is essential to address the issue effectively.

• Health Implications – Opioid misuse has contributed significantly to global public health concerns. Overdoses, often fatal, have surged in many regions, putting strain on healthcare systems and emergency services. The risk is further amplified when individuals unknowingly consume synthetic opioids, thinking they are less potent alternatives.
• Economic Strain – The opioid crisis places a considerable financial burden on countries. Costs arise from healthcare treatments, emergency services, rehabilitation, and law enforcement initiatives. Moreover, the loss of workforce productivity due to addiction or related deaths also negatively impacts the economy.
• Law Enforcement and Regulation Challenges – As synthetic opioids continue to evolve, law enforcement agencies worldwide grapple with identifying and controlling these substances. Regulatory frameworks sometimes lag behind the rapid emergence of new variants, making legal interventions challenging.
• Social Consequences – Families and communities globally bear the brunt of the opioid epidemic. The social fabric of many communities is disrupted, with increased child neglect cases, broken families, and heightened crime rates in certain areas.
• Treatment and Rehabilitation – The rising demand for opioid addiction treatment has spotlighted the need for more rehabilitation centers, trained professionals, and effective treatment methodologies on a global scale.

The global impact of synthetic opioids is multifaceted, touching upon health, economic, social, and political spheres. While challenges abound, global cooperation offers a beacon of hope in addressing the issue comprehensively.

Recognizing Overdose Symptoms

Opioid overdose is a serious medical emergency. Timely recognition of its symptoms can mean the difference between life and death. When an individual has taken more opioids than their body can handle, they may display the following symptoms:

• Shallow or Labored Breathing – A decreased respiratory rate or difficulty in breathing is one of the most indicative signs of an opioid overdose.
• Pinpoint Pupils – The individual’s pupils may become very small, often described as “pinpoint” in appearance.
• Loss of Consciousness – The person may become unresponsive or may not wake up even if you try to rouse them.
• Bluish Lips or Fingernails – This indicates a lack of oxygen in the bloodstream.
• Limp Body – Muscles may lose tone, causing the individual to appear floppy or limp.
• Gurgling or Snoring Sounds – These can be signs that someone’s airway is partially blocked.
• Pale or Clammy Skin – The skin may feel cold and clammy to the touch.
• Slow or Erratic Pulse – The heart rate may become irregular or slow down significantly.

If someone is showing these signs after consuming opioids, it’s crucial to act swiftly. Call emergency services immediately and, if available and you are trained to do so, administer naloxone, a medication designed to reverse opioid overdoses. It’s also important to stay with the person until help arrives and to place them in the recovery position (on their side) to help keep their airway clear. Remember, quick action can save a life.

Harm Reduction and Prevention

Harm reduction and prevention are vital strategies in addressing the challenges posed by potent opioids. At the heart of harm reduction is the acknowledgment that drug use exists and that measures can be taken to minimize associated dangers.

• Naloxone Distribution – Equipping first responders, community centers, and even individuals with naloxone, an opioid overdose reversal agent, can save lives. Prompt administration during an overdose can reverse its effects and buy critical time for further medical intervention.
• Safe Consumption Sites – These are controlled environments where individuals can consume drugs under the supervision of health professionals. These sites can prevent overdoses and connect individuals with resources for treatment and support.
• Drug Testing Kits – By providing access to drug testing kits, individuals can identify the presence of potent opioids in substances, helping them make informed decisions and potentially avoiding lethal doses.
• Education and Outreach – Community workshops, school programs, and public campaigns can raise awareness about the dangers of potent opioids, their identification, and safe practices if encountered.
• Support and Treatment Access – Facilitating access to treatment programs and support groups can help individuals seeking to reduce or cease their drug use. Offering multiple pathways, from counseling to medical treatments, ensures that everyone can find an approach that fits their needs.

By embracing harm reduction and prevention strategies, communities can create safer environments, reduce the number of overdoses, and offer support to those affected by substance use disorders.

Treatment Options

Addressing opioid use disorder requires a comprehensive approach tailored to individual needs. Here are some of the primary treatment options available:

• Detoxification – The first step often involves medically supervised detoxification to manage withdrawal symptoms safely. This process helps clear the drug from the body and is typically the precursor to long-term treatment.
• Counseling and Behavioral Therapies – These provide the backbone of opioid addiction treatment. Through individual or group sessions, they learn coping strategies, build life skills, and address underlying issues contributing to their addiction.
• Pharmacological and Holistic Interventions – Treatment involves a combination of pharmacological and holistic interventions to address both the physical and mental aspects of substance use disorders. It’s a proven approach for treating opioid use disorders, improving the chances of long-term recovery.
• Inpatient and Residential Treatment – For those needing intensive care, inpatient or residential treatment centers offer structured environments, away from potential triggers, and provide round-the-clock medical and therapeutic support.
• Outpatient Treatment Programs – Suitable for individuals with a strong support system, outpatient programs offer flexibility. Individuals can attend therapy sessions while maintaining work or school commitments.
• Support Groups – Peer-led groups like Narcotics Anonymous provide a supportive environment where individuals in recovery can share experiences and coping techniques.
• Aftercare and Relapse Prevention – A crucial part of long-term recovery, aftercare involves ongoing therapy, regular check-ins with addiction specialists, and possibly continued participation in support groups.
• Co-occurring Mental Health Disorder Treatment – It’s essential to address any co-occurring mental health disorders, such as depression or anxiety, alongside opioid addiction. Integrated treatment approaches can ensure comprehensive care.

Opioid addiction is a serious concern, and timely intervention with the right treatment can make a significant difference. It’s important for individuals and their families to consult with medical professionals and addiction specialists to determine the most suitable treatment options.

Amid the growing opioid epidemic, Futures Recovery Healthcare serves as a dedicated partner and advocate for those affected. We are deeply committed to addressing the challenges of opioid use disorders, offering evidence-based and individualized care tailored to each person’s unique needs. Our professional team brings together cutting-edge methodologies and comprehensive treatment plans, ensuring that those grappling with addiction have a reliable path to recovery. If opioid use is a concern for you or a loved one, Futures Recovery Healthcare is here to guide, support, and help reclaim a life free from addiction.