Strategies of intervention to limit the novel synthetic opioids (NSO) escalation in Europe

October 9th 2018 marked the entry into force of the EU-funded project JUSTSO (Analysis, knowledge dissemination, JUstice implementation and Special Testing of novel Synthetic Opioids) (1). The JUSTSO Project involves 10 European partners from Italy, Spain, Greece, Latvia, Germany… DOWNLOAD

Novel Synthetic Opioids – an update for Health Care Professionals

What are Synthetic Opioids?

NSOs: various legal and illegal fentanyl analogs (e.g., acetyl fentanyl,furanylfentanyl, carfentanil);
failed opioid drug candidates (e.g., benzamide deriva>ves);
non-fentanyl compounds such as U-47700;
Diverted prescription opioid analgesics (e.g., as oxycodone (OxyCon>n®), hydrocodone (Vicodin®), codeine, morphine) …


Novel Synthetic Opioids – an update for educators and high-school students

What are Synthetic Opioids?

Synthetic drugs that function like heroin/morphine causing analgesia, euphoria, feelings of relaxation and drowsiness.
But also constipation, nausea, pruritus, hypotension and respiratory depression. They include drugs normally described for intense pain not responsive to non steroidal anti-inflammatory drugs …


Report of Summary data of demographics, cause(s) of death, substances detected/implicated in deaths, geographical location, circumstances of death, trends over time and detailed analysis.

This deliverable summarizes most recent data, period 2018/19, about number of deaths associated to opioids, focusing new synthetic opioids in Europe.

Even though the latest “European Drug Report 2020: Trends and Development” EMCDDA report has not yet been published, we have collected the most recent data available in order to provide an overview of the issue. It is relevant to take in to account that countries do not provide individual data before the publication of the European Drug Report.  DOWNLOAD

The Challenge Posed by New Synthetic Opioids: Pharmacology and Toxicology

Editorial on the Research Topic: The Challenge Posed by New Synthetic Opioids: Pharmacology and Toxicology Simona Pichini (1), Simona Zaami  (2), Roberta Pacifici (1), Adriano Tagliabracci (3) and Francesco Paolo Busardò (3*

Diverted prescription opioid analgesics (e.g., oxycodone, hydrocodone, hydromorphone), failed opioid drug candidates (e.g., benzamide derivatives), and various legal and illegal fentanyl analogs (e.g., acetyl fentanyl, furanylfentanyl, carfentanil) constitute the class of New Synthetic Opioids (NSOs), which is currently posing a global public health threat (Pichini et al., 2018). DOWNLOAD

(1 )National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy, (2) Section of Legal Medicine – SAIMLAL Department, Sapienza University of Rome, Rome, Italy, (3) Section of Legal Medicine, Department of Excellence SBSP – University “Politecnica delle Marche”, Ancona, Italy

Drug Interactions With New Synthetic Opioids
Clara Pérez-Mañá (1,2), Esther Papaseit (1,2*), Francina Fonseca (3,4), Adriana Farré (3,4), Marta Torrens (3,4) and Magi Farré (1,2)

Fentanyl, fentanyl analogs, and other new synthetic opioids (NSO) have burst onto the illegal drug market as new psychoactive substances (NPS). They are often sold as heroin to unsuspecting users and produce euphoria through their agonist action on μ- opioid receptors. Their high consumption, often combined with other substances, has led to multiple intoxications during recent years. In some countries, such as the United States, the consumption of opioids, whether for medical or recreational purposes, has become epidemic and is considered a public health problem. DOWNLOAD

(1) Clinical Pharmacology Unit, Hospital Universitari Germans Trias i Pujol (HUGTP-IGTP), Badalona, Spain, (2) Department of Pharmacology, Therapeutics and Toxicology, Autonomous University of Barcelona, Barcelona, Spain, (3) Drug Addiction Unit, Institute of Neuropsychiatry and Addictions, Hospital del Mar Medical Research Institute, Barcelona, Spain, (4) Department of Psychiatry and Legal Medicine, Autonomous University of Barcelona, Barcelona, Spain

Metabolic Pathways and Potencies of New Fentanyl Analogs

Maurice Wilde (1,2), Simona Pichini (3), Roberta Pacifici (3), Adriano Tagliabracci (4), Francesco Paolo Busardò (4*), Volker Auwärter (1) and Renata Solimini (3)

Up to now, little is known about the metabolic pathways of new fentanyl analogs that have recently emerged on the drug markets worldwide with high potential for producing addiction and severe adverse effects including coma and death. For some of the compounds, limited information on the metabolism has been published, however, for others so far no information is available. Considering the well characterized metabolism of the pharmaceutically used opioid fentanyl and the so far available data, the metabolism of the new fentanyl analogs can be anticipated to generally involve reactions like hydrolysis, hydroxylation (and further oxidation steps), N- and O-dealkylation and O-methylation. Furthermore, phase II metabolic reactions can be expected comprising glucuronide or sulfate conjugate formation. DOWNLOAD

(1) Department of Forensic Toxicology, Institute of Forensic Medicine, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany, (2) Hermann Staudinger Graduate School, University
of Freiburg, Freiburg im Breisgau, Germany, (3) National Centre on Addiction and Doping, Istituto Superiore di Sanità, Rome, Italy, (4) Unit of Forensic Toxicology, Section of Legal Medicine, Department of Excellence SBSP, Università Politecnica delle Marche, Ancona, Italy


Misuse of Novel Synthetic Opioids: A Deadly New Trend

Matthew P. Prekupec, MD, Peter A. Mansky, MD, and Michael H. Baumann, PhD

Novel synthetic opioids (NSOs) include various analogs of fentanyl and newly emerging non-fentanyl compounds. Together with illic- itly manufactured fentanyl (IMF), these drugs have caused a recent spike in overdose deaths, whereas deaths from prescription opioids have stabilized. NSOs are used as stand-alone products, as adulter- ants in heroin, or as constituents of counterfeit prescription medi- cations. During 2015 alone, there were 9580 deaths from synthetic opioids other than methadone. Most of these fatalities were associ- ated with IMF rather than diverted pharmaceutical fentanyl. In opioid overdose cases, where the presence of fentanyl analogs was examined, analogs were implicated in 17% of fatalities. DOWNLOAD

Nonmedical Use of Prescription Medications Among Medical Students in Greece: Prevalence of and Motivation for Use

Georgios Papazisis , Ioannis Tsakiridis, Chryssa Pourzitaki, Eirini Apostolidou, Dimitrios Spachos & Dimitrios Kouvelas

Nonmedical use of prescription medications (NUPM) is a growing global public health issue because of its increasing prevalence and associated negative conse- quences. NUPM is de ned as the use of prescription drugs, whether obtained by prescription or otherwise, other than in the manner, for the reasons, or time period prescribed or by a person for whom the drug was not prescribed (UNODC, 2011). NUPM is not a new prob- lem, but it is one that deserves renewed attention. Sev- eral studies have shown that NUPM has increased signif- icantly over the past two decades and is most prevalent among adolescents and young adults (Compton, Jones, & Baldwin, 2016; McCabe & Cranford, 2012). DOWNLOAD

Pharmacotoxicology of Non-fentanyl Derived New Synthetic Opioids

Renata Solimini (1), Simona Pichini (1*), Roberta Pacifici (1), Francesco P. Busardò (2†) and Raffaele Giorgetti (3†)

A class of opioid agonists not structurally related to fentanyl, derived from research publications of pharmaceutical companies or patents within the United States and abroad are contributing to the current opioid epidemic. Novel synthetic opioids (NSOs) created to circumvent drug control laws such as U-47700, U-49900, AH-7921, or MT- 45 have no recognized therapeutic use, are clandestinely manufactured and sold on conventional or dark web. We herein provide a review of the pharmacological properties available on most of these substances trying to provide a better knowledge on these compounds, particularly with respect to toxicity and dangerous adverse effects in users. Indeed, these NSOs share not only a great potency of action and receptor affinity with respect to natural or synthetic opiates (e.g., morphine, heroin, and methadone) but also a non-negligible toxicity leading to intoxications and fatalities, posing a serious harm to public health and society. DOWNLOAD

Presentations by JUSTSO’s team

In the fourth line of activity of JUSTSO, existing information and that generated by the project will be made available to the public in order to provide awareness of the toxic liability of these compounds and with tools to reduce their use and to treat their emergencies.
It is hoped that this action will contribute to invert the current growing trend of NSO use and mortality.

Below you can dowload some presentations written by the members of WP4.

Le Nuove Sostanze Psicoattive by Francesco Paolo Busardò 

Sicurezza degli Operatori. Sicurezza degli utenti. La gestione delle condotte aggressive in SPDC  by Giovanni Martinotti
Esordio psicotico e uso di sostanze: psicopatologia della complessità by Giovanni Martinotti
Sostanze e transizioni by Giovanni Martinotti

Risvolti diagnostici delle Nuove Sostanze Psicoattive (NPS) by Simona Pichini
SNAP by Simona Pichini