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USA. New Opioids Called Nitazenes May Be 20 Times Stronger Than Fentanyl

A potent synthetic opioid class called nitazenes has been discovered after people overdosed on them.

The nitazene class of medication was created over 60 years ago as a potential pain-relief medication, according to the WHOTrusted Source.

Medical experts say this opioid may be up to 20 times more powerful than fentanyl. (Healthline, USA, 08.12.2021)


Etazene induces developmental toxicity in vivo Danio rerio and in silico studies of new synthetic opioid derivative. 

Kurach Ł, Chłopaś-Konowałek A, Budzyńska B, Zawadzki M, Szpot P, Boguszewska-Czubara A. 

Sci Rep. 2021 Dec 20;11(1):24269. doi: 10.1038/s41598-021-03804-9. PMID: 34931035; PMCID: PMC8688443.


USA/Kanada. Etodesnitazene — New Synthetic Opioid Identified During Forensic Death Investigations in the United States and Canada

Purpose: The objective of this announcement is to notify public health and safety, law enforcement, first responders, clinicians, medical examiners and coroners, forensic and clinical laboratory personnel, and all other related communities about new information surrounding the emergent synthetic opioid etodesnitazene. (NPS Discovery, USA, Dezember 2021)


USA/Kanada. NPS Alerts: New Synthetic Opioid and ‘Unusual’ Overdose Symptoms (protonitazene)

The Center for Forensic Science Research and Education (CFSRE) (…) warns of the emergence of protonitazene, an opioid that is approximately three times more potent than fentanyl. (CFSRE - Center for Forensic Science Research and Education, USA, 13.12.2021)


Info-Folder "Benzos + Opiate"

Dieser Info-Folder befasst sich mit den Risiken und Wirkungsweisen von verschreibungspflichtigen Medikamenten (Benzodiazepine und Opiate), die missbräuchlich zu Rauschzwecken konsumiert werden. Er wendet sich mit speziellen risikomindernden Hinweisen vorwiegend an Konsumierende und konsuminteressierte Jugendliche. (Mindzone, Dezember 2021)


Opioid Analgesia and Opioid-Induced Adverse Effects: A Review. 

Paul AK, Smith CM, Rahmatullah M, Nissapatorn V, Wilairatana P, Spetea M, Gueven N, Dietis N. 

Pharmaceuticals (Basel). 2021 Oct 27;14(11):1091. doi: 10.3390/ph14111091. PMID: 34832873; PMCID: PMC8620360.


USA. PUBLIC ALERT December 2021: Adverse Effects Linked to Next Generation Opioids Reported in Patients Presenting to Emergency Departments After Suspected Opioid Overdose

Purpose: The objective of this announcement is to notify public health and safety, clinicians, law enforcement, first responders, medical examiners and coroners, forensic and clinical laboratory personnel, and all other related communities about new information surrounding new generation synthetic opioids in clinical settings after suspected opioid overdoses and presentation to emergency departments, including: metonitazene, N-piperidinyl etonitazene, isotonitazene, and brorphine. (npsdiscovery.org, USA, Dezember 2021)


Teuer erkaufte Schmerzstillung? Unter Tramadol kommt es häufiger zu Todesfällen als unter Codein

Tramadol wird immer häufiger in der Behandlung chronischer, nicht krebsbedingter Schmerzen eingesetzt, doch scheint es im Vergleich zu anderen Opioiden mit einem höheren Risiko für unerwünschte Wirkungen verbunden zu sein, wie neue Daten zeigen. Die Arbeit wurde im JAMA veröffentlicht [1]. (Medscape, Deutschland, 11.11.2021)


Association of Tramadol vs Codeine Prescription Dispensation With Mortality and Other Adverse Clinical Outcomes. 

Xie J, Strauss VY, Martinez-Laguna D, et al. 

JAMA. 2021;326(15):1504–1515. doi:10.1001/jama.2021.15255



The Role of Mu-Opioids for Reward and Threat Processing in Humans: Bridging the Gap from Preclinical to Clinical Opioid Drug Studies. 

Meier IM, Eikemo M, Leknes S. 

Curr Addict Rep. 2021;8(2):306-318. doi: 10.1007/s40429-021-00366-8. Epub 2021 Apr 15. PMID: 34722114; PMCID: PMC8550464.


Atypical opioid receptors: unconventional biology and therapeutic opportunities. 

Palmer CB, Meyrath M, Canals M, Kostenis E, Chevigné A, Szpakowska M. 

Pharmacol Ther. 2021 Oct 5:108014. doi: 10.1016/j.pharmthera.2021.108014. Epub ahead of print. PMID: 34624426.


Poppies as a sleep aid for infants: The "Hypnos" remedy of Cretan folk medicine. 

Mathianaki K, Tzatzarakis M, Karamanou M. 

Toxicol Rep. 2021 Oct 4;8:1729-1733. doi: 10.1016/j.toxrep.2021.10.002. PMID: 34692423; PMCID: PMC8511716.


Full Opioid Agonists and Tramadol: Pharmacological and Clinical Considerations. 

Edinoff AN, Kaplan LA, Khan S, Petersen M, Sauce E, Causey CD, Cornett EM, Imani F, Moradi Moghadam O, Kaye AM, Kaye AD. 

Anesth Pain Med. 2021 Sep 6;11(4):e119156. doi: 10.5812/aapm.119156. PMID: 34692448; PMCID: PMC8520671.


EMCDDA. Opioids: health and social responses


This miniguide is one of a larger set, which together comprise Health and social responses to drug problems: a European guide 2021. The guide supports practitioners and policymakers in tackling the negative consequences of drug use.The opioids miniguide provides an overview of the most important aspects to consider when planning or delivering health and social responses to opioid-related problems, and reviews the availability and effectiveness of the responses. It also considers implications for policy and practice. (EMCDDA, Lissabon, 21.10.2021)


An endogenous opioid circuit determines state-dependent reward consumption. 

Castro, D.C., Oswell, C.S., Zhang, E.T. et al.

Nature (2021). doi.org/10.1038/s41586-021-04013-0



Powell D, Pacula RL. 

Am J Health Econ. 2021 Winter;7(1):41-67. doi: 10.1086/711723. Epub 2020 Dec 22. PMID: 34568515; PMCID: PMC8460090.


Oxycodon (Oxygesic®): Missbrauch, Abhängigkeit und tödliche Folgen durch Injektion zerstoßener Retardtabletten (Bekanntgabe) - Arzneimittelkommission der deutschen Ärzteschaft, 2003


A Systematic Review of Opioid Use Disorder and Related Biomarkers. 

Bryant BM, Eaton E, Li L. 

Front Psychiatry. 2021 Aug 11;12:708283. doi: 10.3389/fpsyt.2021.708283. PMID: 34456765; PMCID: PMC8385272.


"Etazene, safer than heroin and fentanyl": Non-fentanyl novel synthetic opioid listings on one darknet market. 

Lamy FR, Daniulaityte R, Barratt MJ, Lokala U, Sheth A, Carlson RG. 

Drug Alcohol Depend. 2021 May 31;225:108790. doi: 10.1016/j.drugalcdep.2021.108790. Epub ahead of print. PMID: 34091156.



The rise of illicit fentanyls, stimulants and the fourth wave of the opioid overdose 


Ciccarone, Daniel 

Current Opinion in Psychiatry: July 2021 - Volume 34 - Issue 4 - p 344-350 doi: 10.1097/YCO.0000000000000717 


CDC. Opioids


USA. New High Potency Synthetic Opioid N-Pyrrolidino Etonitazene (Etonitazepyne) Linked to Overdoses Across United States

(CFSRE - Center for Forensic Science Research & Education, USA, Juni 2021)


Does the preparation for intravenous administration affect the composition of heroin injections? A controlled laboratory study. 

Andersen, J. M., Bogen, I. L., Karinen, R., Brochmann, G. W., Mørland, J., Vindenes, V., and Boix, F. (2021) Addiction, doi.org/10.1111/add.15492. 


Commentary - Heroin purity and adulteration: an updated snapshot from the Italian Early Warning System. 

Tittarelli R, di Luca NM, Pacifici R, Pichini S, Del Rio A, Busardò FP. 

Eur Rev Med Pharmacol Sci. 2020 Apr;24(8):4461-4466. doi: 10.26355/eurrev_202004_21028. PMID: 32374014.


Süd-Afrika. The South African play that’s tackling the scourge of the street drug whoonga

The drug whoonga has plagued South African communities for at least a decade, yet only gained significant public attention when it appeared more visibly in the inner-city and surrounding suburbs of Durban, the major city in the country’s KwaZulu-Natal province. (Conversation, UK, 21.02.2021)


Expression of Opioid Receptors in Cells of the Immune System. 

Brejchova J, Holan V, Svoboda P. 

Int J Mol Sci. 2020 Dec 30;22(1):315. doi: 10.3390/ijms22010315. PMID: 33396783; PMCID: PMC7795304.


Abuse‐deterrent extended‐release oxycodone and risk of opioid‐related harm. 

Paljarvi, T., Strang, J., Quinn, P. D., Luciano, S., and Fazel, S. (2021) 

Addiction, doi.org/10.1111/add.15392. 


The dawn of a new synthetic opioid era: the need for innovative interventions. 

Pardo, B., Taylor, J., Caulkins, J., Reuter, P., and Kilmer, B. (2020) 

Addiction, doi.org/10.1111/add.15222.



Tapentadol: An Opioid of Abuse Acquired Online.

Ansley BS, Sethi R. 

Prim Care Companion CNS Disord. 2020 Feb 20;22(1):19l02432. doi: 10.4088/PCC.19l02432. PMID: 32083817.


Direct dating reveals the early history of opium poppy in western Europe. 

Salavert A, Zazzo A, Martin L, Antolín F, Gauthier C, Thil F, Tombret O, Bouby L, Manen C, Mineo M, Mueller-Bieniek A, Piqué R, Rottoli M, Rovira N, Toulemonde F, Vostrovská I. 

Sci Rep. 2020 Nov 20;10(1):20263. doi: 10.1038/s41598-020-76924-3. PMID: 33219318; PMCID: PMC7679390.