DDN June 2017 DDN July2017 - Page 8

AwAreness With a vast range of forms and potencies, the fentanyl family bring too many unknowns. Kevin Flemen gives an essential guide Meet the fentanyls a nother day, another drug warning – lately we’ve had drug scare after drug scare. There was flesh-eating Krokodil, Bath Salt cannibals, Hippy Crack, Zombie Spice and, in the May issue of DDN, concerns about an increase in Xanax use. Most recently came warnings about fentanyl-type drugs. Such bulletins can risk losing impact, but if the evidence from North America and elsewhere is anything to go by, fentanyl and its derivatives have the potential to become a huge problem and cause significant loss of life. Although fentanyl-type drugs have featured sporadically in the UK drug scene for a while, concern about them has increased markedly in the past few months, leading to official warnings from the National Crime Agency (NCA) and Public Health England (PHE). So, it’s time (and some would argue, long overdue) to get up to speed with the fentanyls. Fentanyls are opioids, with fentanyl (Duragesic) used for severe pain. It has numerous analogues and derivatives, with new ones emerging – Wikipedia lists 42 and this may be an underestimate. Several of the fentanyls have legitimate medical use and so are better understood in terms of potency, doses, and metabolites, but others have been developed to sidestep legislation or restriction on precursors. Less is known about these newer compounds. The potency and half-life of different fentanyls varies massively. To illustrate relative potency, fentanyls are compared to morphine – but this is a crude indicator, especially when the composition and purity of street-sourced fentanyls is unclear. To further complicate the issue, some analogues have more than one isomer, which GW&f'FV762WFfVF&vW2FV7g&У3FW2FRFV7b'RFbFW07G&vW"FWVFrv66W"2&W6VBvfV7V6vFR&vRb&GV7G2@FV6W2FR&6bfW&F6R6B&RVFW'7FFVBFW&R2WfW'66Rb֗6FVFf6FB֗2Ч6VƖrF&VvWBFR7Wǒ6g&&GV6W'0GfW'FVFǒ7WǖrFRw&rwVR 6W"F&VvF7WƖW'2֗2֖FVFgrFV &GV7BF&VGV6RFRFV7FW6&RWfV2fVF0VVBF&R'VƶVBWBvF767FfRfW vVB7V62FF2FVG26'&V7@FVFf6FbFRG'Vr6&VgV67VFbFPVBbfW"F&RFFVBBF&Vv֗r`G'VrBfW"7V6֗r2B&W7B&RFW'&'2vVfVF2֗VBvF&Rw&V"7V'7F6W27V62'&vW&B276&RF6WfRF&Vv֗B6FR&6b6W&FB( BЧ7G>( 2w&VFW"7FfVF2( 26&FfPfVF2&FVB2&FVǒFW2FRFV7b'R( 26rbfVF0WVfVBFrb'R6RwVW2&RvVW#6WGfVF2&VBRFW2FRFV7b'RFW'2&Rf"7G&vW#BfV&fVF2&W'FVBF&RGv6RFR7G&VwFbfVF( 06R#FW2FR7G&VwFb'R6&fVFVvFFVǒW6VBFG&VƗ6R&vR22&W'FVFǒ&VBFW0FRFV7b'RFW27G&vW"FfVF’6FV'rb6&fVF0FRWVfVBbr'RࢥF2F6RWVfV6R2fW'7'VFRvbF6Fr&VFfRFV7f&&W27V627VVBb6WBGW&FbVffV7BWfVbvW6fW'7W2WfVb6VFFBFW&WWF2FW6B&R7V&6VB'6RG'Vr2FW27G&vW"FG'Vr"ࣂG&FG'Vw6Ww2VR#p4U$4U2B5UŐ7FW66VB6BV6WvW&RfVF2fP&V6R7&V6vǒf&RFRF&vV"&GV7G2&WWFVFǒ6R6VFVBfVFgW&ЦfVF6&fVFBFW"wVW2vfVFV"fW'vFV7FW&RVƖrFf"FW&F6VvvƖrFWffW"r'VƲvFV7FW&FfRFW&@&Rf&Rf'2ƖR&FW"FVvvrvFW&7WƖW'2fVF2fR&V6RfW'6vf6Bf7F"G'VrFVF2'FW&6BFR"6W6R`FRFVF2'&F66V&vFFRV&W 7BFV&Ɩr&WGvVV#RB#b66W"FRFWfR&VV77VRFRUR'WBB0&&ǒ&VV&F26VG&W2W7V6ǒW7Fv6fR6VVFR&vvW7B&&V2FW&R6&R6RWW&V&GV7F&vW7B&6&RƖ6R&FVB( G'Vw2.( vW&PfVFv2ffVBFVv2B6V"g&FP&W'FrbFR( .( v27FW66rfVF 6VFr'FVBfVF2vFW&f v&B6RDRT$U@VF6ǒFfW'FVBfVF2'W6&R'WBFP6&FbƖ֗FVB&W67&&rBG&6FW&&W&F22VBB2B&VV76fP77VRFRTFFFRfVFwVW2fR&VV&VBW&Rf"vR7&rW7&F6ǒG'Vw2Ǘ6VBf"WR'FRG'VrFVFf6F6W'f6RtTD2'WBFff7VFW2FWFV7FrWvW fVF2RB&BFvVvRFV"&W6V6RB&RFBFWfR&VVf7F"FRG'VrFVF0f"vW"FFVvBB&WfWw2b7B'FVЧ6W2&R&Vr6GV7FVBF6VRbF22FR66R&WFRG'VrFW7FrB67&VVrv( B6rWfVF2BWfVfVF7V6f2FW7G2v( BFWFV7@wVW2vRfVF27BƖVǒFV"27WBআW&B266BƖR2vFRvFW"B0&VVffW&VBƗVBB&GFW"f&2B6&P6VB6'FVBV7FVB"FV&V7FǒBvP&WFW2&R&66r6'&W2FRvW7B&6`fFfW&F6RB7G&VWBWfVFRTB27BƖVǐwwrG&FG'Vw6Ww26