The challenge facing lawmakers is ‘no longer simply how to reduce the supply of the next synthetic drug, but how to reduce the conditions that create demand for it’, according to researchers from King’s College London’s National Programme on Substance Use Mortality and elsewhere.
While the ‘seemingly endless succession’ of high potency novel psychoactive substances that have characterised drug markets in recent decades is usually attributed to ‘illicit innovation’ outpacing systems of drug control, developments in the UK market could reinforce the ‘potency paradox’ argument, the researchers state – the ‘possibility that drug controls may unintentionally promote the emergence’ of more potent drugs.
The UK nitazene market was initially dominated by metonitazene and protonitazene, which – while still ‘highly dangerous’ – were less potent than many others. The amendment of the Misuse of Drugs Act to include generic controls on nitazenes early last year, however, saw the emergence of more powerful analogues such as etonitazene, suggesting that ‘in the absence of broad nitazene controls, market incentives did not favour the most potent compounds’. Meanwhile, orphines – ‘another long-forgotten class’ of highly potent synthetic opioids – have also entered the market. In both instances it could be the case that controls ‘may shape not only whether replacement occurs, but also its direction towards more potent compounds whose trafficking advantages outweigh incentives to develop alternative analogues’, the researchers say, as smaller quantities of highly potent compounds are needed to produce large numbers of doses, making them far easier to traffick and conceal.
This ‘should not be interpreted as an argument against control measures’, the researchers stress, as supply-side interventions can reduce harm – such as with the recent disruption to US fentanyl supply linked to Chinese precursor controls which coincided with ‘substantial’ reductions in overdose deaths. If supply-side interventions continue to be followed by market adaptations associated with increased overdose risk, however, then greater emphasis needs to be placed on ‘prevention, treatment, harm reduction, and wider social interventions’, they state.
Nitazenes were implicated in nearly a quarter of the 1,113 drug-related deaths recorded in Scotland last year, with etonitazene – now the most common nitazene, and shown to have up to 1,500 times the potency of morphine – implicated in 215. Although nitazenes are estimated to have contributed to more than 1,000 deaths so far in the UK, a King’s College report warned that the true figure may be far higher, as the drugs can degrade to the extent that they are undetectable in post-mortem samples. New psychoactive substances, many of them highly potent synthetic opioids, are currently being detected in Europe at a rate of around one a week.
Earlier this year UNODC warned that the global opioid market was at a turning point, with the supply of opium stockpiled by traffickers in the wake of the Taliban’s 2022 cultivation ban now finally dwindling to be replaced by synthetic products like fentanyls, nitazenes and orphines in a ‘permanent shift’.
Selecting for potency: are drug controls shaping the evolution of illicit drug markets? is published in the International Journal of Drug Policy and available here