This article was published on August 28, 2022.
Given the seriousness of the fentanyl epidemic and the huge number of people who are dying each year due to it, all articles on this website about fentanyl and fentanyl analogs are being made available to everyone and not only to our Members (subscribers). Please share these articles widely by email, social media, and other means.
Here are the links to the articles about fentanyl and fentanyl analogs:
What are fentanyl analogs?
The term “fentanyl analogs” is used to describe substances that are similar in chemical structure to fentanyl. They are also sometimes called designer fentanyls, fentanyl derivatives, or fentalogs (Wilde et al., 2019).
Some fentanyl analogs are legally used in healthcare, for example, alfentanil, sufentanil, and remifentanil (Choińska et al., 2022). Carfentanil is used in veterinary medicine to treat large animals.
But, since there are unimaginable profits to be made, criminals and smugglers have gone to work developing more and more new fentanyl-like products. Literally, hundreds of these fentanyl analogs have been developed in illegal laboratories (Pergolizzi et al., 2021b). Here are the names of just a few of them (alphabetically): acetylfentanyl, furanylfentanyl, U47700.
These fentanyl analogs have a long list of street names; one of the commonly used ones is “White China“.
Why are fentanyl analogs important and dangerous?
1. It is not always clear how the potency of these synthetic fentanyl-like compounds compares with that of fentanyl. But some of them are MUCH more potent than even fentanyl, which is very potent to start with. For example, carfentanyl is approximately 100 times more potent than fentanyl (source). But other fentanyl analogs may be less potent than fentanyl but have still been associated with many overdose deaths. An example of this is acetylfentanyl, which is about 3 times less potent than fentanyl (source).
2. Another problem with these fentanyl analogs is that they may not be detected by urine drug screens for fentanyl/ norfentanyl. that are discussed in the following article on our website: Special tests are needed to identify fentanyl in the urine
Even special testing by commercial laboratories may not solve the problem. For example, Labcorp (a large chain of laboratories in the US) offers a urine drug screen called “Fentanyl and Analogs” (LINK). But, other than fentanyl/ norfentanyl, it tests for only 3 fentanyl analogs and their metabolites: Acetyl fentanyl/ acetyl norfentanyl, alfentanil, and sufentanil/ norsufentanil.
Commercially available fentanyl test strips screen for many (though not all) fentanyl analogs (Bergh et al., 2021). So, their widespread use should be encouraged. Their use is discussed in another article on this website. Please see Why and how to use fentanyl test strips
Optional to read
Fentanyl analogs (and heroin laced with fentanyl) have street names including white heroin, Perc-O-Pops, Chiclets, Apache, China Girl, White China, Dance Fever, Jackpot, Murder 8, TNT, Tango and Cash, Friend, Goodfella, and Redrum, which is murder spelled backward (source).
Simple and Practical Medical Education thanks (alphabetically) Jonathan Beatty MD, and Marina Goldman, MD, for peer-reviewing and approving this article (in July and August 2022).
Dr. Beatty is a board-certified addiction psychiatrist in Philadelphia, Pennsylvania, who has extensive clinical experience in treating patients with substance use disorders. His clinical practice website is https://wavetreatmentcenters.com.
Dr. Goldman is a board-certified addiction psychiatrist. She is a Clinical Assistant Professor and Core Faculty in the Addiction Medicine & Addiction Psychiatry Fellowships at Thomas Jefferson University, Philadelphia, Pennsylvania. She also has a busy private practice in Jenkintown, Pennsylvania.
Opioid use disorder
Opioid use disorder—Management
Substance use disorders
American Society of Addiction Medicine. The ASAM National Practice Guideline for the Treatment of Opioid Use Disorder: 2020 Focused Update. J Addict Med. 2020 Mar/Apr;14(2S Suppl 1):1-91. doi: 10.1097/ADM.0000000000000633. Erratum in: J Addict Med. 2020 May/Jun;14(3):267. PMID: 32511106.
Armenian P, Vo KT, Barr-Walker J, Lynch KL. Fentanyl, fentanyl analogs and novel synthetic opioids: A comprehensive review. Neuropharmacology. 2018 May 15;134(Pt A):121-132. doi: 10.1016/j.neuropharm.2017.10.016. Epub 2017 Oct 14. PMID: 29042317.
Bergh MS, Øiestad ÅML, Baumann MH, Bogen IL. Selectivity and sensitivity of urine fentanyl test strips to detect fentanyl analogues in illicit drugs. Int J Drug Policy. 2021 Apr;90:103065. doi: 10.1016/j.drugpo.2020.103065. Epub 2020 Dec 14. PMID: 33333419.
Choińska MK, Šestáková I, Hrdlička V, Skopalová J, Langmaier J, Maier V, Navrátil T. Electroanalysis of Fentanyl and Its New Analogs: A Review. Biosensors (Basel). 2022 Jan 5;12(1):26. doi: 10.3390/bios12010026. PMID: 35049654; PMCID: PMC8774265.
Pergolizzi J, Magnusson P, LeQuang JAK, Breve F. Illicitly Manufactured Fentanyl Entering the United States. Cureus. 2021b Aug 27;13(8):e17496. doi: 10.7759/cureus.17496. PMID: 34603876; PMCID: PMC8476199.
Wilde M, Pichini S, Pacifici R, Tagliabracci A, Busardò FP, Auwärter V, Solimini R. Metabolic Pathways and Potencies of New Fentanyl Analogs. Front Pharmacol. 2019 Apr 5;10:238. doi: 10.3389/fphar.2019.00238. PMID: 31024296; PMCID: PMC6461066.
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