{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T08:49:48Z","timestamp":1790153388666,"version":"4.0.1"},"reference-count":55,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2020,8,31]],"date-time":"2020-08-31T00:00:00Z","timestamp":1598832000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Addiction"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Overdose deaths related to illegal drugs in North American markets are now dominated by potent synthetic opioids such as fentanyl, a circumstance foreshadowed by often\u2010overlooked events in Estonia since the turn of the century. Market transitions generate important and far\u2010reaching implications for drug policy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Argument and analysis<\/jats:title><jats:p>The supplier\u2010driven introduction of illegally manufactured synthetic opioids into street opioids is elevating the risk of fatal overdose. Using the most recent overdose mortality and drug seizure data in North America, we find that overdose deaths and seizures involving synthetic opioids are geographically concentrated, but this might be changing. Examination here suggests that in some places fentanyl and its analogues have virtually displaced traditional opioids, such as heroin. The concealing of synthetic opioids in powders sold as heroin or pressed into counterfeit medications substantially increases harms. The nature and scale of the challenge posed by synthetic opioids is unprecedented in recent drug policy history.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>There is urgent need for policy and technological innovation to meet the challenges posed by illegally produced synthetic opioids. Novel interventions worth examining include supervising drug use, proactively deterring on\u2010line distribution and new technologies aimed at improving transparency, such as point\u2010of\u2010use drug content testing. Continuing to approach this problem only with existing policies and available methods, such as naloxone, is unlikely to be enough and will result in many premature deaths.<\/jats:p><\/jats:sec>","DOI":"10.1111\/add.15222","type":"journal-article","created":{"date-parts":[[2020,9,1]],"date-time":"2020-09-01T03:26:26Z","timestamp":1598930786000},"page":"1304-1312","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":47,"title":["The dawn of a new synthetic opioid era: the need for innovative interventions"],"prefix":"10.1111","volume":"116","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9690-7875","authenticated-orcid":false,"given":"Bryce","family":"Pardo","sequence":"first","affiliation":[{"name":"RAND Corporation Santa Monica CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jirka","family":"Taylor","sequence":"additional","affiliation":[{"name":"RAND Corporation Santa Monica CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7748-9989","authenticated-orcid":false,"given":"Jon","family":"Caulkins","sequence":"additional","affiliation":[{"name":"Stever University Professor of Operations Research and Public Policy Pittsburgh PA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7809-0849","authenticated-orcid":false,"given":"Peter","family":"Reuter","sequence":"additional","affiliation":[{"name":"School of Public Policy and Department of Criminology University of Maryland, College Park MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9333-8080","authenticated-orcid":false,"given":"Beau","family":"Kilmer","sequence":"additional","affiliation":[{"name":"RAND Corporation Santa Monica CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,8,31]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"United Nations Office on Drugs and Crime (UNODC).World Drug Report 2019. United Nations publication Sales no. E.19.XI.8. Vienna Austria: UNODC;2019."},{"key":"e_1_2_8_3_1","volume-title":"European Drug Report 2019: Trends and Developments","author":"European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)","year":"2019"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2016.10.020"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.4155\/fmc.13.215"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.7249\/RR3117"},{"key":"e_1_2_8_7_1","doi-asserted-by":"crossref","DOI":"10.1093\/oso\/9780195125092.001.0001","volume-title":"The American Disease: Origins of Narcotic Control","author":"Musto D. F.","year":"1999"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1126\/science.aau1184"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2019.01.010"},{"key":"e_1_2_8_10_1","article-title":"Drug and opioid\u2010involved overdose deaths\u2014United States, 2013\u20132017","volume":"67","author":"Scholl L.","year":"2019","journal-title":"Morb Mortal Wkly Rep"},{"key":"e_1_2_8_11_1","volume-title":"Provisional drug overdose death counts","author":"Ahmad F. B.","year":"2020"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2019.01.042"},{"key":"e_1_2_8_13_1","unstructured":"Sernoffsky E. andKing J.Fentanyl heroin overdoses in San Francisco more than doubled in 2019. San Francisco Chronicle 20 January2020. Available at:https:\/\/www.sfchronicle.com\/bayarea\/article\/Fentanyl-heroin-overdoses-in-San-Francisco-more-14993628.php(accessed 1 April 2020)."},{"key":"e_1_2_8_14_1","unstructured":"Kunkler A.Fentanyl overdoses keep increasing in King County. Seattle Weekly 24 February2020. Available at:https:\/\/www.seattleweekly.com\/news\/fentanyl-overdoses-keep-increasing-in-king-county\/(accessed 1 April 2020)."},{"key":"e_1_2_8_15_1","unstructured":"Health Canada.Opioid\u2010related harms in Canada as of 26 March2020. Available at:https:\/\/health-infobase.canada.ca\/substance-related-harms\/opioids\/maps?index=1(accessed 1 April 2020)."},{"key":"e_1_2_8_16_1","unstructured":"BC Coroners Service.Illicit Drug Toxicity Deaths in BC as of 17 July2020. Available at:https:\/\/www2.gov.bc.ca\/assets\/gov\/birth-adoption-death-marriage-and-divorce\/deaths\/coroners-service\/statistical\/illicit-drug.pdf(accessed 1 April 2020)."},{"key":"e_1_2_8_17_1","first-page":"17","article-title":"The spread of heroin abuse in a community","volume":"21","author":"De Alarcon R.","year":"1969","journal-title":"Bull Narc"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.62.7.995"},{"key":"e_1_2_8_19_1","first-page":"1292","article-title":"Heroin utilization. A communicable disease?","volume":"72","author":"Jonas S.","year":"1972","journal-title":"NY State J Med"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1136\/jech.33.4.299"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1287\/mnsc.15.5.215"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1287\/mksc.13.3.203"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2017.06.004"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2020.107893"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2017.05.023"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00414-008-0230-x"},{"key":"e_1_2_8_27_1","volume-title":"Latvia Country Drug Report 2019","author":"European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)","year":"2019"},{"key":"e_1_2_8_28_1","unstructured":"SwedishPolice Authority.Swedish National Threat Assessment on Fentanyl Analogues and Other Synthetic Opioids as of 26 March2020. Stockholm: Swedish Police Authority 2018. Available at:https:\/\/polisen.se\/siteassets\/dokument\/ovriga_rapporter\/fentanyl-analogues-report-english.pdf(accessed 1 April 2020)."},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.3109\/15563657508990076"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0108250"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00044-012-0390-6"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.2042-7158.1961.tb11864.x"},{"key":"e_1_2_8_33_1","unstructured":"O'ConnorS.Fentanyl: China's deadly export to the United States. Staff Research Report. Washington DC: US\u2013China Economic and Security Review Commission;2017."},{"key":"e_1_2_8_34_1","doi-asserted-by":"crossref","unstructured":"Pardo B.Evolution of the US Overdose Crisis: Understanding China's Role in the Production and Supply of Synthetic Opioids.Santa Monica CA:RAND Corporation;2018.","DOI":"10.7249\/CT497"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.7249\/RR2733"},{"key":"e_1_2_8_36_1","unstructured":"US Postal Service (USPS).Inbound China ePacket Costing Methodology: Audit Report Office of the Inspector General MS\u2010AR\u201014\u2010002 25 February 2014. Washington DC: USPS;2014."},{"key":"e_1_2_8_37_1","volume-title":"Combatting the Opioid Crisis: Exploiting Vulnerabilities in International Mail","author":"US Senate, Permanent Subcommittee on Investigations, Committee on Homeland Security and Governmental Affairs","year":"2018"},{"key":"e_1_2_8_38_1","unstructured":"Notimex.\u2018En el aeropuerto capitalino incautan 2 kilos de precursor para fentanilo\u2019 [\u2018At the capital airport they seize 2 kilos of precursor for fentanyl\u2019]. 8 February2019. Available at:https:\/\/www.20minutos.com.mx\/noticia\/843701\/0\/aeropuerto-capitalino-incautan-2-kilos-precursor-para-fentanilo\/(accessed 1 April 2020)."},{"key":"e_1_2_8_39_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1360-0443.2012.03829.x"},{"key":"e_1_2_8_40_1","doi-asserted-by":"publisher","DOI":"10.7249\/RR3140"},{"key":"e_1_2_8_41_1","doi-asserted-by":"publisher","DOI":"10.1080\/00952990.2017.1376678"},{"key":"e_1_2_8_42_1","unstructured":"Statistics Estonia.\u2018SD41: Direct Drug\u2010Related Deaths by Sex and Age\u2019 data set 2020 as of 26 March2020. Available at:http:\/\/pxweb.tai.ee\/esf\/pxweb2008\/Dialog\/varval.asp?ma=SD41_en&ti=SD41%3A+Direct+drug%2Drelated+deaths+by+sex+and+age+&path=..\/Database_en\/Population\/04Deaths\/&lang=1(accessed 1 April 2020)."},{"key":"e_1_2_8_43_1","volume-title":"Estonia Country Drug Report 2019","author":"European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)","year":"2019"},{"key":"e_1_2_8_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugpo.2012.11.002"},{"key":"e_1_2_8_45_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1615145"},{"key":"e_1_2_8_46_1","doi-asserted-by":"publisher","DOI":"10.1124\/jpet.119.258566"},{"key":"e_1_2_8_47_1","doi-asserted-by":"publisher","DOI":"10.1111\/add.14747"},{"key":"e_1_2_8_48_1","unstructured":"Kilmer B.\u2018Reducing barriers and getting creative: 10 federal options to increase treatment access for opioid use disorder and reduce fatal overdoses\u2019. Brookings Institution2020. Available at:https:\/\/www.brookings.edu\/research\/reducing-barriers-and-getting-creative-10-federal-options-to-increase-treatment-access-for-opioid-use-disorder-and-reduce-fatal-overdoses\/(accessed 1 April 2020)."},{"key":"e_1_2_8_49_1","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.114.149195"},{"key":"e_1_2_8_50_1","doi-asserted-by":"publisher","DOI":"10.7249\/WR1263"},{"key":"e_1_2_8_51_1","doi-asserted-by":"publisher","DOI":"10.1111\/add.14614"},{"key":"e_1_2_8_52_1","doi-asserted-by":"publisher","DOI":"10.1080\/10903127.2017.1315203"},{"key":"e_1_2_8_53_1","unstructured":"BC Centre for Disease Control.Overdose Response Indicator Report: February 2020 as of 17 July2020. Available at:http:\/\/www.bccdc.ca\/resource-gallery\/Documents\/Statistics%20and%20Research\/Statistics%20and%20Reports\/Overdose\/Overdose%20Response%20Indicator%20Report.pdf(accessed 1 April 2020)."},{"key":"e_1_2_8_54_1","doi-asserted-by":"publisher","DOI":"10.1111\/add.14664"},{"key":"e_1_2_8_55_1","unstructured":"CBC News.\u2018Hundreds of British Columbians are accessing province's \u201csafe supply\u201d of drugs\u2019. 1 June2020. Available at:https:\/\/www.cbc.ca\/news\/canada\/british-columbia\/safe-supply-bc-drug-overdose-covid-public-health-emergency-1.5594197(accessed 1 April 2020)."},{"key":"e_1_2_8_56_1","volume-title":"Enforcement strategies for fentanyl and other synthetic opioids","author":"Pardo B.","year":"2020"}],"container-title":["Addiction"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/add.15222","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/add.15222","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/add.15222","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,8,12]],"date-time":"2024-08-12T22:43:55Z","timestamp":1723502635000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/add.15222"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8,31]]},"references-count":55,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2021,6]]}},"alternative-id":["10.1111\/add.15222"],"URL":"https:\/\/doi.org\/10.1111\/add.15222","archive":["Portico"],"relation":{},"ISSN":["0965-2140","1360-0443"],"issn-type":[{"value":"0965-2140","type":"print"},{"value":"1360-0443","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,8,31]]},"assertion":[{"value":"2020-03-31","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-08-06","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-08-31","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}