{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T16:55:09Z","timestamp":1791478509241,"version":"4.3.4"},"reference-count":72,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2019,2,1]],"date-time":"2019-02-01T00:00:00Z","timestamp":1548979200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Since 2013, an unprecedented surge in fentanyl overdose deaths has been caused by heroin laced with illicitly produced fentanyl and\/or fentanyl analogs (FAs) sold as heroin. The US Drug Enforcement Agency's National Forensic Laboratory Information System reported a &amp;gt;300% increase in fentanyl encounters from 4697 in 2014 to 14440 in 2015. In 2015, the CDC reported 9580 deaths caused by synthetic opioids, primarily fentanyl, a 72% increase from 2014. The European Monitoring Centre for Drugs and Drug Addiction has also encountered several new FAs in the heroin supply. Counterfeit pharmaceuticals containing mixtures of fentanyl and FAs continue to be a poorly recognized worldwide problem despite the WHO classifying several FAs as a serious threat to public health.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONTENT<\/jats:title>\n                    <jats:p>This review covers the epidemiology of fentanyl abuse and discusses the clinical practice implications of widespread fentanyl abuse. It includes a historical perspective on the illicit FAs that have appeared in the US and European Union and reviews the methods available to identify FAs and emerging technologies useful for identifying previously undescribed analogs. A compilation of structural and mass spectral data on FAs reported thus far is provided.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>SUMMARY<\/jats:title>\n                    <jats:p>Fentanyl and FAs have evolved into a global public health threat. It is important to understand the analytical, clinical, and regulatory efforts underway to assist communities affected by the current fentanyl epidemic.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1373\/clinchem.2017.281626","type":"journal-article","created":{"date-parts":[[2018,10,10]],"date-time":"2018-10-10T12:24:25Z","timestamp":1539174265000},"page":"242-253","source":"Crossref","is-referenced-by-count":151,"title":["The Fentanyl Epidemic and Evolution of Fentanyl Analogs in the United States and the European Union"],"prefix":"10.1093","volume":"65","author":[{"given":"Paul J","family":"Jannetto","sequence":"first","affiliation":[{"name":"Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"Helander","sequence":"first","affiliation":[{"name":"Department of Laboratory Medicine, Karolinska Institutet, Karolinska University Laboratory, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uttam","family":"Garg","sequence":"first","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, Children's Mercy Hospitals and Clinics, Kansas City, MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory C","family":"Janis","sequence":"first","affiliation":[{"name":"MedTox Laboratories, Laboratory Corporation of America Holdings, St. Paul, MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruce","family":"Goldberger","sequence":"first","affiliation":[{"name":"Department of Pathology, Immunology, and Laboratory Medicine, College of Medicine, University of Florida College of Medicine, Gainesville, FL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hemamalini","family":"Ketha","sequence":"first","affiliation":[{"name":"Mass Spectrometry and Toxicology, Laboratory Corporation of America Holdings, Burlington, NC"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,2,1]]},"reference":[{"key":"2020022605461134600_B1","doi-asserted-by":"crossref","first-page":"5391","DOI":"10.1073\/pnas.90.12.5391","article-title":"A brief history of opiates, opioid peptides, and opioid receptors","volume":"90","author":"Brownstein","year":"1993","journal-title":"Proc Natl Acad Sci U S A"},{"key":"2020022605461134600_B2","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1001\/jama.1884.02390340009001a","article-title":"Morphia and atropia by hypodermic injection previous to the administration of anaesthetics","volume":"II","author":"Reeve","year":"1884","journal-title":"JAMA"},{"key":"2020022605461134600_B3","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.15585\/mmwr.mm6643e1","article-title":"Deaths involving fentanyl, fentanyl analogs, and U-47700 in 10 States, July\u2013December 2016","volume":"66","author":"O'Donnell","year":"2016","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2020022605461134600_B4","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.neuropharm.2017.10.016","article-title":"Fentanyl, fentanyl analogs and novel synthetic opioids: a comprehensive review","volume":"134","author":"Armenian","year":"2018","journal-title":"Neuropharmacology"},{"key":"2020022605461134600_B5","first-page":"155","article-title":"Opioids","volume-title":"The clinical toxicology laboratory: contemporary practice of poisoning evaluation","author":"Ropero-Miller","year":"2013","edition":"2nd Ed"},{"key":"2020022605461134600_B6","first-page":"846","article-title":"Disposition of toxic drugs and chemicals in man","author":"Baselt","year":"2014"},{"key":"2020022605461134600_B7","doi-asserted-by":"crossref","first-page":"904","DOI":"10.15585\/mmwr.mm6634a3","article-title":"Overdose deaths related to fentanyl and its analogs in Ohio, January\u2013February 2017","volume":"66","author":"Daniulaityte","year":"2017","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2020022605461134600_B8","unstructured":"Michigan Legislature Senate Bill SB-0274. http:\/\/legislature.mi.gov\/doc.aspx?2017-SB-0274 (Accessed December 2017)."},{"key":"2020022605461134600_B9","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s13722-016-0068-3","article-title":"Opioid overdose prevention and naloxone rescue kits: what we know and what we don't know","volume":"12","author":"Kerensky","year":"2017","journal-title":"Addict Sci Clin Pract"},{"key":"2020022605461134600_B10","unstructured":"United Nations Office on Drugs and Crime. 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