Diverse psychotropic substances detected in drug and drug administration equipment samples submitted to drug checking services in Toronto, Ontario, Canada, October 2019–April 2020

Background The overdose crisis has generated innovative harm reduction and drug market monitoring strategies. In Toronto, Ontario, Canada, a multi-site drug checking service (DCS) pilot project was launched in October 2019. The project provides people who use drugs with information on the chemical composition of their substances, thereby increasing their capacity to make more informed decisions about their drug use and avoid overdose. DCS also provides real-time market monitoring to identify trends in the unregulated drug supply. Methods Sample data were obtained through analyses of drug and used drug administration equipment samples submitted anonymously and free of charge to DCS in downtown Toronto from October 10, 2019, to April 9, 2020, representing the first six months of DCS implementation. Analyses were conducted in clinical laboratories using liquid chromatography- and/or gas chromatography-mass spectrometry (LC–MS, GC–MS) techniques. Results Overall, 555 samples were submitted, with 49% (271) of samples that were found to contain high-potency opioids, of which 87% (235) also contained stimulants. Benzodiazepine-type drugs were found in 21% (116) of all samples, and synthetic cannabinoids in 1% (7) of all samples. Negative effects (including overdose, adverse health events, and extreme sedation) were reported for 11% (59) of samples submitted for analysis. Conclusions Toronto’s DCS identified a range of high-potency opioids with stimulants, benzodiazepine-type drugs, and a synthetic cannabinoid, AMB-FUBINACA. This information can inform a range of evidence-informed overdose prevention efforts.

The New Deep Web Drug Market Place (And the role of Bitcoin as a currency for drugs)

Drugs are a true menace to our society today. “Drug use on the rise” is an increasingly common headline in newspapers and it is well-known that this is the case. With the topic of drugs becoming more and more common in popular media, youngsters are especially influenced to try drugs. This is not a new problem, as such, and has been a relevant issue in modern society. Coupled with this, the internet plays a huge role in spreading information about emerging drugs (such as synthetic and ‘designer’ drugs). [2] This paper aims to understand the role of the internet’s Deep Web [3] and Bitcoin (and other Crypto currencies) in dealing drugs online.

A comprehensive evaluation of the potential binding poses of fentanyl and its analogs at the µ-opioid receptor

Fentanyl and its analogs are selective agonists of the µ-opioid receptor (MOR). Among novel synthetic opioids (NSOs), they dominate the recreational drug market and are the main culprits for the opioid crisis, which has been exacerbated by the COVID-19 pandemic. By taking advantage of the crystal structures of the MOR, several groups have investigated the binding mechanism of fentanyl, but have not reached a consensus, in terms of both the binding orientation and the fentanyl conformation. Thus, the binding mechanism of fentanyl at the MOR remains an unsolved and challenging question. Here, we carried out a systematic computational study to investigate the preferred fentanyl conformations, and how these conformations are being accommodated in the MOR binding pocket. We characterized the free energy landscape of fentanyl conformations with metadynamics simulations, as well as performed long-timescale molecular dynamics simulations to compare and evaluate several possible fentanyl binding conditions. Our results indicate that the most preferred binding pose in the MOR binding pocket corresponds well with the minima on the energy landscape of fentanyl in the absence of the receptor, while the energy landscape can be reconfigured by modifying the fentanyl scaffold. The interactions with the receptor may stabilize a slightly unfavored fentanyl conformation in an alternative binding pose. By extending similar investigations to fentanyl analogs, our findings establish a structure-activity relationship of fentanyl binding at the MOR. In addition to providing a structural basis to understand the potential toxicity of the emerging NSOs, such insights will contribute to developing new, safer analgesics.

Drugs on the internet: Mapping the terrain of engagement with darknet drug cryptomarkets in New Zealand

<p>This thesis explores the experiences of New Zealanders who order illicit drugs from cryptomarkets, with particular attention to their perspectives on New Zealand’s conventional illicit drug market, the negatives and positives of drug cryptomarkets, and their notable insights and features. Internationally, research on engagement with drug cryptomarkets is emergent. However, peer-reviewed research on New Zealand drug cryptomarket users remains absent. This thesis attempts to begin to fill this gap, exploring the experiences and viewpoints of New Zealand drug cryptomarket users within the context of existing international literature. The study utilised qualitative, semi-structured interviews with 12 New Zealanders who have accessed drug cryptomarkets. The data from the interviews were interpreted through thematic analysis using constructivist grounded theory. The research found that the constraints of New Zealand’s conventional drug market push some drug consumers to use cryptomarkets to access illicit drugs. Although drug cryptomarkets have various pull factors that attract participants to them, they also have negative aspects which influence participants’ choices and behaviours when accessing cryptomarkets. The findings that are presented give voice to the lived experiences of New Zealanders who access drug cryptomarkets, extend scholarly knowledge of cryptomarket users, and highlight further avenues for research.</p>

Drugs on the internet: Mapping the terrain of engagement with darknet drug cryptomarkets in New Zealand

<p>This thesis explores the experiences of New Zealanders who order illicit drugs from cryptomarkets, with particular attention to their perspectives on New Zealand’s conventional illicit drug market, the negatives and positives of drug cryptomarkets, and their notable insights and features. Internationally, research on engagement with drug cryptomarkets is emergent. However, peer-reviewed research on New Zealand drug cryptomarket users remains absent. This thesis attempts to begin to fill this gap, exploring the experiences and viewpoints of New Zealand drug cryptomarket users within the context of existing international literature. The study utilised qualitative, semi-structured interviews with 12 New Zealanders who have accessed drug cryptomarkets. The data from the interviews were interpreted through thematic analysis using constructivist grounded theory. The research found that the constraints of New Zealand’s conventional drug market push some drug consumers to use cryptomarkets to access illicit drugs. Although drug cryptomarkets have various pull factors that attract participants to them, they also have negative aspects which influence participants’ choices and behaviours when accessing cryptomarkets. The findings that are presented give voice to the lived experiences of New Zealanders who access drug cryptomarkets, extend scholarly knowledge of cryptomarket users, and highlight further avenues for research.</p>

Shifting North American drug markets and challenges for the system of care

Drug markets are dynamic systems which change based on demand, competition, legislation and revenue. Shifts that are not met with immediate and appropriate responses from the healthcare system can lead to public health crises with tragic levels of morbidity and mortality, as experienced Europe in the early 1990s and as is the case in North America currently. The major feature of the current drug market shift in North America is towards highly potent synthetic opioids such as fentanyl and fentanyl analogues. An additional spike in stimulant use further complicates this issue. Without understanding the ever-changing dynamics of drug markets and consequent patterns of drug use, the healthcare system will continue to be ineffective in its response, and morbidity and mortality will continue to increase. Economic perspectives are largely neglected in research and clinical contexts, but better treatment alternatives need to consider the large-scale macroeconomic conditions of drug markets as well as the behavioural economics of individual substance use. It is important for policy makers, health authorities, first responders and medical providers to be aware of the clinical implications of drug market changes in order to best serve people who use drugs. Only with significant clinical research, a comprehensive reorganization of the system of care across all sectors, and an evidence-driven governance, will we be successful in addressing the challenges brought on by the recent shifts in drug markets.

Gradient of Russian pharmaceutical market development in covid conditions

In 2020, markets are showing both unpredictable and anticipated development trends. The pharmaceutical market was no exception. Turnover of the commercial drug market in 2020 amounted to 1,128 billion rubles, which is 10.6% more than in the previous year. Parapharmaceutical sales amounted to RUB 279 billion in 2020. In the analyzed period, state purchases of pharmaceuticals reached 634 billion rubles. It was expected an increase in Pharma-2020’s turnover in value terms; the basis for the increase was over-the-counter drugs and domestically produced drugs. At the same time, in the statistics of packaging, a decrease in sales was observed in the commercial sector of medicines — by 2.3%, and in parapharmaceuticals — by 15.4%, and in hospital purchases — by 15.0%. According to the results of the analysis, there is an increase in the consumption of expensive drugs, as well as a redistribution of demand to the segment of large packages. The share of online sales in the pharmaceutical market for the monitored 2020 increased from 5.5% in January to 8.2% in December. The share of expensive drugs in the online segment is higher than in the offline segment.

2C-x and DOx hallucinogens: a systematic review

The drug market has seen a significant global expansion in the last decades. The synthetic designer drugs belonging to the class of amphetamines and derived phenylethylamines have experienced the greatest spread in the drug market for abuse. As phenylethylamines are organic compounds that stimulate the central nervous system of humans, many are abused as recreational drugs. A large array of substituted amphetamines can be easily synthetized by replacing one or more hydrogen atoms in the structure of phenylethylamine. Among these, the most dangerous for human health are those analogues or homologues that have hallucinogenic effects (besides the stimulant pharmacological activity), such as those belonging to the 2C-x and DOx classes of amphetamines. This review describes the physico-chemical and spectral properties of the most representative compounds of the two classes.

Improvements in Toxicology Testing to Identify Fentanyl Analogs and Other Novel Synthetic Opioids in Fatal Drug Overdoses, Connecticut, January 2016–June 2019

Objectives Drug overdose deaths in Connecticut increasingly involve a growing number of fentanyl analogs and other novel nonfentanyl synthetic opioids (ie, novel synthetics). Current postmortem toxicology testing methods often lack the sophistication needed to detect these compounds. We examined how improved toxicology testing of fatal drug overdoses can determine the prevalence and rapidly evolving trends of novel synthetics. Methods From 2016 to June 2019, the Connecticut Office of the Chief Medical Examiner increased its scope of toxicology testing of suspected drug overdose deaths in Connecticut from basic to enhanced toxicology testing to detect novel synthetics. The toxicology laboratory also expanded its testing panels during this time. We analyzed toxicology results to identify and quantify the involvement of novel synthetics over time. Results From 2016 to June 2019, 3204 drug overdose deaths received enhanced toxicology testing; novel synthetics were detected in 174 (5.4%) instances. Ten different novel synthetics were detected with 205 total occurrences. Of 174 overdose deaths with a novel synthetic detected, most had 1 (n = 146, 83.9%) or 2 (n = 26, 14.9%) novel synthetics detected, with a maximum of 4 novel synthetics detected. Para-fluorobutyrylfentanyl/FIBF, furanylfentanyl, and U-47700 were most identified overall, but specific novel synthetics came in and out of prominence during the study period, and the variety of novel synthetics detected changed from year to year. Conclusions Enhanced toxicology testing for drug overdose deaths is effective in detecting novel synthetics that are not identified through basic toxicology testing. Identifying emerging novel synthetics allows for a timely and focused response to potential drug outbreaks and illustrates the changing drug market.