Illicit fentanyls in the opioid street market: desired or imposed?
Open accessAbstract
Background: Illicitly manufactured fentanyl and its analogues are appearing in countries throughout the world, often disguised as heroin or counterfeit prescription pills, with resulting high overdose mortality. Possible explanations for this phenomenon include reduced costs and risks to heroin suppliers, heroin shortages, user preferences for a strong, fast‐acting opioid and the emergence of Dark Web cryptomarkets. This paper addresses these potential causes and asks three questions: (1) can users identify fentanyl; (2) do users desire fentanyl; and (3) if users want fentanyl, can they express this demand in a way that influences the supply? Argument/analysis: Existing evidence, while limited, suggests that some users can identify fentanyl, although not reliably, and some desire it, but because fentanyl is frequently marketed deceptively as other drugs, users lack information and choice to express demand effectively. Even when aware of fentanyl's presence, drug users may lack fentanyl‐free alternatives. Cryptomarkets, while difficult to quantify, appear to offer buyers greater information and competition than offline markets. However, access barriers and patterns of fentanyl‐related health consequences make cryptomarkets unlikely sources of user influence on the fentanyl supply. Market condition data indicate heroin supply shocks and shortages prior to the introduction of fentanyl in the United States and parts of Europe, but the much lower production cost of fentanyl compared with heroin may be a more significant factor Conclusion: Current evidence points to a supply‐led addition of fentanyl to the drug market in response to heroin supply shocks and shortages, changing prescription opioid availability and/or reduced costs and risks to suppliers. Current drug users in affected regions of the United States, Canada and Europe appear largely to lack both concrete knowledge of fentanyl's presence in the drugs they buy and access to fentanyl‐free alternatives.
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Fentanyl did not saturate each state's unregulated drug market at the same time; from about 2013 onward, it spread from east to west over the course of several years.
“However, fentanyl did not saturate each state’s unregulated drug market at the same time25; from about 2013 onward, it spread from east to west over the course of several years.20,26”
From Drug Decriminalization, Fentanyl, and Fatal Overdoses in Oregon (2024) · cites this paper as [25]
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Experimental — accuracy not yet measuredThe contamination of fentanyl in illicit drugs is driven by supply rather than demand.
“which is consistent with findings that the contamination of fentanyl in illicit drugs is supply, rather than demand, driven”
From “I probably got a minute”: Perceptions of fentanyl test strip use among people who use stimulants (2021) · cites this paper as Mars, Rosenblum, & Ciccarone, 2019
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- Authors
- Mars, S. G., Rosenblum, D., & Ciccarone, D.
- Affiliations
- University of California, San Francisco (US)
- Dalhousie University (CA)
- Corresponding author
- Mars, Sarah G.
- Venue
- Addiction
- Publisher
- Wiley
- Published
- 2018-12-04
- Volume
- 114
- Issue
- 5
- Pages
- 774-780
- ISSN
- 0965-2140 (ISSN-L)
- 1360-0443
- PMC
- PMC6548693
- OpenAlex
- W2902629504
- Semantic Scholar
- 2048d3ecd94b7c8e09727bb406e57aa119703ed7
- Cited by
- 185
- References
- 49
- Citations by year
- 2026: 11 · 2025: 27 · 2024: 27 · 2023: 24 · 2022: 24 · 2021: 33 · 2020: 25 · 2019: 13 · 2018: 1
- FWCI
- 17.16
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Addiction (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institute on Drug Abuse (R01DA037820)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Social Sciences › Sociology and Political Science › Crime, Illicit Activities, and Governance
- Keywords
- illicit fentanyl, fentanyl analogs, heroin shortage, drug supply, drug overdose deaths
- MeSH terms
- Costs and Cost Analysis, Heroin, Dose-Response Relationship, Drug, Fentanyl, Humans, Illicit Drugs, United States, Drug Costs, Counterfeit Drugs, Drug Overdose, Drug Trafficking
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