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Shifting drug markets in North America - a global crisis in the making?
Open accessAbstract
Understanding drug market dynamics and their underlying driving factors is paramount to developing effective responses to the overdose crisis in North America. This paper summarises the distinct drug market trends observed locally and internationally over the past decade to extrapolate future drug market trajectories. The emergence of fentanyl on North American street markets from 2014 onwards led to a shift of street drug use patterns. Previously perceived as contaminants, novel synthetic opioids became the drugs of choice and a trend towards higher potency was observed across various substance classes. The diversification of distribution strategies as well as the regionalisation and industrialisation of production followed basic economic principles that were heavily influenced by prosecution and policy makers. Particularly, the trend towards higher potency is likely most indicative of what to expect from future illicit drug market developments. Nitazenes and fentanyl-analogues, several times more potent than fentanyl itself, are increasingly detected in toxicological testing and have the potential of becoming the drugs of choice in the future. The dynamic of drug import and local production is less clear and influenced by a multitude of factors like precursor availability, know-how, infrastructure, and the success of local drug enforcement strategies. Drug market dynamics and the current trajectory towards ultrapotent opioids need to be recognised by legislation, enforcement, and the health care system to prepare effective responses. Without significant improvements in treatment access, the implementation of preventative approaches and early warning systems, the mortality rate will continue to increase. Furthermore, there is no mechanism in place preventing the currently North American focused overdose crisis to spread to other parts of the globe, particularly Europe. A system of oversight, research, and treatment is needed to address mortality rates of historic proportions and prevent further harm.
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Following international scheduling in 2021, a rapid proliferation of other nitazene analogues has emerged worldwide, with dozens reported in toxicology investigations and seized-drug casework.
“Following its international scheduling in 2021, a rapid proliferation of other nitazene analogues has emerged worldwide, with dozens of different nitazene analogues now reported in both toxicology investigations and seized-drug casework [6,7,8,9].”
From Nitazenes: The Emergence of a Potent Synthetic Opioid Threat (2025) · cites this paper as [9]
The Introduction’s “Major drug market trends of the past decade” section describes rapid structural development of nitazenes and increasing availability, including a rise in Canadian isotonitazene seizures from 2019 to 2021 (page not specified). It does not state that international scheduling occurred in 2021 or that dozens of different analogues were reported worldwide in toxicology investigations and seized-drug casework. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe first nitazene widely identified in the recreational drug market was isotonitazene, in 2019, in Europe, Canada, and the United States.
“The first nitazene to be widely identified in the recreational drug market was isotonitazene, in 2019, in Europe, Canada, and the United States.”
From Nitazenes: The Emergence of a Potent Synthetic Opioid Threat (2025) · cites this paper as [9]
The Introduction, under “The trend of higher potency” (page not provided), reports that isotonitazene was identified in Canadian drug seizures in 2019. It does not say isotonitazene was the first nitazene widely identified in the recreational drug market, or report its identification in Europe and the United States in 2019. (LLM, conf=0.87)
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Cites
From the Centers for Disease Control and Prevention Tuberculosis Morbidity—United States, 1997
(2001) · doi:10.4135/9781412963862.n82 · Cited by 15,795 · cited 1×
“The current trend towards the use of high potent synthetic opioids, especially fentanyl, has caused an extreme increase in the prevalence of non-fatal and fatal overdose events [13, 14].”
BackgroundStrang, J., Volkow, N. D., Degenhardt, L., Hickman, M., Johnson, K., Koob, G. F., Marshall, B. D. L., Tyndall, M., & Walsh, S. L. (2020) · Nature Reviews Disease Primers · doi:10.1038/s41572-019-0137-5 · Cited by 639 · cited 1×
“Indeed, the most effective treatment approach for opioid use disorder is opioid agonist treatment (OAT) [50].”
BackgroundHumphreys, K. N., Shover, C. L., Andrews, C. M., Bohnert, A. S. B., Brandeau, M. L., Caulkins, J. P., Chen, J. H., Cuéllar, M.-F., Hurd, Y. L., Juurlink, D. N., et al. (2022) · The Lancet · doi:10.1016/s0140-6736(21)02252-2 · Cited by 481 · cited 2×
“Although prescription opioid-involved deaths rates have remained relatively stable, it is important to remember what role prescription drug-control policies had in shaping the nature of today’s drug markets [5].”
BackgroundSeely, K. A., Lapoint, J. M., Moran, J. H., & Fattore, L. (2012) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2012.04.017 · Cited by 463 · cited 1×
“The use of these novel modified psychotropic substances has been associated with fatal outcomes and numerous, some-times life-threatening, side effects which are reported in literature [24–26].”
BackgroundA review: Fentanyl and non-pharmaceutical fentanyls.
Suzuki, J., & Haddad, S. E. (2017) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2016.11.033 · Cited by 420 · cited 1×
“In 2021, 8% of all illicit drug toxicity deaths in British Columbia (BC) Canada involved this agent [14, 15].”
BackgroundFriedman, J., Montero, F., Bourgois, P., Wahbi, R., Dye, D., Goodman-Meza, D., & Shover, C. L. (2021) · medRxiv · doi:10.1101/2021.09.20.21263680 · Cited by 336 · cited 1×
“Another adulterant, that is increasingly identified in combination with fentanyl, heroin and cocaine and has been linked to a growing number of overdose deaths and injection-related soft tissue damage is xylazine, which has also been found to give fentanyl “legs” [41, 42].”
BackgroundKhat and synthetic cathinones: a review
Valente, M. J., de Pinho, P. G., Bastos, M. D. L., Carvalho, F. D., & Carvalho, M. C. (2013) · Archives of Toxicology · doi:10.1007/s00204-013-1163-9 · Cited by 336 · cited 1×
“In North America and Europe alike, they have commonly been sold legally (e.g., as bath salts) and mis-sold illegally as MDMA [35–37].”
BackgroundToday’s fentanyl crisis: Prohibition’s Iron Law, revisited
Beletsky, L. A., & Davis, C. S. (2017) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2017.05.050 · Cited by 298 · cited 1×
“This has previously been referred to as the ‘Iron Law of Pro-hibition’, whereby pressures due to attempted interruption and suppression of the illicit drug supply leads to ever-more compact substitutes [46].”
BackgroundHeroin uncertainties: Exploring users’ perceptions of fentanyl-adulterated and -substituted ‘heroin’
Ciccarone, D., Ondocsin, J., & Mars, S. G. (2017) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2017.06.004 · Cited by 291 · cited 1×
“This later shifted towards locally produced fentanyl due to several factors, including its economic advantages and a crack-down on fentanyl in China [7].”
BackgroundRuiz-Colón, K., Chavez-Arias, C., Díaz-Alcalá, J. E., & Martínez, M. A. (2014) · Forensic Science International · doi:10.1016/j.forsciint.2014.03.015 · Cited by 262 · cited 1×
“In humans, its side effects include respiratory depression, bradycardia, hypotension, with intoxications often leading to fatal outcomes [43].”
BackgroundMauro, P. M., Gutkind, S., Annunziato, E. M., & Samples, H. (2022) · JAMA Network Open · doi:10.1001/jamanetworkopen.2022.3821 · Cited by 226 · cited 1×
“Still, in the US, treatment coverage is estimated to be 28% and waiting times for treatment services can extend to several weeks [51].”
BackgroundFentanyl depression of respiration: Comparison with heroin and morphine
Hill, R., Santhakumar, R., Dewey, W. L., Kelly, E., & Henderson, G. (2019) · British Journal of Pharmacology · doi:10.1111/bph.14860 · Cited by 221 · cited 1×
“This synthetic opioid is approximately 70 times more potent than morphine and has become a main driver of the overdose crisis [4].”
BackgroundDick, A. W., Pacula, R. L., Gordon, A. J., Sorbero, M., Burns, R. M., LESLIE, D. L., & Stein, B. D. (2015) · Health Affairs · doi:10.1377/hlthaff.2014.1205 · Cited by 159 · cited 1×
“Furthermore, OAT in North America is usually not individualised, meaning that most patients receive either sublingual buprenorphine or oral methadone [52].”
BackgroundPsychoactive "bath salts" intoxication with methylenedioxypyrovalerone.
Ross, E., Reisfield, G., Watson, M., Chronister, C. W., & Goldberger, B. (2012) · American Journal of Medicine · doi:10.1016/j.amjmed.2012.02.019 · Cited by 143 · cited 1×
“In North America and Europe alike, they have commonly been sold legally (e.g., as bath salts) and mis-sold illegally as MDMA [35–37].”
BackgroundSold as Heroin: Perceptions and Use of an Evolving Drug in Baltimore, MD
Mars, S. G., Ondocsin, J., & Ciccarone, D. (2017) · Journal of Psychoactive Drugs · doi:10.1080/02791072.2017.1394508 · Cited by 127 · cited 1×
“That is, individuals who use opioids will be gradually exposed to these drugs, as the fentanyl sold will be cut, knowingly or unknowingly to the individuals using it [11, 45].”
BackgroundHeroin-assisted treatment in Switzerland: a case study in policy change.
Uchtenhagen, A. (2010) · Addiction · doi:10.1111/j.1360-0443.2009.02741.x · Cited by 109 · cited 1×
“These countries broke with established paradigms and successfully tackled the heroin-and HIV-crisis of the 1990s by implementing heroin-assisted treatment as a novel and effective treatment regimen [57].”
BackgroundThe State of Opioid Agonist Therapy in Canada 20 Years after Federal Oversight
Eibl, J. K., Morin, K. A., Leinonen, E., & Marsh, D. C. (2017) · The Canadian Journal of Psychiatry · doi:10.1177/0706743717711167 · Cited by 100 · cited 1×
“Slow-release oral morphine and fast-acting agonists are utilised in Canada to some extent, but treat-ment barriers like waiting times and long-distance travel to reach clinics limit access to them [53, 54].”
BackgroundThe opioid overdose crisis as a global health challenge
Krausz, R. M., Westenberg, J. N., & Ziafat, K. (2021) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000712 · Cited by 91 · cited 1×
“This suggests a much more intricate array of factors that can account for the ongoing development in North America [6].”
BackgroundSelf-citationA crisis of opioids and the limits of prescription control: United States
Kertesz, S. G., & Gordon, A. J. (2018) · Addiction · doi:10.1111/add.14394 · Cited by 89 · cited 3×
“Strong prescription control was then put in place, but without an expansion of pain and addiction treat-ment [44].”
BackgroundInfluentialMontanari, E., Madeo, G., Pichini, S., Busardò, F. P., & Carlier, J. (2022) · Therapeutic Drug Monitoring · doi:10.1097/ftd.0000000000000970 · Cited by 89 · cited 1×
“Furthermore, benzimidazole opioids or “nita-zenes” emerged in North America and have since gained a foothold in its drug street markets [16, 17].”
BackgroundVandeputte, M. M., Krotulski, A. J., Walther, D., Glatfelter, G. C., Papsun, D., Walton, S. E., Logan, B. K., Baumann, M. H., & Stove, C. P. (2022) · Archives of Toxicology · doi:10.1007/s00204-022-03276-4 · Cited by 80 · cited 1×
“Nitazenes and their analogues can exceed the potency of fentanyl by a factor of ten and their availability is steadily increasing [18].”
BackgroundTreatment or “high”: Benzodiazepine use in patients on injectable heroin or oral opioids
Vogel, M., Knöpfli, B., Schmid, O., Prica, M., Strasser, J., Prieto, L. C. V., Wiesbeck, G. A., & Dürsteler‐MacFarland, K. M. (2013) · Addictive Behaviors · doi:10.1016/j.addbeh.2013.05.008 · Cited by 77 · cited 1×
“For instance, illicit benzodi-azepines may be sought by PWUD to self-manage opioid withdrawal or enhance opioid potency [55].”
BackgroundSelf-citationProvisional Drug Overdose Death Counts
(2025) · doi:10.15620/cdc/20250305020 · Cited by 75 · cited 1×
“The overdose crisis death toll in the United States (US) exceeds 100,000 fatalities each year and represents the highest mortality due to a mental health condition [1, 2].”
BackgroundKnown fentanyl use among clients of harm reduction sites in British Columbia, Canada
Karamouzian, M., Papamihali, K., Graham, B. M., Crabtree, A., Mill, C., Kuo, M. E., Young, S., & Buxton, J. A. (2020) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2020.102665 · Cited by 62 · cited 3×
“That is, individuals who use opioids will be gradually exposed to these drugs, as the fentanyl sold will be cut, knowingly or unknowingly to the individuals using it [11, 45].”
BackgroundEtizolam: A rapid review on pharmacology, non‐medical use and harms
Nielsen, S., & McAuley, A. (2020) · Drug and Alcohol Review · doi:10.1111/dar.13052 · Cited by 56 · cited 1×
“Compared to other benzodiazepines, it is short-acting, has a fast onset of effect and is 5–10 times more potent than diazepam [39].”
BackgroundThirakul, P., Hair, L. S., Bergen, K. L., & Pearson, J. M. (2017) · Journal of Analytical Toxicology · doi:10.1093/jat/bkx004 · Cited by 55 · cited 2×
“The use of these novel modified psychotropic substances has been associated with fatal outcomes and numerous, some-times life-threatening, side effects which are reported in literature [24–26].”
BackgroundNew and Emerging Illicit Psychoactive Substances.
Graddy, R., Buresh, M. E., & Rastegar, D. (2018) · The Medical clinics of North America · doi:10.1016/j.mcna.2018.02.010 · Cited by 53
Nordt, C., Vogel, M., Dey, M., Moldovanyi, A., Beck, T., Berthel, T., Walter, M., Seifritz, E., Dürsteler, K. M., & Herdener, M. (2018) · Addiction · doi:10.1111/add.14442 · Cited by 42 · cited 1×
“In a naturalistic and liberal opioid agonist treatment setting, the evidence demonstrates that there is no excessive demand for a single medication [56].”
BackgroundSelf-citationShifting North American drug markets and challenges for the system of care
Krausz, M. R., Westenberg, J. N., Mathew, N., Budd, G., Wong, J. S. H., Tsang, V. W. L., Vogel, M., King, C., Seethapathy, V., Jang, K. L., et al. (2021) · International Journal of Mental Health Systems · doi:10.1186/s13033-021-00512-9 · Cited by 38 · cited 3×
“In recent years, heroin, the formerly dominant street opioid in North America, has been systematically replaced by fentanyl [3].”
BackgroundMethodInfluentialSelf-citationMeyer, M., Strasser, J., Köck, P., Walter, M., Vogel, M., & Dürsteler, K. M. (2021) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2021.103548 · Cited by 35
Self-citationCase Report: Synthetic Cannabinoid Deaths in State of Florida Prisoners.
Hvozdovich, J. A., Chronister, C. W., Logan, B., & Goldberger, B. (2019) · Journal of Analytical Toxicology · doi:10.1093/jat/bkz092 · Cited by 34
Price, O. H., Man, N. W. Y., Sutherland, R., Bruno, R., Dietze, P., Salom, C., Agramunt, S., Grigg, J., Degenhardt, L. J., & Peacock, A. (2023) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2023.103976 · Cited by 32 · cited 1×
“Until now, these exports had little impact on Australian drug markets which is probably owed to the diligent work of Australian border con-trol forces [66].”
BackgroundOviedo-Joekes, E., MacDonald, S., Boissonneault, C., & Harper, K. (2020) · Substance Abuse Treatment, Prevention, and Policy · doi:10.1186/s13011-021-00358-x · Cited by 29 · cited 1×
“To this day, strategies that directly address the issue of treatment attractiveness like intranasal heroin-assisted treatment and extended take-home doses are actively being investigated and early results are promising [58–61].”
BackgroundInvestigating opioid preference to inform safe supply services: A cross sectional study
Ferguson, M., Parmar, A., Papamihali, K., Weng, A., Lock, K., & Buxton, J. A. (2022) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2021.103574 · Cited by 29 · cited 2×
“Fentanyl is currently the most-seized opioid but likely in the process of being replaced with even more potent synthetic opioids [10, 11].”
BackgroundImpact of legislation on NPS markets in Germany - The rise and fall of 5F-ADB.
Halter, S., Haschimi, B., Mogler, L., & Auwärter, V. (2020) · Drug Testing and Analysis · doi:10.1002/dta.2786 · Cited by 22 · cited 1×
“The trend of rapid chemical modification also extends to cannabinoids and stimulants, requiring policy makers to constantly amend their lists of controlled substances [21–23].”
BackgroundInsights Into Mixing Fentanyl and Benzodiazepines From Canadian Drug Seizures.
Pardo, B. (2021) · JAMA psychiatry · doi:10.1001/jamapsychiatry.2021.3292 · Cited by 20 · cited 1×
“Combining opioids with benzodiazepines to increase potency and prolong the duration of effect has become a widespread practice [38].”
BackgroundFogarty, M. F., Vandeputte, M. M., Krotulski, A. J., Papsun, D. M., Walton, S. E., Stove, C. P., & Logan, B. K. (2022) · Archives of Toxicology · doi:10.1007/s00204-022-03257-7 · Cited by 20 · cited 1×
“Novel synthetic opioids like nitazenes are also the subject of rapid structural development and challenge forensic chemists in their efforts to keep up with toxicological profiling and characterisation [20].”
BackgroundYang, J., Román-Urrestarazu, A., & Brayne, C. (2019) · PLoS ONE · doi:10.1371/journal.pone.0226349 · Cited by 19 · cited 1×
“Slow-release oral morphine and fast-acting agonists are utilised in Canada to some extent, but treat-ment barriers like waiting times and long-distance travel to reach clinics limit access to them [53, 54].”
BackgroundThe upcoming synthetic ultrapotent opioid wave as a foreseeable disaster
Krausz, M. R., Westenberg, J. N., Meyer, M., & Choi, F. (2022) · The Lancet Psychiatry · doi:10.1016/s2215-0366(22)00241-3 · Cited by 15 · cited 2×
“Furthermore, benzimidazole opioids or “nita-zenes” emerged in North America and have since gained a foothold in its drug street markets [16, 17].”
BackgroundSelf-citationA record 100 000 people in the US died from overdoses in 12 months of the pandemic, says CDC
Dyer, O. (2021) · British medical journal · doi:10.1136/bmj.n2865 · Cited by 13 · cited 1×
“The overdose crisis death toll in the United States (US) exceeds 100,000 fatalities each year and represents the highest mortality due to a mental health condition [1, 2].”
BackgroundVogel, M., Meyer, M., Westenberg, J., Kormann, A., Simon, O., Fadlelseed, R. S. H., Kurmann, M., Bröer, R., Devaud, N., Sanwald, U., et al. (2023) · Harm Reduction Journal · doi:10.1186/s12954-023-00731-y · Cited by 11 · cited 1×
“To this day, strategies that directly address the issue of treatment attractiveness like intranasal heroin-assisted treatment and extended take-home doses are actively being investigated and early results are promising [58–61].”
BackgroundSelf-citationAddressing fentanyl use disorder with fentanyl-assisted treatment.
Krausz, R. M., Westenberg, J., & Vogel, M. (2021) · Lancet psychiatry · doi:10.1016/s2215-0366(21)00393-x · Cited by 10 · cited 1×
“These strategies to improve treatment attractiveness are needed in North America and novel approaches like fentanyl-assisted treatment have already been proposed but are far from being evaluated and implemented [62].”
BackgroundSelf-citationMeyer, M., Westenberg, J., Strasser, J., Dürsteler, K. M., Lang, U., Krausz, M., & Vogel, M. (2022) · Harm Reduction Journal · doi:10.1186/s12954-022-00644-2 · Cited by 9
Self-citationCanada’s Response to the Dual Public Health Crises: A Cautionary Tale
Krausz, M. R., Wong, J. S. H., Westenberg, J. N., Choi, F., Schütz, C. G., & Jang, K. L. (2021) · The Canadian Journal of Psychiatry · doi:10.1177/0706743721993634 · Cited by 9 · cited 1×
“Without significant improvements in the system of care, the implementation of preventative approaches and early warning systems, as well as specialised services for adolescents and young adults, the mortality rate will likely continue to increase [48].”
BackgroundSelf-citationU.S. Customs and Border Protection
Press, C. (2020) · CQ Press eBooks · doi:10.4135/9781544377230.n90 · Cited by 2 · cited 2×
“In recent years, there was a continuous growth in methamphetamine seizures whereas seizures of cocaine declined slightly in the US [32].”
BackgroundIllegal markets: the economics and social costs of drug distribution
Babor, T., Caulkins, J., Fischer, B., Foxcroft, D., Humphreys, K., Medina-Mora, M., Obot, I., Rehm, J., Reuter, P., Room, R., et al. (2018) · Oxford Scholarship Online · doi:10.1093/oso/9780198818014.003.0005 · Cited by 2 · cited 1×
“Furthermore, domestic production is a key strategy to reduce drug prices as the biggest markups typically occur at the time of border-crossing [31].”
BackgroundMeyer, M., Westenberg, J. N., & Krausz, M. R. (2023) · International Journal of Health Policy and Management · doi:10.34172/ijhpm.2023.7409 · Cited by 1 · cited 1×
“Even though response frameworks for health care systems and policy models from other countries exist, the US and Canada have so far been unable to develop an effective strategy [63].”
BackgroundSelf-citation
Flagged first, then by citations
17 of the 64 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Weiner, S. G., Little, K., Yoo, J., Flores, D. P., Hildebran, C., Wright, D. A., Ritter, G. A., & Ibrahimi, S. E. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.23954 · Cited by 41
Vandeputte, M. M., & Stove, C. P. (2025) · Neuropharmacology · doi:10.1016/j.neuropharm.2025.110470 · Cited by 36
The emergence of nitazenes: a new chapter in the synthetic opioid crisis
Caprari, C., Ferri, E., Rossetti, P., Gregori, A., Citti, C., & Cannazza, G. (2025) · Archives of Toxicology · doi:10.1007/s00204-025-04102-3 · Cited by 19
“In Canada, drug seizure data reveal that fentanyl is still currently the most seized opioid, but on the verge of being replaced by more potent synthetic opioids like carfentanil (Meyer et al. 2023).”
Nitazenes: The Emergence of a Potent Synthetic Opioid Threat
Pereira, J. R. P., Quintas, A., & Neng, N. R. (2025) · Molecules · doi:10.3390/molecules30193890 · Cited by 21
Approved medications for opioid use disorder : current update
Soyka, M. (2025) · Expert Opinion on Pharmacotherapy · doi:10.1080/14656566.2025.2507124 · Cited by 9
Building Multidisciplinary Consensus on Inpatient Xylazine Management through Clinical Protocols
Shang, M., Hull, I., Liebschutz, J. M., Abesamis, M. G., Lynch, M. J., Tamama, K., Glikes, L., Roy, P. J., León-Barriera, R., Shulman, J. A., et al. (2025) · Substance Use & Addiction Journal · doi:10.1177/29767342251329681 · Cited by 8
Xylazine and Adulterants in the Evolving Drug Supply: Urgent Call for Responsive Education Models
Jawa, R., Murray, S., Blakemore, S., Ventura, A. S., Hristova, T., Wilder, A., Shang, M., & Labelle, C. (2024) · Substance use & addiction journal · doi:10.1177/29767342241231114 · Cited by 8
Chayama, K. L., Ti, L., Lira, J. A. S., Coulaud, P.-J., Bardwell, G., & Knight, R. (2024) · International Journal of Drug Policy · doi:10.1016/j.drugpo.2024.104560 · Cited by 7
Behavioural Effects and Naloxone Effectiveness With New Synthetic Opioids
Nielsen, S., Silva, J. P., Jones, J. D., Krotulski, A., Poovendran, D., Muzangizi, D., Forte, G., White, J., & Comer, S. D. (2026) · Drug and Alcohol Review · doi:10.1111/dar.70040 · Cited by 6
“…was implemented in some countries (e.g., USA, China), other synthetic opioid substances started to emerge on the global drug market, including the ben-zimidazolone opioids (e.g., brorphine) and the 2-benzyl benzimidazole opioids, commonly called ‘nitazenes’ (e.g., isotonitazene, metonitazene) [9].”
Gray, J. Y., Krieger, M. S., Skinner, A., Parker, S. J., Basta, M., Reichley, N., Schultz, C., Pratty, C., Duong, E., Allen, B., et al. (2025) · BMC Public Health · doi:10.1186/s12889-025-22004-y · Cited by 5
Meyer, M., Quinto, A., Guessoum, A., Strasser, J., Dürsteler, K. M., Lang, U. E., & Vogel, M. (2025) · Harm Reduction Journal · doi:10.1186/s12954-025-01325-6 · Cited by 4
“On the other hand, instances of unregulated synthetic opioids emerging in Switzerland have sparked the discussion of expanding preventive measures to mitigate a potential future overdose crisis [23, 24].”
Self-citationRudolph, J. E., Martínez-Ocasio, L. M., Feder, K. A., Tomko, C. A., Cepeda, J., Kirk, G. D., Mehta, S. H., German, D., & Genberg, B. L. (2025) · Drug and Alcohol Dependence Reports · doi:10.1016/j.dadr.2025.100403 · Cited by 4
Dunham, K. T., Macon, E. C., Joseph, R., Wightman, R., & Collins, A. B. (2025) · Drug and Alcohol Review · doi:10.1111/dar.70026 · Cited by 3
Swaich, A., Ignatieff, D., Milloy, M., Choi, J., Kerr, T., & Hayashi, K. (2024) · The International journal on drug policy · doi:10.1016/j.drugpo.2024.104633 · Cited by 3
Swartz, J. A., Zhao, P., Jacobucci, R., Watson, D. P., Mackesy‐Amiti, M. E., Franceschini, D., & Jimenez, A. D. (2024) · BMC Public Health · doi:10.1186/s12889-024-19217-y · Cited by 5
“This is especially puzzling given the near ubiquity of fentanyl in the illegally manufactured opioid supply and the identification of fentanyl as a main contributing factor to drug overdoses unless, possibly, fluctuations in fentanyl potency play a larger role than currently understood [2, 31–33].”
BackgroundSwartz, J. A., Zhao, P., Jacobucci, R., Watson, D. P., Mackesy-Amiti, M. E., Franceschini, D., & Jimenez, A. D. (2024) · Research Square · doi:10.21203/rs.3.rs-3834948/v1 · Cited by 1
“This is especially puzzling given the near ubiquity of fentanyl in the illegally manufactured opioid supply and the identi�cation of fentanyl as a main contributing factor to drug overdoses unless, possibly, �uctuations in fentanyl potency play a larger role than currently understood (2, 29–31).”
BackgroundPossible effects of cheap fentanyl on drug markets, use, and harm: A theoretical analysis
Caulkins, J. P., Bushway, S. D., Milward, H. B., & Reuter, P. H. (2025) · Global Crime · doi:10.1080/17440572.2025.2561658 · Cited by 3
“Vancouver, British Columbia was a bellwether market and has been unusually well-studied (Bardwell et al., 2021; Ickowicz et al., 2022; Meyer et al., 2023).”
Ray, B. R., Sheets, S., Constant, P., Athimuthu, P., Christopher, M.-C., & Desjardins, M. M. (2025) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2025.112832 · Cited by 2
Zinsli, K. A., Krotulski, A. J., Fogarty, M. F., Kress, D., Logan, B. K., Morgan, A. R., Beckford, J. M., Guthrie, B. L., Tsui, J. I., Jarlais, D. C. D., et al. (2025) · Substance Use & Misuse · doi:10.1080/10826084.2025.2497951 · Cited by 2
“As the illicit drug market is highly variable by region and subject to many shifts in drug availability and novel substances (Meyer et al., 2023), rapid drug monitoring is important.”
NPS, PEDs and other emerging drugs on the Clearnet and the Darkweb: Use in Sport.
Mazzoni, I., & Rabin, O. (2024) · Emerging Trends in Drugs, Addictions, and Health · doi:10.1016/j.etdah.2024.100148 · Cited by 2
Overdose doesn't live in the average: The overlooked role of fentanyl supply volatility.
Sibley, A., & Dasgupta, N. (2026) · The International journal on drug policy · doi:10.1016/j.drugpo.2026.105302 · Cited by 1
Cadet, K., Brinzo, P., & Martins, S. S. (2026) · Addiction · doi:10.1111/add.70409 · Cited by 1
Edgar, N. E., Taha, H., Ly, V., & Hatcher, S. (2025) · Harm Reduction Journal · doi:10.1186/s12954-025-01311-y · Cited by 1
“Of particular concern, is the overdose crisis which continues to affect North America, with rates of drug over-dose deaths steadily increasing each year [3, 6].”
Ending the overdose epidemic by ending the war on drug users: Can this work?
Leyton, M., & Krausz, M. R. (2024) · Journal of Psychiatry and Neuroscience · doi:10.1503/jpn.240003 · Cited by 1
Self-citationManaging coexisting depression and substance use disorder: insights from clinical experience
Schifano, F., Martinotti, G., Wojnar, M., de Melo, I. H., Korbel, C., & Sani, G. (2026) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2026.1919720
Bird, J., Tobias, S., Palis, H., Law, M., Angelucci, J., Wood, E., Crabtree, A., & Ti, L. (2026) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2026.113407
Pandey, A., Soni, P., & Saxena, H. (2026) · Arab Journal of Forensic Sciences & Forensic Medicine · doi:10.26735/lhhs3642
Znamierowski, E., Hill, K., Butner, J., Stouffer, A., McDermit, J., & Morford, K. L. (2026) · Addiction Science & Clinical Practice · doi:10.1186/s13722-026-00697-9
“Attempts at regulation of the opioid supply, have driven US markets to shift to unregulated, inexpensive and increasingly potent alternatives [2,3].”
The Detection of Novel Nitazene‐Class Opioids in Unregulated Drug Markets in Canada
Gelgoot, E. A., Scarfone, K. M., Maghsoudi, N., McDonald, K., Hao, W., Stefan, C., Beriault, D. R., Delaney, S. R., Ti, L., Tobias, S., et al. (2026) · Drug and Alcohol Review · doi:10.1111/dar.70189
Cohort Profile: The Austrian National Opioid Agonist Treatment Cohort (OAT-AT)
Schwarz, T., Anzenberger, J., Busch, M., Strohmaier, S., Uhl, A., Westenberg, J. N., & Schernhammer, E. S. (2026) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-026-01639-x · Cited by 1
Self-citationBarra, B. F. C., Pereira, J. R. P., Ferreira, D. R., Oeri, H. E., Martins, D. J. M., Almeida, R. M., Oatley, G., Neng, N. R., Gaspar, H., & Quintas, A. (2026) · Scientific Reports · doi:10.1038/s41598-026-35256-4 · Cited by 1
“It’s just what’s around these days”: social and contextual pragmatism in substance transitions
Sibley, A. L., Colston, D. C., Joniak-Grant, E., Mortensen, H., Swilley-Martinez, M. E., Pence, B. W., & Ranapurwala, S. I. (2025) · Harm Reduction Journal · doi:10.1186/s12954-025-01345-2
“In an era of unpredictable drug markets and polysubstance use [4, 56], understanding how people navigate these environments can inform structural interventions that account for the constraints shaping substance use patterns.”
Mrukowicz, C., Wanat, M., Montano, D., Gomez, E. B., Valdez, S., Carranza, M., White, J., & Dale, A. (2025) · Public health reports (1974) · doi:10.1177/00333549251374923
Matheson, C., Soyka, M., Hard, B., Brousse, G., Meyner, S., Seibold, C., & Torrens, M. (2025) · Heroin addiction and related clinical problems · doi:10.62401/2531-4122-2025-24
Tariffs, the War on Drugs, and Predominantly Biomedical Approaches to Addiction
Crockford, D. (2025) · Canadian Journal of Addiction · doi:10.1097/cxa.0000000000000237
Metadata
- Authors
- Meyer, M., Westenberg, J. N., Jang, K. L., Choi, F., Schreiter, S., Mathew, N., King, C., Lang, U. E., Vogel, M., & Krausz, R. M.
- Affiliations
- University of British Columbia (CA)
- Charité – Universitätsmedizin Berlin (DE)
- University of Basel (CH)
- Corresponding author
- Meyer, Maximilian
- ORCID
- Venue
- International Journal of Mental Health Systems
- Published
- 2023-10-25
- Volume
- 17
- Issue
- 1
- Pages
- 36-36
- ISSN
- 1752-4458 (ISSN-L)
- PMC
- PMC10598952
- OpenAlex
- W4387950124
- Cited by
- 41
- References
- 64
- Citations by year
- 2026: 9 · 2025: 19 · 2024: 13
- FWCI
- 10.50
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- International Journal of Mental Health Systems (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- cIRcle (University of British Columbia) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Open Collections
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Forensic Toxicology and Drug Analysis
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Keywords
- illicit drug markets, opioid epidemic, fentanyl, synthetic opioids, nitazenes, fentanyl analogs, drug potency, drug importation, drug enforcement, drug policy, drug market dynamics, opioid-related deaths, harm prevention, North America
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