OPİOİDLERİN TIBBİ AMAÇ DIŞI KULLANIMI VE KÜRESEL FENTANİL KRİZİ

Öz

Haşhaş bitkisinden elde edilen opiyatlar yüzyıllardır ağrı kesici olarak kullanılmanın yanında oluşturdukları öfori etkisi sebebiyle kötüye de kullanılmıştır. Morfin ve kodein gibi alkoloitleri içeren ilaçlar hala reçeteli olarak kullanılmaktadır. Morfinin bağımlılık yapma etkisinin görülmesi üzerine eroin sentezlenmiş; onun kötüye kullanımının da küresel bir salgına ulaşması sonucu ilaç olarak kullanımı yasaklanmıştır. Alkoloitlerin yapılarının ve etki ettikleri reseptörlerin tespiti yeni tip sentetik opioidlerin sentezlenmesine imkan sağlamış ve bu maddeler reçeteli olarak kullanılmaya başlamıştır. Sentetik opioidlerden özellikle fentanil ve analoglarının eroinin yerini alması ve tıbbi amaç dışında kötüye kullanılması yeni bir küresel salgına sebep olmuştur. Uzmanlar opioidlere bağlı salgınları; reçeteli opioidlere bağlı, eroine bağlı ve sentetik opioidlere bağlı olmak üzere üç dalga modeli ile açıklamaktadır. Kuzey Amerika ve Kuzey-batı Avrupa opioid salgınından en çok etkilenen bölgeler durumundadır. Salgın başladığından bu yana 750.000’den fazla Amerikalı opioid kaynaklı aşırı dozdan hayatını kaybetmiştir. Estonya başta olmak üzere Avrupa ülkelerinde de opioid kaynaklı aşırı doz ölüm sayıları hızlı bir şekilde artmaktadır. Sosyal medya ve karanlık ağlar gibi takibi zor kanallar kullanılarak yeni tip opioidler dünyanın farklı yerlerindeki kullanıcılara ulaşmaktadır. Kuzey Amerika’da yayılma hızını azaltmak için önlemler alma fırsatı azalırken; Avrupa’da hala salgının yayılmasını engellemek mümkün görülmektedir. Bu derleme çalışmasında fentanil başta olmak üzere sentetik opiodlere bağlı küresel salgının Kuzey Amerika ve Kuzey Avrupa özelinde ulaştığı durum literatüre dayalı sayısal verilerle açıklanacaktır. Uyuşturucu ile mücadele profesyonelleri nezdinde farkındalık oluşturmak amaçlanmıştır

Anahtar Kelimeler

• Opiyat
• opioid
• eroin
• morfin
• alkoloit
• fentanil

Non-medical Use of Opioids and the Global Fentanyl Crisis

Öz

Opiates obtained from the poppy plant have been used as painkillers for centuries, they also abused due to the euphoria effect they create. Drugs containing alkaloids such as morphine and codeine are still under use with prescription. Upon seeing the addictive effect of morphine, heroin was synthesized; as a result of its abuse reached to a global epidemic, its use as medicine was banned. Determination of the structures of alkaloids and the receptors they act enabled the synthesis of new types of synthetic opioids, and these substances began to be used as prescription drugs. The replacement of heroin by synthetic opioids, especially fentanyl and its analogues, and their misuse for non-medical purposes have caused a new global epidemic. Experts explains opioid-related epidemics in three wave models: due to prescription opioids, due to heroin and due to synthetic opioids. North America and Northwestern Europe are the regions most affected by the opioid epidemic. More than 750,000 Americans have died from opioid-related overdoses since the epidemic began. The number of opioid-related overdose deaths is increasing rapidly in European countries, especially in Estonia. New types of opioids are reaching users in different parts of the world by using difficult-to-track channels such as social media and dark networks. While the opportunity to take measures to reduce the rate of spread in North America is decreasing; it still seems possible to prevent the spread of the epidemic in Europe. In this review study, the situation of the global epidemic due to synthetic opioids, especially fentanyl related, in North America and Northern Europe will be explained with numerical data based on the literature. It is aimed to raise awareness among professionals in the fight against drugs.

Anahtar Kelimeler

• Opiate
• opioid
• morphine
• heroin
• alkaloid
• fentanyl.

Kaynakça

1. Bogdanova-Smilevska, B. (2018). Drug Trafficking Threat Assessment in the Balkan Region. International Scientific Conference. Security System Reforms as Precondition for Euro-Atlantic Integrations. 04-06 June 2018, Ohrid, Macedonia.
2. Caulkins, J.P., Tallaksen, A., Taylor, J., Kilmer, B. ve Reuter, P. (2024). The Baltic and Nordic responses to the first Taliban poppy ban: Implications for Europe & synthetic opioids today. Int.Journal of Drug Policy. 124, 104314
3. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Commonly used terms. Erişim tarihi: 08 Mart 2024 Cdc.gov/opioids/basics/terms.html.2021
4. Ciccarone, D. (2021) The rice of illicit fentanyls, stimulants and fourth wave of the opioid overdose crisis. Current Opinion Psychiatry. 34(4), 344-350.
5. Ciccarone, D. (2017). Fentanyl in the US heroin supply: A rapidly changing risk environment. Int. J. Drug Policy. 46, 107-111.
6. Claridge, H., Williams, BD. ve Copeland, CS. (2020). A deadly trend in fentanyl fatalities (England, 1998-2017). British J of Clinical Pharmacol. 86, 437-444.
7. Çakıcı, M., Araz, D., Aksoy, E. ve Gökyiğit, A. (2019). Opioid bağımlılığının tedavisinde metadon ve buprenorfinin etkinliği: Hangisini Kullanalım. Cyprus Turkish Journal of Psychiatry & Psychology. 1(3), 194-199.
8. Çıtır, B. (2015). Uluslararası Afyon Anlaşmalarında Osmanlı İmparatorluğu, Sosyal ve Kültürel Araştırmalar Dergisi (The Journal of Social and Cultural Studies) Cilt/Volume: I, Sayı/Issue: 1, ss. 17-47.

9. Drug-related deaths in Scotland in 2022. Official report of National Records of Scotland. Erişim tarihi: 7 Şubat 2024. https://www.nrscotland.gov.uk.
10. Drummer, OH. (2019). Fatalities caused by novel opioids: a review. Forensic Sciences Research. 4(2), 95-110.
11. European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). (2019) European Drug Report 2019: Trends and Developments. Publications Office of the European Union: Luxembourg.
12. European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). (2018), Fentanils and synthetic cannabinoids: driving greater complexity into the drug situation. An update from the EU Early Warning System (June 2018), Publications Office of the European Union, Luxembourg.
13. European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). (2015). European Drug Report, Trends and Developments, Publications Office of the European Union, Luxembourg.
14. Han, Y., Yan, W., Zheng, Y., Khan, M.Z., Yuan, K. ve Lu, L. (2019). The rising crisis of illicit fentanyl use, overdose, and potential therapeutic strategies. Transl Psychiatry. 9, Article 282.
15. Jannetto, P., Helander, A., Garg, U., Janis, G.C., Goldberger, B. ve Ketha, H. (2019). The Fentanyl epidemic and Evolution of Fentanyl Analogs in the United States and the European Union. Clinical Chemistry. 65(2), 242-253.
16. Killgore, J.K. ve Jacob, M. (2007). Methods for the synthesis of alfentanil, sufentanil and remifentanil. Patent ID: US7208604.
17. Krause, D., Plörer, D., Koller, G., Martin, G., Winter, C., Adam, R., Canolli, M., Al-Iassin, J., Musselmann, R., Walcher, S., Schäfer, F. ve Pogarell, O. (2017). High Concomitant Misuse of Fentanyl in Subjects on Opioid Maintenance Treatment, Subst. Use & Misuse, 52(5), 639-645.
18. Kronstrand, R., Druid, H., Holmgren, P. ve Rajs, J. (1997). A cluster of fentanyl-related deaths among drug addicts in Sweden. Forensic science international. 88, 185-195.
19. Lembke, A., Humphreys, K. ve Newmark, J. (2016). Weighing the risks and benefits of chronic opioid therapy. American Family Physician. 93(12), 982-990.
20. Manchikanti, L., Singh, V.M., Staats, P.S., Trescot, A.M., Prunskis, J., Knezevic, N.N., Soin, A., Kaye, A.D., Atluri, S., Boswell, M.V., Abd-Elsayed, A. ve Hirsch, J.A. (2022). Fourth wave of opioid (Illicit Drug) overdose deaths and diminishing Access to prescription opioids and interventional techniques: cause and effect. Pain Physician. 25, 97-124.
21. Ojanpera, I., Gergov, M., Liiv, M., Riikoja, A. ve Vuori, E. (2008). An epidemic of fatal 3-methylfentanyl poisoning in Estonia. International Journal of Legal Medicine. 122, 395-400.
22. Pardo, B., Taylor, J., Caulkins, J.P., Kilmer, B., Reuter, P. ve Stein, B.D. (2019) The future of fentanyl and other opioids. RAND Corporation, Santa Monica, Calif. ISBN: 978-1-9774-0338-4.
23. Rejer, K. (2022). Fentanyl in the global market: Examining the new opioid epidemic at an international level. Undergraduate Honors Thesis.
24. Suzuki, J. ve El-Haddad, S. (2017). A review: Fentanyl and non-pharmaceutical fentanyls. Drug and Alcohol Dependence. 171, 107-116.
25. Tuusov, J., Vals, K., Tonnison, M., Riikoja, A., Denissov, G. ve Vali, M. (2013). Fatal poisoning in Estonia 2000-2009. Trends in illegal drug-related deaths. Journal of Legal and Forensic Medicine. 20, 51-56.
26. Viskari, I. ve Tammi, T. (2021). An assessment of national synthetic preparedness in five countries: Belgium, Estonia, Finland, Germany and the Netherlands. SOPREP. ISBN:978-952-343-020.
27. World Drug Report 2023, UNODC. (United Nations publications, 2023). Erişim tarihi: 20 Şubat 2024. www.unodc.org/unodc/en/data-and-analysis/world-drug-report-2023.html
28. WHO-UNODC Fifth Expert Consultation on New Psychoactive Substances Addressing the Challenges of Non-medical Use of Opioids. UNODC Meeting Report. 24-25 September 2018. www.cdc.gov/opioids/basics/terms.html, Commonly Used Terms. Centers for Disease Control and Prevention. Erişim Tarihi: 12 Şubat 2024.
29. Zoorob, M. (2019). Fentanyl shock: The changing geography of overdose in the United States. International Journal of Drug Policy. 70, 40-46.
30. Zawilska, J.B., Adamowicz, P., Kurtepa, M. ve Wojcieszak, J. (2023). Forensic Sci. Int. 111775.