Reducing the Risks of Fentanyl in the U S. National Institute on Drug Abuse NIDA

This increase has largely been driven by rising overdoses involving synthetic opioids, primarily fentanyl. Overdose deaths involving psychostimulants, and particularly methamphetamine, have also risen steeply in recent years, and many of these deaths involved use of an opioid at the same time. However, questions remain on how trends in methamphetamine use  contribute to greater risk for overdose deaths.

Advancing Recovery Research

Fentanyl is about 50 times more potent than heroin and a lethal dose may be as small as two milligrams. Opioid overdose reversal medications such as naloxone and nalmafene do not reverse xylazine’s effects. But experts recommend giving them because xylazine overdoses almost always include opioids and other drugs. In an emergency, call or other emergency services immediately for care after administering an opioid overdose reversal medication. People with physical dependence on opioids may have withdrawal symptoms within minutes after they are given naloxone. Withdrawal symptoms might include headaches, changes in blood pressure, rapid heart rate, sweating, nausea, vomiting, and tremors.

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The absence of the drug causes several physiological reactions, ranging from mild in the case of caffeine, to potentially life-threatening, such as with heroin. Some chronic pain patients are dependent on opioids and require medical support to stop taking the drug. (2) Advance cross-cutting research to prevent and treat OUD and overdoses in the context of chronic pain and other mental health conditions. Toward that goal, this Strategic Plan reflects NIDA’s commitment to ensure that HEAL-supported research will remain focused on efforts to accelerate scientific solutions to urgently address the overdose crisis and prevent it from happening again. “New psychoactive substances” is a term used to describe lab-made compounds created for research purposes or for illicit drug markets, sometimes by slightly modifying an existing drug in an effort to skirt existing drug laws. The category may include medications created by pharmaceutical companies or researchers how is methamphetamine manufactured national institute on drug abuse nida that were never meant to reach the public.

NIDA researchers and grantees collaborate to identify how these emerging drugs work and their potential health effects, including those that have the potential to impact the overdose crisis. NIDA also supports the National Drug Early Warning System (NDEWS) to track emerging substances and their impact on drug-related emergency calls. To address this gap, the study authors analyzed data on overdose deaths involving psychostimulants other than cocaine from cause of death files in the National Vital Statistics System from 2015 to 2019. Overdose deaths involving methamphetamine nearly tripled from 2015 to 2019 among people ages in the United States, according to a study by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health. The number of people who reported using methamphetamine during this time did not increase as steeply, but the analysis found that populations with methamphetamine use disorder have become more diverse.

In animals, a single high dose of the drug has been shown to damage nerve terminals in the dopamine-containing regions of the brain. The large release of dopamine produced by methamphetamine is thought to contribute to the drug’s toxic effects on nerve terminals in the brain. High doses can elevate body temperature to dangerous, sometimes lethal, levels, as well as cause convulsions.

How much does naloxone cost?

The emergency and referral resources listed above are available to individuals located in the United States and are not operated by the National Institute on Drug Abuse (NIDA). NIDA is a biomedical research organization and does not provide personalized medical advice, treatment, counseling, or legal consultation. Information provided by NIDA is not a substitute for professional medical care or legal consultation. Methamphetamine is a powerful lab-made (synthetic) stimulant with high addiction potential.1 The U.S. Food and Drug Administration (FDA) has approved methamphetamine for treatment of attention deficit hyperactivity disorder (ADHD) as well as for short-term treatment of obesity. Drug Enforcement Administration (DEA) as a Schedule II stimulant, which makes it legally available only through a nonrefillable prescription. HIDTA data does not differentiate between fentanyl and its analogs, nor estimate the amount of fentanyl present in seized substances.

NIDA HEAL Opioid Use Disorder and Overdose Strategic Plan FY 2025-2029

Although fentanyl seizures were historically less common in the Western U.S., this analysis found that this region now accounts for most of law enforcement seizures of fentanyl overall, as well as total weight of fentanyl seized. The proportion of fentanyl pill seizures compared to the overall number of fentanyl seizures was also highest in the West, with 77.8% of all law enforcement seizures of fentanyl in the West being in pill form in 2023. These data emphasize the need for continued monitoring of regional shifts in the fentanyl supply, to help inform targeted prevention and public health responses. Side effects from naloxone are rare, but people might have allergic reactions to the medicine. But it only reverses an overdose in people with opioids in their systems and will not reverse overdoses from other drugs like cocaine or methamphetamine.

We hope this compilation of scientific information about methamphetamine will help inform readers about the harmful effects of methamphetamine abuse and will assist in prevention and treatment efforts. Xylazine-related skin wounds can include skin infections, wounds below the skin (abscesses) and open, weeping wounds (skin ulcers). Wounds can heal if a person continues to use substances and receives appropriate medical care.

Naloxone is being used more by police officers, emergency medical technicians, and non-emergency first responders than before. In most states, people who are at risk or who know someone at risk for an opioid overdose can be trained on how to give naloxone. Families can ask their pharmacists or health care provider how to use the devices.

Some of these include drugs that were once common prescriptions, such as Laudanaum. The cost of drug abuse in the US is nearly $820 billion per year, taking into account crime, healthcare needs, lost work productivity, and other impacts on society. Registrants are not always aware of which substances are on this “Code H” list, or what special processes or criteria are required for these substances. This subsection would require DOJ to make public which substances are on the list, what special processes or criteria apply to them, and how those processes or criteria differ from those applying to other substances on the same schedule. The Administration proposes to do this by streamlining and clarifying the Schedule I research registration process as described in Section 7 of the proposed legislation, “Registration Requirements Related to Research,” and summarized below. They note that benzylideneoxymorphone, though structurally related to the potent opioid oxymorphone, has very low potential for abuse.

• Schedules categorize drugs by their potential for medical use or for abuse.
• Families can ask their pharmacists or health care provider how to use the devices.
• Opioid overdose reversal medications such as naloxone and nalmafene do not reverse xylazine’s effects.
• Overdose deaths involving methamphetamine nearly tripled from 2015 to 2019 among people ages in the United States, according to a study by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health.

What precautions are needed when giving naloxone?

Illicit xylazine is often mixed in with illicit opioids, most frequently fentanyl, but it is not an opioid. Xylazine is also known as “tranq” or, when combined with fentanyl or other opioids, “tranq dope.” Xylazine can be used by injecting, snorting, swallowing, or inhaling. All systems used by first responders deliver the stated dose of naloxone and can be highly effective in reversing an opioid overdose. Study findings released in March 2019 suggests that the FDA-approved naloxone devices deliver higher blood levels of naloxone than the improvised nasal devices.

• Some chronic pain patients are dependent on opioids and require medical support to stop taking the drug.
• These data emphasize the need for continued monitoring of regional shifts in the fentanyl supply, to help inform targeted prevention and public health responses.
• This places anyone who uses drugs at risk of exposure, overdose and even death.
• NIDA also supports research that is developing and testing approaches to prevent substance use and misuse studies investigating whether and how harm reduction methods may prevent, reverse, or reduce rates of overdose.
• NIDA conducts research on specific emerging drugs through its Designer Drug Research Unit and through support for the National Drug Early Warning System (NDEWS), which detects early signals of potential drug epidemics.

Likewise, mirfentanil, a substance that meets the structural definition of a fentanyl-related substance, has been shown to have low abuse liability. They also point to AT-202, a fentanyl-related substance studied as a potential analgesic that does not show the same adverse effects profile as other compounds that activate mu opioid receptors and is expected to possess only low abuse liability. Even experienced researchers have reported that obtaining a new Schedule I registration, adding new substances to an existing registration, or getting approval for research protocol changes is time consuming. Unlike for Schedule II through V substances, new and amended Schedule I applications are referred by the DEA to the HHS for a review of the protocol and a determination of the qualifications and competency of the investigator.

For example, this expansion clarifies that it is permissible for a senior investigator in a research department to hold a registration under which other independent researchers in the department work. Since such acts inconsistent with a registrant’s duties could imperil the registrant’s registration, he/she would have a strong incentive to ensure that such acts do not occur. These include problems with self-reporting and the omission of people who are homeless and not living in shelters or are institutionalized. Thus, the analysis may have underestimated the prevalence of methamphetamine use and MUD.