CEC06-05 Fentanyloïds

Abstract

Fentanyl analogs – structurally related synthetic opioids within the 4-anilidopiperidine class – have become increasingly implicated in the rising incidence of opioid-related overdose deaths. These compounds, which include acetylfentanyl, butyrylfentanyl, and furanylfentanyl, are illicitly manufactured and trafficked, often sold as heroin or counterfeit prescription pills, leading to unintentional and frequently fatal exposures.

Fentanyl analogs exhibit high potency and rapid central nervous system penetration due to their lipophilicity. While they share core structural features with fentanyl, even minor chemical modifications can lead to substantial changes in receptor binding affinity, potency, and duration of action. These compounds produce classic opioid toxidromes, including respiratory depression, bradycardia, and miosis, which can be reversed with naloxone. However, due to their high potency, standard naloxone dosing may be insufficient, and higher initial doses (≥2 mg) are recommended. Law enforcement data show increasing seizure rates of various analogs, reflecting both high demand and the ease with which these compounds are synthesized and distributed. The clandestine nature of their production, coupled with a lack of clinical data, complicates diagnosis, treatment, and regulation.

Fentanyl analogs represent a relevant component of the opioid epidemic, distinguished by their high potency, rapid onset, and potential to cause fatal overdose at low doses. Their presence in the illicit drug supply steers the need for improved detection methods, targeted public health responses, and the development of effective harm-reduction and regulatory strategies.