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Facing fentanyl: should the USA consider trialling prescription heroin?

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In 2016 in the USA, 19547 fatal overdoses (about a third of all fatal overdoses) were attributed to synthetic opioids, primarily fentanyls.1 Fentanyl, almost always sold as or mixed with illicitly sourced opioids, sharply increases risk of overdose. Its potency (roughly 50 times that of heroin) makes accurate dosing and titration difficult. The duration of desired effects is shorter than that of other abused opioids, necessitating more frequent dosing. Each of these factors increases risk of overdose and the social damage caused by non-prescription opioid use. Additional interventions that take account of the increasing lethality of street drugs are needed.

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