Most new drugs that shake up illegal markets strike with apparently little warning. Pharmaceutical companies, in contrast, go through years of development and multiple trials before releasing a drug, illegal markets bring new products seemingly out of nowhere. Crack arrived as a shock in the early 1980s, as did methamphetamine in the 1990s. Both arrived as altered forms of previously known drugs, but the speed or ferocity with which they dominated illegal markets caught health professionals, policymakers and law enforcement by surprise.
Some prescient observers had been forecasting that synthetic drugs could take over from plant-based drugs. That reflected a belief that modern chemistry could produce more interesting psychostimulants closer to the customer base and with a more controllable production cycle because, for example, it would not be dependent on a growing season. However, it was a broad and vague prediction, unhelpful for policymakers. Yet the arrival of illegally manufactured fentanyl (IMF) in 2014 was a shock, even though or perhaps because there had been a few short-lived episodes of it popping up. Furthermore, fentanyl patches had been a staple anesthetic in the United States for over 40 years, with some diversion and misuse resulting in about 2,000 to 3,000 fatal overdoses annually, a small share of all overdose fatalities.