Table 1 The phases of development in the North American drug market related to fentanyl use
From: Shifting North American drug markets and challenges for the system of care
Phase | Timeline | Significant features | Overdose | Outcomes |
|---|---|---|---|---|
0—traditional drug market: occasional fentanyl use | Before 2013 | Repurposing of fentanyl patches; fentanyl use in small groups | Occasional fentanyl-related overdose deaths | Local problems |
1—growing market: contamination of street drugs | 2013–2018 | Import of fentanyl from Asia to North America and Mexico | Significant increase in overdose deaths; synthetic opioids surpass heroin and prescription opioids | Regional problems, especially West Coast of Canada |
2—developed market: locally produced fentanyl | 2019 to present | Interruption of overseas fentanyl import; precursor import and local fentanyl production; additional COVID-19 impacts | Historically high numbers of opioid overdose deaths; almost exclusive fentanyl-related | High availability of fentanyl; new routes of application; intentional fentanyl use |