Updates: The Ever-changing Landscape of Opioid Use Disorder
First, some good news Deaths, primarily overdoses, from synthetic opioids declined last year by 2%. By far the most commonly involved drug is fentanyl.
However, fentanyl overdoses are increasingly complicated by the addition of adulterants such as metatomidine - a nonopioid unresponsive to naloxone. Recently, nitrazines, a more potent class of opioids, have been detected in the illicit drug supply mixed with fentanyl as they are less expensive. Nitrazines were first developed in the 1950s but never approved or marketed. They’re tenfold more potent than fentanyl and a hundred times stronger than morphine! Because of their potency, overdoses involving nitrazines may respond more slowly to naloxone and require more monitoring.
There is growing concern about the increasing use of kratom, enriched in synthetic 7(OH) mitragynine, a proven opioid receptor agonist. Largely unregulated and available in vape stores across the country, 7(OH) MG is available in tablets, fruit-flavored gummies, shots and drink mixes. Because of its highly addictive potential, the FDA is pushing for classification and regulation under the Controlled Substances Act. (JAMA, 8/2025)
Feel Free is marketed as a “natural” supplement for “relaxation, increased productivity and focus.” FF has been in the news recently (NBC, FOX, NPR) with reports of its significant addictive potential.; The supplement is sold in vaping stores, gas stations, and other herbal outlets as well as online. FF is a combination of kratom and kava, both substances known to have psychoactive effects. Kava is advertised as a stress and anxiety reducer and binds to the same receptors as benzodiazepines (think Valium or Xanax). With regular consumption of FF, dependence can develop with users requiring multiple bottles to achieve the same effects. Stopping suddenly can result in intense withdrawal symptoms. The manufacturer (Botanic Tonics) recently changed the label to include “may be habit forming and people with a history of substance use disorder should consider not consuming.” Almost 130 million bottles have been sold in the U.S. It was recently banned in Utah, but probably remains available at your corner gas station.
Finally, the Wall Street Journal reports (9/4/2025) that more Americans are testing positive for fentanyl use in randomized workplace drug tests. In 2024, 1.13% of urine drug tests were positive for fentanyl, double the rate of 2020.