From the Special Edition of the International Journal of Drug Policy: US Heroin in Transition: Supply Changes, Fentanyl Adulteration and Consequences, August 2017, Volume 46, pp 107-111.
The supply of heroin into the US has changed with new source-forms and market strategies. Of particular concern is the rampant and persistent adulteration of heroin with synthetic opioids, most conspicuously the family of fentanyls. Medical consequences including alarming reports of increasing opioid-related overdose, chest wall rigidity syndrome and naloxone resistant overdoses demand urgent public health and policy responses. This Special Section of the International Journal of Drug Policy explores the phenomenon of substituting “traditional” heroin with new less predictable and less culturally established forms and how those forms are perceived and adopted or avoided by those who use them; it maps the consequences and explores structural risk as well as behavioral risk-factors.