In November 2020, Tennessee coroners began to see overdoses that involved the drug para-fluorofentanyl; in January 2021, they began to see metonitazene pop up. From 2020 to early 2021, these drugs also started to increasingly appear in seizures. While the drugs have usually been found with fentanyl or each other, reports of people dying from either alone have started to increase over time as well. Out of 562 overdose deaths that tested positive for fentanyl reported by the KCRFC from November 2020 to August 2021, 48 also involved para-fluorofentanyl and 26 involved metonitazene. Other states have reported the emergence of these and other novel drugs on the market in recent years as well.
Para-fluorofentanyl is a fentanyl analog first developed in the 1960s that saw some popularity in the black market up through the 1980s, before it was classified as a Schedule 1 drug by the federal government. Metonitazene belongs to a class of synthetic drugs known as benzimidazole-opioids. These drugs were first synthesized in the 1950s but have never seen clinical use due to concerns about their health risks. Para-fluorofentanyl and metonitazene are thought to be snorted or injected, and both seem more likely to cause life-threatening overdoses than even fentanyl, which is already a more potent opioid than heroin, according to report author Darinka Mileusnic-Polchan, head of the medical examiner’s office in Knoxville, Tennessee.
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