In retrospect, some opioids are as bad. Superjunkie was making fentanyl and beta hydroxy fentanyl in the lab and he claimed he was doing so when the lecturer was there. They both ended up with 20 minute habits i.e. they had to IV 5mg+ of fentanyl or 2mg+ of beta hydroxy fentanyl (both has cannulasin their arms). When they were caught, Superjunkie got 10 years, Robojunkie got a large fine and house arrest.
I talked to him a year after his supply stopped and he was still going through the acute phase of withdrawal. The only thing that helped was MXE, interestingly. He said he would have a line at bed time and when he woke, another line... so at least he slept.
I've read of many people who developed such habits commit suicide because their lives were so aweful. Robojunkie told me that no dose of another opioid helped.
I do appreciate that this is at the very edge of opioid abuse but fentanyl does seem to produce an extra level of dependence.
Thomas K. Highsmith who was one of the 2 original clandestine etonitazine manufacturers and when he was caught, he was put onto a LOT of methadone but he killed himself before he went to court. The Russian chemist who was making it lost both hands when a large flask he was holding exploded. I have NO idea what was in it, but I suspect it was something that should not be moved.
For such people, the acetyl ester of R-4066 (a methadone derivative) seems appropriate. It has a biosostere that equates to an N-arylethyl, a T½ of 20.5 hours (allowing it to be given every 2 or 3 days) and it's x212 M in potency. Yes it's costly, but given the small quantities involved and the long duration, the cost is not THAT high. I mean, racemic methadone is only ½M in potency - it's the accumulation that provides it's utility.
So 5.6mg of the above will substitute for 15mg of fentanyl but since it's T½ is so long, it means that people can get on with their lives. It's not that it's a new drug, it was patented in 1978 - so the patent has even run out...
But I see nobody looking at this as an appropriate treatment. Rather thienorphine is being pushed for a US marketing licence.
BTW sorry for the crappy structure draw. If I use 'clean structure, it connects the piperidine and cyclohexane ring together along an edge. But you can see how the piperidine connects to the benzene ring so it's a rigid derivative of the more common 4-phenyl piperidine moiety seen in other compounds. I looked into synthesis and that 3,4-dihydro-2H-spiro[naphthalene-1,4'-piperidine] takes 10 steps from commercially available precursors.... but at scale and optimised, it's extreme potency would make it viable. After all 1g of the compound in the image is worth 530g of methadone (given potency and duration).
