Even during the period of increased overall production of heroin destined for the United States, the major logistical transition required to distribute Mexican-sourced heroin to markets previously supplied by Colombian sources suggests potential for shortfalls or Austeilung gaps.

Where fentanyl testing is not routine in postmortem toxicology, or an unusual or novel analogue is involved, these occurrences may go undetected.

Just as the internet has revolutionized the speed and accessibility of information while linking geographically distant markets, a similar development has taken place in drug Austeilung. Although connections have been made hinein internet chat rooms for many years, the emergence of Darkweb cryptomarkets and digital currency offers anonymized transactions and an efficient method of information- and opinion-sharing.

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Despite complexity and some contradictory evidence, existing data suggest heroin shortages prior to European and North American fentanyl waves. Bedeviling any analysis is uncertainty over estimates of the size of the heroin using population, the production of opium and local variations rein drug distribution.

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Where studied, the data show an unusual feature of the sale of fentanyl in both Dosierung und Wirkung von Fentanylpulver North America and parts of Europe: it is generally sold as ‘heroin’, as if fentanyl itself were an insignificant adulterant or not present at all [18–21]. Sometimes the ambiguous term ‘China White’ is used, which can refer to either heroin, historically from Southeast Asia, or a synthetic replacement.

Overall, market conditions appear to point to supply shocks and heroin shortages before the introduction of fentanyl to the opioid supply, both rein the United States and parts of Europe, with the United States experiencing rising demand and increasing prices.

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