Professional Documents
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The CSA provides the Attorney significance of abuse; and what, if any, United States, and a lack of accepted
General (as delegated to the risk there is to the public health. 21 safety for use under medical
U.S.C. 811(h)(3). Consideration of these supervision. DEA’s three-factor analysis
1 Though DEA has used the term ‘‘final order’’ factors includes actual abuse; diversion is available in its entirety under
with respect to temporary scheduling orders in the ‘‘Supporting and Related Material’’ of
past, this notice of intent adheres to the statutory 2 The Secretary of HHS has delegated to the
language of 21 U.S.C. 811(h), which refers to a Assistant Secretary for Health of HHS the authority
the public docket for this action at
‘‘temporary scheduling order.’’ No substantive to make domestic drug scheduling www.regulations.gov under Docket
change is intended. recommendations. 58 FR 35460, July 1, 1993. Number DEA–716.
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78048 Federal Register / Vol. 85, No. 233 / Thursday, December 3, 2020 / Proposed Rules
Factor 4. History and Current Pattern of substance) and fentanyl (a schedule II NFLIS registered 20 reports of
Abuse substance). In reports from the brorphine from Ohio (4), Pennsylvania
Brorphine is part of a structural class Northeastern Illinois Regional Crime (1), and Wisconsin (15) in 2019 and
of compounds known as substituted Laboratory, suspected heroin/fentanyl 2020. NFLIS was queried on August 18,
piperidine benzimidazolones. The powders were analyzed and found to be 2020, for brorphine. Due to the rapid
general synthesis of brorphine was first brorphine in combination with appearance of the drug, brorphine is
reported in the literature in 2018. flualprazolam, a non-scheduled most likely under reported as forensic
Brorphine is not an approved benzodiazepine, and diphenhydramine, laboratories secure reference standards
pharmaceutical product and is not an over-the-counter antihistamine.5 for the confirmative identification and
approved for medical use anywhere in Post-mortem toxicology samples reporting of this substance.
the world. The Assistant Secretary, by a collected and submitted to National The population likely to abuse
letter to DEA dated October 27, 2020, Medical Services (NMS) Laboratory 6 in brorphine appears to be the same as
stated that there are no FDA-approved June and July 2020 verified the those abusing prescription opioid
new drug applications or investigational appearance of brorphine. Brorphine was analgesics, heroin, tramadol, fentanyl,
new drug applications for brorphine in first reported by the Center for Forensic and other synthetic opioid substances.
the United States; hence, there is no Science Research and Education This is evidenced by the types of other
legitimate channel for brorphine as a (CFSRE)—Novel Psychoactive drugs co-identified in samples obtained
marketed drug product. The appearance Substance (NPS) Discovery Program from brorphine seizures and post-
of brorphine on the illicit drug market (under the novel psychoactive mortem toxicology reports. Because
is similar to other designer drugs substances discovery program, in abusers of brorphine are likely to obtain
trafficked for their psychoactive effects. collaboration with NMS Labs) in July it through unregulated sources, the
Since 2014, numerous synthetic 2020. In seven post-mortem toxicology identity, purity, and quantity of
opioids structurally related to fentanyl reports in June 2020 and July 2020, brorphine are uncertain and
and several synthetic opioids from other brorphine was found in combination inconsistent, thus posing significant
structural classes have begun to emerge with fentanyl, flualprazolam, and adverse health risks to the end user. The
on the illicit drug market as evidenced heroin. Evidence suggests that misuse and abuse of opioids have been
by the identification of these drugs in individuals are using brorphine as a demonstrated and are well-
forensic drug exhibits and toxicology replacement to heroin or other opioids, characterized. According to the most
samples. Beginning in June 2019, either knowingly or unknowingly. recent data from the National Survey on
brorphine emerged in the U.S. illicit, Drug Use and Health (NSDUH),7 as of
Factor 5. Scope, Duration, and 2018, an estimated 10.3 million people
synthetic drug market as evidenced by Significance of Abuse
brorphine’s identification in drug aged 12 years or older misused opioids
seizures. Between July and September of Brorphine has been described as a in the past year, including 9.9 million
2019, brorphine was first reported in potent synthetic opioid and evidence prescription pain reliever misusers and
drug casework in Canada and was first suggests it is being abused for its 808,000 heroin users. In 2018, an
reported in police seizures in Sweden in opioidergic effects (see Factor 6). estimated 2 million people had an
March 2020.3 According to a recent publication by opioid use disorder which included 1.7
Brorphine has been encountered by CFSRE—NPS Discovery, brorphine has million people with a prescription pain
U.S. law enforcement in powder form. been positively identified in seven reliever use disorder and 500,000
In the United States, brorphine has been death investigation cases spanning people with heroin use disorder. This
identified as a single substance and in between June 2020 and July 2020. These population abusing opioids is likely to
combination with other substances. cases correspond to three states— be at risk of abusing brorphine.
Twenty reports of brorphine have been Illinois (3), Minnesota (3), and Arizona Individuals who initiate use (i.e., use a
reported in the National Forensic (1). Most (n = 6) of the decedents were drug for the first time) of brorphine are
Laboratory Information System (NFLIS) male. The decedents’ ages ranged likely to be at risk of developing
in 2019 and 2020 from three different between 40’s and 60’s with an average substance use disorder, overdose, and
states (see Factor 5).4 In several NFLIS age of 52 years. Other substances death similar to that of other opioid
encounters, brorphine was found in identified in postmortem blood analgesics (e.g., fentanyl, morphine,
combination with heroin (a schedule I specimens obtained from these etc.). Law enforcement reports
decedents include flualprazolam, a demonstrate that brorphine is being
3 Health Canada Drug Analysis Service (2019);
nonscheduled benzodiazepine (n = 5), illicitly distributed and abused.
Analyzed Drug Report Canada 2019—Q3 (July to fentanyl, a schedule II substance (n = 7),
September); European Monitoring Centre for Drugs 7 The National Survey on Drug Use and Health
and Drug Addiction (EMCDDA) (2020); EU Early and heroin, a schedule I substance (n = (NSDUH), formerly known as the National
Warning System Situation Report, Situation report 4). The appearance of benzodiazepines Household Survey on Drug Abuse (NHSDA), is
1—June 2020. and other opioids is common with conducted annually by the Department of Health
4 NFLIS represents an important resource in and Human Services Substance Abuse and Mental
polysubstance abuse.
monitoring illicit drug trafficking, including the Health Services Administration (SAMHSA). It is the
diversion of legally manufactured pharmaceuticals primary source of estimates of the prevalence and
5 Email communications with Northeastern
into illegal markets. NFLIS-Drug is a comprehensive incidence of nonmedical use of pharmaceutical
information system that includes data from forensic Illinois Regional Crime Laboratory, dated 7/1/2020 drugs, illicit drugs, alcohol, and tobacco use in the
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laboratories that handle the nation’s drug analysis and 6/11/2020. United States. The survey is based on a nationally
cases. NFLIS-Drug participation rate, defined as the 6 NMS Labs, in collaboration with the Center for representative sample of the civilian, non-
percentage of the national drug caseload Forensic Science Research and Education at the institutionalized population 12 years of age and
represented by laboratories that have joined NFLIS, Fredric Rieders Family Foundation and the older. The survey excludes homeless people who
is currently 98.5 percent. NFLIS includes drug Organized Crime Drug Enforcement Task Force at do not use shelters, active military personnel, and
chemistry results from completed analyses only. the United States Department of Justice, has residents of institutional group quarters such as
While NFLIS data is not direct evidence of abuse, received funding from the Centers for Disease jails and hospitals. The NSDUH provides yearly
it can lead to an inference that a drug has been Control and Prevention to develop systems for the national and state level estimates of drug abuse, and
diverted and abused. See 76 FR 77330, 77332, early identification and notification of novel includes prevalence estimates by lifetime (i.e., ever
December 12, 2011. NFLIS data was queried on psychoactive substances in the drug supply within used), past year, and past month abuse or
August 18, 2020. the United States. dependence.
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Federal Register / Vol. 85, No. 233 / Thursday, December 3, 2020 / Proposed Rules 78049
Factor 6. What, if Any, Risk There Is to Minnesota. Information gathered from imminent hazard to the public safety,
the Public Health case history findings shows that the temporary order scheduling this
The increase in opioid overdose brorphine use is similar to that of classic substance will be effective on the date
deaths in the United States has been opioid agonists. As documented by the order is published in the Federal
exacerbated recently by the availability toxicology reports, poly-substance abuse Register, and will be in effect for a
of potent synthetic opioids on the illicit remains common in fatalities associated period of two years, with a possible
drug market. Data obtained from pre- with the abuse of brorphine. extension of one additional year,
clinical studies demonstrate that pending completion of the regular
Finding of Necessity of Schedule I
brorphine exhibits a pharmacological (permanent) scheduling process. 21
Placement To Avoid Imminent Hazard
profile similar to that of other mu (m)- U.S.C. 811(h)(1) and (2). It is the
to Public Safety
intention of the Acting Administrator to
opioid receptor agonists. Data from in In accordance with 21 U.S.C. issue a temporary scheduling order as
vitro studies completed in 2020 showed 811(h)(3), based on the available data soon as possible after the expiration of
that brorphine binds to and activates the and information summarized above, the 30 days from the date of publication of
m-opioid receptors. In the [35S]GTPgS uncontrolled manufacture, distribution, this document. Upon publication of the
cell-based receptor assay, brorphine, reverse distribution, importation, temporary order, brorphine will then be
similar to fentanyl, acted as a m-opioid exportation, conduct of research and subject to the CSA’s schedule I
receptor agonist. Brorphine’s activation chemical analysis, possession, and regulatory controls and administrative,
of m-opioid receptor was also shown to abuse of brorphine pose an imminent civil, and criminal sanctions applicable
involve recruitment of beta-arrestin-2, a hazard to the public safety. DEA is not to the manufacture, distribution, reverse
regulatory protein whose interaction aware of any currently accepted medical distribution, importation, exportation,
with the m-opioid receptor has been uses for brorphine in the United States. research, conduct of instructional
implicated in the adverse effects of m- A substance meeting the statutory activities and chemical analysis, and
opioid receptor activation. Brorphine requirements for temporary scheduling, possession.
binds to and activates the m-opioid found in 21 U.S.C. 811(h)(1), may only The CSA sets forth specific criteria for
receptor and has efficacy on scale with be placed in schedule I. Substances in scheduling a drug or other substance.
fentanyl. It is well established that schedule I are those that have a high Regular scheduling actions in
substances that act as m-opioid receptor potential for abuse, no currently accordance with 21 U.S.C. 811(a) are
agonists have a high potential for accepted medical use in treatment in the subject to formal rulemaking procedures
addiction and can induce dose- United States, and a lack of accepted done ‘‘on the record after opportunity
dependent respiratory depression. safety for use under medical for a hearing’’ conducted pursuant to
As with any m-opioid receptor agonist, supervision. Available data and the provisions of 5 U.S.C. 556 and 557.
the potential health and safety risks for information for brorphine indicate that 21 U.S.C. 811. The regular scheduling
users of brorphine are high. The public this substance has a high potential for process of formal rulemaking affords
health risks associated to the abuse of abuse, no currently accepted medical interested parties with appropriate
heroin and other m-opioid receptor use in treatment in the United States, process and the government with any
agonists are well established and have and a lack of accepted safety for use additional relevant information needed
resulted in large numbers of drug under medical supervision. As required to make a determination. Final
treatment admissions, emergency by 21 U.S.C. 811(h)(4), the Acting decisions that conclude the regular
department visits, and fatal overdoses. Administrator, through a letter dated scheduling process of formal
According to the Centers for Disease September 22, 2020, notified the rulemaking are subject to judicial
Control and Prevention (CDC), opioids, Assistant Secretary of DEA’s intention review. 21 U.S.C. 877. Temporary
mainly synthetic opioids other than to temporarily place brorphine in scheduling orders are not subject to
methadone, are predominantly schedule I. judicial review. 21 U.S.C. 811(h)(6).
responsible for drug overdose deaths in
recent years. A CDC report shows that, Conclusion Regulatory Analyses
from 2013 to 2018, opioid-related This notice of intent provides the 30- The CSA provides for a temporary
overdose deaths in the United States day notice pursuant to 21 U.S.C. scheduling action where such action is
increased from 25,052 to 46,802. Of the 811(h)(1) of DEA’s intent to issue a necessary to avoid an imminent hazard
drug overdose deaths for 2018, opioids temporary scheduling order. In to the public safety. 21 U.S.C. 811(h)(1).
were involved in about 69.5 percent of accordance with 21 U.S.C. 811(h)(1) and As provided in this subsection, the
all drug-involved overdose deaths. (3), the Acting Administrator considered Administrator (as delegated by the
In the United States, the abuse of available data and information, herein Attorney General) may, by order,
opioid analgesics has resulted in large set forth the grounds for his schedule a substance in schedule I on a
numbers of treatment admissions, determination that it is necessary to temporary basis. Such an order may not
emergency department visits, and fatal temporarily schedule brorphine in be issued before the expiration of 30
overdoses. The introduction of potent schedule I of the CSA, and finds that days from: (1) The publication of a
synthetic opioids such as brorphine into placement of this substance in schedule notice in the Federal Register of the
the illicit market may serve as a portal I of the CSA is necessary in order to intention to issue such order and the
to problematic opioid use for those avoid an imminent hazard to the grounds upon which such order is to be
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seeking these powerful opioids. public’s safety. issued, and (2) the date that notice of
Brorphine has been co-identified with The temporary placement of the proposed temporary scheduling
other substances in seven post-mortem brorphine in schedule I of the CSA will order is transmitted to the Secretary of
toxicology cases in June and July of take effect pursuant to a temporary HHS.
2020. These substances include other scheduling order, which will not be Inasmuch as 21 U.S.C. 811(h)(1)
opioids such as fentanyl and heroin, issued before January 4, 2021. Because directs that temporary scheduling
and other substance classes such as the Acting Administrator hereby finds actions be issued by order and sets forth
benzodiazepines. These deaths occurred that it is necessary to temporarily place the procedures by which such orders are
in three states: Illinois, Arizona, and brorphine in schedule I to avoid an to be issued, including the requirement
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