Etonitazene
and related 2-benzylbenzimidazoles are potent analgetics
invented in the research laboratories of the Swiss pharmaceutical
giant CIBA in the late 1950s. Though the unprecedented structure distinguishes
this class of compounds from poppy-derived and other synthetic analgetics,
a range of studies indicate that these drugs are selective μ
opioid receptor agonists possessing morphine-like pharmacotoxicological
properties in animals as well as humans. Several unscheduled members
of this synthetically readily accessible class of opioids that are
not controlled under the international and national drug control systems
have recently emerged on the illicit drug market. Among them, isotonitazene
has been implicated in at least 200 fatalities in Europe and North
America. None of the 2-benzylbenzimidazole derivatives have been developed
into medicines, but etonitazene and some of its derivatives have been
used as receptor probes and in addiction behavior studies in animals.
The unique structure has inspired research on such benzimidazoles
and related benzimidazolones of which “brorphine” made
its debut as one of the newest psychoactive substance to emerge on
the illicit opioid drug market in mid-2019. This in-depth review provides
a historical introduction, an overview on the chemistry, pharmacological
profiles, adverse effects, addiction liability, regulatory status,
and the impact on chemical neuroscience of the 2-benzylbenzimidazoles.
Structurally related benzimidazoles with opioid and/or analgesic properties
are also discussed briefly.