fentanyl Overview

Fentanyl is an extremely potent and dangerous synthetic opioid drug. As a prescription drug, it is used for severe pain in those who have built tolerance to other opioids. The term “synthetic opioid” means that it is completely man-made in a laboratory; no form of fentanyl exists in nature. As an opioid pain reliever, fentanyl was designed to be 50 to 100 times more potent than morphine. Due to its strength, the risk of overdose is incredibly high. Because it is relatively cheap and easy to manufacture, fentanyl is often added to other illegal opioids such as heroin to increase their strength.

Forms of Fentanyl

Several versions of fentanyl exist, including prescription products such as a transdermal patch, lollipop, solution for injection as well as illegal street powder and blotter paper.

  • Transdermal patch – Available under the brand name Duragesic. This form is a small patch that is applied to the skin. The drug is absorbed slowly through the skin and into the blood stream. Users will sometimes break open the fentanyl patch and extract the pure fentanyl.
  • Lollipop – Available under the brand name Actiq. This form of fentanyl contains the drug in a flavored lollipop that is slowly sucked on. The drug is absorbed through the tissue of the mouth.
  • Solution for injection – Available under the brand name Sublimaze. This form of fentanyl is dissolved in a solution to be injected into the muscle or vein for fast-acting pain relief in a hospital setting.
  • Powder – Fentanyl obtained illegally is usually obtained as a powder, which may vary in color due to adulterants used to dilute it, also known as “cutting.” This form is incredibly dangerous because there is no way to determine its true potency. It may also contain other dangerous ingredients. Users may dissolve the drug and inject it into their vein, snort it or smoke it.
  • Blotter Paper – Also obtained illegally, distributors soak small strips of absorbent paper (blotter paper) with the drug. Similar to LSD, users will place the blotter paper on their tongue where the drug is absorbed quickly.
Fentanyl – A New Player in The Opioid Epidemic

An opioid epidemic has swept the United States, involving widespread use of both prescription and illegal opioids. From 1999 – 2017, opioids have been responsible for approximately 400,000 deaths, with nearly 130 deaths every day being attributed to opioids.

Fentanyl is a relatively new player in the opioid epidemic. While fentanyl has been available as a prescription product in the United States since the 1960s, its use as an illicit drug has only started to rise since the early 2010s. It is believed that most illegally produced fentanyl is manufactured in China and smuggled into the United States through Mexico.

A Quickly Rising Killer

A recent report from the Centers for Disease Control and Prevention clearly illustrates the dangers of fentanyl. In 2016, the number of deaths involving fentanyl was estimated to be 18,335 compared to only 1,663 in 2011. This represents more than a ten-fold increase in deaths involving fentanyl from 2011 to 2016.

Because drug dealers will often add fentanyl to heroin, the rise of heroin-related deaths has grown due to fentanyl’s popularity. As shown on the graph above, heroin-related deaths have increased rapidly since 2011.

How Fentanyl Works in The Brain

Fentanyl is an opioid agonist, meaning it binds to opioid receptors in the central nervous system. When fentanyl binds to opioid receptors, it blocks pain signals, making them invaluable tools for alleviating pain. Despite its use a legitimate painkiller, it also has the potential to make the user feel euphoric, which is why it is so addicting.

Side Effects of Fentanyl

Opioids like fentanyl also cause a significant amount of side effects. Listed below are some of the most common side effects of fentanyl.

  • Nausea and vomiting
  • Severe constipation
  • Tiredness
  • Sweating
  • Respiratory depression

The most dangerous side effect of fentanyl is respiratory depression. Respiratory depression is when breathing becomes shallow and ineffective. If too much fentanyl is taken, respiratory depression can be so severe the user stops breathing completely.

While all opioids carry the risk of respiratory depression, fentanyl’s high potency significantly increases the risk of overdose because only a small amount is required to cause respiratory depression.

Fentanyl Overdose

Fortunately, there is a product that can reverse the deadly respiratory depression associated with a fentanyl overdose – Narcan. Narcan is a nasal spray containing the drug naloxone, an opioid antagonist. It works by removing fentanyl from the user’s system to restore breathing.

Narcan is available without a prescription in California. If you or someone you know is addicted to fentanyl, having Narcan on-hand can mean the difference between life and death.

It is important to know the signs of fentanyl overdose, which can include:

  • Pinpoint pupils
  • Slow, labored breathing (respiratory depression)
  • Slow heartbeat
  • Unconsciousness
Fentanyl Abuse

Because fentanyl is incredibly strong at even small doses, many users will take it when they no longer feel the effects from weaker opioids such as heroin.

The length of time until the effects of fentanyl can be felt (onset) and how long the effects last (duration) depend on how it is taken.

 OnsetDuration
Intravenous injectionInstantly30 min – 1 hour
SmokedInstantly30 min – 1 hour
Skin patch6 hours72 hours
Since the high from injecting and smoking fentanyl is felt instantly, most users will choose to inject or smoke it rather than apply the patch, which can take up to six hours to feel the effects.
Tolerance and Dependence

Like all opioids, tolerance can develop to fentanyl, where more of the drug is required to feel the same effects.  This leads to users taking more fentanyl to feel the same effects and further exposing themselves to dangerous side effects.

Dependence on fentanyl can also occur when it is taken long term. Dependence is when the body requires the drug to function normally. Once a user is dependent, withdrawal can occur if they do not take the drug.

Withdrawal

Withdrawal from fentanyl, while usually not life-threatening, can be incredibly painful and uncomfortable. Most users who are addicted to fentanyl will continue taking it not only to feel high but also avoid withdrawal.

Some withdrawal symptoms of fentanyl are listed below.

  • Diarrhea
  • Cold sweats
  • Muscle aches/cramps
  • Depression
  • Insomnia

Withdrawal symptoms will start within 24 hours of the last fentanyl dose, peak within 1-3 days and subside over the following 1-2 weeks.

Addiction Treatment

Since fentanyl is an opioid, addiction treatment will follow typical guidelines for opioid use disorders.

While the goal of addiction treatment is complete detoxification from the drug, the immediate goal is to control withdrawal symptoms. This can be accomplished by switching to a long-acting opioid such as methadone to control withdrawal symptoms. Some practitioners may recommend the use of newer drugs for opioid dependence such as Suboxone or Subutex.

Once fentanyl is replaced with a safer opioid, the dose is slowly tapered (decreased) over time until it can be safely discontinued. How long the tapering period will last is dependent on many factors including how long the user was abusing fentanyl, the dose of fentanyl being abused and the ability to tolerate dose reductions during the tapering period.

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