The Hidden Threat of Fentanyl
According to the Centers for Disease Control (CDC), of the estimated 72,000 accidental drug overdose deaths in 2017 (a number that doubled in the past decade), 30,000 of them were related to fentanyl and fentanyl analogs (analogs are closely related drugs, so one example of a fentanyl analog is acetyl fentanyl).1
Fentanyl overdose rates are increasing more sharply than any other drug in the U.S.
Fentanyl accounts for a large share of the opioid crisis. It’s similar to morphine and heroin, but 50 to 100 times more potent than morphine, and 25 to 40 times more potent than heroin.2
This year, the Drug Enforcement Administration (DEA) proclaimed that fentanyl is the most prevalent and the most significant opioid threat in the U.S.3
What is Fentanyl?
Fentanyl is a synthetic opioid produced legally and illegally. It came out in 1959 and was widely used as an intravenous anesthetic in the 1960s. Today, it’s classified as a schedule II narcotic under the U.S. Controlled Substances Act.
In medical settings, fentanyl is not given out lightly, but more commonly as a last-ditch effort when other methods have failed. As a prescription painkiller, it goes by names such as Actiq, Duragesic and Sublimaze. It’s used to treat patients with extremely severe pain, usually after a major surgery or if the patient has chronic pain, but is tolerant to other opioids and requires an analgesic alternative.
Pharmaceutical fentanyl can be given via intravenous injection, transdermal patch, tablet, nasal spray, lozenge (e.g. a lollipop), or film, and doses are closely monitored since it’s so powerful. Like other prescription opioids, prescription fentanyl can foster opioid dependence, abuse and addiction, leading the patient to seek illicit drugs when the prescription ends.
Non-pharmaceutical fentanyl is produced illegally in laboratories. It’s widely distributed, although it’s concentrated in the eastern U.S., where powder heroin is the norm. The two are correlated because fentanyl is commonly mixed with or used to replace heroin in powder form. The West Coast predominantly sees heroin in black tar form, which is harder to mix with powder fentanyl. While these are just trends, fentanyl has become a country-wide crisis—no area is immune to its dangers.
Illicit fentanyl is sold as a pill, powder or spiked on blotted paper. People swallow, snort, smoke, intravenously inject it, or put blotter paper inside the mouth so that the fentanyl is absorbed through the skin. Some common street names for fentanyl and fentanyl-laced heroin are Apache, China Girl, Dance Fever, Friend, Goodfella, Jackpot, Murder 8, TNT
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Similar to heroin and morphine, when fentanyl is ingested, it binds to the opioid receptors of the brain that are connected to emotions, pain and breathing. Dopamine floods the brain, which produces feelings of euphoria and comfort. Fentanyl is a short-acting opioid, so its effects come on quickly and intensely, and last a short time.
In addition to producing a sense of euphoria and relaxation in users, other effects of using fentanyl include:
- Drowsiness and sedation
- Nausea and constipation
- Confusion and disorientation
- Pupillary constriction
- Respiratory depression and arrest
- Tolerance and addiction
- Unconsciousness and coma
- Overdose and death
Because fentanyl attaches to opioid receptors that control breathing, high doses can depress the respiratory system and cause breathing to stop entirely. It’s so potent that overdose is a major risk of use—and that’s any use, as even small amounts of fentanyl (think a few grains of table salt) can be lethal.
If someone has overdosed, they may be unconscious or in a stupor, have “pinpoint pupils,” cold and clammy skin, and show signs of respiratory failure (shallow or labored breathing).
In the last several years, non-pharmaceutical fentanyl overdoses have surged at an increasingly steep rate. More often than not, people aren’t even aware they’re using fentanyl. With street drugs, users never know exactly what they’re getting. Because of the supply chain structure, drug dealers may not even know exactly what they’re distributing.
For drug suppliers, fentanyl is much cheaper to acquire than pure heroin, making it an economical choice to cut pure drugs with in order to make more money off them. It’s a vicious cycle; the more hands the drug passes through, the more likely it’s been cut with different substances to maximize profits.
Drug Enforcement Administration (DEA) reports show that the majority of fentanyl-laced heroin is imported from Mexico and China. The first batches trace back to 2005 and 2006, and the channels have become stronger since then. From there, it’s hard to know how many more times it’s been mixed, and with what substances.
Because the quantity of fentanyl in other substances is usually unknown, people often overdose accidentally by taking the amount they would have been able to use of the other substance alone. Again, fentanyl is 25-40 times stronger than heroin, so the results are 25-40 times more intense. It’s extremely fast-acting, so overdose death can happen immediately after use.
A common scenario is when fentanyl is laced into other drugs, especially heroin, unbeknownst to recipients.
- Fentanyl and fentanyl analogs, such as acetyl fentanyl (also called desmethyl fentanyl) are showing up in pills that are disguised as pharmaceuticals like Xanax and Oxycontin.
- Fentanyl is commonly mixed with other powder drugs such as heroin and cocaine. Alone all three of these drugs can be lethal; a combination of them multiplies the risk of overdose and death.
Fentanyl seizures by law enforcement increased 400% from 2013 to 2014. That time period is when the major spike in fentanyl took off, and as that statistic has grown over the years, authorities are discovering that it has covertly found its way into a greater variety of drugs.2
Abuse and Overdose Treatment
A fentanyl overdose is treated in the same way a heroin overdose is: administering naloxone. Naloxone acts as an opiate overdose antidote by attaching to the same opioid receptors in the brain, thereby reversing the effects of the first opioid taken (fentanyl, heroin, etc.).
Friends and family of at-risk users can keep Naloxone on hand as a precaution. It’s a fast-acting, FDA-approved medicine that can save a life if it’s administered quickly after an overdose. It can be given as an injection (EVZIO), which is designed with a user-friendly handheld auto injector, or nasal spray (NARCAN).
While Naloxone was once only available with a prescription, it’s becoming more widely accessible. Some clinics now even offer fentanyl testing strips so that at-risk users can test substances before they take them.
One application of Naloxone typically lasts for 30-90 minutes. It’s still imperative to call for emergency help. Another dose may be required to keep the individual alive after the overdose and before help arrives.
If you know your loved one is using opioids, they are at risk of using fentanyl unknowingly. Heroin alone is fatal; but when fentanyl comes into the picture, especially when the individual doesn’t know it has, the risk of fatal overdose is extremely high.