Fentanyl, a synthetic opioid first developed in Belgium in 1959, was introduced to the medical field in the 1960s as an intravenous anesthetic in the operating room. This drug was also widely used to manage chronic pain in treating individuals with terminal diseases like cancer.1 Of course, today, most of us know fentanyl in its illegal form. In fact, while fentanyl represented less than 15% of opioid-related deaths in 2010, the latest data from 2017 shows that it is implicated in upwards of 60% of opioid-related deaths.
Types of Fentanyl
Fentanyl is classified as either pharmaceutical fentanyl or illicitly manufactured fentanyl. Illicitly manufactured fentanyl, known by various street names, including China Girl, China Town, and China White, points to many chemicals needed to produce fentanyl illegally being sourced from China.
Pharmaceutically manufactured fentanyl is labeled a Schedule II drug by the Drug Enforcement Administration.2 Schedule II drugs are substances or chemicals assessed to be high risk for abuse leading to negative consequences and physical dependency. Fentanyl products are available orally as effervescent tablets or transmucosal lozenges commonly referred to as fentanyl “lollipops,” nasal sprays, patches, films, or injectables under various trade names, including Actiq®, FentoraTM, Duragesic®, Abstral®, and Lazanda®.
The development of fentanyl was based on medical needs. Those suffering from chronic pain who were no longer receiving the benefit of their opioid medication needed something to control the problem. Hence fentanyl and its rather unbelievable potency.
Death by Fentanyl
The United States witnessed a wave of opioid-related deaths, specifically from illicitly manufactured fentanyl, from April 2005 to March 2007.1 These deaths were concentrated in Delaware, Illinois, Maryland, Michigan, Missouri, New Jersey, and Pennsylvania. As a result, the Drug Enforcement Administration took steps to control the chemicals required to manufacture illicit fentanyl.1 Illicit fentanyl is manufactured in Mexico and smuggled across the United States border.
Statistics
According to the Centers for Disease Control, opioids were linked to 70% (46,802) overdose deaths in 2018. Although staggering, this represented a 2% decline in all opioid-related deaths compared to 2017. However, overdose rates involving synthetic drugs like fentanyl increased by 10%.3
Danger of Fentanyl
Fentanyl is especially dangerous due to its potency and fast-acting effect. It is dubbed the most potent opioid on the planet, 50 times stronger than heroin and 100 times stronger than morphine as an analgesic. Due to its potency, it can take only 2mg of fentanyl for an overdose to occur.5 According to an April 2021 Drug Enforcement Administration report, over 42% of illicitly confiscated pills like Oxcodoyne contained at least 2mg of Fentanyl. Some pills contained as much as 5.01mg, more than twice the amount for a deadly overdose.
CAN YOU TELL THE DIFFERENCE? Authentic oxycodone M30 tablets (Top row) Counterfeit oxycodone M30 tablets containing fentanyl (Bottom row)
Picture from The Drug Enforcement Administration Source: https://www.getsmartaboutdrugs.gov/family/counterfeit-pills-what-you-need-know
Why Does This Happen?
It’s all about the money. Fentanyl is a multi-billion-dollar industry propped up by drug cartels. For the cartels, money is more valuable than human life. Hence, as a cheap alternative grown in labs, fentanyl is frequently mixed with other opioids and packaged to mimic pharmaceutically manufactured opioids to maximize profit margins. In 2020, 23-year-old Wyatt Williamson made national news after consuming fentanyl marketed as Xanax, resulting in his death.6
Unfortunately, many young people, an increasingly common practice on college campuses, are turning to social media and other e-commerce platforms to secure what they think are pharmaceutically manufactured opioids.
From the DEA: Wyatt Williamson’s Story
You don’t have to go far to find the horror stories associated with fentanyl. Indeed, a particularly poignant story was featured on the DEA’s website: https://gsadtest.dea.gov/videos/wyatts-story.
Fentanyl is so potent that even trace amounts can contaminate other drugs packaged in the same area to be sold by an unsuspecting drug dealer, with deadly consequences for the buyer. Even the most cautious buyer is at risk as Fentanyl is colorless, tasteless, and odorless.
The award-winning journalist Mariana van Zeller takes us behind the scenes of illicitly manufactured fentanyl in the National Geographic documentary Traffick. The “chemist” producing this drug is seen in a hazmat suit as the journalist comments, “chemists accidentally kill themselves all the time.”4 Sadly, the national campaign “One pill can kill” has many faces.
How Can I Protect Myself and My Loved Ones?
- Check the source: It is crucially important that drugs be secured from a licensed pharmacy. Any drug not directly purchased from a licensed pharmacy puts you or your loved one at risk. It is like playing Russian Roulette with a fully loaded gun. It is not if but when.
- Test, test, test: Before using any drug or chemical not legally purchased, utilize Fentanyl test strips (FTS) to determine if the drug or chemical is fentanyl free. What are FTSs? Fentanyl test strips are a form of inexpensive drug testing technology initially developed for urinalysis. Emerging research is finding Fentanyl test strips to be effective at detecting the presence of fentanyl and fentanyl-analogs in drug samples before ingestion. Check out your State policy regarding fentanyl test strips. The law may classify them as drug paraphernalia.
- Know the signs of an overdose: Educate yourself to spot the signs of an overdose. Knowing these signs enables you to take quick action to help save a life.
- Keep NAR-CAN easily accessible: If you or a loved one is chemically dependent, learning about naloxone and its use may be a life-saving measure. Naloxone is a medicine that rapidly reverses an opioid overdose. It is an opioid antagonist meaning it attaches to opioid receptors and blocks the effects of opioids, reversing the effects and stopping the overdose. Naloxone can quickly restore normal breathing to a person if their breathing has slowed or stopped because of an opioid overdose. Naloxone is available as an injectable or nasal spray marketed as Narcan® and Kloxxado®. It is worth remembering that fentanyl is far more potent than other opioids on the market, and it is not uncommon to require multiple doses of naloxone to stop the overdose.
- Never use alone: If you are a chemically dependent person, it is ill-advised to use alone. This advice is even more critical if the drug or chemical you are ingesting has not been purchased from a licensed pharmacy.
Why Can’t I Quit?
Because of its potency, getting a high from fentanyl is very easy. Drug dealers use the compound to enhance the high of other drugs like heroin and cocaine while at the same time lowering the cost to produce. Federal can even be problematic for long-term opioid users as the additive increases the strength of the substance they are abusing. This may make the mixed drug more addictive and increase the likelihood of a dangerous overdose.
The greater addictiveness of fentanyl-laced compounds also comes with the distinct problem of often more significant and more powerful withdrawal symptoms. It can be highly uncomfortable to withdraw from fentanyl, and the symptoms can begin very shortly after the last use. For some, muscle and joint pain can be unbearable. Others may experience diarrhea, vomiting, significant cravings, insomnia, and other physical and psychological symptoms.
Of course, being under the care of a highly experienced treatment center such as ours improves the chances of getting through the withdrawal process and moving on to treatment for long-term abstinence. Our medical team may administer medically assisted therapy that is suitable for the client as part of our program. Behavioral therapies and adjunctive approaches follow this to solidify long-term recovery and absence.
Ultimately, while opioid addiction has been a significant societal concern for decades, fentanyl adds another layer of complexity to treating and managing the disease of addiction. There’s never been a more critical time to educate yourself and your loved ones on the potential signs and symptoms of fentanyl use and overdose. Today, more than ever, we can slow fentanyl’s deadly march.
References/ Sources
- Drug and Chemical Evaluation Section, Office of Diversion Control, Drug Enforcement Administration. Fentanyl Fact Sheet. March 2015. http://www.deadiversion.usdoj.gov/drug_chem_info/fentanyl.pdf.
- DEA. 10 July 2018. Drug Scheduling. Retrieved from https://www.dea.gov/drug-information/drug-scheduling on 2 June 2022
- Wilson N, Kariisa M, Seth P, Smith H IV, Davis NL. Drug and Opioid-Involved Overdose Deaths — United States, 2017–2018. MMWR Morb Mortal Wkly Rep 2020;69:290–297. DOI: http://dx.doi.org/10.15585/mmwr.mm6911a4 external icon.
- Fentanyl (Full Episode) | Trafficked with Mariana Van Zeller https://youtu.be/uj1nnnCPAKA
- DEA. 29 April, 2021. Facts about Fentanyl. Retrieved from https://www.dea.gov/resources/facts-about-fentanyl on 2 June, 2022
- https://gsadtest.dea.gov/videos/wyatts-story
Knowledge Corner:
Did you know?
Natural opioids include morphine and codeine. Semisynthetic opioids include oxycodone, hydrocodone, hydromorphone, and oxymorphone. Prescription opioids include methadone, natural, and semisynthetic opioids. Synthetic opioids include prescription and illicitly manufactured fentanyl, methadone, and tramadol. Heroin is an illicit opioid made from morphine.