Fentanyl is a powerful prescription medication of the opioid class. Opioids, which work by activating opioid receptors in the brain, are drugs that are used for a wide range of purposes, ranging from recreational abuse to pain treatment. Fentanyl, which is synthetically derived, is a particularly potent variety of opioid. In fact, fentanyl is more than 50 times more potent than heroin. Due to its efficacy, medical professionals prescribe fentanyl for patients suffering from extreme or chronic pain, such as during and after major surgeries. However, because the medication is so powerful it can very quickly lead to a number of health complications such as physical dependency and addiction.
Fentanyl is currently a major cause of the so-called opioid epidemic in the United States. Fentanyl, along with other prescription opioids, is currently overprescribed by the medical establishment. In fact, according to The Centers for Disease Control and Prevention, there are 58 opioid prescriptions filled out for every 100 Americans. The result is that many people who do not need fentanyl are given prescriptions nonetheless. Many people develop debilitating opioid addictions after using fentanyl, including people who do not deviate from the instructions included with their prescription. Fentanyl is commonly sold on the street in various forms. Black market drug distributors use it as an additive to make their products more potent. While most recreational drug users do not seek out fentanyl specifically due to its dangerous reputation, the drug’s potency and potential for addiction can lead users to turn to other drugs such as heroin.
The abuse of synthetic opioids such as fentanyl is a leading cause of death in the United States. In fact, the opioid crisis has led to drug overdoses surpassing automobile crashes as the most common cause of premature death in the United States. 20,101 people died as a direct result of abusing prescription opioids in 2015 alone, and by 2018 that number had reached approximately 31,000. It is estimated that every 12 minutes a person dies from an opioid overdose.
While fentanyl is a modern medication, opioids have been around for thousands of years. In ancient an indigenous civilizations, opium poppies were used for recreational purposes, medicinal purposes, and for religious rituals. Hyppocrates, who in Ancient Greece was considered the “Father of Medicine,” used opium poppies for treating pain and inducing sleep. However, even these early physicians often recommended caution when using opium poppies, due to side effects and potential for abuse.
In India, China, and the Middle East the opium poppy had become an important crop by the Middle Ages. It eventually began to be cultivated in other forms, such as laudanum, a medicinal tincture containing both alcohol and opium. During the 17th and 18th centuries, a thriving opium trade resulted in opium becoming quite popular throughout Europe, especially among colonial states. In fact, this highly profitable enterprise even led to several wars. China, whose population was devastated by opium addiction, refused to allow Britain to continue selling the substance. Over the decades, Britain continued to illegally smuggle opium into China. This practice led to the so-called “Opium Wars” in the mid 19th century.
Soon opium began to be consumed using other more efficient methods. Scientific advances led to the development of the hypodermic needle. Scientists also succeeded in deriving morphine from the opium poppy, and in 1832 codeine, another opium derivative, was discovered. During most of the 19th century and much of the 20th century, morphine and codeine were widely prescribed. Medical professionals treated them as a cure-all, prescribing them for gastrointestinal problems, lung ailments, menstrual pain, and even psychological conditions such as anxiety. Morphine and codeine were widely perceived to be non-addictive and risk-free. Eventually, however, skyrocketing rates of physical dependence and addiction led physicians to exercise greater caution.
During the early 20th century, scientists expended enormous effort to find forms of opium that would not pose the same risks. Ultimately, they created semisynthetic opioids that were far more potent. For a while, pharmaceutical companies marketed these opioid medications as non-addictive, but research eventually revealed that these more potent opioids were also more addictive. Heroin, for instance, was developed at first as a treatment for lung disease and chronic pain, before it was widely understood that heroin has a high potential for abuse. Oxycodone and hydrocodone were also developed in the beginning of the 20th century. In 1932, the first fully synthetic opioid, meperidine, was developed and shortly thereafter marketed as Demerol. Synthetic opioids activate the same opioid receptors in the brain that natural opioids do. However, they are developed using artificial means in a laboratory, and as a result they can be hundreds of times stronger.
Fentanyl, a synthetic opioid, was developed by a Belgian scientist named Paul Janssen in 1960. In 1968, the substance was approved in the United States for medical purposes. For the first few decades, fentanyl was prescribed only sparingly as a last-case-scenario anesthetic. In the 1990s Janssen Pharmaceutica developed fentanyl in a patch form, allowing for the medication to be administered steadily over a long period of time. Shortly thereafter, they developed fentanyl in a lollipop form. This quick-acting formation of fentanyl revolutionized pain treatment in the United States. Among the more than 150 synthetic opioids currently known today, fentanyl is now the most widely prescribed. Fentanyl patches for cancer pain are on the World Health Organization’s list of essential medicines.
However, despite fentanyl’s widely acknowledged usefulness in the field of medicine, as of 2016 fentanyl is the most common cause of overdose deaths in the United States. Approximately 20,000 people died of fentanyl overdoses in 2016 alone, which is almost 50% of all opioid deaths. As the opioid crisis continues to rage throughout the United States and much of the world, it is also important to examine fentanyl’s role as a street drug additive and as a gateway drug to heroin, oxycodone, and other recreational opioids.
Fentanyl does not grow naturally in the wild the way opium poppies do. Scientists produce this synthetic opioid in a lab. Fentanyl is a synthetic opioid in the phenylpiperidine family, and thus has a similar chemical make-up to sufentanil, alfentanil, remifentanil, and carfentanil. Many synthetic and semisynthetic opioids are made by modifying morphine; these substances include codeine, hydrocodone, oxycodone, and hydromorphone. Members of the phenylpiperidine class of opioids, however, are produced by altering meperidine.
While much of the fentanyl abuse that occurs in the United States occurs when people distribute prescription fentanyl, recent years have seen a rise in fentanyl produced illicitly in unofficial labs. Much of this non-prescription-grade fentanyl is produced without following proper protocol and regulations. The result is that it is hard to determine the strength or potency of the drug until it is too late. Fentanyl made in illicit labs is also likely to contain adulterants, contaminants, and it is often mixed with other drugs. Mixing fentanyl with other drugs can have unpredictable and dangerous effects. Drug interactions between fentanyl and stimulants like cocaine and methamphetamine can be particularly life-threatening. As a result, it is absolutely essential to use legal fentanyl only — and to use it as prescribed.
Fentanyl is commonly abused even by people in possession of authentic medical prescriptions. In these cases, it is usually referred to by its official name. However, fentanyl is also often distributed in black market deals. In these cases, the substance can range from official fentanyl to illicitly produced formations of the drug. Distributors and drug dealers often use code names for the drug to avoid detection by law enforcement agencies. In youth drug culture, fentanyl also often goes by alternative names. The following list does not cover very name for fentanyl, since dealers and drug users are constantly inventing new terms, but it covers some of the most common ones:
Some of these names include:
Fentanyl in its powder form is often cut with other drugs such as heroin. It can also be laced with additives when drug dealers sell it. As such, the potency of fentanyl powder can be unpredictable. Even users with high levels of opioid tolerance can easily overdose on fentanyl powder.
Fentanyl lollipops, despite sounding like a type of candy, are made for medical purposes. Used primary as analgesics for treating extreme pain, fentanyl lollipops are designed to deliver a quick-acting dose of the drug. However, these lollipops are also sold quite profitably on the street. Their quick-acting nature makes them ideal for recreational drug users who are looking to get high.
Transdermal patches, unlike the lollipops, were developed to deliver a relatively low and stable dose over a long period of time. They can be effectively prescribed by medical professionals who are trying to alleviate a patient’s chronic pain. These transdermal patches are placed on the skin and deliver a steady quantity of fentanyl over a 24-48 hour period. Like other forms of fentanyl, transdermal patches have a high potential for abuse. Recreational drug users can apply the patch without a prescription to maintain a steady high. More enterprising users and dealers sometimes also remove the sticky psychoactive portion of the patch. This substance can then be shot up, smoked, or even boiled to form a fentanyl tea.
Fentanyl tablets are another form of fast-acting fentanyl. Patients are generally instructed to place the tablet above their rear molar teeth and wait for it to dissolve, which generally takes approximately 25 minutes. The tablet delivers a concentrated dose of fentanyl that is ideal for treating rapid-onset pain. Drug dealers often manufacture their own fentanyl tablets using fentanyl powder. Many of these tablets are also produced using carfentanil or other fentanyl analogs. These tablets are far more unpredictable and deliver variable doses of fentanyl that can be potentially life-threatening.
Fentanyl lozenges, like tablets, are designed to be dissolved in the mouth. Like lollipops, they deliver a rapid dose. However, fentanyl lozenges do not have a handle the way fentanyl lollipops do. People who are prescribed fentanyl lozenges are instructed to swish the lozenge around in their mouth every few minutes. The fentanyl in the lozenges are absorbed through users’ cheeks.
Fentanyl nasal spray is most commonly prescribed for extreme cancer-related pain. Users generally deliver one to two sprays in a nostril. This rapid-onset formation of fentanyl is also easy to abuse.
Liquid fentanyl is most commonly injected by users who are aiming to get high. Unfortunately, because liquid fentanyl is so potent, administering even a slightly higher dose than normal can result in a fatal drug overdose.
The United States is currently suffering from what public health professionals refer to use an opioid epidemic. This means that the rate of opioid abuse is so high that it poses a hazard to the population at large. Opioid addiction and abuse has destructive effects not only on the individual abusing the substance, but on families, communities, the economy, and the country’s medical infrastructure. In the 1990s, medical professionals began prescribing opioid painkillers with increasing frequency. Eventually, opioids became the most frequently prescribed class of medications in the United States. In 2002, most the opioids prescribed were relatively weak, with only one out of every six users being prescribed drugs more potent than morphine. However, by 2012 one out of every three drug users were prescribed medications more potent than morphine, such as oxycodone and hydrocodone. This set the stage for the rise of fentanyl abuse.
As of 2016, synthetic opioids are now the most common drugs involved in overdose deaths in the United States. The primary culprit is fentanyl, especially illegal fentanyl illicitly produced for the black market. While fentanyl and other synthetic opioids were only responsible for 14% of overdose deaths in 2010, by 2016 that percentage had risen to nearly 50%, with approximately 19,413 individuals dying of synthetic opioid-related overdoses in that year alone. Fentanyl and other prescription opioids are implicated in overdoses involving other drugs as well, since physical dependency on prescription opioids often leads users to turn to cheaper and more widely available street drugs such as heroin.
The Substance Abuse and Mental Health Services Administration estimates that in 2018 approximately 10.3 million Americans had problems related to abusing opioids. Of the 10.3 million substance abuse cases, 9.9 million people had problems with prescription opioids specifically. As a result, for young people in the United States, drug overdose is now the leading cause of premature death, surpassing even automobile accidents. As substance abuse rates continue to climb, the rate of fentanyl overdose is also expected to increase.
All opioids are addictive, but fentanyl in particular is likely to lead to addiction because it is so potent. Fentanyl is 50 times more powerful than heroin and 100 times more powerful than morphine. Almost no other opioid is stronger than fentanyl. Even people taking fentanyl as prescribed for legitimate pain problems are likely to quickly develop a physical dependency on the drug. As the opioid receptors in the brain adapt to regular doses of fentanyl, it takes greater quantities of the medication to achieve desired effects. Withdrawal symptoms can also make it very difficult to stop using. This kind of physical dependency can quickly lead to addiction.
When users stop taking fentanyl, the withdrawal symptoms can be debilitating.
Symptoms of fentanyl withdrawal include:
When an individual has reached a point of physical dependency where these withdrawal symptoms are likely to occur, obtaining fentanyl can feel absolutely essential. People with opioid use disorders often stop at nothing, including criminal activity, to obtain the drug and avoid these symptoms. It can be even more demoralizing when an individual does successfully go through withdrawal but then relapses. The prospect of going through a lengthy and arduous withdrawal process even once — let alone twice — is a major impediment to successful addiction recovery.
Part of the difficulty is that over time, fentanyl abuse actually alters the chemical make-up of the brain. Fentanyl and other opioids release large quantities of dopamine in the brain when they are consumed. Dopamine is a chemical responsible for positive emotions that occur when a person achieves a goal, has sex, or plays sports. It is the “reward” chemical in the brain, and the release of dopamine incentivizes individuals to repeat whatever behavior resulted in the release. Because opioids and fentanyl in particular release such high quantities of dopamine, the areas of the brain associated with motivation and decision-making can become permanently changed. The result is that even individuals who intellectually decide to stop using fentanyl often find that it is impossible to carry out their plans.
Fentanyl addiction, often known as opioid use disorder by medical professionals, occurs when an individual finds it difficult if not impossible to manage their fentanyl use. They may be unable to control their intake, even when harmful consequences make it clear that it is time to stop. Substance use disorders exist on a spectrum, with some people only suffering from mild addictions and others having more developed conditions. However, all opioid use disorders are demoralizing, destructive, and potentially life-threatening. This is true especially in the case of fentanyl, with its high potential for fatal overdoses. Individuals who suffer from an opioid use disorder may go to great lengths to try quitting on their own. However, it is crucial to understand that because of the way addiction alters brain functionality, quitting without outside help is nearly impossible. If you or a loved one is suffering from a fentanyl addiction, it is best to seek the aid of a medical detox center or a formal treatment facility, such as an inpatient or outpatient treatment center.