Fentanyl

Main type

Fentanyl is a powerful narcotic painkiller that is used to treat severe pain. It is an opioid, meaning that it is a fully synthetic (man-made) drug based on the opiate group of drugs derived from the Opium poppy such as Morphine and Heroin. Because of its potency (roughly 100 times stronger than morphine) it is generally only used in the management of severe pain and as a hospital analgesic.

As with other opiate and opioid drugs, Fentanyl works by mimicking chemicals (neurotransmitters) that are produced naturally in the body, and binds to Opiate receptors in the brain and elsewhere in the central nervous system. Because the neurotransmitters that usually bind to these receptors, such as endorphin, normally block the communication of pain signals in the body, opiates/ opioids produce this same effect.

Thus, once introduced into the bloodstream through a variety of delivery methods, Fentanyl is transported to these receptors in the brain, blocking the perception of pain by the individual.

Fentanyl is used in wide variety of medical situations, predominantly for the management of severe pain. It is used as an analgesic (painkiller) and as an anaesthetic in hospital intensive care wards and operating theatres. It is also used to manage pain in cancer sufferers that is unresponsive to other analgesics. It may also be prescribed for other serious conditions which result in constant severe pain.

Because of its potency and its high potential for abuse, Fentanyl is a controlled drug in many countries and is tightly restricted.In the US it is a Schedule II substance, meaning that it is illegal to possess or use it without a prescription, and illegal to sell it without an official license. In the UK it is a Class A drug without a prescription – the same group that Heroin and Cocaine belong to.

However this has not stopped it from being used illicitly as a recreational drug. Fentanyl is sold on the black market and is often used by those who have an opiate addiction to illegal narcotics such as Heroin. Sometimes it may be used to enhance the effects of poor quality Heroin, or even sold as Heroin. There have been many cases of accidental Fentanyl overdose, with some resulting in death. Due to its high potency, Fentanyl is also extremely addictive when used non-medically.

Other Types

Fentanyl is available in a number of different forms for medical use, and under a variety of brand names. In addition to being administered intravenously in hospital, it is also available as a trans-dermal patch which slowly releases the drug over a period of many hours. It is also available as tablets, lozenges, as a nasal spray and in ‘lollipop’ form on prescription. Brand names include: Duragesic, Actiq, Sublimaze, Fentora, Instanyl and Abstral. It is also sometimes supplied as a generic medicine under the Fentanyl name.

On the street Fentanyl is known by a number of slang names, with the most common being ‘China White’. Other street names include China Girl, Apache, Dance Fever, Percopop, Murder 8, Tango & Cash and Jackpot.

In addition to the diversion of prescription Fentanyl to the black market through illicit means, Fentanyl ‘analogues’ are also manufactured in illegal laboratories and sold on the street as a white powder (hence China White), and are often dubbed ‘Synthetic Heroin’.

Major Effects

As an opioid drug, Fentanyl has a number of powerful physical and psychological effects, most noticeably reduction/ elimination of pain, and sedation. When taken recreationally it can also trigger feelings of euphoria, numbness and disassociation though this is reportedly not as intense as the euphoric ‘high’ associated with heroin.

As with other opiate and opioid drugs, Fentanyl’s euphoric qualities are thought to be due to its stimulation of dopamine release in the brain – the chemical which the human body uses to ‘reward’ certain behaviours. Though this euphoria is usually not experienced to any great degree when the drug is used medically in controlled and time-managed doses, illicit use subverts this to generate an instantaneous high which is powerfully psychologically addictive.

Because the potency of Fentanyl is so high compared to other narcotics, the risk of a dangerous overdose is extremely high, particularly when used by individuals who have not previously built up tolerance to opiates. An overdose can result in respiratory depression or failure, loss of consciousness, coma and death. The risk of overdose is even greater if illicitly produced Fentanyl has been mixed with Heroin, as the user may easily take a dose which is many times too high unknowingly.

Other side effects of using Fentanyl non-medically include a confused state of mind, drowsiness and constipation. Because the drug produces a chemical dependency, addicts will also experience a range of negative effects when they are not under the influence of the drug, including depression, anxiety and destructive cravings for more. As tolerance builds they will need to take more and more of the drug simply to lift themselves out of this state, thus further perpetuating the addiction and increasing the risk of overdose.

Production countries

Fentanyl is produced legally under license in pharmaceutical laboratories around the world for medical use. Because the drug is a fully synthetic opioid rather than an opiate, the production of Fentanyl is not at all dependent on the opium poppy as other narcotics are.

Fentanyl is produced through a series of complex chemical reactions requiring specialist equipment, knowledge and skills, as well as access to a number of restricted chemicals. In addition to Fentanyl, a number of Fentanyl analogues have been produced by pharmaceutical companies, with similar chemical and physical properties. These include Sufentanil, Carfentanil, Alfentanil and Lofentanil.

For medical and prescription use, Fentanyl is produced to be delivered into the bloodstream in a number of ways. As a liquid it is used intravenously for managing pain after operations and other hospital procedures.

Patients suffering from ongoing severe and chronic pain due to cancer and other diseases may be prescribed it as a ‘transdermal’ patch which attaches to the skin much like a nicotine patch. Such patches usually contain Fentanyl in gel form, though some manufacturers have developed gel-less patches to prevent their abuse.

Fentanyl is also produced as a lozenge on a stick, very similar to a lollipop, which is placed in the mouth and allowed to gradually absorb through the gums and the insides of the mouth. This delivery method is also used in Fentanyl tablets which are placed in the mouth to dissolve. These kinds of medications are often referred to as ‘buccal’ tablets or lozenges (buccal refers to the mouth or cheek).

Drugs intended for legal prescription use arrive on the black market via number of routes. Firstly they may be bought or stolen from someone with a legitimate prescription. They are also stolen from hospitals, pharmacies and storage centres, or they may be sold or diverted by corrupt medical and pharmaceutical staff. In some cases organised crime gangs are involved in such thefts and illegal acquisitions. Whatever the route they take, these legally manufactured Fentanyl products eventually end up being sold to illicit drug users by street level dealers.

On the street these legitimate Fentanyl medications are not used in the way that they are medically intended, and this usually results in much higher doses being delivered to the user in a shorter time. For example, the gel from time-release patches is often extracted and either smoked or applied to the gums.

However, these prescription products are not the only source of Fentanyl on the street. A number of ‘Analogues’ – drugs which are similar but have slight differences in chemical structure and properties – have appeared on the street in a number of forms. These are produced illegally by underground laboratories. Due to their nature there is little information about their location or numbers, but it is suspected that much of the illicit Fentanyl in the US is manufactured in Mexico. Fentanyl producing drug labs have also been raided in Canada and the US.

As with other illegal drugs, illicitly manufactured Fentanyl analogues may be smuggled across international borders from their point of origin, before being split up into smaller packages and sold on the street.

Fentanyl may be sold on the street in its own right, but it is also cut with Heroin, or even substituted for Heroin without the user knowing what they are buying.

Facts and stats

Facts

  • Fentanyl is a fully synthetic opioid.
  • It is a narcotic used for relief and management of severe and continued pain, for example in cancer sufferers and people recovering from operations and accidents.
  • It is a controlled substance in many countries, meaning that it is illegal to possess without a prescription. Manufacture and distribution are tightly controlled and monitored.
  • In the UK, Fentanyl without a prescription is a Class A drug. Illicit possession is punishable by up to seven years in prison and an unlimited fine. Supplying the drug to others, even friends, can result in a life sentence in prison.
  • In the US it is a Schedule II drug. Small-scale possession is punishable by up to five years in jail and a substantial fine. Possession of large amounts with intent to supply can result in up to ten years in prison and an even greater fine. Illicitly manufactured Fentanyl analogues however are Schedule I, and carry the risk of much higher penalties.
  • It reduces and relieves pains by binding to opioid receptors in the brain and central nervous system.
  • It is far more potent gram for gram than most opiates, such as Morphine and Heroin.
  • Fentanyl can be both psychologically and physically addictive.
  • Overdoses on Fentanyl among illicit users are relatively high due to its potency, and can result in coma or death.
  • Fentanyl analogues are often sold as ‘synthetic Heroin’ and may be cut with Heroin and other illegal substances.

Stats

  • Fentanyl is estimated to be up to 100 times more potent than Morphine, and around 50 times stronger than Heroin.
  • Fentanyl transdermal patches for pain relief can last up to 72 hours due to their controlled dosage time-release system. Illegal users tend to extract the contents of these and take much higher dosages in short spaces of time.
  • According to US government figures, 1,013 people died between 2005 and 2007 as a result of illegal Fentanyl analogues manufactured in Mexico. These overdose deaths were most pronounced amongst addicts in Chicago, Philadelphia and Detroit. Most of the overdoses were due to dealers cutting Heroin with Fentanyl. The ‘outbreak’ was contained after law enforcement officials shut down an illegal Fentanyl lab in Toluca, Mexico.
  • The initial period of Fentanyl withdrawal can last 2-4 weeks, but some negative effects can persist for months.
  • In the US in 2000 there were 2.5 million prescriptions to Fentanyl nationwide. By 2008 this figure had almost tripled, standing at 7.64 million.
  • In 2005, the US was the largest worldwide consumer of prescription Fentanyl in the world, accounting for 53% of the global total.
  • Germany was the second largest Fentanyl consumer, with 14% of the global total.
  • The next four biggest consumers of Fentanyl in 2005 were Spain, France, UK and Canada. Combined together, these countries were responsible for 16% of Fentanyl consumption worldwide.
  • Global Fentanyl production has skyrocketed since the early 1990s, when the amount of Fentanyl exported globally was around 10kg a year. By 2005 this figure had reached 2,716kg.

Addiction Signs

As an opioid narcotic, Fentanyl is powerfully addictive both physically and psychologically. Both prescription users who are taking the drug for legitimate pain management reasons, and recreational drug users can become addicted.

In prescription users of Fentanyl, the individual may begin to depart from the recommended safe methods and dosages of the drug, and may exhibit signs of dependence. For example they might appear very anxious when their supplies of the drug are running low, or respond hostilely to suggestions that they should change pain medications.

In individuals who are taking Fentanyl illicitly for non-medical reasons, there may be signs of intravenous drug use on the body, in the form of needle marks, scars and associated abscesses. Various forms of the drug may be found on their person or amongst their possessions: trans-dermal patches (either whole or cut up), tablets or lozenges bearing the Fentanyl name or a related brand name, and lollipop-like delivery systems. In the case of illegally manufactured Fentanyl analogues, unusual powders may be found, along with drug paraphernalia for preparing and consuming the drug (small pieces of tin foil, lighters, empty biro tubes etc).

When withdrawing from the drug, someone addicted to Fentanyl will display a range of symptoms. Because Fentanyl is such as strong narcotic, these withdrawals can be very pronounced indeed. Physical withdrawal symptoms include nausea and Diarrhoea, fatigue, insomnia and abdominal discomfort or pain. When some time has elapsed since their last ‘hit’ of the drug they will also display a range of psychological symptoms, including intense anxiety, depression, and extremely strong cravings for the drug. They will likely care about little other than acquiring their next dose of Fentanyl.

Treatments

Continued use of Fentanyl in ways other than those which are medically intended can result in a very serious addiction to the drug. As with any opiate or opioid narcotic, a physical dependence forms in which the individual’s body needs a steady supply of the drug to maintain balance. This is because, in response to the artificial chemicals introduced by the drug, the body has reduced its own production of essential neurotransmitters such as endorphins, whose roles the drug has usurped.

Suddenly stopping the drug after a period of use is therefore never recommended as this will trigger a range of unpleasant and even dangerous withdrawal symptoms. These symptoms can include diarrhoea and sickness, pain, fatigue, sleeping problems, anxiety, irritation and depression.

In addition to the actual physical addiction that has developed in the body, a powerful psychological addiction is usually present among Fentanyl abusers. Not only may the individual consciously crave a return to the relaxed, numb and pain-free state that the drug provides, their addiction may be subconsciously maintained by the drug’s activation of natural ‘reward’ and pleasure systems of the brain.

Whether an addiction to Fentanyl has grown out of valid prescription use of the drug or is a result of illicit drug use, professional help is usually needed to break free. In many cases a stay in hospital or a dedicated rehabilitation centre is the best course of action, as this enables the individual to be carefully monitored and supported during the detox and recovery process.During a stay as an inpatient, a number of approaches will often be used to deal with each separate component of the Fentanyl addiction.

Detoxification from the drug is the first step, and the way this is done depends very much on the specific drug habit, the recommendations of a doctor and the wishes of the individual. One option is for the patient to abruptly cease Fentanyl use entirely, or ‘cold turkey’, while under medical supervision. This method is most likely to generate more severe withdrawal symptoms, but medications may be administered to help the individual deal with these.

Alternatively, the dosage of Fentanyl can be gradually tapered off, often in conjunction with a substitute opiate, such as Suboxone or Methadone. This is a much slower process, and must be carefully managed to avoid simply replacing one opiate addiction with another.

In addition to the physical detox process, psychological and emotional support is equally as important to help the individual deal with the withdrawal period, to come to terms with their addiction and to help prevent future relapse.

Counselling sessions may be necessary to help the individual deal with any issues in their life that led them to abuse the drug. Cognitive behavioural therapy (CBT) may be used to identify triggers for their drug seeking behaviour, and to help them develop healthy new habits to replace the old destructive ones.

Additional emotional support may come in the form of support groups with other recovering addicts, and these can greatly enhance the individual’s sense of well-being and further reduce the chance of relapse.