Fentanyl is a powerful narcotic analgesic used in the treatment of severe pain. It is an opioid, a fully synthetic (man-made) drug based on opiates derived from the poppy plant, such as morphine and heroin. Because of its potency (about 100 times greater than morphine), its use is generally limited to the management of severe pain and as an analgesic in hospital settings.
Like other opiates and opioids, fentanyl mimics the chemicals (neurotransmitters) produced naturally in the body and binds to opiate receptors in the brain and the rest of the central nervous system. Because the neurotransmitters that normally bind to these receptors, such as endorphin, normally block the transmission of pain signals in the body, opiates/opioids produce the same effect.
Thus, once fentanyl enters the bloodstream through various methods, it is delivered to these receptors in the brain, blocking the individual’s perception of pain.
Fentanyl is used in a variety of medical situations but primarily for the management of severe pain. It is used as an analgesic (painkiller) and anesthetic in hospital intensive care units and operating rooms. It can also be used to relieve pain in cancer patients who are not responding to other analgesics. Finally, it can be prescribed for other serious pathologies causing intense and constant pain.
Because of its potency and high potential for abuse, fentanyl is a controlled drug in many countries and is subject to strict restrictions.
In the United States, fentanyl is a Schedule II substance, which means that it is illegal to possess or use it without a prescription, and also illegal to sell it without official authorization. In the United Kingdom, it is a Class A drug without a prescription, the same group to which heroin and cocaine belong.
However, this does not prevent it from being used illegally as a recreational drug. Fentanyl is sold on the black market and is often used by people who are addicted to opiate drugs, such as heroin. It is sometimes used to enhance the effects of poor quality heroin and can even be sold as heroin. There are many cases of accidental fentanyl overdose, some resulting in death. Because of its high potency, fentanyl is extremely addictive if used in a non-medical setting.
Fentanyl is available in a variety of medical forms and brands. In addition to being administered intravenously in a hospital setting, it is also available as a transdermal patch, which releases the drug slowly over several hours. It is also available in tablet, lozenge, nasal spray and prescription “lollipop” form. Brand names include: Duragesic, Actiq, Sublimaze, Fentora, Instanyl and Abstral. It is sometimes dispensed as a generic drug under the name Fentanyl.
On the street, fentanyl is known by several slang names, the most common being “China White”. It is also known as China Girl, Apache, Dance Fever, Percopop, Murder 8, Tango & Cash and Jackpot.
Prescription fentanyl can be diverted to the black market through illicit means, but “look-alike” products are also manufactured in clandestine laboratories and sold on the street as a white powder, often called “synthetic heroin.
As an opioid, fentanyl has a number of powerful physical and psychological effects, including pain reduction or elimination and sedation. When taken recreationally, it can also trigger euphoria, apathy and dissociation, although the euphoria does not appear to be as intense as with heroin.
Like other opiates and opioids, the euphoric qualities of fentanyl are thought to be due to a stimulation of the release of dopamine in the brain, the chemical used by the human body to “reward” certain behaviors. While this euphoria is generally not significant when the drug is used in a medical setting (controlled, time-limited doses), illicit use hijacks this to create an instantaneous effect that is highly addictive psychologically.
Because fentanyl is so powerful compared to other narcotics, the risk of a dangerous overdose is extremely high, especially in individuals who have not developed any prior tolerance to opiates. An overdose can result in respiratory depression or failure, loss of consciousness, coma or death. The risk of overdose is even higher if illegally produced fentanyl has been mixed with heroin, since the user can easily take a much higher dose without knowing it.
Other side effects of non-medical fentanyl use include mental confusion, drowsiness and constipation. Because the drug is chemically addictive, addicts also experience a number of negative effects when not under the influence of the drug: depression, anxiety and a destructive urge to take more. As tolerance builds, they need to take more and more of the drug to overcome this state, which perpetuates the addiction and increases the risk of overdose.
Fentanyl is legally produced, under license, in pharmaceutical laboratories around the world for medical purposes. Because it is a fully synthetic opioid and not an opiate, its production is not at all dependent on the poppy, as are other narcotics.
Fentanyl is the result of a series of complex chemical reactions, which require specialized equipment, knowledge and skills, and access to a number of regulated chemicals. In addition to fentanyl, pharmaceutical companies have produced a number of analogous substances with similar chemical and physical properties. These include sufentanil, carfentanil, alfentanil and lofentanil.
In a medical setting and when prescribed, fentanyl is designed to enter the bloodstream by various means. In liquid form, it is used intravenously to manage pain after operations and other hospital procedures.
For patients with severe chronic pain related to cancer and other diseases, a transdermal patch, which attaches to the skin in the same way as a nicotine patch, may be prescribed. These patches usually contain fentanyl gel, but some manufacturers have developed gel-free patches to prevent abuse.
Fentanyl is also available in the form of a lozenge attached to a stick (a kind of lollipop), which is placed in the mouth so that it is gradually absorbed by the gums and other internal parts of the mouth. This method of administration is also used for fentanyl tablets that are allowed to dissolve in the mouth. These drugs are often called lozenges or oral tablets.
Normal prescription drugs enter the black market through a number of channels. They may first be bought or stolen from someone with a legitimate prescription. They are also stolen from hospitals, pharmacies and storage facilities or sold or diverted by corrupt medical or pharmaceutical personnel. In some cases, organized gangs are involved in these thefts and illegal acquisitions. Regardless of the route taken, this legally manufactured fentanyl ends up in the hands of street dealers and then drug users.
It is then not used properly, and users typically take much larger doses over a shorter period of time. For example, the gel in time-release patches is often extracted and then smoked or applied to the gums.
However, these prescription products are not the only ones that fuel the fentanyl trade. A number of “analogue” drugs (similar but with slightly different chemical structure and properties) have appeared on the street in various forms. These drugs are produced illegally in clandestine laboratories. Because of their nature, little is known about their location or number, but it is believed that most of the illicit fentanyl in the United States is manufactured in Mexico. Fentanyl production labs have also been discovered in Canada and the United States.
Like any illegal drug, clandestinely manufactured fentanyl analogues can be exported around the world from their point of origin, before being divided into small quantities and sold on the street.
Fentanyl can be sold as such, but it is also cut with heroin and even substituted for it without the consumer knowing what they are buying.
FACTS AND STATISTICS
- Fentanyl is a fully synthetic opioid.
- This narcotic is used to relieve and manage severe and ongoing pain, for example in cancer patients and people recovering from surgery or accidents.
- It is a controlled substance in many countries, which means that it is illegal to possess without a prescription. Its manufacture and distribution are closely monitored and controlled.
- In the United Kingdom, non-prescription fentanyl is a Class A drug. Unlawful possession is punishable by up to seven years in prison and an unlimited fine. Supplying fentanyl to others, even friends, is punishable by life imprisonment.
- In the United States, it is a Schedule II drug. Possession of a small amount is punishable by five years in prison and a substantial fine. Possession of a large amount with the intent to sell is punishable by ten years in prison and an even larger fine. Illegally manufactured fentanyl analogues, on the other hand, are included in Schedule I and carry a much more severe penalty.
- Fentanyl reduces and relieves pain by binding to opioid receptors in the brain and central nervous system.
- It is much more potent gram for gram than most opioids such as morphine and heroin.
- Fentanyl can be both psychologically and physically addictive.
- In drug users, fentanyl overdoses are relatively common because of its potency and can result in coma or death.
- Fentanyl analogues are often sold as synthetic heroin and can be cut with heroin and other illegal substances.
- Fentanyl is estimated to be up to 100 times more potent than morphine and about 50 times stronger than heroin.
- Transdermal patches for pain relief can last up to 72 hours due to their controlled dosage delivery system. Addicts tend to extract the contents of these patches and take much larger doses over a short period of time.
- According to US authorities, 1013 people died between 2005 and 2007 after consuming illegal fentanyl analogues manufactured in Mexico. These overdose deaths were mostly among drug users in Chicago, Philadelphia and Detroit. Most of these overdoses were caused by traffickers cutting heroin with fentanyl. This “epidemic” was brought under control once law enforcement shut down a clandestine fentanyl lab in Toluca, Mexico.
- The initial withdrawal period from fentanyl can last 2-4 weeks, but some adverse effects can persist for several months.
- In the United States, 2.5 million fentanyl prescriptions were dispensed nationwide in 2000. By 2008, this figure had almost tripled to 7.6 million prescriptions.
- In 2005, the United States was the world’s largest consumer of prescription fentanyl with 53% of the global total.
- Germany was second with 14% of the world total.
- Spain, France, the United Kingdom and Canada followed. Together, these countries accounted for 16% of global fentanyl consumption in 2005.
- Global fentanyl production has surged since the early 1990s, when the amount exported worldwide was about 10kg per year. In 2005, this figure reached 2716kg.
SIGNS OF ADDICTION
As a narcotic opioid, Fentanyl is highly addictive, both physically and psychologically. Whether its users take it on prescription for pain management or for recreational purposes, they can all become addicted.
Prescription fentanyl users may begin to break the recommended safe methods and dosages and show signs of addiction. For example, they may appear very anxious when their supply runs out or react with hostility if it is suggested that they change their pain medication.
For those who use fentanyl illegally in a non-medical setting, there may be signs of intravenous use on their bodies, such as puncture marks, scars and abscesses. These individuals may be in possession of several forms of the drug: transdermal patches (whole or cut up), tablets or lozenges bearing the name Fentanyl or an associated brand, and “lollipops. In the case of illegally manufactured fentanyl analogues, unusual powders may be found, as well as equipment for preparing and using the drug (small pieces of aluminum foil, lighters, empty pen tubes, etc.).
In a state of withdrawal, a person addicted to fentanyl will show several symptoms. Fentanyl is such a powerful narcotic that the effects of withdrawal can be very pronounced. Physical symptoms include nausea, diarrhea, fatigue, insomnia and abdominal discomfort or pain. After a while after their last dose, addicts will also have psychological symptoms, including intense anxiety, depression and a very strong urge to take the drug. They are likely to care about little more than getting their next dose of fentanyl.
Continued use of fentanyl through non-medical methods can lead to a very strong dependence on the drug. Like any opiate or narcotic opioid, a physical dependence is created and the individual’s body then requires a regular dose of the drug to maintain its balance. This is because in response to the artificial chemicals provided by the drug, the body has reduced its production of essential neurotransmitters, such as endorphins, whose role the drug has usurped.
Therefore, abruptly stopping the drug is never recommended as it would trigger a series of unpleasant, even dangerous withdrawal symptoms. These symptoms include diarrhea and nausea, pain, fatigue, sleep disturbances, anxiety, irritability and depression.
The physical dependence developed in the body is usually accompanied by a strong psychological dependence on fentanyl. Not only may the individual consciously crave the state of relaxation, apathy and absence of pain generated by the drug, but the addiction may be unconsciously sustained by the activation of the brain’s natural “reward” and pleasure systems.
Whether fentanyl addiction is the result of prescription or illicit use, professional help is usually needed to break the addiction. A stay in a hospital or rehab facility is often the best solution as the individual can be closely monitored and supported during the detox and recovery process.
During a hospital or center stay, several approaches are taken to treat each aspect of fentanyl addiction.
The method of detoxification (the first step) will depend very much on the individual’s drug use habits, doctor’s recommendations and wishes. One option is to stop fentanyl abruptly, under medical supervision. This method usually creates more severe withdrawal symptoms, but medications can be given to the patient to help manage them.
Doses can also be tapered, often in combination with an opioid replacement such as Suboxone or methadone. This process is much slower and must be managed carefully, simply to avoid replacing one opiate addiction with another.
In addition to the physical detoxification process, psychological and emotional support is equally important to help the individual manage the withdrawal period, overcome the addiction and avoid relapse.
Counseling may be necessary to help the individual deal with the issues that led to the drug. Cognitive behavioral therapy (CBT) can help identify the triggers of the addiction and help the individual adopt healthy habits to replace the destructive ones.
Support groups with other recovering addicts can provide additional emotional support and significantly improve the individual’s well-being by limiting the risk of relapse.