Table of Contents
What is Fentanyl?
Fentanyl was first synthesized (or invented) by Paul Janssen in 1960, a world-renowned Belgian physician and founder of pharmaceutical giant Janssen Pharmaceutica. It was approved for medical use in the United States and quickly took its place as one of the leading analgesics (painkillers) and anesthetics. With the development of fentanyl patches by California based ALZA Corporation in the late 80’s, its use grew even greater and it earned a place on the World Health Organization’s (WHO) list of essential medicines. It is now the most widely used synthetic opioid in clinical practice in the world.
50 to 100 times more potent than its naturally occurring opioid counterparts like morphine, Fentanyl is used for severe pain cases such as advanced cancer and post-op patients as well as moderate to severe chronic pain. It is also very prevalent in general anesthesia cocktails, mixed with a sedative and muscle relaxants.
Tragically, fentanyl began to be diverted to the arena of recreational drugs. Both legally produced fentanyl and illicitly manufactured versions have flooded the streets and claimed many lives in its wake. It can be lethal in even tiny doses for people who are not opioid tolerant and has replaced heroin as the chief opiate killer in the USA.
What Fentanyl looks, tastes, and smells like
A major issue with Fentanyl is its lack of unique identifying qualities. It is odorless, easily disguised in powders or pills and often impossible to taste it. The sinister dealer practice to increase profit margins by lacing heroin and cocaine with fentanyl has become all too common. A substance abuser will ingest it while thinking he is using cocaine or heroin. This recipe for tragedy has greatly contributed to skyrocketing overdose rates.
How Fentanyl works
Like all opioids, fentanyl binds to opioid receptors. These receptors reside in the areas of the brain that control pain and emotion and blocks pain messages. Concurrently it increases release of dopamine, which is the chemical that motivates us to engage in activities we find pleasurable and rewarding. This produces the exhilaration and euphoria that causes addiction.
As the body builds up tolerance for the increased dopamine levels it needs higher dosages to feel that high. Its shelf life in the body is very short, inducing the body to constantly demand to be fed with the substance as it cycles out of the body.
What Fentanyl is Called on the Streets
Apace, China Girl, China Town, China White, Dance Fever, Goodfellas, Great Bear, He-Man, Poison and Tango & Cash
How Fentanyl is used and abused
There are myriad forms of exposure to fentanyl and it can be added to almost anything. It can be injected, inhaled, ingested orally in pill form, or absorbed by the skin via transdermal patches. It is also available as powder, lollipops (transmucosal lozenges) or spiked onto blotter paper. It’s even been found in eye drop and nasal spray solutions.
Illicitly manufactured fentanyl has been identified in counterfeit pills, imitating drugs such as oxycodone or other prescription opioids. As mentioned above it is sometimes combined with illegal drugs such as heroin or cocaine and ingested unwittingly by a drug abuser.
Each individual’s reaction is different and determined by variables such as size, weight, and general state of health. New users are susceptible to fatal overdose with even tiny doses the equivalent of a few grains of sugar.
Its addictive qualities are intense. Firstly, as the body builds up tolerance with repeated use, larger doses will be demanded to achieve the high the drug abuser is seeking. Additionally, its half-life, comparative to other drugs is rapid. Within hours, the high is gone, the addict once again feels emptiness and his body begins to press for yet another dose.
Symptoms and Physical Consequences of Fentanyl
There are many signs of fentanyl abuse. There are both mental and physical consequences. It is wise to be on the lookout for these symptoms if a loved one is struggling with Substance Use Disorder (SUD).
- Mood swings
- Bad decision-making processes
- Neglect of social and work responsibilities
- Slurred speech
- Memory impairment
- Concentration and attention difficulty
- Depression and anxiety
- Disorientation and confusion
- Suicidal ideation
- Dilated and Constricted pupils
- Changed sleep patterns (insomnia etc.)
- Heart rate decrease
- Muscle rigidity
- Dry mouth
- Constricted throat
Signs of overdose include very slow and shallow breathing and unresponsiveness. Fentanyl abuse leads to hypoxia, heart and respiratory failure, and in many cases, eventual death.
Abuse, Overdose, and Fatality Statistics
Law enforcement research indicates a significant rise in illicitly manufactured fentanyl. In the space of two years confiscations of illegally produced fentanyl increased seven-fold, per the National Forensic Laboratory Information System (NFLIS). This and other similar data suggest that the rising synthetic opioid crisis is largely due to the influx of illicit non-pharmaceutical versions as opposed to its prescribed iterations.
The National Institute on Drug Abuse (NIDA), a federal agency charged with researching addiction, reported that in 2016 synthetic opioids -primarily illegal fentanyl- had passed prescription opioids as the number one drug killer in the United States. It was involved in close to 50% of opioid-related deaths (19,413), representing a 36% increase from 2010. A significant percentage of overdose deaths in every drug class, including naturally occurring opioids such as heroin and stimulants such as cocaine and meth, were linked to being combined with fentanyl or its analogs. A recently released RAND Corporation report pegged fentanyl and its analogs as involved in over 31000 deaths in 2018, which is two thirds of all opioid overdose fatalities and nearly half of the overall drug toll of more than 70,000. In a space of less than six years -2013 to 2018-the synthetic opioid mortality rate has increased tenfold.
Upon encountering an opioid overdose, Naloxone should be administered immediately. Naloxone (widely known as Narcan due to its original brand name) is a non-selective opioid antagonist. It binds to the opioid receptors in the brain, competing with the illicit substance and temporarily blocking its effects. Quickly restoring slowed or stopped breathing to normal levels, it is the difference between life and death for many overdose victims. It is not subject to abuse or addictive and is the best emergency response for an occurring overdose.
Rapidly spiking overdose rates have encouraged legislators both at the state and federal levels to adopt policies aimed at increasing accessibility. Third-party prescriptions, first responder authorizations and allowing prescriptions for caregivers or family members of a SUD sufferer are all among measures taken in many states to combat opioid overdose in general and fentanyl in particular.
It has been available as an injectable since the 1970’s. In 2014 an autoinjector named Evzio was introduced on the market and in 2015 a nasal spray called Narcan arrived. Both products have made administering the drug easier and accessible even to untrained professionals.
It is critical to note that due to the potency of fentanyl, many times a single dose is not enough. The overdose victim must be carefully monitored in case another dose needs to be added. Furthermore, Naloxone can precipitate withdrawal and their attendant symptoms. Emergency services and professional medical help is required even if it seems the overdose has been successfully reversed.
Detox and Treatment
Entering a detox facility is the first step for the fentanyl addict to getting clean. Withdrawal can cause physical symptoms such as nausea, fever and an altered heartbeat. There can be depression and heightened stress levels. In some cases, hallucinations and extreme paranoia has been exhibited by recovering users. Detox when done incorrectly can be fatal and is imperative that it be overseen by competent medical professionals.
Once the residual toxins from drug use has left the system the addict must enter treatment. It is vital to investigate your options and find a good faith rehab provider. Most health plans today cover treatment for drug rehabilitation. Identify the facility that works with you and for you.
The industry is rife with opportunistic greed merchants who see your loved one as a chance to make a quick buck. Keep your eyes wide open and ask questions. Be wary of those offering a quick fix and a two-week vacation. The fentanyl user’s life is at stake.