Every single day in the United States more than 130 people die from opioid overdoses.
Gone are the days when only intravenous heroin use hit news headlines with regards to drug related deaths. There are many opiate class drugs both pure and synthesized, legal, illicit and prescribed that are currently contributing to the continually rising death toll.
Amongst the prescribed and controlled opiates, fentanyl has become a popular choice for drug abusers.
This drug is extremely powerful - in uneducated hands it is extremely dangerous. For the first time, the odds of dying from an opiate overdose now surpass the odds of dying in a road traffic accident, mainly due to fentanyl.
What Is Fentanyl?
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Fentanyl is a powerful synthetic opioid drug approved by the FDA for pain relief and anesthesia. It was first introduced in the early 1960s as an IV anesthetic. It is a Schedule II narcotic under the United States Controlled Substances Act of 1970.
FDA-approved brand and generic versions include:
- Actiq (lozenge)
- Abstral (tablet sublingual)
- Duragesic (film, extended release, transdermal)
- Fentanyl Citrate (lozenge)
- Fentora (tablet, buccal, sublingual)
- Lazanda (spray, metered, nasal)
- Onsolis (film, buccal) Subsys (spray, sublingual)
- Sufentanil - (sublingual, injection, tablets)
- Sublimaze (injection, intravenous infusion)
Pharmaceutical fentanyl is available in tablets, lozenges, transdermal patches, sublingual tabs and can be administered by injection and intravenous infusion.
The fentanyl that is responsible for the recent rise in deaths is non-pharmaceutical and manufactured in homemade laboratories. This fentanyl is illegal and unregulated. This makes it exceptionally dangerous.
Illicit fentanyl generally comes in the form of powder that can be snorted or prepared for injection, and, on spiked blotter paper that can be swallowed. It is also notably cut with heroin and cocaine making street drugs stronger and more volatile.
What Is Fentanyl Used For?
Pharmaceutical fentanyl is generally only used for the relief of severe pain such as in the treatment of end of life cancer patients, postoperative pain and in conditions where tolerance to other opiates has developed.
Illicit fentanyl is very much associated with abuse, addiction and overdose. This is one heavy weight opiate drug that should never be used recreationally.
Just like any other opioid, fentanyl is extremely addictive both physically and psychologically. This is why extreme caution is exercised around its prescription. Fentanyl dependence can develop very quickly, even when taken as prescribed.
Is Fentanyl Dangerous?
Fentanyl is extremely dangerous, especially in the hands of an individual using it purely for abuse purposes. They are unlikely to comprehend fentanyl’s strength.
It is 50 times more lethal than heroin and 100 times more powerful than morphine. It is so deadly that some states use this drug as part of their lethal injection for inmates facing the death penalty. Additionally, even a dusting of the substance can be fatal and accidental exposure can even cause death.
Overdose deaths from fentanyl abuse have skyrocketed in recent years. Synthetic opioids like fentanyl and excluding methadone now account for 60% of all opioid deaths and are the main driver behind the falling life expectancy rate in the US.
The statistics for US drug overdoses involving synthetic opioids other than methadone recorded 28,466 deaths in 2017. This gives an indication of the scale of the problem that the US is currently facing with about 78 people dying each day from fentanyl abuse and overdoses.
Fentanyl Side Effects
The most dangerous side effect of fentanyl is a slowed respiratory rate. This is what causes most deaths through overdose. The respiratory system can slow to such an extent that it actually stops, causing imminent death.
Other fentanyl side effects include:
- Drowsiness and sedation
- Strong analgesia
- Loss of consciousness
- Suppressed appetite
Is Fentanyl An Opiate or Opioid?
Fentanyl is a synthetic opioid that is manufactured to mimic the effects of opiates, which are the natural entities of the opioid drugs, examples being morphine and codeine. Fentanyl binds to the opioid receptors in the brain and changes the brain's perception of pain, similar to opiates, semi-synthetic opioids like hydrocodone, and other synthetic opioids such as tramadol. Strictly speaking, fentanyl is classified as an opioid as opposed to an opiate although the terms tend to be used interchangeably.
Opioids are synthetically made in a lab whereas opiates have natural ingredients (from the opium poppy flower)
Signs of Fentanyl Overdose
Recognising the signs of fentanyl overdose could potentially save a life, by enabling you to act quickly and get the individual the emergency medical help they need.
Fentanyl overdose symptoms include:
- Pinpoint pupils
- Unresponsive to stimuli
- Cold clammy skin
- Slowed respiratory rate (respiratory depression)
- Bluish tinge to the lips and skin
- Extreme drowsiness
Fentanyl and Heroin Addiction
Heroin laced with fentanyl is often a lethal mix; it is also highly addictive when tolerated. Opiates should never be mixed with other drugs and fentanyl is no exception.
Those that try heroin laced with fentanyl the first few times are at particular risk of overdose as they expose their body to a potentially deadly amount of opioids. They may not even be aware that fentanyl has been added to heroin they are about to use.
Drug addiction is a chronic and progressive life threatening disease of the brain. An individual addicted to heroin and fentanyl will literally go to any lengths to prevent the horrendous opiate withdrawal symptoms from kicking in. They are compelled to seek and take the drug regardless of the high risks involved.
Fentanyl and Cocaine
Cocaine laced with fentanyl has been responsible for many deaths. The National Institutes on Drug Abuse recorded 4,184 deaths for cocaine combined with non-methadone opioid synthetics, dominated by fentanyl in 2016. This is a 23-fold increase from 2012
Cocaine is not known to be physically addictive, however laced with fentanyl it becomes a whole new incredulously addictive and dangerous drug.
The vast majority of cases linked to fentanyl overdose deaths in the US have been traced to illicit fentanyl. Whilst prescribed fentanyl can be abused, it is only usually prescribed for patients in the advanced stages of cancer or in acute pain where no other opioid is effective.
Like any opioid, fentanyl abuse causes tolerance with repeated use. Tolerance leads to dependence. Dependence, where there is a psychological attachment also present, creates addiction.
An individual suffering from fentanyl addiction will find it incredibly difficult to stop fentanyl and stay stopped. This is due to the overwhelming compulsions and drug cravings that characterize addiction.
Ideally, a fentanyl addict should enrol in a SAMHSA-certified opioid treatment program to access medically assisted treatment in order to recover.
Fentanyl Withdrawal Symptoms
Due to its potency, withdrawal from fentanyl can be very intimidating for an individual to face physically and mentally. Opiate withdrawal can in itself be a reason for an individual to continue in their addiction.
- Muscle aches and cramps
- Nausea, vomiting, and diarrhea
- Anxiety, profuse sweating, and restlessness
- Intense drug cravings
- Blurry vision
- High blood pressure
If you or a loved one are fentanyl dependent, it is strongly advised that you seek professional SAMHSA approved medical help and treatment.
How Long Does Fentanyl Stay In Your System?
Fentanyl does not test positive on typical urine screening tests. It can however be detected using tests specific to the screening for fentanyl presence.
With fentanyl transdermal patches, lozenges and tablets, the drug will take approximately 3 - 5 days to be completely eliminated from the body. Fentanyl can be detected in urine for up to 3 days post administration.
It is critical during this time that any medication, drugs or alcohol that the patient plans on taking is discussed with a medical practitioner first to avoid adverse interactions.