What Is Fentanyl? A Powerful Drug That’s Often Abused
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What Is Fentanyl? A Powerful Drug That’s Often Abused

What Is Fentanyl? A Powerful Drug That’s Often Abused
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Updated on April 14, 2023
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Overdose deaths from opioids, including prescription opioids, heroin, and synthetic opioids like fentanyl, have increased more than 5 times since 1999.

In 2020, more than 56,000 deaths involving synthetic opioids other than methadone (Dolophine) occurred in the United States, accounting for 82 percent of all opioid deaths.

Fentanyl has now become one of the drugs most frequently responsible for overdose deaths.

Looking at death certificates from 2011 through 2019, researchers identified patterns in specific drugs most frequently involved in drug overdose deaths. They found that synthetic opioids, primarily fentanyl, were the main cause of drug overdose deaths, which have increased 14-fold from 2012 to 2019, greatly outnumbering all other types of drug overdose deaths.

What Is Fentanyl?

Fentanyl is a powerful, synthetic opioid that is part of the class of drugs called opioid analgesics. Developed in the early 1960s, fentanyl was first used as an intravenous anesthetic but is now prescribed and administered to treat chronic severe pain, for instance, with cancer or end-of-life care.

Fentanyl is prescribed under trade names such as Duragesic, Actiq, and Subsys. Names for illegally used fentanyl include Goodfellas, Dance Fever, and Apache.

 The drug comes in several forms: a transdermal patch, a lozenge, a tablet that goes under the tongue, a nasal spray, and a sublingual spray. Side effects include euphoria, drowsiness, nausea, confusion, constipation, sedation, tolerance, addiction, respiratory depression and arrest, and unconsciousness.

How Fentanyl Works in the Body

Fentanyl works by binding to nervous system proteins called opioid receptors. This blocks pain signals to the brain but boosts levels of dopamine, a chemical messenger between brain cells that controls the reward and pleasure center in the brain. Because of its high potency — it’s 50 to 100 times more powerful than morphine and 50 times more potent than heroin — fentanyl can quickly enter the brain tissue, causing an intense and euphoric “high.” Potent opioids such as fentanyl can cause breathing to stop completely, which can lead to death.

Why Is Fentanyl So Dangerous?

Fentanyl sold on the street is manufactured illegally in labs, primarily in countries like China or Mexico, where they synthesize a less pure, potentially more dangerous form of fentanyl. Since it comes in a fine powder, fentanyl is often added to fake prescription pills and illicit drugs like heroin, cocaine, or methamphetamine. Even 2 milligrams (mg) of fentanyl can be lethal for people who aren’t opioid-dependent.

The drug has also been used in counterfeit prescription pills, made to closely resemble oxycodone (Oxycontin), alprazolam (Xanax), and acetaminophen and hydrocodone (Norco).

The amount of fentanyl in each counterfeit pill varies, but it’s estimated that as many as 6 in 10 fentanyl-laced fake prescription pills now contain a potentially lethal dose of fentanyl.

“People can be unintentionally exposed to fentanyl,” says Lindsey Vuolo, MPH, vice president of health law and policy at the Partnership to End Addiction. “Overdoses can happen very quickly, in a matter of minutes.”

How and Why Is Fentanyl Abused?

Fentanyl can be injected, snorted, sniffed, smoked, taken orally by pill or tablet, or spiked onto blotter paper. Fentanyl patches are abused by removing its gel contents and then injecting or ingesting it.

Fentanyl is classified as a Schedule 2 controlled substance by the U.S. Drug Enforcement Administration (DEA). Schedule 2 drugs have a high potential for abuse and addiction, despite their specific medical uses.

What makes fentanyl so addictive is that it’s cheap and it can produce an intense high with just a small amount, even at a much lower dose than heroin. Abusing fentanyl can build up a tolerance to the drug, which increases the risk of overdosing. Many people may not even be aware they are abusing fentanyl. They may think they are taking heroin, Percocet, or Xanax.

An overdose can result in a stupor, cold and clammy skin, or even a coma and death.

Are Fentanyl-Related Compounds Just as Dangerous?

Fentanyl-related compounds, like acetyl fentanyl, carfentanil, and butyrfentanyl, pose an even greater threat because they’re designed to be more potent. Carfentanil, typically used as a sedative for large animals like elephants, is estimated to be 10,000 times more potent than morphine and 100 times more potent than fentanyl.

 It’s considered one of the most potent fentanyl analogs detected in the United States, and there have been a number of carfentanil-related deaths in states like Florida, Michigan, and Ohio. In just one year, 1,181 people died in carfentanil-involved overdoses in Florida.

Acetyl fentanyl, though less potent than fentanyl, has been linked to fatalities in several states, including California, Louisiana, North Carolina, Oregon, Pennsylvania, and Rhode Island.

 In 2019, preliminary data shows that DEA labs’ databases identified 10,798 items as acetyl fentanyl.

How to Recognize and Help Someone Who Is Overdosing on Fentanyl

Because fentanyl overdose can be fatal, it’s imperative that a person overdosing on fentanyl get immediate medical help. The following are signs of an opioid overdose:

  • Loss of consciousness
  • Unresponsiveness
  • Awake but unable to talk
  • Breathing that is very slow and shallow, erratic, or has stopped
  • Choking sounds, or a snore-like gurgling noise (sometimes called the “death rattle”)
  • Vomiting
  • Body that is limp
  • Face that is pale or clammy
  • Small, “pinpoint” pupils
  • Lips or nails turning blue

Naloxone (Narcan) is a medication that rapidly reverses the effects of opioid overdose. The drug can potentially save a person’s life, although multiple doses may be required for it to work successfully. Naloxone works only on people who have opioids in their system and has no harmful effects if given to someone who does not have opioids in their system. You don’t need to be a medical professional to administer naloxone to someone having an overdose.

The U.S. Food and Drug Administration has approved naloxone in three forms: an injectable, an auto-injectable, and a prepackaged nasal spray.

 The drug works by binding to opioid receptors, reversing and blocking the effects of other opioids, and quickly restoring normal breathing in someone whose breathing has slowed or stopped as a result of an overdose.

 Because naloxone has a relatively short duration of effect, overdose symptoms may return. Therefore, it is essential to get the person to an emergency department or other source of medical care as quickly as possible, even if the person revives after the initial dose of naloxone and seems to feel better.
In 2016, the Centers for Disease Control and Prevention (CDC) began recommending naloxone be co-prescribed with opioids in certain cases. According to the United States Government Accountability Office, as of March 2021, 47 states and Washington, D.C., had enacted Good Samaritan laws that provide legal immunity for people helping reverse an overdose. All 50 states have passed legislation to increase access to naloxone, allowing laypeople to get the drug at pharmacies.

The effect of naloxone distribution is undeniable. One study published in 2018 found that opioid overdose deaths decreased by 14 percent in states where naloxone was easily accessible.

 And in a study published in 2019, statistical modeling found that increased distribution of naloxone could prevent 21 percent of overdose deaths.

There are various treatment options for fentanyl dependence, including medication, counseling, and cognitive behavioral therapy. It’s important to remember that opioid addiction is a chronic condition. Treatment will likely require a combination of approaches and long-term follow-up.

Additional reporting by Shira Feder.

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Heidi Green, MD

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Castle Connolly Top Doctor, Member of American College of Lifestyle Medicine
Heidi Green, MD, is board certified in psychiatry, addiction medicine, and lifestyle medicine. She currently divides her time between maintaining a small private practice and working at specialized opioid treatment programs in North Carolina.

In her private practice, Dr. Green provides psychiatric consultative services and offers an office-based buprenorphine maintenance program to support recovery from opioid addictions. She enjoys offering lifestyle medicine consultation to those interested in maximizing their emotional and physical health by replacing unhealthy behaviors with positive ones, such as eating healthfully, being physically active, managing stress, avoiding risky substance use, improving sleep, and improving the quality of their relationships.

At the opioid treatment programs, Green serves as medical director, working with a team of counselors, nurses, and other medical providers. The programs provide evidence-based treatment (including buprenorphine, methadone, and naltrexone) for persons suffering from opioid use disorders (such as addictions to heroin, fentanyl, or prescription pain medications).

Previously, Green has worked in community health and mental health settings where she provided consultation to behavioral health teams, integrated care teams, substance abuse intensive outpatient programs, and a women’s perinatal residential program. She also enjoyed supervising residents in her prior role as assistant consulting professor to the department of psychiatry at Duke University School of Medicine. During her training at the UNC department of psychiatry, she was honored to serve as chief resident, clinical instructor of psychiatry, and psychotherapy supervisor.

Green is passionate about the years we can add to our life and the life we can add to our years through lifestyle medicine! She focuses on maintaining her own healthy lifestyle through work-life balance, contemplative practices, and eating a plant-based diet. She finds joy through a continual growth mindset, shared quality time with her partner, and time spent outdoors backpacking and mountain biking.
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Linda Thrasybule

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Linda Thrasybule is a senior editor at Everyday Health, where she oversees coverage of digestive health, heart health, and cancer. She has more than 20 years of experience covering health, nutrition, lifestyle and wellness trends, and science. Her work has appeared in Reuters Health, LiveScience.com, NPR’s Shots blog, Yahoo News, and TheWeek.com. She has also written clinical topics and research briefs for a number of government agencies and nonprofit health organizations. She earned a master’s degree in journalism from Columbia University in 2011.

In her spare time, Thrasybule enjoys hiking, taking Pilates classes, and going on the occasional yoga retreat to restore and reset.

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Resources
  1. Understanding the Opioid Overdose Epidemic. Centers for Disease Control and Prevention.
  2. Synthetic Opioid Overdose Data. Centers for Disease Control and Prevention.
  3. Drug Overdose Deaths in the United States, 1999–2018. Centers for Disease Control and Prevention.
  4. Drug Overdose Death Rates. National Institute on Drug Abuse.
  5. The Fentanyl Story. The Journal of Pain.
  6. Drug Fact Sheet: Fentanyl. U.S. Drug Enforcement Administration.
  7. Fentanyl DrugFacts. National Institute on Drug Abuse.
  8. Facts About Fentanyl. U.S. Drug Enforcement Administration.
  9. DEA Laboratory Testing Reveals that 6 out of 10 Fentanyl-Laced Fake Prescription Pills Now Contain a Potentially Lethal Dose of Fentanyl. U.S. Drug Enforcement Administration.
  10. Drug Scheduling. U.S. Drug Enforcement Administration.
  11. Carfentanil. National Library of Medicine.
  12. Carfentanil Outbreak — Florida, 2016–2017. Centers for Disease Control and Prevention.
  13. Notes From the Field: Opioid-Involved Overdose Deaths With Fentanyl or Fentanyl Analogs Detected — 28 States and the District of Columbia, July 2016–December 2018. Centers for Disease Control and Prevention.
  14. Acetyl Fentanyl. U.S. Drug Enforcement Administration.
  15. Opioid Overdose Basics. National Harm Reduction Coalition.
  16. Information About Naloxone. U.S. Food and Drug Administration.
  17. Naloxone DrugFacts. National Institute on Drug Abuse.
  18. Naloxone for Opioid Overdose: Life-Saving Science. National Institute on Drug Abuse.
  19. Opioid-Overdose Laws Association With Opioid Use and Overdose Mortality. Addictive Behaviors.
  20. Cost-Effectiveness Analysis of Alternative Naloxone Distribution Strategies: First Responder and Lay Distribution in the United States. International Journal of Drug Policy.
Additional Sources