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Fentanyl: What You Should Know

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May 1, 2018 -- Fentanyl, the synthetic narcotic painkiller implicated in the 2016 overdose death of singer Prince, has been named a chief culprit in the nation’s opioid crisis, a new study finds. 

“The findings …. confirm what front-line health care and law enforcement professionals in towns and cities across the country know from firsthand experience: deadly synthetic opioids like fentanyl are now the main drivers of drug overdose deaths in the United States,” says Linda Richter, PhD, director of policy research and analysis for the National Center on Addiction and Substance Abuse.

Richter and other experts talked about fentanyl, how it works, and why it is so lethal when misused.

What is fentanyl, and what does it do?

Fentanyl is a powerful synthetic opioid approved by the FDA for use as a painkiller and anesthetic. It works by binding to opioid receptors in the brain, but it does so faster -- and in smaller doses -- than morphine or heroin. Like other opioids, it boosts levels of the chemical dopamine, which controls feelings of reward, pleasure, euphoria, and relaxation.

How is fentanyl used legally, as a prescription medication?

Fentanyl typically treats patients who need long-term, around-the-clock relief from severe pain, and it treats pain after surgery. When used for medical purposes, it is often given in a shot, a patch on the skin, or in lozenges.

How and why has it become a common illegally abused drug?

Fentanyl is about 50-100 times more potent than morphine and 50 times more potent than many forms of heroin. As a result, it can be dangerous and deadly if misused. When abused, it is typically swallowed, snorted, or injected.

How long has it been on the market?

Fentanyl was created in 1960 and introduced as an anesthetic later that decade. Because it is synthetic, it can be easily and inexpensively made in a lab. 

What makes fentanyl so deadly?

Due to its chemical structure, fentanyl has rapid and potent effects on the brain and body, and even very small amounts can be extremely dangerous.

“It only takes a tiny amount of the drug to cause a deadly reaction,” Richter says. “Fentanyl can depress breathing and lead to death. The risk of overdose is high with fentanyl.”  

How is fentanyl contributing to U.S. overdose deaths and the nation’s opioid crisis?

Despite the relatively low rate of fentanyl prescriptions, it has become a major player in the opioid epidemic. Illegal versions of fentanyl were largely responsible for the tripling of overdose deaths from synthetic opioids in just 2 years -- from 3,105 in 2013 to 9,580 in 2015, according to the National Institutes of Health.

says some fentanyl users become addicted to the drug and then move on to heroin. “Many drug cartels realized they could quickly and cheaply produce fentanyl -- and then cut heroin with it,” she says. “Instead of heroin being cut and made weaker, fentanyl makes the substance exponentially more dangerous.”

What happens when someone stops using fentanyl?

Withdrawal symptoms can be extremely uncomfortable and painful, and may include muscle pain, diarrhea, vomiting, nausea, sweating, abdominal pain and cramping, rapid heart rate, insomnia, tremors, and anxiety.

What is the treatment for addiction to fentanyl?

Treatment for fentanyl addiction, like any opioid use disorder, includes the use of FDA-approved medications -- methadone, buprenorphine, or naltrexone -- prescribed and managed by a health care professional. It also includes professional therapy and recovery support systems, such as group counseling.

“There are medical interventions that work, and every person with an opioid use disorder should receive such professional care and have the treatments covered by insurance,” Richter says. “Nobody chooses to have addiction. It is a treatable disease.”

Can anything be done to reverse a fentanyl overdose?

The medication naloxone (Narcan) can reverse fentanyl overdoses. But because the opioid is so potent, patients often require much higher doses of the medication to be successful. Case in point: Prince received Narcan in the days before his death, but it didn't work, law enforcement officials reported.

How has law enforcement responded to the challenges posed by fentanyl makers, who are constantly changing the formulas for the drug so new versions might not be covered by laws making them illegal?

That has been a serious problem for law enforcement. Since fentanyl is a legal prescription drug, it didn’t fall under Schedule I of the Controlled Substances Act (CSA), which would have made it illegal. In response to this problem, the Drug Enforcement Administration in February issued a temporary order to place all fentanyl-related substances that are not already regulated by the CSA into Schedule I.

Criminal penalties will now apply to anyone who illegally makes, distributes, imports, exports, or possesses fentanyl-related substances. The order is effective for 2 years, with a possible 1-year extension. This will make it easier for law enforcement to deal with the explosion in fentanyl-related trafficking and overdose deaths.

WebMD Article Reviewed by Neha Pathak, MD on May 01, 2018

Sources

Journal of the American Medical Association: "Changes in Synthetic Opioid Involvement in Drug Overdose Deaths in the United States, 2010-2016."

Linda Richter, PhD, director of policy research and analysis, National Center on Addiction and Substance Abuse.

NPR.org: “Prince Died With 'Exceedingly High' Level Of Fentanyl, Report States.”

 The Journal of Pain: “The Fentanyl Story.”

Drug Enforcement Administration: “FAQ’s-Fentanyl and Fentanyl-Related Substances.”

National Institute on Drug Abuse, National Institutes of Health: “Research on the Use and Misuse of Fentanyl and Other Synthetic Opioids.”

Scientific American: “Why the Pain Drug That Killed Prince Can Be Especially Dangerous.”

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