Now that the opioid crisis has reached pandemic levels, there has been a surge in the use of synthetic opioid analgesics such as fentanyl. These painkillers have been around for a long time, but their use is at an all-time high, especially in North America, where the opioid crisis has been going on for years. Their uses extend beyond pain management, and they have found many other ways to get around current regulations. In this blog post, we look at what fentanyl is and how it can be used against us. What is it? Fentanyl citrate is a drug that can only be bought with a doctor’s prescription. It is usually sold under the brand name Subsys as a patch or an injectable solution. It’s used to treat breakthrough cancer pain; shortness of breath from bronchitis or emphysema; chronic pain from nerve damage or injury; and pain caused by surgery or appendix removal. It is also often given to people who have had major surgery, like back surgery or a hysterectomy, and are in a lot of pain because of it. How is it used? Fentanyl citrate can be given by a healthcare provider as an injection either directly into muscle tissue or subcutaneously (just beneath the skin). The drug can also be given as a transdermal patch to treat long-term pain after surgery, end-of-life care, palliative care, hospice care, and other types of pain that don’t happen in a clinical setting.
Synthetic Opioid Epidemic
Since the turn of the 21st century, opioid painkillers have been used to treat chronic pain. There was a shift towards prescribing such medications to patients suffering from chronic pain. This was done with the aim of reducing the use of more potent painkillers, like opioids like oxycodone and hydrocodone. This change made it harder for people to abuse and die from opioids, but it also led to a big rise in the use of prescription opioids. There is evidence that prescribing more opioids, especially in a short amount of time, can hurt the overall health of a population in ways that were not intended. Some parts of the population, like those with a history of drug abuse or mental health problems, feel this effect more than others. Another contributing factor to the opioid epidemic is the illegal use of these drugs.
Fentanyl – the 21st Century Plague
The rise in fentanyl abuse is a massive cause for concern and should be treated as such by all. Fentanyl is a synthetic opioid roughly 50–100 times more potent than morphine. When ingested as a drug or administered via nasal spray, it acts quickly and has a high potential for causing an overdose because of its potency. However, unlike other opioids, they can be absorbed via the skin and patches. This makes it easier to abuse. Every year, deaths related to fentanyl overdoses have risen rapidly. The numbers are staggering. In 2016, 2,812 people died in the US after overdosing on fentanyl, up from just 12 deaths in 2014. However, its use has skyrocketed in the past few years. In the US, fentanyl causes more deaths than any other drug.
Breaking fentanyl down: what is it?
Fentanyl is a synthetic opioid that is used to treat extreme pain. It is considered a safe, or “relatively safe,” pain medication because of its potency. Fentanyl is not made naturally. Instead, it’s manufactured from synthetic opioid ingredients in medications like oxycodone and morphine. Unlike opium and morphine, which occur naturally, fentanyl cannot be made from the seeds of the poppy plant. Fentanyl is usually prescribed as a patch or as an injectable solution. When it is taken by mouth, it quickly gets into the bloodstream and is then sent to all parts of the body. Although fentanyl is not considered an addictive drug, people who misuse it can build up a tolerance to it, which can lead to overdosing if the same dose is taken repeatedly.
Illegal fentanyl on a street in China. Photo credit: DEA Diversion and Trafficking Center.
China is one of the primary producers of fentanyl. Mexico and Central America are also big producers. China produces 80% of the fentanyl on the market, while Mexico produces most of the rest. However, Mexican institutions have found that they can’t monitor the flow of fentanyl coming into the country. Investors are always coming up with new ways to bring fentanyl into the country, primarily through the border between the US and Mexico. Unlike heroin, which can be bought legally in most countries, fentanyl is usually a “controlled substance” and can’t be purchased legally. It is only available on the black market.
The black market of fentanyl
Like other opioids, fentanyl is obtained and used via the black market. It can be purchased from drug dealers, obtained from the internet, or obtained from a friend or relative who has already abused it. The price of fentanyl varies wildly, depending on its purity, where it’s sourced from, and whether it’s bought on the street or via the internet. The black market for fentanyl is highly lucrative due to its high-profit margin. In some cases, fentanyl sold on the black market is as much as 10 times more expensive than heroin. The large profit margin also contributes to the high profits and longevity of the black market for fentanyl. Dealers are constantly trying to improve the quality and purity of their products. They do this by mixing fentanyl with other drugs like heroin or sugar to dilute the strength of their product. In turn, the black market for fentanyl is constantly trying to develop new ways of getting high.
What makes fentanyl so deadly?
Fentanyl is so potent that just a few grains of powder can kill you. What’s more, it can be easily hidden in any number of things—from fake pills to hand sanitizers—making it difficult to detect. And as fentanyl gets more robust, it’s often mixed with other substances, which makes it even more dangerous. You could have a small baggie of white powder with just a few grains of fentanyl and nothing else, or you could have a lethal amount of pure fentanyl. However, even in its purest form, fentanyl is still much less potent than heroin. A standard dose of pure fentanyl is around 5 milligrams, while a standard amount of heroin is about 25 or 50 milligrams.
As with other opioids, fentanyl is relatively easy to get and can be used just about anywhere there’s an opioid high. As with other opioids, people who begin using fentanyl almost always become dependent. People who use fentanyl are much more likely to develop an opioid addiction than people who use other drugs, like heroin. When someone uses fentanyl for a prolonged period, they will build up a tolerance to the drug and will need to take more of it to get the same high. This is understood as a “positive” (or “negative”) feedback loop. For example, a person who uses just a few grains of fentanyl once will probably not have much effect. However, that same person, if he or she uses that same small amount of fentanyl again, will probably feel much more vital and notice the drug more. This is when the person would realize that they have a problem and need to get help.
Signs of Fentanyl Abuse or addiction
Many signs and symptoms of fentanyl abuse and addiction can be related to drug tolerance. More significant- being unable to sleep without using drugs spending a lot of money on drugs, not being able to stay away from drug use even when it’s causing great harm to the individual; – being unable to go without medications for long periods of time.
Prevention tips for fentanyl abuse warning signs and symptoms
Think about how you’re using drugs and how much you’re spending. If you find that you’re spending too much money or using drugs more often than you’d like, or if you notice that your health/safety is suffering, if you need more drugs to function, or if you have a friend/family member who is displaying any of the warning signs for fentanyl abuse or addiction, it’s time to get help. Many resources are available to those who need them, and it’s essential to reach out for help as soon as possible.
Dr. Ronald Bissell is a retired surgeon, author of 6 books on Personal and Spiritual Growth, writer of numerous articles and facilitator of workshops. He has been giving talks to help people with life-threatening diseases for the past 10 years. After three years of chemotherapy he recently had a bone marrow transplant to treat Multiple Myeloma. His work now involves helping others with life-threatening diseases as well as teaching people how to live their best lives without fear or anxiety.