Fentanyl is an opiate that has been getting a lot of press lately, and with good reason. This drug once only found in hospital settings has now found its way to the street with deadly consequences.
So what exactly is fentanyl? It’s an extremely powerful opiate, on the scale of 50 to 100 times more powerful than morphine. It works on the opiate receptor in the brain, the same as morphine or heroin. Fentanyl is prescribed to treat severe pain such as cancer related pain or used for pain control during medical procedures. When prescribed it can be given intravenously or orally, there used to be (maybe even still is) a fentanyl lollipop that has the drug mixed into a sugary concoction. It is a quick acting, addictive drug. Fentanyl overdoses occur similarly to other opiate overdoses. Specifically the drug reduces a person’s drive to breath leading to lack of oxygen, coma, brain damage, and death.
Fentanyl was developed in the 1960’s. It was mainly used in hospitals or by prescription but only had a minor street presence until around 2010. Why? Firstly, there was a limited supply. Illegal production has now increased the drug’s availability. Prior to this, illicit use of fentanyl was dependent on diversion from a legitimate source to someone for whom it wasn’t prescribed, or production by a few, skilled, illicit chemists. Then foreign labs, specifically Mexican, Chinese, and North Korean, found a way to cheaply produce and distribute the drug. With increased availability came increased use .
Another factor increasing its use is the availability of fentanyl on the internet, or more specifically the dark web. Fentanyl in particular lends itself to this type of distribution because it is so potent only small amounts of it are needed, making this drug particularly hard to detect in the mail. The internet has also allowed information on how to produce Fentayl to become more widely distributed, leading to even more widespread production.
Due to its potency it is an extremely dangerous drug to mess with. I can personally attest to this. I routinely perform procedures where Fentanyl is given as one of the drugs for sedation. The doses we use are in micrograms. Yes, a millionth of a gram. In order to give this drug, we have someone whose only job during the procedure is to continuously monitor the effects of sedation on the patient and make sure they are not oversedated. We monitor heart rate, blood pressure, blood oxygen saturation, and even the CO2 level in the patient’s breath. It takes no time at all for someone to go from talking to you to not properly breathing. Outside of a controlled setting like this, fentanyl is extremely dangerous.
Given all this it’s not hard to see how overdose deaths from synthetic opioids (which include fentanyl) have increased approximately 10 fold from 2003 to 2018. As this has happened government officials, law enforcement, and the media have publicized the risk of this drug. Most people today have heard of Fentayl and are aware of its dangers. So why then do overdoses from this drug remain sky high?
Two reasons- people aren’t aware they are using Fentanyl or they are aware they are using it but are at the point they feel they need to. Let me explain.
Drug suppliers are lacing everything with Fentanyl. What is being sold as cocaine, ecstasy, heroin, insert an illegal drug name here, is very often that drug laced with Fentayl. It took me a while to wrap my brain around this one. I’m not naive enough to think that suppliers of illegal drugs genuinely care about the people they are selling to, but surely they don’t want to kill them because that is a horrendous business decision (you’ve lost your customer and now law enforcement will likely want to have a word with you).
So then why lace stuff with something that can easily kill the user? The only thing I can come up with is that it's cheaper. They can cut it in with the drug they are supposed to be selling, the user will definitely get high and they’ve saved money because fentanyl is cheaper than other drugs. Suppliers of drugs are not surprisingly tight lipped about their practices so there’s not a lot out there by way of explanation.
Then there is the second group of people overdosing- the ones aware they are using Fentanyl but feel they have no choice. Opiates are expensive and as a user builds a tolerance maintaining a habit can become financially out of reach. Fentanyl is cheaper so moving to using it would appear to make sense. Many of these users will say they know they have a certain tolerance level. They are experienced with opiates and they wanted to move on to Fentanyl. The issue with this arises because the margin for error with this drug is so small. Even experienced, opiate tolerant users overdose on Fentanyl.
So there you have it. Unless you are in a controlled medical setting or have severe cancer-related pain, fentanyl is a drug better left alone.