The U.S. Drug Enforcement Administration (DEA) called fentanyl the most lethal category of opioids in the United States. Fentanyl is involved in the majority of opioid overdose deaths, and it’s one of the chief causes for fatalities in the opioid epidemic. As lawmakers, addiction treatment professionals, and researchers look for ways to turn the tide in the opioid crisis, fentanyl is involved in more and more overdoses each year. But what makes fentanyl so dangerous?

Learn more about fentanyl and why it’s such a significant threat in the opioid epidemic.

What Is Fentanyl?

Fentanyl is a potent synthetic opioid that works in a way that’s similar to morphine. It’s used as a prescription painkiller in hospital settings, especially in the treatment of severe pain. Fentanyl may be used in epidurals because it’s relatively fast to start working compared to other opioids. 

Since labor timelines can be unpredictable, fast-acting painkillers like fentanyl are helpful.

It’s also used in surgery recovery and in chronic pain among patients that are tolerant to other opioids. 

Frequent opioid use can cause people to need more and more of the drug to achieve the same effects. However, fentanyl is so powerful than even a tiny amount can be extremely potent. 

Legally, Fentanyl is often administered in a transdermal patch, and it’s sold under the brand names Duragesic and Sublimaze. It is also given as a lozenge or lollipop under the brand name Actiq. 

Fentanyl is also sold as an illicit drug where it’s often taken intravenously like heroin. Street names include Apache, China Girl, and China White. It’s growing as a source of overdose deaths in the United States. In 2010, a little more than 14 percent of opioid-related deaths involved fentanyl. In 2017, nearly 60 percent of opioid deaths involved fentanyl. 

Fentanyl works in the brain in a way that’s similar to other opioids. It binds to your opioid receptors directly, on binding sites that would normally before your naturally occurring endorphins. When activated, these receptors are designed to block pain signals on their way to the brain. Endorphins help mitigate the pain response in your body, allowing you to rest and recuperate. However, some pain is too much for your endorphins to mask. Opioid medications are more powerful than your endorphins and help to stop severe pain.

Fentanyl is significantly more potent than morphine and even heroin. According to the DEA, fentanyl is about 80 to 100 times more powerful. That makes it around 50 times more potent than heroin. Fentanyl can be effective in the microgram range. As little as 100 micrograms can be considered a high dose in people that aren’t tolerant of opioids. The drug is fatal in as little as 2 milligrams in the average adult. Heroin is lethal in a dose of about 30 milligrams. To put that into perspective, a single snowflake is about the same weight as a lethal dose of fentanyl.

Like other opioids, fentanyl suppresses activity in the central nervous system. That’s what gives opioids there sedating, relaxing, and euphoric effects. In moderate doses, this effect is useful in treating pain. It stops pain symptoms and helps you to relax and recover. However, these effects are also what make fentanyl deadly in high doses. At normal doses, opioids slow down your nervous system to the point of limiting excessive cognition and causing you to feel contented and maybe even sleepy. 

At higher doses, it can start to affect other important functions of your nervous system. Your autonomic nervous system controls things you never have to think about things like breathing, heart rate, and blood pressure. When fentanyl starts to suppress those essential functions, it can have deadly results. 

Most fatal overdoses end in a symptom called respiratory depression, or slowed breathing. Fentanyl can slow down or stop your breathing altogether, causing oxygen deprivation, brain damage, coma, and death. The signs and symptoms of a fentanyl overdose include:

  • Unconsciousness
  • Inability to be woken up
  • Blue lips or fingertips
  • Unable to speak or respond
  • Slow heart rate
  • Pale complexion
  • Clammy skin
  • Loss of motor control
  • Limp body and limbs
  • Slow or shallow breathing

A fentanyl overdose can be reversed with a medication called naloxone (sold as Narcan). Naloxone is often carried by firefighters, paramedics, and sometimes police officers. In some places, it can be sold over the counter. However, a fentanyl overdose can happen quickly, and if naloxone isn’t administered right away, it can be too late.

Fentanyl is manufactured for medical use and prescribed in hospital settings all over the country. In the early 2000s, the recreational use of fentanyl began to grow in popularity. At that time, prescription drugs were abused, and fentanyl was extracted from transdermal patches. 

Today, fentanyl is made in clandestine factories and shipped to the United States through black market trade. Though the overprescription of opioids does supply some of the recreational use, fentanyl abuse is typically supplied by transnational criminal organizations like the Mexican cartels. 

According to the DEA’s 2018 National Drug Threat Assessment, fentanyl is primarily sourced from China and Mexico. Since the rise of the opioid epidemic, China, Mexico, and the U.S. have placed new restrictions on fentanyl manufacturing and trade, but manufacturers create new fentanyl analogs to get around these regulations. 

If fentanyl is so dangerous, why do people use it instead of weaker alternatives? For the most part, opioid users have no idea they’re using fentanyl when they encounter it. Fentanyl is added to heroin and cocaine by drug dealers, and users usually have no way of knowing it’s contaminated their supply. Fentanyl is often added to other drugs to give it a powerful boost, making it seem like a purer and more valuable product. However, users who take a dose that’s contaminated with fentanyl may take a dose that’s appropriate for their normal drug of choice. The addition of fentanyl makes the drug way more deadly in an otherwise normal dose.

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