What is fentanyl?

Fentanyl is a synthetic opiate analgesic. It is similar to morphine but significantly more potent. It is typically prescribed to cancer patients and those suffering from chronic or breakthrough pain. Breakthrough pain is when a person is taking an opiate pain medication but has temporary pain that breaks through the opiate barrier.

The prescription form of fentanyl is sold under the names Actiq, Duragesic and Sublimaze.

Common street names include Apache, China Girl, China White, Dance Fever, Friend, Goodfella, Jackpot, Murder 8, TNT and Tango and Cash.

History

Fentanyl was first synthesized in Belgium by Paul Janssen under the label of his relatively newly formed Janssen Pharmaceutica in 1959. It was developed by screening chemicals similar to pethidine(meperidine) for opioid activity. The widespread use of fentanyl triggered the production of fentanyl citrate (the salt formed by combining fentanyl and citric acid in a 1:1 stoichiometric ratio). Fentanyl citrate entered medical use as a general anaesthetic in 1968, manufactured by McNeil Laboratories under the trade name Sublimaze.

In the mid-1990s, Janssen Pharmaceutica developed and introduced into clinical trials the Duragesic patch, which is a formation of an inert alcohol gel infused with select fentanyl doses, which are worn to provide constant administration of the opioid over a period of 48 to 72 hours. After a set of successful clinical trials, Duragesic fentanyl patches were introduced into medical practice.

Following the patch, a flavoured lollipop of fentanyl citrate mixed with inert fillers was introduced in 1998 under the brand name of Actiq, becoming the first quick-acting formation of fentanyl for use with chronic breakthrough pain.

In 2009, the US Food and Drug Administration approved Onsolis (fentanyl buccal soluble film), a fentanyl drug in a new dosage form for cancer pain management in opioid-tolerant subjects. It uses a medication delivery technology called BEMA (BioErodible MucoAdhesive), a small dissolvable polymer film containing various fentanyl doses applied to the inner lining of the cheek.

Fentanyl has a US DEA ACSCN of 9801 and a 2013 annual aggregate manufacturing quota of 2,108.75 kg, unchanged from the prior year.

What does fentanyl look like?

Fentanyl is available as a pill, powder, blotter paper, tablet, spray or under-the-tongue film. Time-release formulas of fentanyl come in gel patches or lollipops. Injectable forms are found in hospital settings. The street-produced version of fentanyl is typically in powder form.

Fentanyl Addiction Symptoms

Fentanyl is available only by prescription. It does have some medical benefits, but even if you are taking the drug only as prescribed by a physician, there are still side effects you may want to be aware of. Some of the most typical side effects are:

Vomiting and nausea

Sweating

Feeling cold

Loss of appetite

Headache

Fatigue

Insomnia and sleep disturbances

Gastrointestinal problems like constipation

Less common side effects of fentanyl are confusion, anxiety, tingling, depression and hallucinations. Other potential side effects particularly associated with the fentanyl patch are urinary problems, fluid retention and a slow heart rate. The fentanyl patch can also cause skin irritation as well as itching wherever the patch is applied to the skin.

Fentanyl Addiction Signs

If you suspect someone you love is illicitly using fentanyl, it can be very scary. It’s good to understand what the signs of fentanyl use are so you will know what to look for. Although these symptoms can be present with those who are taking fentanyl with a prescription. Some of the signs of fentanyl use may include:

Anyone who is taking fentanyl – particularly if they are abusing it or taking it in much higher dosages that usual – will seem euphoric as they first start to take fentanyl. Then they will seem drowsy, confused and depressed as the high feeling wears off.

Slurred speech, drowsiness and a sense of confusion are all common with fentanyl use.

Weakness as well as coordination and walking problems are often experienced by those who are using fentanyl.

Fainting, slowed breathing and pinpoint pupils may be signs of fentanyl use.

Other possible symptoms of fentanyl use include appetite loss, dry mouth, hallucinations as well as sleep problems.

Immediate Effects

Like any addiction to a drug, dependence on fentanyl is dangerous. It can cause short-term and long-term health problems, lead to mental health issues, cause complications in several areas of one’s life, and lead to an overdose that may be fatal. As compared with other drugs, fentanyl abuse can be particularly dangerous. It is more potent than other opioids and is often combined with other drugs. These two factors increase the potential for a fatal overdose.

Fentanyl addiction is also dangerous because of the side effects and long-term complications it can cause, from infectious diseases and organ damage to mental illness, social isolation, and financial and legal problems.

Fortunately, fentanyl addiction treatment is available, and although this is a very difficult addiction to overcome, it is possible with dedication to professional and comprehensive treatment.

The effects of fentanyl may last up to a few hours and can:

make you feel really good

make physical pain disappear

give you wind, indigestion, cramps

make you feel nauseous or vomit

make you constipated and/or diarrhea

make your breathing become shallow

slow pulse and lowered blood pressure

make you feel sleepy

give you a ash (inflammation, itch, swelling at patch site)

impair your capacity as a parent/primary carer of children.

Long term effects

If you use fentanyl often for a long time you may:

overdose (have too much fentanyl at one time. The longer you use fentanyl, the more likely you are to overdose!)

have long-term constipation

get damaged veins from injecting a lot in the same site

lose your appetite

get skin abscesses (sores with pus)

get tetanus — a disease caused by infection through the places on your body where you inject.

The Risks of Overdose

All opioid drugs can cause an overdose that may be fatal. These drugs are central nervous system depressants. They cause activity in the brain and spinal cord to slow down, which leads to reduced heart rate, blood pressure, and respiration. Dangerous amounts of opioids can cause respiration to slow to a degree that a person stops breathing. If not reversed immediately, this is fatal. The risk of an overdose with fentanyl is higher than with other opioids because of its elevated potency.

Statistics demonstrate that fentanyl is a major player in a significant proportion of drug overdose deaths and that it is present in many deaths attribute to opioid misuse. The most recent statistics show that single opioid overdose deaths are down, but those that involve fentanyl and another drug are on the rise. In 2016, the number of overdose deaths in the U.S. that involved fentanyl spiked, with a 540 percent increase over a three-year period. Signs of fentanyl overdose include:

A decreased urge to breathe or difficulty breathing

Shallow, slow breathing

Dizziness

Confusion

Difficulty swallowing

Extreme drowsiness

Loss of consciousness

Overdose triggered by fentanyl is a medical emergency and will lead to death if not treated immediately. Anyone who suspects that someone is overdosing should call for emergency help. First responders carry naloxone, an opioid antagonist that if administered in time can reverse the effect of an opioid like fentanyl and reverse the overdose.

The Fentanyl Test

The fentanyl test strips were originally designed for doctors, who used them to test the urine of patients to make sure they were taking prescription fentanyl, which is used as a pain medication, and not selling it. But as illegal fentanyl poured into North America in concentrations that varied widely from dealer to dealer, harm-reduction groups began offering them in 2016 to test for fentanyl in heroin and other drugs. Users dip the strips into a mixture of drugs and water, usually — but not always — before they inject.

Iqbal Sunderani, chief executive of Canada’s BTNX, the main commercial provider of the strips, said his company has sold more than 650,000 test strips in the United States this year, nearly six times the 2017 total. He now sells many more strips to harm-reduction groups and city and state governments than he does to physicians, he said.

The strips offer users something that naloxone and trips to the emergency room can’t: A way to know whether they are consuming fentanyl before they do it, Zibbell said. “Right now there’s no intervention for people prior to using,” he said. A positive test result and taking the time to conduct the test both helped people change their behaviors, he added.

The RTI survey and a February 2018 survey by the Johns Hopkins Bloomberg School of Public Health showed that while some users actively sought fentanyl, most were concerned about the danger it posed.

The strips in the RTI research were distributed by Greensboro’s Urban Survivors Union, which offers clean syringes and other services, in September and October of 2017. Drug users answered an online survey at the group’s headquarters.

Overall, 43 percent of the users reported that they had changed their drug consumption behavior, and 77 percent said that the test strips made them feel safer, according to the survey.

The researchers concluded that use of the strips “can follow the path of syringe exchange and lay naloxone distribution, interventions initially developed by harm reduction activists and organizations” before they were adopted by public health agencies.