Fentanyl belongs to a class of drugs known as opioid (narcotic) analgesics. It works in the brain to change how your body feels and responds to pain. It is used to treat chronic and severe pain. It binds to the nervous system proteins called opioid receptors, thereby blocking the transmission of pain signals to the brain. It has a rapid onset and short duration of action. It can more easily penetrate de Central Nervous System because of its high lipophilicity property (dissolves easily in fat).
The synthetic opiate first appeared in the 1960s under the trade name Sublimaze as an intravenous anesthetic, and its use in cancer treatment and palliative care became widespread when it appeared as a gel-filled PATCH that could be absorbed through the skin. The drug acts quickly and pharmacists often use it in combination with other opioids that take longer to take effect. It was mostly used in cancer patients with severe pain and high opioid-tolerance threshold. It’s been a Schedule II drug, like OxyContin, since 1970. Schedule II means a drug has a high possibility of abuse and addiction.
As of 2012 fentanyl was the most widely used synthetic opioid in medicine. In 2013, 1700 kilograms were used globally.
Fentanyl is available in different formulations, such as intravenous injection (Sublimaze), as a skin patch (Duragesic) for slow release pain treatment, as a dissolving tablet placed between the upper cheek and gum (Fentora), as an oral lozenge or lollipop (Actiq) for children or people who are intolerant to injections, and as a mouth spray (Subsys).
Fentanyl transdermal patches (Durogesic/Duragesic) are the most used formulations in chronic pain management. The patches work by slowly releasing fentanyl through the skin into the bloodstream over 48 to 72 hours, allowing for long-lasting pain management. Dosage is based on the size of the patch, since, in general, the transdermal absorption rate is constant at a constant skin temperature.
Fentanyl first showed up on the streets in the 1970s and the variety of products were immediately made popular in a culture beginning to abuse prescription medication on a massive scale, and by those turned off by more obviously illegal drugs, like heroin. As a consequence, it’s also been responsible for the accidental deaths of many non-addicts, including children.
These days, it is known by its street names “fake heroin,” “fingers,” “magic” and “the bomb.” But its unknown presence in prescription pills sold on the black market and its appearance as a deadly cocktail with heroin is the cause of this new wave of ODs. An amount the size of two grains of salt can kill a healthy adult.
Fentanyl use can lead to addiction, abuse, and misuse, even at the recommended doses — this risk is higher for people with a personal or family history of substance abuse or mental illness. Drug dealers tend to prefer selling Fentanyl because the high doesn’t last as long as heroin’s. It’s better business.
Fentanyl is almost 100 times more potent than morphine and 20 to 40 times stronger than heroin, but the drug-patch is designed to deliver small amounts of fentanyl each hour over an extended period of time.
When ingested, however, the Duragesic patch can deliver its entire dose all at once, increasing the risk of an overdose.
Death from fentanyl overdose was declared a public health crisis in Canada in September 2015, and it continues to be a major killer drug. In 2016, deaths from fatal fentanyl overdoses in British Columbia averaged two persons per day. It is believed that the drug is being imported from Asia to the western coast by organized crime groups in powder form and being pressed into pseudo-OxyContin tablets.
Medical examiners concluded that musician Prince died in April 2016 from an accidental fentanyl overdose. The drug was among many identified in counterfeit pills recovered from his home, especially some that were mislabeled as Watson 385, a combination of hydrocodone and paracetamol.
Russian security forces used a “fentanyl gas” to incapacitate people quickly in the Moscow theater hostage crisis. The siege was ended, but about 130 of the 850 hostages died from the gas. The Russian Health Minister later stated that the gas was based on fentanyl, but the exact chemical agent has not been identified. No other answers were provided after that.
Adverse effects?
Common side effects are diarrhea, nausea, constipation, dry mouth, somnolence, confusion, depression.
Some signs of fentanyl abuse are:
• Feelings of euphoria and relaxation.
• False sense of well-being.
• Confusion.
• Sedation.
• Drowsiness.
• Dizziness/lightheadedness.
• Nausea and vomiting.
• Constipation
• Withdrawal symptoms when stop using
The deadly aspect of fentanyl comes from this:
• Fentanyl may produce more prolonged respiratory depression than other opioid analgesics. The breathing slows down and eventually stops all together. People die from not breathing anymore. The abuser goes to sleep and never wakes up, slipping away into death.