What is fentanyl?
Fentanyl is a potent synthetic opioid analgesic similar to morphine but can be 50 to 100 times more powerful. It’s often used to treat patients with severe pain or to manage pain after surgery. It is also sometimes used to treat people with chronic pain who are physically tolerant to other opioids. In its prescription form, fentanyl is known as Actiq®, Duragesic®, and Sublimaze®. Street names for fentanyl or fentanyl-laced heroin include Apache, China Girl, China White, Dance Fever, Friend, Goodfella, Jackpot, Murder 8, TNT, and Tango and Cash.
Uses for Fentanyl
Fentanyl is used to treat patients with severe pain or to manage pain after surgery. It is also sometimes used to treat people with chronic pain who are physically tolerant to other opioids. People use fentanyl for both recreational and non-recreational purposes. Factors that may influence an individual’s decision to misuse fentanyl include availability, low cost, ease of procurement, and the user’s ability to obtain prescribed medication from one or more health care providers.
The rise in prescription opioid abuse has paralleled increases in heroin abuse in many regions of the United States. As heroin abuse continues to be problematic, users often transition from using prescription opiates/opioids such as Percocet®, Vicodin®, Lortab®, and oxycodone (OxyContin®) to using heroin because it is cheaper and easier to obtain.
Many users have transitioned to abusing both heroin and prescription opioids. There are significantly more deaths related to the use of fentanyl compared with other commonly abused prescription medications because it is often mixed with heroin or cocaine, which can lead to overdose.
Heroine dealers mix heroin with fentanyl to increase potency or compensate for low-quality heroin. Users purchasing cocaine are sometimes surprised when they are also given fentanyl, unbeknownst to them, because the combination can be deadly in addition to providing a powerful high.
How does fentanyl affect the brain?
The binding of fentanyl to opioid receptors in the brain leads to an overall decrease in pain perception. When large doses of fentanyl are used as an anesthetic for surgery, patients require smaller doses of supplemental anesthesia drugs that act on the brain (i.e., sedatives).
Fentanyl works by activating mu-opioid receptors located throughout the body. These mu-receptors control how we perceive pain, which can also change how we react emotionally to pain. When opioids like fentanyl activate mu-receptors, they can create feelings of euphoria, relaxation, and drowsiness.
Fentanyl also activates noradrenergic neurons through both the spinal cord and brainstem. These neurons release norepinephrine, which creates a sudden surge of energy to make you feel alert or awake. This is why individuals who use opioid drugs report feeling a “rush” from their use.
In addition to decreasing pain perception, opioids can affect parts of the brain that control emotions such as fear and pleasure. In the case of illicit drug use, this may result in increased susceptibility to fatal overdose if users are unaware of the potency of what they are taking or fail to recognize the presence of another drug in the fentanyl-laced product.
Fentanyl’s effects resemble those of heroin and include euphoria, drowsiness, nausea, confusion, constipation, sedation, tolerance with repeated use and increasing doses, and potential respiratory depression. The effects of fentanyl are hazardous, considering that this drug is often used by addicts who have built up a tolerance to other opioids such as morphine and codeine.
The more powerful synthetic opioid drugs such as fentanyl may produce more potent effects than many other opiates. This is due to the fact that fentanyl can more easily cross from the brain into the body’s other tissues and organs because it is fat-soluble. Because of this, fentanyl produces a more euphoric high and potentially fatal respiratory depression compared to heroin.
Respiratory depression occurs when breathing slows or stops altogether. It can be caused by drugs, alcohol, anesthesia, trauma, brain injury, infections, and other factors. People who overdose in this way often die because they cannot breathe; respiratory depression is how many opioid drugs, including fentanyl, cause death in users.
The risk of overdose for fentanyl
With the increasing use of injected illicit fentanyl in recent years has come an increased risk that individuals will experience a fatal overdose when using it. Because the effects of fentanyl’s effects resemble heroin’s more than any other opioid drug’s effect does—and heroin overdoses are reasonably common—people may not immediately recognize their symptoms are due to fentanyl ingestion.
Fentanyl has a substantial safety ratio compared with heroin and morphine, so the risk of fatal overdose is much lower when using pure samples. However, street samples often contain varying amounts of fentanyl mixtures leading to potentially dangerous overdoses. Additionally, an opioid-tolerant individual who uses this drug while still having minimized tolerance may experience hazardous respiratory depression, leading to death even in small doses if adjusted for their tolerance levels incorrectly.
People using opioids such as fentanyl often do not realize that the strength of their prescription opioid has been altered by being mixed with other drugs or substances that can have hazardous effects when combined with opioid medication.
How to Treat a Fentanyl Overdose:
If there is concern about opiate intoxication, call 911 immediately and begin rescue breathing and CPR. Do not put yourself at risk by trying to handle the situation alone. The FDA has allowed the sale of naloxone nasal sprays over the counter in pharmacies. It blocks opiate receptor sites and temporarily reverses many effects but does not prevent death from occurring before its effects run out. Permanent brain damage is also possible in the event of an overdose without medical attention. It is important to call for emergency services even after self-administering naloxone.
Emergency medical professionals will usually use naloxone in intravenous intramuscular (IM) form because it starts working faster, and the effects last longer. It is also more likely to cause a complete reversal of respiratory depression than when naloxone is administered by injection into a muscle flap as compared to nasal administration.
Fentanyl overdose deaths are increasing, and unfortunately, can be fatal in small doses. If you know someone who uses fentanyl, it is crucial to seek help for them and yourself if you use opioids regularly; talk to a local treatment center about getting into treatment if you need it.