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Fentanyl is a powerful opioid drug, originally created to treat severe pain, especially in people who may take large doses of painkillers for long-lasting or chronic pain and have developed a tolerance to opioid medications. This synthetic opioid painkiller is between 50 and 100 times more potent than morphine, which is the original synthetic opioid drug. It is also roughly 80 times more powerful than heroin, a now illicit drug. Fentanyl, however, is prescribed to manage pain after surgery, in the hospital, or chronic pain.

Fentanyl is also produced illicitly, and it has led to a spike in opioid overdoses in the United States. Prescription versions of fentanyl come as transdermal patches, lozenges, and injections; illicit versions of the drug may be sold instead of or mixed into cocaine or heroin, as a powder, on blotter paper, or mimicking tablets of illicit prescription drugs.

Since fentanyl is an opioid, it is chemically similar to other drugs like hydrocodone, oxycodone, heroin, and morphine. However, the specific ingredients may be different, especially in illicit versions of the substance.

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The Chemical Formula and Its Analogues

The full chemical formula for fentanyl is N-(1-(2-phenethyl)-4-piperidinyl-N-phenyl-propanamide. This chemical is derived from piperidine, an alkaloid chemical found not just in the opium plant but in wheat and black pepper as well. Illicit versions of fentanyl loosely follow the pharmaceutical production of the drug, producing molecules called NPF derivatives. Moving a methyl group into the third piperidine ring can increase the drug’s potency, so many clandestine labs produce fentanyl with differing, unpredictable potency.

These clandestine labs are also beginning to produce carfentanil, a drug used as an elephant tranquilizer in veterinary medicine. Other forms that may appear on the black market include acetylfentanyl and furanylfentanyl. This process without appropriate oversight makes fentanyl and its analogues especially dangerous. People who abuse fentanyl, accidentally or intentionally to get high, are at great risk of overdosing on this drug.

Two milligrams of the drug, which is equivalent to a few grains of table salt, is considered a deadly dose. Opioid overdoses can be deadly. If symptoms appear, it is important to call 911 so the person can get emergency medical attention.

  • Cold or clammy skin
  • Seizures
  • Slow, shallow, and irregular breathing
  • Passing out and being able to be roused
  • Blue tint to skin, especially under the nails or on the tip of the nose

Fentanyl Is a Deadly Cutting Agent

Although illicit fentanyl may contain adulterants, it is more often found as an adulterant in other illegal drugs. Fentanyl produced in clandestine laboratories in China or Mexico is mixed into heroin or cocaine, or sometimes sold instead of heroin. Alone, fentanyl is difficult to dose and likely to cause an overdose; mixed into other substances, the drug’s deadliness is increased.

The first wave of fentanyl overdoses occurred between 2005 and 2007, as diversion from hospitals and prescriptions led to abuse and overdose deaths; about 1,000 overdoses during this time involved the deadly mixture of heroin and fentanyl. Between 2013 and 2014, DEA seizures of illicit fentanyl jumped from 942 to 3,334. Since 2014, fentanyl produced in clandestine labs has been sold as counterfeit prescription pills and mixed into heroin. The Drug Enforcement Administration (DEA) estimates that 500,000 counterfeit pills can be manufactured from a kilogram of fentanyl, and synthesizing this drug is not difficult for clandestine laboratories.

People who struggle with heroin addiction and consume fentanyl instead of heroin are likely to take much more fentanyl because they think they are taking heroin, and this can be deadly.

The Centers for Disease Control and Prevention (CDC) found that, between 2014 and 2015, overdose deaths involving all opioids rose across the nation by 72 percent, largely due to the introduction of new forms of fentanyl mixed into street opioids. Just in Massachusetts, fentanyl overdoses rose 57 percent between 2015 and the beginning of 2016.

The US has conducted extensive negotiations with China to stop the import of fentanyl into the US, and the DEA has added several fentanyl analogues, based on chemical formulas, to the list of banned substances. However, laboratories can modify these chemicals slightly to produce new forms of fentanyl, which may enter the US and prove deadly.

Mixing fentanyl into cocaine or heroin is becoming more common, as the latter two drugs are more difficult to produce and more expensive. Fentanyl, however, is inexpensive to manufacture, so it is being used to bulk up drug supplies.

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Overdose deaths involving fentanyl have risen 540 percent from 2013 to 2016; from 2000 to 2015, over 20,000 people in the United States died from fentanyl and its analogues, specifically. Fentanyl abuse, either to get high or accident use, is the leading cause of the spike in overdose deaths in the US.

Help to safely detox from opioid abuse is essential. Ongoing abuse and addiction increase the risk of death from these serious drugs, but professional treatment can help.