Fentanyl is a synthetic opioid. Initially, the drug was developed and used as a drug to manage pain. However, over time, there has been the development of illegally made fentanyl (IMF). This means that fentanyl is available through two channels: via prescription and through channels outside of the medical establishment.
The rise in the availability of fentanyl is alarming, given its associated risks. The American Centers for Disease Control and Prevention (CDC) notes that, in the US, over 150 people die each day from overdoses on synthetic opioids such as fentanyl.
This indicates that a large population of individuals with access to fentanyl are misusing the drug in some way. In what cases, then, is fentanyl illegal? How dangerous is the drug? What is fentanyl prescribed for, and what effects can long-term use of the opioid have?
What is Fentanyl?
Fentanyl is an opioid. This means that it belongs to the opioid family of drugs, a type of substance that is known for its analgesic properties. Opioids are comm
only used as a type of pain management. However, they are also used for their sedative qualities and specific opioid-high.
As opioids can be quite addictive, they are usually only prescribed in instances of treatment-resistant or otherwise severe pain. For chronic pain, it is not typical for opioids to be prescribed immediately. Usually, the efficacy of other modes of management will be investigated first. Opioids such as morphine may be prescribed to treat acute instances of pain, such as following a serious injury or following an operation.
Fentanyl is used to treat both short and long-term instances of pain. It may be used by patients dealing with:
- post-operative pain
- pain experienced by cancer patients
- chronic pain that is otherwise resistant to other opioid medications
Fentanyl is a prescription medication that is available at the discretion of prescribing clinicians. But prescription fentanyl is no longer the only version of the drug available. In recent years, illegally made fentanyl has appeared on the illicit drug market. This type of fentanyl is made in clandestine laboratories and is, therefore, not monitored or regulated. This carries a whole range of risks that stem from limited knowledge of what the illegally made fentanyl contains.
Most substances have more than one name. These names can be the slang or ‘common’ terms for a drug or specific brand names given by pharmaceutical companies.
Street names:
- Abstral
- Actiq
- Apache
- China Girl
- China Town
- Dance Fever
- Duragesic
- Fentora
- Friend
- Goodfellas
- Great Bear
- He-Man
- Jackpot
- King Ivory
- Lazanda
- Murder 8
- Subsys
- Tango & Cash
Fentanyl statistics
- Fentanyl is reported to be up to 50 times more potent than heroin and 100 times stronger than morphine, categorising it as an exceptionally powerful and, consequently, hazardous opioid.
- According to the CDC, the United States witnesses over 150 fatal overdoses involving synthetic opioids every day, with fentanyl-related deaths contributing to this alarming statistic.
- The surge in illegally made fentanyl (IMF) is believed to contribute to the concerning statistics. IMF, commonly cut with various substances like xylazine or combined with heroin and cocaine, poses unpredictable dangers as the composition of these illicit substances remains unknown until it is too late.
- Prescription opioids, including fentanyl, are still dangerous and are often linked to the development of addiction and experimentation with other substances.
- A meta-analysis examining the impact of prescription opioids on the American population revealed that between 2002 and 2011, 25 million individuals received opioid prescriptions. Shockingly, over 11 million of them “misused the medications” in some form, emphasising the widespread misuse and potential risks associated with prescription opioids.
Fentanyl: The chemistry
Fentanyl, a synthetic opioid derived from piperidine, is manmade and does not occur naturally in the opium poppy. Acting on the central nervous system stimulates mu-opioid receptors, altering pain perception by dulling intensity or temporarily eliminating sensation. This stimulation triggers the release of neurotransmitters, inducing feelings of happiness, relaxation, and reward. These pleasurable sensations, combined with pain relief, contribute to habit-forming behaviours and repeated fentanyl use.
The impact of fentanyl use
Opioid addiction is considered to be at epidemic levels worldwide. Whilst the opioid epidemic has historically been associated with America, opioid dependency is now visible across the globe. An estimated 16 million people are struggling with opioid addiction worldwide. Of these, 3 million are thought to be based in America.
Unfortunately, opioid use disorder (OUD) is also associated with a range of socioeconomic difficulties, including:
- financial issues
- unemployment
- homelessness
- criminality
These factors directly impact the individual and can make it difficult for individuals in certain areas of the world to access appropriate treatment. It can also contribute to strain in relationships and potential estrangement. Due to the link between addiction and loneliness, this can be particularly dangerous.
Fentanyl’s impact on the body
Opioids are known for their pain-killing abilities; they are also known for their sedative and relaxant effects. However, they also come with a range of potential physical risks. These can range anywhere from mild dizziness to the development of respiratory depression.
If you are using prescription fentanyl, it is important to speak with your prescribing clinician about what types of side effects to expect from the drug. If the side effects get too much, there may be ways to manage this.
If you are using illegally made fentanyl, it is more difficult to navigate the physical risks of taking the drug. That being said, it can be helpful to know, generally speaking, what sensations and effects to look for.
Short-term physical effects
- pain relief
- sedation
- dizziness
- itchiness of the skin
- nausea and vomiting
- urinary retention
- constipation
- respiratory depression
- loss of consciousness
- risk of overdose
- sharps related injury or infection
Long-term physical effects
- physical dependency
- withdrawal symptoms
- loss of consciousness
- development of bloodborne disease (contracted via sharps use)
- coma
- overdose
- tablets
- capsules
- patches
- powder
- ‘lollipops’
- sprays (to be used nasally)
- injectable solutions
Each mode of use could be associated with different harms; for example, injecting fentanyl could lead to sharp injury, whilst inhaling fentanyl powder could lead to nasal and sinus damage.
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Fentanyl’s impact on the brain
As an opioid, fentanyl primarily acts on our central nervous systems. That means that it primarily affects the functioning of the brain.
Short-term psychological effects
The short-term psychological effects of fentanyl are typical of the opioid high; they include:
- relaxation
- euphoria
- confusion
- drowsiness
Long-term psychological effects
- addiction
Addiction can have both physical and psychological elements. It is possible to be both physically dependent on a drug whilst also showing signs of psychological addiction.
Fentanyl: The law
In the UK, fentanyl is classified as a Class A controlled drug, regulated by medical professionals under The Misuse of Drugs Act (1971). Prescribed for severe pain, guidelines include following doses and usage instructions. Illegitimate activities face Class A drug penalties: possession up to 7 years in prison or an unlimited fine, and supply/production up to life imprisonment or an unlimited fine, or both.
Fentanyl: The history
Initial synthesis and early use
Synthesised by Dr. Paul Janssen in 1960 from mephedrone, fentanyl was initially intended to be chemically more manageable than morphine. Three years later, in 1963, it was first used clinically through injection, with American adoption occurring in 1968 for intraoperative analgesia, especially in high-risk surgeries. Fentanyl gained prominence as a crucial opioid analgesic, often replacing morphine in various medical contexts.
Development of the fentanyl patch
In the 1990s, the fentanyl patch emerged as a pain management solution, particularly for cancer treatment and chronic non-malignant pain. Known as a ‘transdermal patch,’ its slow-release action made it suitable for opioid-naive patients. While various fentanyl delivery methods, like nasal sprays and lozenges, have surfaced, the patch remains the most widespread.
Fentanyl misuse
Despite perceiving addiction as a modern issue, it has historical roots, including the misuse of fentanyl shortly after its medical introduction. Illicitly manufactured fentanyl has surged in the past decade, extending its availability beyond authorised channels. This amplifies risks, including counterfeit pills and concurrent use with substances like cocaine or heroin, as well as other prescription medications, both opioid and non-opioid.
Signs of fentanyl addiction
Chronic use of fentanyl can lead to the development of opioid use disorder. An opioid use disorder is characterised by increasing use of opioids, intense cravings and difficult withdrawal symptoms.
Withdrawals from fentanyl can include:
- cravings
- chills
- disturbed sleep
- feeling anxious, agitated or otherwise distressed
- goosebumps
- involuntary muscle movements (particularly in the legs)
- pain in the muscle or bone
- sickness and diarrhoea
There are signs of addiction outside of withdrawal symptoms. These signs can be found in all areas of life, whether physical, psychological or social.
Some of the key signs of fentanyl addiction include:
- social withdrawal
- suddenly engaging with new groups of people
- unpredictable changes in moods – sudden peaks of euphoria followed by deep depression
- anxiety or paranoia
- appearing to lie or become more deceitful
- feeling more tired but struggling to sleep
- losing weight
- financial struggles
- engagement with criminal activity
- struggling with meeting work or educational requirements
- conflict with family
- lower standards of personal hygiene
- aches or pains in the muscles
- headaches
- dilated pupils
- frequent instances of unexplained sickness, as though the functioning of the immune system has been lowered
There can also be additional signs when it comes to addiction to prescription medications. These may include:
- more frequent visits to the GP
- running out of medication ahead of time
- using more of a medication than is advised
- using prescription medications alongside other substances
- exaggerating instances of sickness and pain to obtain more medication
- asking friends and family to share painkillers (prescription or otherwise)
Treatment for fentanyl addiction
Some individuals dealing with addiction may be afraid to ask for support. This may be due to anxieties around the kind of attitude they may be met within a clinical context. Unfortunately, the stigma around addiction still exists. But in the specialist addiction sector, medical practitioners have a sensitive, pragmatic and fair approach to addiction treatment.
The most common approach for treating an opioid use disorder is through a combination of pharmacological and behavioural therapies.
Pharmacological support
Pharmacological support involves medication. A common type of pharmacological support is methadone maintenance therapy. It is dangerous to stop using opioids straight away. This is due to the unpleasant withdrawal symptoms they can cause. Instead, it is advised to speak to a clinician about your substance use. By doing so, you can access medicines that can help you manage withdrawals more safely.
Psychotherapy
You may think that once cravings are dealt with, addiction is cured. But that is not necessarily the case. For addiction treatment to have the best chance of succeeding, it is advised that individuals in rehab engage in some therapy.
For some people, traditional talking therapies can be the most beneficial. For others, treatment in the form of community support can be invaluable. Potential therapies and support options for fentanyl addiction include:
- Cognitive behavioural therapy (CBT)
- Dialectical Behavioural Therapy (DBT)
- Experiential Therapy
- Group Therapy
- Individual Therapy
- Psychodynamic Therapy
- Psychotherapy
- Self-Help Groups
These therapies can allow you time to reflect. This reflection can be a powerful way to help individuals struggling with addiction ground themselves, consider the risky behaviours they may have been engaging with, and find safer, healthier alternatives.
If you’re prepared to confront the challenges of overcoming fentanyl dependency, connect with a dedicated addiction specialist or consult your general practitioner to initiate your path towards recovery. Your commitment to breaking free from the grips of fentanyl is the first crucial stride towards a healthier and drug-free life.
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