More than 70,000 people died from drug overdoses in the United States in 2017, a record total according to the Centers for Disease Control and Prevention. That is about 12,000 more American deaths than the entire Vietnam War.
More than 28,000 of those deaths involved a powerful synthetic opioid—50 times more potent than heroin and 100 times more potent than morphine—called fentanyl.
Fentanyl is a synthetic (meaning it is man-made) opioid legally prescribed by doctors to treat moderate to severe pain, first developed for pain management treatment of cancer patients. According to the Centers for Disease Control and Prevention website, there are two types of fentanyl:
There are also fentanyl analogs, meaning different forms of fentanyl that are similar in chemical structure but more potent and more difficult to detect due to the requirement of specialized toxicology testing. For example, Carfentanil—the most potent fentanyl analog detected in the U.S.—is estimated to be 10,000 times more potent than morphine.
Fentanyl is a Schedule II narcotic under the United States Controlled Substances Act of 1970.
Fentanyl binds to opioid receptors in the brain just like heroin, morphine and other opioids. These receptors control pain and emotions, often resulting in intense pleasure and euphoria when fentanyl is ingested in the body.
Fentanyl effects include temporary feelings of euphoria, extreme happiness, drowsiness, nausea, sedation, constipation, and pupil constriction.
A more serious side effect of fentanyl is respiratory depression, meaning breathing either slows or stops completely. This inhibits the flow of oxygen to the brain—a condition called hypoxia—leading to brain damage, coma, or death.
Fentanyl contributes to nearly half of all opioid-related deaths in the United States, often ingested without the user’s knowledge. It is also responsible for overdose deaths involving non-opioid drugs. According to the National Institute on Drug Abuse (NIDA) website, it accounts for “40.3% of cocaine-involved overdose deaths; 31.0% of benzodiazepine-involved overdose deaths; and 20.8% of antidepressant-related deaths.”
NIDA adds that:
The authors (of studies related to fentanyl death rates) caution that lack of awareness about the potency of fentanyl, along with its variability, availability and increasing contamination of the illicit drug supply, poses substantial risks to people who use drugs.
They emphasize the need for widespread public health education and training of clinicians and first responders about fentanyl risks, suggest they be equipped with multiple doses of naloxone to reverse overdose, and call for expanded access to medication-assisted treatment for opioid addiction.
Fentanyl is also highly addictive. Users often experience rapid tolerance—that, is, needing more and more of the drug to experience a high—leading to dependence and intense withdrawal symptoms if drug use discontinues. Withdrawal symptoms include muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes, uncomfortable leg movements, and severe cravings.
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