It is the deadliest drug in the United States, and its use is spreading dangerously worldwide. It has become the drug of choice in several countries and is being used without control among certain segments of the population. Back in the 1970s and 1980s, products containing fentanyl and its analogues appeared and began to be known for the accidental overdoses they caused. Today, use of this drug has increased exponentially. It is a substance that is very easy to synthesise and can be obtained at a low price. This has led to an increase in clandestine manufacturing and recreational use.
What is fentanyl?
Fentanyl is a powerful synthetic opioid similar to morphine, used mainly in anaesthesiology, vascular surgery and intensive care medicine. It has an estimated analgesic potency 80 to 100 times greater than morphine, from which it is derived. It is a prescription medication that is sometimes prescribed to patients with severe pain, especially after surgery. It is also sometimes used to treat patients who suffer from chronic pain and have developed physical tolerance to other opioids. This tolerance occurs when the patient needs to take increasingly larger amounts of a drug, or needs to take it more frequently, to achieve the desired effect.
Effects of fentanyl
Like heroin, morphine and other opioid drugs, fentanyl works by binding to the body’s opioid receptors, which are found in areas of the brain that control emotions and pain. When opioid drugs bind to these receptors, they can increase dopamine levels in the brain’s reward areas, producing a state of euphoria and relaxation.
Fentanyl use causes a series of clinical effects:
- Analgesia
- State of euphoria
- Reduced ability to concentrate
- Progressive sedative effect
- Nausea and/or vomiting
- Hives
- Urinary retention
- Confusion
- Drowsiness
- Constipation
In cases of intoxication, fentanyl induces respiratory depression through a direct effect on the respiratory centre. It is also characterised by the rigidity it causes in the thoracic and abdominal skeletal muscles, leading to a coma. Detection of fentanyl in overdose cases generally appears associated with heroin in compounds produced entirely in clandestine laboratories. This increases the risk of adverse effects, tolerance and addiction.
The origins of its use
The appearance of fentanyl on the illicit market began in the United States in the 1980s, mainly in California. It was then that sudden deaths among users began to be documented. At first, they were attributed to an alleged mixture of very pure heroin. However, later findings revealed that another synthetic compound derived from fentanyl was responsible for these deaths. The synthesis of that compound was carried out in clandestine facilities.
When prescribed by a doctor, fentanyl is administered by injection, transdermal patch or tablets. However, fentanyl and fentanyl analogues associated with recent overdoses are produced in clandestine laboratories. This non-pharmaceutical fentanyl is sold in the following forms: as powder, added to blotting paper, mixed with or replacing heroin, or as tablets that mimic other less potent opioids. People can ingest, inhale or inject fentanyl, or they can place blotting paper in their mouths so that fentanyl is absorbed through the mucous membrane.
A drug on the rise
Health experts warn that fentanyl is the drug most commonly found in fatal overdose cases. For example, in 2017 in the United States, it was associated with 38.9% of all drug overdose deaths. This represented a considerable increase compared to the previous year. In Spain, this drug is sold in pharmacies, by prescription and under strict control, as transdermal patches or lollipops. Even so, this has not prevented it from being the fifth-highest consuming country in the world.
In addition, in recent years, more than a dozen fentanyl analogue products have appeared and entered the illegal opioid market. Some of them are butyrfentanyl, acetylfentanyl, ocfentanyl and furanyl fentanyl. All of them have a very high potential for harm. The reason lies in the countless possibilities for generating new compounds by introducing small changes in chemical structures. The proliferation of these compounds has led many countries to become engaged in a fight against the abuse of these substances.
Taking action against fentanyl
In the worst-case scenario, the user may suffer an overdose. Sometimes, the substance consumed may be fentanyl mixed with other drugs such as heroin, cocaine, MDMA and methamphetamine. This product is the result of the mixture that many dealers sell because, for them, doing so is cheaper. In these cases, it is difficult to know which of the drugs caused the overdose.
Naloxone is a medication that can help counteract a fentanyl overdose if administered immediately. This drug rapidly binds to opioid receptors and blocks the effects of opioid drugs. However, fentanyl is more potent than other opioids, such as morphine, and may require several doses of naloxone. Anyone who receives naloxone must be monitored for two hours after receiving the last dose of naloxone to ensure that their breathing does not slow or stop. This medication is available as an injectable solution (with a needle), as a hand-held auto-injector and as a nasal spray.
Developing an addiction through fentanyl use can only be reversed with the right treatment. Over our years of experience helping people and families recover, at CCAdicciones we have managed to combine several types of treatment, creating a specific model. The CCAdicciones model maintains a high recovery rate—higher than the average of other treatments—with 86% of patients recovered.
