Written by Lindsey Carnick
Fentanyl is an opioid analgesic drug. Opioid analgesics are incredibly potent substances that act on the central nervous system to drastically reduce the user’s perception of pain, in addition to creating a feeling of sedation and sometimes euphoria. Morphine, the medical precursor to fentanyl, and its deadly street drug counterpart heroin, are both derived from the opium plant. All three substances work on the same receptor sites in the brain. The CDC estimates that heroin-related overdose deaths have quadrupled since 2010, and the overdose rate from 2014 to 2015 increased by almost 21% to nearly 13,000 individuals; and fentanyl’s potency ranges from between fifty to a hundred times that of heroin.
Fentanyl is synthetically produced in laboratories (not from the Opium plant) and is available by prescription under three individual brand names. Fentanyl became available in a transdermal patch form in the 1990s, and was frequently prescribed for cancer patients. It has been increasingly prescribed as a pain management medication for surgical patients and patients with severe chronic pain who have developed a tolerance to other opioid medications due to prolonged use, or those who have acute breakthrough pain episodes that are otherwise not responsive to less aggressive medication therapies.
At low to moderate doses, opiates reduce the user’s perception of pain, induce drowsiness, and can create mild euphoria. Nonlethal side effects include nausea, vomiting, constipation, dizziness, and sedation. Physical and psychological dependence, as well as tolerance (needing more of the substance to achieve the same effects) are also common side effects of opioid use. All opioid substances are potentially lethal due to their impact on the central nervous system. Central nervous system depression is dangerous because it inhibits brain activity and subsequently slows the vital, automatic functions of the body such as breathing and heartrate, increasing the risk of coma and death. Fentanyl’s potency makes its potential for deadly physiological effects significantly higher than other opiates, particularly because users may not be aware of how much stronger fentanyl is than other opioid substances they may have used previously.
The development of newer and stronger pain management medications such as Fentanyl is both a result and a catalyst of a population that has an increasingly lower and lower threshold for pain tolerance. This is due in large part to overprescribing of opiate medications by a range of medical professionals from dentists to surgeons. Many of whom are largely unaware of substantial addictive and tolerance potentials of these substances. Opiate medications have resulted in a widely decreased pain tolerance in tandem with an increased tolerance (lack of response) to previously effective drugs, necessitating the development of stronger substances for the management of the same initial presenting problem.
Fentanyl has become increasingly attractive to individuals struggling with a number of opiate-misuse and dependency-related issues. Because of its potency, fentanyl users require less of the substance to achieve the desired result. Like any other substance of this strength, fentanyl is also extremely attractive to illicit street drug manufacturers, who use it to maintain the potency (and therefore the profit margin) of the drugs they are selling. Additionally, the strength of drugs cut with a substance as strong as fentanyl increases the likelihood that the purchasers of illicit drugs will be highly motivated to acquire more, often regardless of cost.
According to the Centers for Disease Control (CDC), fentanyl is increasingly responsible for the drug-related overdose deaths of persons using illicitly manufactured fentanyl, heroin, or other street drugs mixed with manufactured fentanyl. Deaths in the United States due to heroin and illicit opioids (fentanyl) were six times higher (over 20,000) in 2015 than in 2002, which suggests not only increased availability and consumption of street fentanyl, but also increased use of heroin by individuals addicted to but unable to obtain synthetic opiates. These two drugs alone were responsible for more opiate-related deaths in 2015 as all other opiates combined (18,000), which only increased by two times between 2002 and 2015.
The risk of death associated with illicit fentanyl use is high, and as with other opiates, there are other devastating consequences of misuse and abuse. Addiction and dependence frequently have severe and debilitating impacts on an individuals’ physical, emotional, mental, social, and financial health. Individuals misusing fentanyl may experience severe disruption in their relationships, as acquiring the drug frequently becomes users’ sole focus and interest, and the effects of the substance make it difficult to engage in relationships in a meaningful way. Users are often unable to maintain relationships with family, friends, spouses, and colleagues, and they often become reclusive. Dishonesty due to their addiction, along with feelings of guilt and shame are often prevalent. Accompanying behaviors such as lying and manipulation to obscure the abuse are also common. Drug addiction often results in severe financial quandaries. As the user seeks to maintain the feelings the drug creates, and, because of opioid tolerance, they require increasing amounts and/or concentrations to achieve the same effect. Finding the financial resources to secure more of the drug can severely impact the individuals’ intimate relationships as well as their attention to other financial responsibilities. Legal and criminal consequences often follow opioid misuse, as users become increasingly desperate to maintain their access to the substance and may engage in illegal activity directly (possession, dealing) or indirectly (stealing) related to the substance itself.
Opioid addiction creates tremendously painful emotional and physical challenges for individuals and their families. It is often intertwined with well-intentioned attempts by medical professionals to alleviate pain and suffering. Individuals are often hard-pressed to live with chronic pain conditions, and opioid tolerance creates a quandary for those who are seeking to live productive lives in spite of very difficult circumstances that often are beyond their control. Helping individuals get clean from opioid addiction has the added challenge of re-exposing the underlying condition that may have been the initial reason for opiate use and with decreased means of addressing it.
Due to the startling upswing in heroin and illicit opioid related deaths and law enforcement encounters, as well as the increasing numbers of persons seeking addiction treatment, the dangers of fentanyl are increasingly at the forefront of a national dialogue on responsible opiate prescribing practices and the pressing need for alternative pain management therapies. Educating providers about the dependence and tolerance potentials of opiate pain medications and establishing responsible prescribing guidelines and clinical best practices has become a priority for the professional organizations governing prescribers across the healthcare spectrum, from primary care offices to operating rooms. It will take a collective and concerted effort by healthcare providers, law enforcement professionals, public policy makers, and consumers to impact the public health crisis that has arisen from the remarkable development of these powerful drugs.
Fentanyl: Growing Use and Abuse
Written by Lindsey Carnick