How Dangerous Is Fentanyl Really? (& Why?)
Fentanyl is a synthetic opioid pain medication that is 50 to 100 times stronger than morphine, according to the National Institute on Drug Abuse. Fentanyl can be used to help patients with severe and chronic pain, particularly those who have developed a strong tolerance to other opioid medications. The drug is used to manage pain after surgeries and for other patients with long-term chronic conditions that require pain management.
Because the drug is so potent, even very small amounts can have serious impact. This can be an effective way to treat patients with painful conditions such as cancer, but it can be very dangerous when used without the supervision of a doctor. Even patients who take their medication as prescribed can develop a dependency on the drug incredibly quickly, making it difficult to stop use.
All opioid medications can be addictive, and fentanyl is a highly addictive drug. The Drug Enforcement Administration classifies fentanyl as a Schedule II drug, meaning that it is a drug that has a high potential for abuse and can lead to severe psychological or physical dependency.
What Are the Current Dangers of Fentanyl?
Public health officials have issued advisories warning about heroin and other drugs that have been cut with fentanyl and the dangers of overdose and death due to this combination. Drug dealers have been able to obtain fentanyl for the illicit drug markets by importing supplies from other countries or by manufacturing the drug themselves.
Because fentanyl is cheaper than heroin and cocaine, the use of fentanyl as a cutting agent has enabled dealers to increase profits exponentially. This trend has increased the amount of illicit fentanyl being introduced into illegal markets.
As a result, many people don’t realize they are taking fentanyl. They think they are buying heroin or cocaine, but the batch actually contains fentanyl. This often leads to overdose.
Fentanyl Involved in Overdose Deaths
Fentanyl has contributed to the 130 deaths from opioid overdoses every day in the United States. NIDA reports that synthetic opioids, mostly comprised of illegally purchased fentanyl, became the most common drugs involved in overdose deaths in 2016.
In 2016, synthetic opioids were implicated in 19,413 deaths in the United States, up from 3,007 just six years earlier in 2010. These alarming rates of synthetic opioid overdose deaths surpassed the 17,087 prescription opioid overdose deaths that year as well as the 15,469 heroin-related overdose deaths. Many of these overdose deaths involved a combination of substances, including cases where more than one opiate contributed to the deaths.
Unfortunately, many people who take prescribed opioid medications, such as fentanyl, become addicted. When it becomes too difficult to get their hands on prescription drugs, they turn to illicit sources like heroin to prevent withdrawal symptoms. The increase in heroin supplies being cut with fentanyl means that more of these consumers are at risk for a dangerous overdose.
What Are the Short-Term and Long-Term Effects of Fentanyl Use?
Fentanyl works in the same way as other opioid drugs — by binding to the opioid receptors in the brain and increasing dopamine levels, triggering a pleasurable reward response. This has the effect of reducing the sensation of pain and providing a sense of euphoria, relaxation, and pleasure.
While fentanyl can be a very effective medication for pain management, it comes with the potential for side effects, even with short-term use. Side effects from using fentanyl are similar to those associated with other opioids.
- Respiratory depression
There are also serious side effects.
- Changes in heartbeat
- Hives or rash
- Difficulty breathing
People with chronic pain conditions who have used opioids on a long-term basis will eventually develop tolerance and dependency, possibly leading to severe addiction. Opioids can trigger withdrawal symptoms with long-term use, and fentanyl is an extremely potent drug, which increases its potential to cause dependence and addiction.
Withdrawal symptoms from fentanyl can be very unpleasant and will typically begin within 12 to 30 hours after the last dose is taken. They include the following:
- Active tear ducts
- Excessive yawning
- Runny nose
- Muscle cramps
- Muscle pain
- Stomach cramps
Safe withdrawal from fentanyl requires medical supervisions and should always be conducted under the care of a doctor. Patients who are being weaned off the drug as part of their treatment plan will undergo a medical detox that typically involves tapering down the dosage and treating withdrawal symptoms with other medications to decrease the discomfort of the process.
What Makes Fentanyl So Dangerous?
Fentanyl is so dangerous, both because of its potency and potential for addiction as well as the potential for overdose, particularly when it is cut with other drugs. A study from the International Journal of Drug Policy notes that fentanyl is 40 times more potent at the point of the opioid receptor in the brain than heroin, but it lasts for a shorter duration.
According to the U.S. National Library of Medicine, fentanyl should only be prescribed by doctors who have experience managing pain conditions, and it should only be used for adults with breakthrough cancer pain who have a tolerance to opioid medications. Breakthrough pain refers to sudden episodes of pain that happen even when a patient is taking another regular pain management medication.
This is a very narrow recommendation, which indicates the seriousness with which the medication is regarded by the medical community. NLM further warns that fentanyl can cause serious breathing problems and death if used by people who are not tolerant of opioid medications.
Fentanyl is especially dangerous when obtained on the street or cut with other illegal drugs. There is no way for a consumer to control the amount of fentanyl that has been added to a heroin or cocaine supply. They will therefore have no way of knowing how powerful the drug they are taking is.
The Potential for Overdose
The rapid rise in fentanyl-related overdose deaths is another indicator of the dangerous nature of this drug. Users who believe they have a high tolerance for opioid drugs, such as regular heroin users, may quickly overdose on a supply that has been cut with fentanyl.
Emergency personnel who usually treat opioid overdose deaths with naloxone may not be able to reverse the effects of a fentanyl-related overdose with a typical dose of naloxone. This is why quick response times and the availability of naloxone are important factors in treating opioid overdoses. Multiple doses of naloxone may be needed in emergency situations.
Fentanyl should only be used under medical supervision and should only be taken as directed. Because of the serious risk of addiction and potent nature of the drug, only patients who meet the criteria for therapeutic use of fentanyl should consume this medication.
People who use illegal drugs, such as cocaine or heroin, should use fentanyl testing strips to test their drug supplies for the presence of fentanyl and should not consume any product that has been contaminated with fentanyl. The presence of fentanyl in any amount increases the risk of overdose and death for people who consume it outside of supervision from medical professionals.
Drug Scheduling. Drug Enforcement Administration.
Emerging Trends and Alerts. National Institute on Drug Abuse.
Fentanyl. (June 2016). National Institute on Drug Abuse.
Fentanyl and Other Synthetic Opioids Drug Overdose Deaths. (May 2018). National Institute on Drug Abuse.
Naloxone for Heroin, Prescription Opioid, and Illicitly Made Fentanyl Overdoses: Challenges and Innovations Responding to a Dynamic Epidemic. (August 2017). International Journal of Drug Policy.
Opioid Overdose Reversal with Naloxone. (April 2018). National Institute on Drug Abuse.
Perspectives on rapid fentanyl test strips as a harm reduction practice among young adults who use drugs: a qualitative study. (January 2019). Harm Reduction Journal.