Fentanyl was developed in the 1950s, and since its approval by the Food and Drug Administration in the 1960s, it has been used as a powerful opioid painkiller for very select cases involving pain. Currently, fentanyl comes as a transdermal patch, injectable liquid, nasal spray, or lozenge. It is mainly prescribed to people who suffer from chronic pain or intense pain from an injury, especially if the person has become tolerant to other opioid medications. The drug is 50-100 times more powerful than morphine, however, so doctors are very strict about how this medication is prescribed.
Why and How Fentanyl Is Abused
Because fentanyl is an opioid medication, it binds to the opioid receptors in the brain and spinal cord to relieve pain. This can also create euphoria, or a “high,” which can become addictive, leading to abuse for some people.
Because fentanyl is so potent, the drug can cause dangerous side effects and lead to overdose very easily. However, the potency also makes it a target for illicit abuse and diversion.
The Drug Enforcement Administration (DEA) noted the first incidents of fentanyl diversion in the 1970s. In 2014, the federal agency noted that there were 6.64 million fentanyl prescriptions distributed legally. However, illicit uses of fentanyl have been on the rise.
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Legal Ways to Take the Medication
Legal fentanyl prescriptions come in a few forms. Brand names include:
- Actiq: This is a lozenge that is prescribed specifically for cancer patients who are struggling with breakthrough pain that cannot be controlled by other medications like Percocet or Vicodin. This medication is especially useful for patients who have difficulty swallowing.
- Duragesic: This is a transdermal patch that releases a dose of fentanyl into the bloodstream slowly through the skin. This is also good for patients who have chronic pain and difficulty swallowing. However, it is not used to treat pain that requires around-the-clock management.
- Fentora: This is a pill that treats breakthrough cancer pain.
- Lazanda: This is a nasal spray that acts quickly to stop breakthrough cancer pain in patients who have a tolerance to other opioid medications. It is especially useful for patients who have difficulty swallowing.
- Sublimaze: This is an injectable form of fentanyl.
All of these versions of fentanyl are tightly controlled by the DEA, FDA, state laws, and doctors’ prescribing practices. They have important medical uses, but the potent opioid content means they are also targets for abuse.
Illicit Ways Fentanyl Is Abused
Practically since fentanyl’s FDA approval, it has become a target for diversion and abuse. When the patches were invented, doctors began seeing people struggling with substance abuse problems steep the patches like tea. This bypassed the time-release aspects of the transdermal patch and gave the individual almost the full dose of fentanyl all at once. People would acquire fentanyl by stealing from family or friends, or purchasing it on the black market. Instances of crushing and snorting pills have been seen in law enforcement reports, as well as people turning the drug into a liquid and injecting it intravenously.
Street names for fentanyl include:
- Synthetic heroin
- China white
- Drop dead
- Dance fever
Between 2005 and 2007, an outbreak of fentanyl-related overdose deaths occurred because the drug was being used to lace heroin. Combining the two increased heroin’s strength, so a person who took heroin got a stronger high. However, this dramatically increased the risk of overdose and death. The DEA noted at least 1,013 confirmed nonpharmaceutical fentanyl-related deaths from overdose. Fentanyl was also found lacing cocaine.
More recently, beginning in 2013, designer fentanyl, or fentanyl analogs, have been found on the black market. These have dramatically increased the number of overdose deaths related to the drug. In some instances, fentanyl was disguised as other substances, from Pez candies to Xanax, which led to overdose in victims who did not even know they were taking it. Some of the more potent fentanyl analogs have been found to be 470-600 times more potent than morphine.
These drugs can rapidly lead to overdose, even in people who have developed a tolerance to opioids due to long-term use, addiction, or abuse. These illegally manufactured versions of fentanyl are so strong and dangerous that the DEA issued a warning about them in March 2015.
It is important never to sell a fentanyl prescription, or give it away, even to a friend or family member. This is called diversion, and it is a common way for people struggling with addiction to opioids to get their drugs. It is also important not to buy prescription medications without a legal prescription, even if the substance is allegedly a prescription medication like oxycodone or Xanax. The drug could be laced with other harmful chemicals or not be the substance advertised. This can lead to overdose and death.
For people struggling with opioid addiction, including addiction to fentanyl, it is very important to find a rehabilitation program immediately. These programs offer medical support to detox safely from the drug and also comprehensive therapy to effectively address the addiction issue.