Figure 1: Fentanyl - C₂₂H₂₈N₂O
What is fentanyl?
Fentanyl is in a class of medications called narcotic analgesics and it is one of the most powerful opioids on the market. Its strength is helpful in treating severe pain however, like any drug, using it comes with many risks. Fentanyl is an opioid painkiller that shares similar properties and characteristics to other addictive painkillers, like morphine and methadone, but is nearly double in potency. In fact, variations and analogues of this powerful opioid can be up to 10,000 x stronger than heroin. Fentanyl and its analogues come in varying strengths, for example it is clinically used as a sedative for intubated patients but carfentanil, an analogue, is used to tranquilize large animals like elephants.
Because of its great potency, fentanyl should only be used to treat severe pain for someone undergoing cancer treatment or suffering from chronic pain. The patient would only be prescribed fentanyl if they developed a tolerance to other opiates that relieve pain. Even then, it should be taken with caution and under supervision from a professional as it is extremely addictive. It is very easy to develop an addiction to fentanyl if the drug is not used as prescribed. Fentanyl impacts the brain, tapping into the rewarding addictive properties that many drugs provide. This combined with the usual euphoric and relaxing effects make it very difficult to stop using this drug.
Fentanyl is known by many names. It can be prescribed and purchased by the names of Actiq®, Duragesic®, and Sublimaze®, while common street names might include Apace, China Girl, China Town, China White, and Dance Fever.
characteristics of fentanyl
Figure 2: opium poppy
All opioids, including fentanyl, have similar traits because they are all synthesized from the opium poppy. Though fentanyl originates from a plant it is considered synthetic because it is made from other opioids in a lab.
First developed in 1959, this addictive painkiller works by changing the way the brain and the nervous system interpret pain by targeting and activating the opioid receptors. These neuroanatomical structures are responsible for emotions, pain, and the reward mechanism. Fentanyl primarily acts at the 𝛍-opioid receptors in the neuron which react by producing analgesia, the inability to feel pain. Fentantyl passes through the brain’s tissues much faster than morphine and other painkillers because it is fat soluble. This characteristic has both its pros and cons because while it is helpful in quickly numbing pain, its instant gratification makes this drug highly addictive.
Fentanyl can be found in many physical forms. It is sold in the form of a transdermal patch that adheres to the skin, lozenges (fentanyl lollipops), tablets, oral and nasal spray. Illegally sold fentanyl and its illicit analogues take the shape as a white, granular, crystalline powder that can be melted into a liquid which is taken in the form of injection.
Figure 3: fentanyl patches
Effects of fentanyl
In general:
- Euphoria
- Relaxation
- Numbing effect
- It works well to quickly relieve intense pain
- It treats pain when other medications are ineffective
- It can be easily ingested: people experiencing copious amounts of pain may struggle swallowing pills
- May be effective in the treatment of epilepsy
- It comes with undesirable side effects: nausea/vomiting, itching, constipation, confusion, poor coordination, hallucinations
- Physical health effects: low blood pressure, abnormal heart rate, liver failure, troubles breathing - respiratory depression, seizures, skin problems - rash or hives
- Mental health effects: serotonin syndrome, depression and other mood disorders, opioid use disorder, dependency and addiction
Of course the most tragic side effect of using fentanyl is overdose, something that about 20 Canadians fall victim to daily. Canada is facing an opioid overdose crisis with a rising number of deaths from illicit drug supply. B.C. Coroner’s Service recorded that in 2021 there were a devastating number of 2,224 illicit drug related deaths in British Columbia. The number hit a drastic spike during the height of the COVID-19 pandemic.
Because fentanyl is more potent and less expensive than heroin, illegal manufactures mix fentanyl with other illicit drugs such as heroin to make more doses from a batch for a fraction of the price. Unfortunately, people who use drugs like heroin are unaware that it has been laced with fentanyl and are more likely to overdose.
Figure 4: A deadly dose of heroin compared to that of fentanyl
Preventing overdose
If suspect someone is going to or experience an overdose: stay with them, help them… you could save a life. If you are witnessing an opioid overdose, you may need to utilize a naloxone kit. These kits can come in the form of an injection or a nasal spray and work to keep the person conscious and breathing until an ambulance arrives. Naloxone is a fast-acting drug that temporarily reverses the effects of opioid overdoses. This reverse opioid overdose medication works by knocking the opioids out of the affected receptors and prevents them from returning. It is important to know that naloxone only works to prevent an opioid overdose and not an overdose caused by other substances such as alcohol. This is because naloxone works on the receptors which are only altered by opioids while other psychoactive substances target other parts of the brain.
Figure 5: What To Do If Someone is Overdosing
Anyone can carry a naloxone kit with them and can get one from a pharmacy without a prescription. Whether someone is using fentanyl recreationally or medically, they are at risk for opioid poisoning. Being prepared and educated is the first step in helping reduce the number of overdoses and bettering someone’s chance at survival.
How to utilize a naloxone kit
Treatment
Like any addiction, cutting out fentanyl in a “cold turkey” approach can be a difficult and miserable experience. Withdrawal from the drug, though not life threatening, can come with painful flu-like side effects. To avoid experiencing harsh withdrawal symptoms, patients are slowly tapered off the drug with professional supervision and aid. Detoxing in combination with therapy are the main focuses in treating an opioid addiction.
What are your thoughts?
Do you think that the government is doing enough to raise awareness and stop the ongoing opioid crisis in Canada? Does having naloxone readily available prevent overdoses or just encourage the use of opioids? What can we do to end the stigma around addiction so that people feel safe to reach out?
bibliography
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Figure 1: abcam. "Norfentanyl Structure." https://www.abcam.com/norfentanyl-metabolite-of-fentanyl-ab141662.html.
Figure 2: The Editors of Encyclopaedia Britannica. "opium poppy." Britannica, https://www.britannica.com/plant/opium-poppy.
Figure 3: ARKBehavioralHealth."fentanyl patches." arkbh, https://www.arkbh.com/opioids/fentanyl/patch/.
Cheung, Christopher. "Overdoses killed 10 times as many Bristish Columbians as COVID-19 in July." The Tyee, 25 Aug 2020, https://thetyee.ca/News/2020/08/25/175-More-Overdose-Deaths-July/.
Government of Canada. "National report: Apparent opioid-related deaths in Canada." Government of Canada, 11 Dec 2017, https://www.canada.ca/en/public-health/services/publications/healthy-living/apparent-opioid-related-deaths-report-2016-2017-december.html.
Figure 4: Bond, Allison. "Why fentanyl is deadlier than heroin, in a single photo." Stat News, 29 Sep 2016, https://www.statnews.com/2016/09/29/why-fentanyl-is-deadlier-than-heroin/.
Figure 5: MinutesMatter. "What Do You Do if Someone Is Overdosing?" https://minutesmatter.upmc.com/what-do-you-do-if-someone-is-overdosing/.
HSSCommunications. "How to Use a Naloxone Kit." Youtube, 31 May 2017, https://www.youtube.com/watch?v=OLZjmYPNxJE.
MedlinePlus. "Fentanyl", American Society of Health-System Pharmacists Inc. 25 Mar 2022, https://medlineplus.gov/druginfo/meds/a605043.html.
A Train Education. "Fentanyl: Scourge of the Opioids", 4. Pharmacokinetics and Pharmacodynamics of Fentanyl, https://www.atrainceu.com/content/4-pharmacokinetics-and-pharmacodynamics-fentanyl.
Public Health Infobase. "Opioid- and Stimulant-related Harms in Canada", Government of Canada. Mar 2022, https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants.
Ramos-Matos, Carlos F. et al. "Fentanyl", StatPearls, NCBI Bookshelf, Last Updated 18 Feb 2022, https://www.ncbi.nlm.nih.gov/books/NBK459275/.
Figure 1: abcam. "Norfentanyl Structure." https://www.abcam.com/norfentanyl-metabolite-of-fentanyl-ab141662.html.
Figure 2: The Editors of Encyclopaedia Britannica. "opium poppy." Britannica, https://www.britannica.com/plant/opium-poppy.
Figure 3: ARKBehavioralHealth."fentanyl patches." arkbh, https://www.arkbh.com/opioids/fentanyl/patch/.
Cheung, Christopher. "Overdoses killed 10 times as many Bristish Columbians as COVID-19 in July." The Tyee, 25 Aug 2020, https://thetyee.ca/News/2020/08/25/175-More-Overdose-Deaths-July/.
Government of Canada. "National report: Apparent opioid-related deaths in Canada." Government of Canada, 11 Dec 2017, https://www.canada.ca/en/public-health/services/publications/healthy-living/apparent-opioid-related-deaths-report-2016-2017-december.html.
Figure 4: Bond, Allison. "Why fentanyl is deadlier than heroin, in a single photo." Stat News, 29 Sep 2016, https://www.statnews.com/2016/09/29/why-fentanyl-is-deadlier-than-heroin/.
Figure 5: MinutesMatter. "What Do You Do if Someone Is Overdosing?" https://minutesmatter.upmc.com/what-do-you-do-if-someone-is-overdosing/.
HSSCommunications. "How to Use a Naloxone Kit." Youtube, 31 May 2017, https://www.youtube.com/watch?v=OLZjmYPNxJE.