History of Fentanyl
Prior to 1960, the only anesthetic pain medication available for people undergoing surgery was morphine-oxygen anesthesia. However, the risks involved with this type of anesthesia, especially severe respiratory depression and amnesia, led to extensive research into an alternative to morphine-oxygen anesthesia.
Discovered in 1960 by the founder of Janssen Pharmaceutica, Dr. Paul Janssen, fentanyl eventually became the alternative anesthetic doctors had been advocating for since the end of WW II. Marketed under the brand name Sublimaze, fentanyl – a powerful synthetic opioid – was approved by the U.S. FDA in 1968 as a general anesthetic strictly for the purpose of sedation and pain relief.
Fentanyl was later marketed in the 1990s as Duragesic, a transdermal patch intended to alleviate severe pain in people with cancer. The patch was followed by Fentora, a buccal (dissolve in the cheek) tablet, and the fentanyl "lollipop" sold under the brand name Actiq. Currently, fentanyl is listed as a Schedule II controlled substance by the U.S. DEA and can only be prescribed by a licensed physician.
Legitimate Medical Uses of Fentanyl
Prescribed for severe, post-surgical pain, breakthrough pain, and pain caused by late-stage or metastasized cancer, pharmaceutical fentanyl is currently available as a buccal, patch, and sublingual tablet (brand name Abstral).
Breakthrough pain is an intense flare-up of pain in people who are already taking prescription pain medication for cancer, arthritis, multiple sclerosis, or other serious chronic diseases. Fentanyl is a type of emergency last resort opioid analgesic provided to patients experiencing severe pain that does not respond to other medications.
Differences Between Fentanyl and Heroin
Heroin is made from morphine, an organic substance derived from poppy plant seeds. Fentanyl is a synthetic opioid made in pharmaceutical laboratories using the molecular formula C22H28N2O.
Fentanyl is a prescription opioid analgesic with legal medical uses involving anesthesia and pain relief. Heroin is an illegal drug with no accepted medical benefits.
The National Institute on Drug Abuse (NIDA) reports that fentanyl is up to 100 times stronger than heroin or morphine.
Minor differences between the chemical structures of heroin and fentanyl allow fentanyl to target opioid receptors in the brain much faster than heroin. This action is due to the ability of fentanyl to pass through layers of lipid tissue (fat tissue) located at the blood-brain barrier and elsewhere throughout the brain.
Narcan works better to revive someone overdosing on heroin than fentanyl. Increased doses of naloxone are usually needed to counteract a fentanyl overdose.
Fentanyl is significantly more deadly than heroin. Anne Milgram, the current DEA administrator, recently said in an interview that the DEA seized enough fentanyl in 2020 to "kill every single U.S. citizen".
Why Has Fentanyl Become So Prevalent?
The majority of fentanyl sold in the U.S.comes from China, where regulations overseeing the pharmaceutical industry have less control. China also exports other fentanyl products, such as fentanyl analogs and fake prescription medications cut with various amounts of fentanyl.
Fentanyl appeared in the U.S. sometime in the early 2000s. In 2014, U.S. border agents seized eight pounds of fentanyl at the Mexico-US border. In 2015, border agents seized a stunning 200 pounds of fentanyl. Although the amount of fentanyl confiscated at the border has dropped considerably since then, the nearly 6500 pounds of fentanyl seized in 2021 is more than the fentanyl seized in 2020 (4776 pounds).
Reasons for the long-term prevalence of fentanyl in the U.S. include:
- China continues to provide drug cartels with the chemicals needed to synthesize fentanyl.
- Fentanyl is 50 times denser than heroin, which allows smugglers to cheaply and efficiently transport more fentanyl to the U.S.
- Demand for fentanyl consistently exceeds the amount of fentanyl making it into the U.S. As long as there is a market for fentanyl, drug cartels will continue making huge profits from selling such a cheaply produced drug.
- Smuggling fentanyl is easier than smuggling "bulk" drugs like cocaine and marijuana. Most illegal fentanyl comes in pill form, which can later be crushed for injection purposes or crushed by dealers who use it to cut heroin.
- The number of counterfeit prescription pills cut with fentanyl has increased by over 400 percent since 2019. Many of these fentanyl-laced tablets contained enough fentanyl to significantly increase the risk of a fatal overdose.
- Over 75 percent of fentanyl analogs sold in the U.S. contain one or more of the following: acetyl fentanyl, carfentanil, cyclopropyl fentanyl, and furanyl fentanyl.
- One kilogram of fentanyl bought for $5,000 can be pressed into tablets containing about 1.5 mg of fentanyl. By selling one fentanyl tablet for $10, drug cartels and their dealers can make $6 million. That's a profit of approximately $5.4 million.
The following statistics are provided by the National Institute on Drug Abuse (NIDA):
- Nearly 43,000 fentanyl overdose deaths were recorded in 2020.
- Two milligrams of fentanyl can cause a lethal overdose, compared to 100 mg of heroin or 250 mg of cocaine.
- Overdose rates for fentanyl are increasing two and a half times faster than heroin overdose rates.
Knowingly ingesting fentanyl isn’t the only reason behind a skyrocketing number of overdoses and overdose deaths; another reason is that many overdose victims do not know they are ingesting fentanyl. A recent Wall Street Journal article reported that federal authorities seized over 20 million fake prescription pills (oxycodone, benzodiazepines) in 2021, with most of the pills containing fentanyl. People who think they are buying Valium or OxyContin from a drug dealer may actually be purchasing enough fentanyl to cause a potentially fatal overdose.
Outpatient Treatment and Ongoing Care for Treating Opioid Use Disorder
Outpatient treatment programs for people with opioid use disorder (OUD) allow them to continue working and living at home while going to daily psychotherapy sessions, substance abuse counseling, and receiving medication-assisted treatment.
Ongoing care is a comprehensive support service that focuses on relapse prevention therapy after a patient has finished an outpatient treatment program. Relapse prevention emphasizes recognizing "trigger" situations that could cause a person to start using opioids again. In addition, additional services and resources are offered to ensure patients are given all the tools they need to overcome their addiction and maintain their recovery.