Fentanyl is responsible for an epidemic of overdose deaths which are occurring at an alarming rate.

What is fentanyl?

First synthesized in Belgium in the late 1950s, fentanyl with an analgesic potency of about 100 times that of morphine, was introduced into medical practice in the 1960s as an intravenous anesthetic.

Today, fentanyl is extensively used for anesthesia and analgesia.  Duragesic, is a fentanyl transdermal patch used in chronic pain management.  Actiq is a solid formulation of Fentanyl citrate on a stick that dissolves slowly in the mouth for transmucosal absorption.  Actiq is intended for opiate-tolerant individuals and is effective in treating breakthrough pain in cancer patients. 

Illicit use of pharmaceutical fentanyl first appeared in the mid-1970s in the medical community and not only continuing to be a problem in the United States, but the problem is growing.  To date, over 12 different analogs of fentanyl have been produced clandestinely and identified in the U.S.  The biological effects of fentanyl are indistinguishable from those of heroin, with the exception that fentanyl may be hundreds of times more potent.

The danger with clandestinely manufactured fentanyl is quality control.  Illicit-drug chemists do not intend to harm users, a source of their income, but the chemist is mixing inconsistent batches of the drug and pressing pills with “hot spots” capable of providing lethal doses.

What is carfentanyl?

Carfentanyl (Wildnil) is an analog of fentanyl with an analgesic potency 10,000 times that of morphine and is used in veterinary practice.

Carfentanyl is a synthetic opioid that is 10,000 times more potent than morphine and 100 times more potent than fentanyl, which itself is 50 times more potent than heroin.  Carfentanyl is used as a tranquilizing agent for elephants and other large mammals and is often disguised as heroin; it is also missed with heroin, cocaine and other drugs.

Lethal dose comparison:

Why do people use fentanyl?

Fentanyl is abused for its intense euphoric effects.  This opioid can serve as a direct substitute for heroin in opioid-dependent individuals.  However, fentanyl is a very dangerous substitute for heroin because it is much more potent and results in frequent overdoses that can lead to respiratory depression and death.


What does fentanyl look like and how is it used?

Fentanyl Patches are abused by removing the gel contents from the patches and then injecting or ingesting these contents.  Patches are also frozen, cut into pieces and placed under the tongue or in the cheek cavity for drug absorption through the oral mucosa.  Used patches are attractive to abusers as a large percentage of fentanyl remains in these patches even after a 30day use.  Fentanyl oral transmucosal lozenges and fentanyl injectable products are also diverted and abused.

Vape Pens: Most recently, an investigation resulted in a discovery of a vape pen with upgraded components used to conceal and vape illicit fentanyl pills.  Modern vape pens have newly designed ceramic heating coils that offer a wide variety of user controls.  Some advanced vape pens have Bluetooth app-based customizable temperature settings and user controls.  Temperature settings can range from 200 degrees to 460 degrees Fahrenheit, depending on user preferences and the material being vaped.

Xanax Bars:  Xanax is a brand name for the drug alprazolam, which belongs to a class of drugs called benzodiazepines.  Alprazolam is used to treat anxiety and panic disorders as they act on the brain and nerves (central nervous system) to produce a calming effect.  The popularity of Xanax reached its peak when it was constantly referenced by hip[hop rappers in hundreds of songs, referencing it to “popping a Xan” or “Takin’ Xannies” to escape from reality.  In 2015, the existence of fake Xanax laced with fentanyl was first discovered by doctors when users came to the emergency rooms with traces of fentanyl in their blood.  The following are a few examples of Xanax bars containing fentanyl: