Recent figures from Office for National Statistics (ONS) indicated that deaths from fentanyl and fentanyl derivatives in the UK have risen by nearly 80% between 2016 and 2017 and the deaths from variants of fentanyl, such as carfentanyl, have risen by a staggering 3,000%!

In 2016, close to 64,000 Americans died from opioids, roughly 32% of those deaths were from fentanyl alone.

What is fentanyl?

Fentanyl is a synthetic drug that is 50-100 times more potent than most opioids such as heroin, oxycodone and morphine. Doctors usually prescribe fentanyl for severe pain because of cancer or major trauma and for some medical procedures. Because of the strength of this drug, the dose must be very carefully monitored to make sure that the person does not overdose.

Prescription fentanyl comes in lozenges, buccal and sublingual tablets, nasal or oral sprays, as an injectable, and in a transdermal patch.

Carfentanyl is a variant of fentanyl, however, it is 100 times more powerful than fentanyl and 10,000 times more powerful than morphine. As it is the most potent commercially used opioid, carfentanyl is inappropriate for use in humans and is intended to be used as a tranquilizer for large animals such as elephants.

How is it abused?

When abused fentanyl patches may be sucked on, chewed, inserted into the body, or the gel can be scraped off the patches and injected. Tablets may be swallowed or crushed and snorted, smoked, or injected.

Fentanyl is sometimes used as a low-cost additive to increase the potency of other illicit drugs such as heroin or sold in tablet form as counterfeit medicines such as Oxycodone and Percocet.

Illegal fentanyl may also be manufactured in powder form or put on blotting paper to be placed under the tongue.

Dealer’s Perspective

From an illicit dealer’s perspective, fentanyl is a licence to print money. It’s easy to manufacture, easy to get and easy to distribute. Unlike heroin there is no cultivation of land for poppy plants, no growing period or complicated manufacturing process, is easy to transport and due to the potency and amount needed to get high it is highly profitable. One kilogram of fentanyl can produce approximately 1 million (1 milligram) counterfeit tablets, resulting in potentially £7.5 – £15 million in revenue.

Risks

Fentanyl is not a normal first entry drug i.e. it is very unlikely that this will be the drug of choice for the first-time user. More often than not it is being used by someone that already has an opiate addiction but whose tolerance has built up and they are looking for something that might just be potent enough to go beyond just stemming their withdrawal.

However, it is highly potent, so it is very difficult for people to know just how much they are extracting from the patch and injecting or taking by other means. Like all opioids such as heroin, fentanyl is a respiratory depressant – it interferes with the ability to breathe. Because it is so concentrated people can easily misjudge the dose for themselves to a dangerous degree and overdose, especially if they are using other substances such as alcohol or benzodiazepines at the same time.

It has been found that it takes only take 2-3 milligrams of fentanyl to induce respiratory depression, arrest and possibly death – visually 2 to 3 milligrams of fentanyl is about the same size as five to seven individual grains of table salt!

As mentioned above fentanyl and its analogues, due to their cheaper cost and higher potency, have been found mixed with heroin and other substances so even for established and new users alike there is a high risk of accidentally overdosing due to its inclusion.

Overdose

Naloxone is an antidote for opioid overdose. Immediately administering naloxone can reverse an opioid overdose but because of fentanyl’s purity and potency multiple doses of naloxone may be required to stabilise someone that has overdosed; so there is a need to continue to administer every 2-3 minutes until the individual is breathing on his/her own for at least 15 minutes, or until emergency services arrives.

Treatment

Like heroin prolonged use of fentanyl can result in a dangerous cycle of addiction i.e. the need to continue use in order to avoid the uncomfortable symptoms of withdrawal, using in higher amounts or more frequently to chase the high or just stem the symptoms of withdrawal. It does not take long for this process to seize control, causing individuals to prioritise their use over everything else that was once important in their lives.

Furthermore, due to the high potency of fentanyl and its analogues the risk of accidental overdose and possible death is incredibly high.

Just stopping taking fentanyl, going “cold turkey”, is unlikely to be fatal but the process is extremely uncomfortable and on its own very rarely results in long term abstinence. All too often people try to get better on their own, but this can be difficult and, in some cases dangerous particularly if there are other substances involved.

Therefore, if you or a loved one is struggling with a fentanyl addiction or is using opiates in an unprescribed way, it’s vital to seek professional treatment as soon as possible.

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