Fentanyl is a synthetic opioid that is utilized in medical practice as a powerful pain reliever. It’s most commonly used in clinical settings either prior to surgery to induce sedation before administering longer-lasting sedation or in the recovery room following surgery for immediate pain relief. Fentanyl is very potent and effective to relieve pain, but it has a short duration of action—one to two hours at most, and often less than one hour.

The drug is also used to relieve extreme pain outside of the clinical setting via a drug patch applied to the skin. This transdermal patch slowly releases fentanyl over a 72-hour period. When I practiced pharmacy in an out-patient setting, a significant number of patients came to my homecare services sporting fentanyl patches as part of their overall pain relief plan while our nursing support administered intravenous medications for a variety of ailments that caused the extreme pain.

As commonly as fentanyl is in both the clinical and non-clinical settings, its reputation has taken on a more ominous one as a “filler” to “cut” heroin as well as other opioid and some non-opioid drugs. Over the last few years, fentanyl has been found as a filler in the party drug cocaine, and this is considered by drug law enforcement as a “game-changer.”

Courtesy of the New Hampshire State Police Forensics Lab

The reason for this enhanced apprehensiveness is somewhat complex, but a central concern is why people abuse heroin vs cocaine and the type of users who abuse these drugs. Heroin, an opioid from the poppy flower plant, is a depressant drug. Heroin is the type of drug that gives a sustained “buzz” and a heroin abuser often has a greater tolerance to opioid drugs. Although fentanyl-laced heroin is an extremely dangerous combination, drug overdoses have not been as extreme as in cases of fentanyl being added to cocaine.

Cocaine is a stimulant drug, a non-opiate from the coca plant, that gives a short-term euphoric effect—thus, its popularity as a party drug. When fentanyl is mixed into cocaine, that becomes the “game-changer,” as law enforcement agencies suggest. Cocaine users are more casual drug abusers, with a lesser chance of long-term addiction. The addition of fentanyl changes those dynamics, and that becomes a lethal combination.

Now it appears that drug-using party animals who use cocaine casually and occasionally have become unsuspecting victims with the progression of fentanyl into street drug mixes.

A 2016 study of overdose deaths in New York City revealed that 44% of the 1,300 overdose deaths involved fentanyl and 37% of those OVERALL overdose deaths involved a fentanyl-cocaine mix—that’s 84% of the lethal overdoses that involved fentanyl and that represents an increase of 11% over the previous year.

Synthetic opioids, such as fentanyl, are cheap to make, are easily available on the dark web and become extraordinarily profitable for illicit drug distributers. Heroin-fentanyl on the street costs a fraction of what prescription painkillers cost on the street. Although much focus has been given recently in news broadcasts regarding prescription opiate abuse and overdoses, most of the deaths are seen with illicit opiate abuse—as with the synthetic opioid fentanyl and fentanyl-laced street drugs.

Fentanyl is an extremely potent and dangerous drug when not used properly. Although heroin is about three times more potent than morphine (the so-called “standard” used for pain-relieving drug potency), fentanyl is up to 100 times more potent than morphine.

The initial symptoms of an overdose include pinpoint pupils, muscle weakness, dizziness and confusion. The symptoms progress to a profound decrease in heart rate and very low blood pressure, with eventual loss of consciousness. Extreme respiratory depression and a dangerously slow heart beat lead to lack of oxygen to the brain (and potentially lethal hypoxia) that can exhibit as permanent brain damage.

If your next storyline involves a drug overdose, a fentanyl-laced drug might be an interesting and timely addition to consider.

Thoughts? Comments? I’d love to hear them!