Opioid medications are the most potent painkillers available to doctors. They act on opioid receptors, which are found throughout the body and brain to reduce the intensity of pain signals reaching the brain.
There are three broad classes of opioid analgesic drugs:
- Natural opiates (such as morphine)
- Semi-synthetic opioids (such as hydromorphone)
- Fully synthetic opioids (such as fentanyl)
Fentanyl is a potent synthetic opioid analgesic similar to morphine but is 50 to 100 times more powerful.
It has legitimate medical uses, including anesthesia before surgery or other medical procedures—and patient-controlled analgesia after surgery—and for managing severe ongoing pain in people with cancer. Fentanyl works quickly to create a sense of euphoria or a “high,” which is why fentanyl has been an attractive street drug.
Although most opioids have been misused by being swallowed, snorted, or injected, the current outbreak of opioid overdoses in North America is primarily due to injecting fentanyl. It is often added to heroin in a powder form and makes its way into a user’s veins when a user injects heroin. Abuse of prescription fentanyl patches can also produce powerful effects similar to intravenous injection.
Fentanyl overdose deaths have skyrocketed over the past few years.
In 2019, synthetic opioids (other than methadone) accounted for more than 36,000 deaths in the United States, which is more than any other type of opioid. Synthetic opioid-related deaths increased by over 15% between 2018 and 2019, accounting for nearly 73% of all opioid-related deaths in 2019. The rate of overdose deaths involving synthetic opioids was more than 11 times higher in 2019 than in 2013.
Recently a new threat has emerged—a street version of an oral opioid analgesic called acetyl fentanyl which is chemically related to but not approved for human use or consumption. Because there is no legitimate medical use for acetyl fentanyl, it is being produced clandestinely for illicit distribution and sale on the black market. It can be mixed with heroin and other types of drugs.
The dangers of fentanyl
As little as 2 milligrams (the equivalent of a few grains of salt) can be lethal, and it is often laced with other opioids such as heroin.
Fentanyl is highly addictive, and withdrawal symptoms can begin within hours of the last use. Withdrawal effects include:
- muscle pain
- cold flashes with goosebumps (called “cold turkey”)
- kicking movements (pacing, rocking)
- uncontrollable emotions like anxiety or rage
The following are signs of fentanyl misuse:
- A strong opioid-like effect similar to heroin or morphine, but more powerful
- New onset of trouble breathing in combination with other indicators
- Extreme drowsiness, especially if combined with difficulty walking or talking
- Pinpoint pupils that don’t respond to light
- Nausea/vomiting or stomach cramping that does not improve even after the person tries to relieve it by sitting up and leaning forward
- Cold, clammy skin that is pale/sweaty
- Trouble breathing that may sound like snoring
The drug Naloxone (brand name Narcan) is an “opioid antagonist” medication used to block the effects of opioids, especially in overdose.
It works by binding to opioid receptors with higher affinity than agonists, effectively blocking them from activating the receptor without activating the receptor itself. Naloxone can be life-saving in cases of severe respiratory depression, especially if combined with immediate transport to an emergency room.
You can buy naloxone over the counter at your local pharmacy without a prescription in most states. If you suspect your loved one is using opioids, including fentanyl, have naloxone available.
If you notice the signs of fentanyl use, seek help immediately. If you suspect someone has overdosed on fentanyl, administer naloxone, and call 911 right away.
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