ALL YOU NEED TO KNOW ABOUT FENTANYL DRUG ABUSE

On April 21, 2016, legendary pop superstar and songwriter Prince was found unresponsive at his Paisley Park Studios outside Minneapolis. According to this report from BBC, the first responders pronounced him dead after several failed attempts to revive him.

After a month, the autopsy report from the Midwest Medical Examiner’s Office in Minnesota confirmed that the 57-year old performer had died from an accidental overdose of the opioid fentanyl, which is several times more potent than heroin.

The U.S. Drug and Enforcement Administration (DEA) had previously issued public warnings about the drug as several counterfeit versions have been found to be laced with heroin. Even when taken in small doses, fentanyl or fentanyl analogs could produce fatal results. According to the DEA National Heroin Threat Assessment Summary, more than 700 fentanyl-related overdose deaths were reported from 2013 to 2014.

The DEA noted that there has been a sharp increase in the numbers of fatalities resulting from fentanyl use in the recent years. For instance, Ohio reported 514 deaths in 2014 compared to 92 in 2013, while Maryland had 185 fentanyl use-related deaths in 2014 compared to 58 in 2013

What is Fentanyl?

Fentanyl is a prescription medication that is recommended for the treatment of 'breakthrough pain' characterized by sudden painful episodes that take place despite using another prescribed medication. They are prescribed for cancer patients aged 18 years and above but in some instances, they can also be used by patients who are at least 16 years old and are taking the lozenge brand called Actiq. It has to be noted though that Fentanyl should only be used by these patients if they are taking narcotic pain medications regularly and are tolerant to such medications. Fentanyl is classified as a narcotic analgesic that works how the nervous system and the brain respond to episodes of pain.

Fentanyl - also popularly known as its brand names such as Sublimaze and Duragesic – is a powerful synthetic opioid analgesic. At present, it is the strongest narcotic that is used in medical treatment. It is estimated to be 80 to 100 times more potent than morphine and about 40 to 50 times stronger than pure heroin, according to drugabuse.com. In its prescription form, it is used to treat or manage severe pain in cancer patients or individuals who have a high tolerance for other opioids.

History of Fentanyl

The very first Fentanyl was formulated by Paul Janssen in 1959 for his company Janssen Pharmaceutica. It was in the 1960s when it was sold as an intravenous anesthesia with a brand name Sublimaze. During the mid of the 1990s, Janssen developed the Duragesis patch by combining fentanyl doses in an alcohol gel. These patches were worn within the duration of two to three days as part of administering opioids in patients. From there, the lozenge Actiq was introduced. The most recent formulation, however, comes in an effervescent tablet that can be used for buccal absorption. This was then followed shortly by the development of the buccal spray device.

The pharmaceutical fentanyl was first synthesized by Paul Janssen in 1960 and it was used by clinicians as an anesthetic. In the following decades, it became available for personal use. Other formulations were developed and sold in tablets, sublingual sprays, and patches. By 2012, fentanyl had become the most widely prescribed opioids for chronic pain conditions.

The drug has a number of fake versions which have been clandestinely manufactured in laboratories. These are sold by drug dealers in the black market as cheaper alternatives to the real prescription drugs. Drug makers are also known to mix heroin powder with fentanyl. This combination goes by several names such as Apache, China Girl, China White, Dance Fever, Goodfella, Cash, Murder 8, TNT, and Tango.

Prescribed Medical Uses

Fentanyl comes in different forms thus having several medical uses

Intravenous fentanyl (Sublimaze) is often used as an anesthesia in combination with sedatives and is administered prior to performing certain surgical and medical procedures. It is also prescribed to cancer patients who experience chronic pain. It can also be used alongside benzodiazepines to sedate patients who will undergo cardiac catheterization, oral surgery or endoscopy. It is also used as an analgesic. As an analgesic, it is more often used in managing chronic pain in cancer patients.

The fentanyl transdermal patch (Durogesic/Duragesic/Matrifen) is used to treat severe pain that usually follows surgery. Skin patches are also prescribed for opioid-tolerant patients. When the patch is applied to the skin, it delivers fentanyl to the bloodstream in small amounts and it may take up to 24 hours before the full dose begins to work. The medication must be used with extreme caution and under the direction of a physician.

Fentanyl lozenges (Actiq) comes in the form of lollipops that are dissolved slowly in the mouth. When consumed within 15 minutes, the lollipop delivers fast results. This is also prescribed for cancer patients and those with an increased tolerance for other opioid analgesics.

Fentanyl is also sold in intranasal formulations (Lazanda). These are used in the treatment of postoperative pain, procedural wound care, cancer-related breakthrough pain, and pediatric orthopedic trauma pain or children suffering from a range of moderate to severe pain.

What Are Fentanyl Analogs?

Clandestine laboratories produce variations of the drug sold in the black market. The effects can be more potent pure fentanyl itself. Some people may not even be aware that they are purchasing drugs that have been chemically adulterated. Ingesting these substances places them at a high risk of adverse effects such as respiratory depression, overdose, coma, and death.

Some of the fentanyl analogs include alfentanil (Alfenta), Brifentanil, Butyrfentanyl, 3-Allylfentanyl, 3-Methylfentanyl, 3-Methyl-thiofentanyl, 4-Phenylfentayl, Acetyl-α-methylfentanyl, Acetylfentanyl, α-Methylfentanyl, β-Hydroxy-3-methylfentanyl, β-Hydroxyfentanyl, ρ-Fluororofentanyl, Carfentanil (Wildnil), Diampromide, Lofentanil, Orcefentanil, Ohmefentanyl, Mirfentanil, Para-fluorofentanyl, Phenaridine, Remifentanil (Ultiva), Sufentanil (Sufenta, Sufentil), Thiofentanyl, and Trefentanil.

While most of these identified analogs have been banned or are currently listed among DEA’s controlled substances, some laboratories have found ways to tweak the chemical structures of the drug to come up with new versions. This makes it easy to import, market, and sell other adulterated versions of fentanyl without being detected.

In April, it was reported that a new analog called furanyl fentanyl was circulating in the U.S. In fact, it accounted for the fatal overdose of a 30-year-old man in Chicago, Illinois.

Fentanyl for Recreational Use

While Fentanyl was introduced in the market purposely for the benefit of those wanting to manage chronic pain, it cannot be denied that it has been illicitly used by many people both in the medical community and those outside the medical profession. In the mid-70s, its illegal use was recorded and this continues to this day with most of them identified with drug trafficking in the US.

The abuse of Fentanyl led to its availability in the market as a recreational drug. It is often referred to as 'China White' and is formulated as acetyl fentanyl as identified by the Centers for Disease Control and Prevention (CDC) and that of Rhode Island public health officials. This form of fentanyl is not actually sold as a drug anywhere in the world but rather as a minor impurity combined with the usual prescription fentanyl drugs.

Fentanyl prescription drug abuse led to its classification as a Schedule II drug in the US. As such, it is characterized as an illegal drug when it is not sold under DEA license and when it is bought without any prescription.

Fentanyl Drug Abuse

Fentanyl works by binding the opiate receptors in the brain to reduce the perception of pain. Like most opioids, it induces a sense of euphoria and relaxation. Its potency and high potential for abuse require that it is used under the direction and close supervision of a licensed medical practitioner.

However, it is also sought by opioid addicts for non-medical purposes due to its pain-relieving and euphoric effects. Some illicit drug manufacturers produce counterfeit pain prescription pills that actually contain fentanyl. These are sold as less expensive versions of the pharmaceutical ones. According to the DEA, there are more than 12 varieties of drugs that have been illegally produced that resemble fentanyl.

Other drugmakers mix heroin with fentanyl to amplify the effects. They sell the combination in powdered form. Users are often unaware that they are not consuming pure heroin. The mixture of fentanyl and other drugs is lethal and it produces effects that are hundreds of times more powerful than street heroin. It is extremely dangerous for individuals who do not have opiate tolerance because of the fast absorption of fentanyl powder. Its consumption has led to numerous deaths due to fentanyl overdose.

Facts about Fentanyl Prescription Drug Abuse

Fentanyl is known by other names aside from China White. It can be referred to as China girl, dance fever, good fella, Tango and Cash and friend among others. It is listed under opioids and morphine derivatives in the Commonly Abused Prescription Drugs Chart. Here are other facts to know about fentanyl prescription drug abuse:

  • In 2007, the DEA found out that Fentanyl has been associated with the death of over 1,000 people. This was a result of the abuse or misuse of the prescription.
  • A report from the National Institute on Drug Abuse or NIDA states that overdose from fentanyl use is commonly a result of a mixture of the substance with that of the powdered form of heroin. Since unmixed fentanyl is said to be up to a hundred times more potent than that of morphine, expect that its combination with heroin will produce greater adverse effects including the possibilities of fentanyl overdose. Such can produce drowsiness, lack of alertness, lightheadedness, dizziness and fainting among others.
  • Misusing Fentanyl can result in physical dependence on the part of the user. This will result in addiction that when the dosage is minimized then the user will experience withdrawal symptoms. Such symptoms may vary from one person to another but would definitely produce detrimental effects both mentally and physically. Among such effects are chills, loss of appetite, hot flashes, rapid breathing, night sweats, irritability, muscle aches and confusion. Such symptoms will be greater in individuals who have been taking large doses of the prescription drug for a longer period of time when compared to those who take them in smaller doses for a shorter span.

Fentanyl Prescription Drug Abuse Statistics

Statistics have a lot to say about the increasing abuse of fentanyl over the years. The following figures would speak about the prevalence of fentanyl prescription drug abuse all over the world:

  • The European Centre for Drugs and Drug Addiction said that trafficking or sale and distribution of fentanyl has increased especially in countries found within the Russian Federation and those bordering the Baltic Sea. While strict regulations have been made as to the distribution of this substance, Fentanyl has been continuously prescribed as a medication with over 7.6 million prescriptions in 2008 alone.
  • The combination of heroin with fentanyl has resulted in an increased number of deaths across the country including Chicago, Detroit, St. Louis, Philadelphia, Camden, New Jersey and Pittsburgh. This is alarming considering that the US has an approximation of up to 500,000 people addicted to heroin alone. Fentanyl-laced heroin must have increased that number through time.

Legal Issues with Fentanyl Prescription Drug Abuse

There are supposed heroin overdose cases in the US that are not really a result of taking heroin but were actually an end-product of taking in acetyl fentanyl in large doses. This opiate that is commonly mixed with some other street drugs is marketed as heroin that is why whenever an overdose case is reported; it is often classified as heroin overdose instead of it being a fentanyl overdose. What makes it even more frightening and threatening is the fact that users are not actually aware that they are ingesting a prohibited substance.

What makes the abuse of such drugs even more alarming is the fact that they have been subjected to a list of illicit uses. Take for instance the fentanyl patches whose gel contents are removed before they are either injected or ingested by the user. Some of these patches have even been frozen then cut into pieces before they are placed and dissolved under the tongue. While the drug has been classified as Schedule II substance by the DEA under its Controlled Substances Act, Indiana has classified some of the many fentanyl derivatives under Schedule I instead.

In order to solve the issues arising from fentanyl prescription drug abuse, the FDA recommends flushing of unused fentanyl medications like Abstral, Actiq, Duragesic, Fentora and Onsolis in order to help prevent its possible threats to people and pets. Here is a complete list of medicines for flushing including the aforementioned drugs with Fentanyl or its derivatives as active ingredients.

Signs and Symptoms of Fentanyl Use and Abuse

Fentanyl can have several adverse side effects and as such, it must be administered with utmost caution to prevent overdose or tolerance. It is important to know how to recognize the signs of fentanyl use so the person taking it may be medically assisted before fatal overdose occurs.

Some of the immediate symptoms of fentanyl use include drowsiness, dizziness, fainting, headache, abdominal pain, loss of appetite, weight loss, nausea, vomiting, fatigue, itching, constipation, urinary retention, sweating, shaking, swollen hands and feet, confusion, lack of focus, decreased alertness, anxiety, depression, and hallucinations.

A person who abuses fentanyl has an increased tolerance for the substance and will consume larger amounts of the drug to get the desired results. He is also likely to develop an addiction that is characterized by compulsive use of the drug despite knowledge of its dangerous consequences. Some of the signs of fentanyl abuse are severe gastrointestinal problems, weakened immune system, difficulty in breathing, seizures, paranoia, delusions, lack of motivation, social withdrawal, and, personality changes.

Health Risks

When a user develops a dependence on the substance, he will experience withdrawal symptoms whenever he attempts to quit using the drug. Among these unpleasant effects are dilated pupils, vomiting, diarrhea, clammy skin, runny nose, hot and cold flashes, chills, loss of appetite, anxiety, insomnia, restlessness, irritability, agitation, and severe generalized pain. These symptoms can begin to manifest within 12 hours from the last dose of fentanyl and can last for a week.

Drug addiction or chronic use places the user at increased risk of having an overdose. The symptoms of overdose are manifested physically and are easy to note. These include difficulty in swallowing, seizures, clammy skin, severe drowsiness, unresponsiveness to painful stimuli, fainting, extreme fatigue, low blood pressure, slowed heartbeat, and respiratory depression. Respiratory depression is among the most dangerous effects and when not medically addressed immediately, the user can go into a coma or die from toxicity.

Overdose Treatment

It is crucial that overdose treatment is administered immediately to prevent fatal complications. If the overdose is caused by a skin patch or a lozenge, the first step is to remove these right away to prevent the body from absorbing more amounts of the substance.

Medical professionals may also pump the user’s stomach to rid the system of the drug before it is absorbed into the bloodstream. While this cannot treat the overdose, it can help to avert further damage to the other organs of the body.

In most cases, an antidote called Naloxone is administered in emergency rooms or hospitals. The formulation of Naloxone is intentionally designed to reverse the effects of opioid overdose. It is fast acting and can reduce the depression of the patient’s central nervous system within a few minutes.

Fentanyl Use Detection

Opioid Drug Test Dip Card

The length of time that fentanyl remains in the body depends on several factors such as the user’s age, genetic makeup, body fat percentage, hydration, metabolic rate, and hepatic function. Routes of administration and dosages also influence how long it takes to be eliminated from the system. In the case of transmucosal and transdermal formulations, fentanyl remains in the body and is detectable within 5 days from cessation of use.

Opioid and fentanyl use may be detected by using various testing methods including urine, saliva, sweat, and hair.

The most common method of testing is urine, which checks for the presence of fentanyl and two of its metabolites called norfentanyl and despropionylfentanyl. Test Country’s Instant Fentanyl Synthetic Opioid Drug Test Dip Card can specifically analyze and detect the usage of opioid fentanyl in minutes.

Treatment of Fentanyl Abuse

The treatment approaches for fentanyl dependence and addiction are the same as those used for opioid abuse. The recovery process includes several components and begins with detoxification. It is important that a qualified medical professional oversees the detoxification process to ensure that the withdrawal symptoms are managed properly and that the user’s body is cleared of the drug in a safe manner.

Some treatment facilities implement various practices to help the patient recover from the withdrawal effects. These may include the administration of certain medications and nutritional supplements to relieve his physical symptoms. The user may be asked to do some mental exercises to help clear the persisting mental fog caused by drug residues and to direct his mind towards recovery.

After the detoxification period, the user is enrolled in an intensive rehabilitation program. The program incorporates several behavioral therapies that aim to guide the patient in identifying the causes of his addiction, recognizing high-risk situations that could lead to relapse, and helping him strengthen his motivation to abstain from drug use.

Counseling sessions may integrate various approaches such as cognitive behavioral therapy, family support sessions, 12-step recovery programs, and self-management and recovery training (SMART).

Most rehabilitation centers also include skills training and workshops to help the patient develop life skills which will allow him to cope with the challenges of being integrated back into society as an actively contributing member.

In cases of severe fentanyl or opioid abuse disorder, it is strongly recommended that the user undergoes a residential rehabilitation program to ensure that he is under the supervision of experts and that he is isolated from environmental influences that can hinder his recovery.

Most inpatient treatment programs last between 30 to 90 days. Rehabilitation is often followed by outpatient counseling and support groups for maintenance therapy.

Final Word

Fentanyl is by far the most potent and dangerous of all the prescription opioids. Taken by itself, it can produce several undesirable effects that include tolerance and addiction. Even doctors are advised to take precautionary measures in directing the use of the substance.

Illicit use of fentanyl poses even greater harm as it is often adulterated with other drugs or compounds. Those who purchase pain pills or similar substances from the black market put themselves at greater risk of severe complications and fatal overdose. The warnings of authorities should be heeded at all times to avoid the dangerous consequences of fentanyl abuse.

Fentanyl users have common reasons why they resort to substance abuse when they are asked. They want to either get away from their problems or have the sense of belongingness and have fun. What comes with this addiction is losing integrity and credibility. With that, drug addiction has been linked to so many crimes that even family members are not spared.

Unless we take a step in helping these individuals, more people will succumb to drug abuse, which can lead to the total destruction of the community.


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