What Everyone Needs to Know About Fentanyl

We have all heard about the opioid crisis and the dangers of fentanyl—but how much do you really know about this drug? Here are the basic facts about fentanyl to help raise awareness about the opioid epidemic and explain the increased dangers of using street drugs.

The Opioid Epidemic

According to the National Vital Statistics System (NVSS) there were 106,699 drug overdose deaths in the United States in 2021 (Spencer et al., 2022). To help us comprehend this number, consider that most NFL stadiums hold between 70,000-80,000 people. Thus in 2021, more than a full NFL stadium of people died from drug overdoses.

The majority of these drug overdose deaths involved an opioid, which is a class of drugs known for causing euphoria, relaxation, sedation, and pain relief. These drugs are derivatives or imitations of substances found in the poppy plant (opium poppy; DEA, 2020) and act on opioid receptors in the brain and body (Pathan & Williams, 2012).

Opioids can be natural (containing naturally occurring compounds from the poppy plant; e.g., morphine, codeine) or semi- or fully-synthetic (made in a lab via chemical synthesis; e.g., oxycodone, fentanyl; Pathan & Williams, 2012). These powerful substances are potentially addictive among some individuals, which has fueled the current opioid crisis.

There have been three major waves of the opioid epidemic in the United States beginning with prescription opioids in the 1990s (e.g., oxycodone), then heroin starting in 2010, and then synthetic opioids starting in 2013 (e.g., fentanyl; Commission on Combating Synthetic Opioid Trafficking [CCSOT], 2022). Given that many synthetic opioids are manufactured elsewhere and imported into the U.S., the illicit drug trade was declared a national emergency in 2021 (CCSOT, 2022).

Fentanyl: A Potent, Synthetic Drug

Fentanyl is a very powerful opioid, about 100 times more potent than morphine (CDC, 2023). It has been approved by the FDA for use as a pain reliever (analgesic) or anesthetic and is prescribed after surgery or among those with late-stage cancer (CDC, 2023; DEA, n.d.).

There are two forms of fentanyl: (a) pharmaceutical fentanyl (which is produced legally for medical purposes) and (b) illicitly manufactured fentanyl (which is nonpharmaceutical and illegally produced; CDC, 2023; Walters, 2023). Illicitly manufactured fentanyl is driving opioid-involved overdose deaths in the current drug crisis.

The fact that fentanyl is so potent means that less of the drug is required for users to experience the desired effects. In fact, it is estimated that three to five metric tons of fentanyl would meet all the opioid use demands in America for one year, compared to 47 metric tons of heroin (CCSOT, 2022).

In addition to its potency, fentanyl is comparatively easier and cheaper to make than other drugs. The fact that fentanyl does not require access to opium poppy plants, but rather requires the synthesis of chemicals that can be purchased online, makes it easier to manufacture (CCSOT, 2022; Sullum, 2023).

Additionally, other compounds exist that are similar to fentanyl, but not identical, called analogues. Fentanyl analogues vary in potency and one such analogue, carfentanil (which is used to tranquilize large animals such as elephants), is estimated to be 10,000 times stronger than morphine (Walters, 2023).

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A Potentially Deadly Adulterant

Fentanyl can exist in powder or liquid form, making it easy to mix with other street drugs (e.g., heroin, cocaine, methamphetamine), pressed into counterfeit pills/tablets, or dropped onto a blotter (CDC, 2023; Singh et al., 2020; Walters, 2023). When a drug is unknowingly mixed with another substance, it is called an adulterant (Singh et al., 2020). This process of adulteration occurs when a substance (like heroin) is laced with another substance (like fentanyl), unbeknownst to the user.

A person selling drugs may find it financially beneficial to add a small amount of fentanyl to another substance as a means of cheaply increasing the potency of the whole batch. The presence of toxic adulterants increases the overdose potential of street drugs, which may contain varying amounts of fentanyl (Singh et al., 2020).

Moreover, it is not possible to tell if a street drug has been laced with fentanyl by merely looking at the drug, so fentanyl test strips now exist. Individuals can test drugs before they use them by mixing a small amount of the drug in water, inserting a fentanyl test strip, and reading the results to ascertain if fentanyl is present.

Using fentanyl and its analogues to create counterfeit tablets marketed as something else (e.g., prescription opioids, benzodiazepines) or as adulterants in street drugs, helps explain the tragic increase in drug overdose deaths in the United States. One way to reverse an opioid overdose is to administer naloxone (in the form of a nasal spray or injection), which, as an opioid antagonist, can prevent death (Pathan & Williams, 2012; Walters, 2023), however much more than naloxone is needed to combat the opioid epidemic. When it comes to substance use disorders, quality treatment and effective prevention efforts are essential.

Why Would People Use Street Drugs in Light of Such Risks?

The definition of addiction is the compulsive use of substances or engagement in rewarding behaviors despite negative consequences (ASAM, 2018). Thus, impaired self-control is an aspect of the disorder (NIDA, 2020). Indeed, the use of drugs of abuse changes the brain (i.e., neuroadaptations) so that individuals feel that they need the substance to survive (NIDA, 2020). The prevalence of opioid use disorders in the United States is estimated to be between 2.04% to 2.77% of the population based on data from 2019 (Keyes et al., 2022). Thus, between 6.7 and 7.6 million people (Keyes et al., 2022) may be compulsively using opioids despite the risk of negative consequences, such as overdosing from fentanyl-laced street drugs.

Raising awareness about the risks of fentanyl is not enough to combat the opioid epidemic. Instead, a multifaceted approach is needed including, increased access to quality treatment for those with substance use disorders, increased evidence-based prevention efforts in schools and among young people to stop drug initiation, the implementation of early intervention for substance use, and continued efforts to stop the trafficking of illicit drugs into the country. The opioid crisis is a complex problem, and a complex solution is needed.