By German Lopez
December 21, 2017
Source: VOX
Photo / Image Source: Unsplash,
Fentanyl is, traditionally, a synthetic opioid used medically to relieve pain. It was first made in the 1960s, and since then it’s been adopted as a spray, patch, lollipop, and other mediums for pain relief.
As it appears in the illicit market, though, fentanyl is really a category for several synthetic opioids that function similarly. “We talk about fentanyl … but there are literally dozens of compounds out there that really belong in a class called fentanyls — fentanyl plural,” David Juurlink, a doctor who studies the opioid epidemic at the University of Toronto, told me.
So, it’s not just fentanyl that’s causing a spike in overdose deaths. It’s also analogs like carfentanil, which has also drawn media attention as it’s appeared in the illicit drug market.
Carfentanil is typically used as a sedative for large animals like elephants. Its use is widely considered too dangerous for humans; the Associated Press even described it as a “chemical weapon” because several countries, including the US, have actually prepared for its potential use in war.
Unlike heroin, fentanyl and its analogs can be made fairly easily in a lab. That makes fentanyl far cheaper to produce, without the hassle of growing opium poppy and then converting the poppy into morphine and then into heroin.
Over the past few years, fentanyl and its analogs have appeared in the streets, often laced into the illicit heroin supply. Law enforcement officials believe that most of this fentanyl comes from labs in China, where it’s produced without the supervision of US drug regulators and law enforcement officials who would very much like the drug to stop going to illegal recreational uses.
The drug is then shipped from China to the US, typically through Latin America. Along the way, it’s cut into heroin by drug traffickers and dealers, who can then make more money out of their newly cut heroin since it will have more kick for a lower dose.
Generally, fentanyl is described as anywhere from 40 to 100 times more potent than morphine and several times more potent than heroin. While it’s hard to get any good numbers for potency, Juurlink believes these descriptions are broadly accurate for fentanyl.
The measurement “is somewhat subjective,” he said. “People metabolize these drugs differently, so there’s always going to be variability. So whenever you hear a firm number, there’s always a fudge factor; it’s really an estimate.” But he added, “It’s probably pretty fair. In a hospital, I would give somebody 10 milligrams of morphine but only 0.1 milligrams of fentanyl.”
One way to understand just how potent fentanyl can be: It often negates naloxone, an antidote used to reverse opioid overdoses. While first responders can typically use one dose of naloxone to save someone’s life if she’s overdosing on common painkillers or heroin, they’ve found that multiple doses of naloxone can be needed to fight back a fentanyl overdose.
Now, none of this is to say that fentanyl is the only threat in the illicit opioid market. Heroin, by itself, is also pretty dangerous. Just look at the tens of thousands of deaths linked to it before fentanyl made a big entrance to the drug market in the past few years.
But fentanyl is more potent, and that makes it more likely to cause an overdose.
One of the things that makes these drugs so deadly is very often drug users don’t seek them out, instead buying drugs marketed as heroin that turn out to be fentanyl or at least laced with fentanyl or one of its analogs. So someone will try the same dose of “heroin” he’s always tried, only to end up overdosing because of the unexpected fentanyl adding far more than he can handle.
But there have also been reports of drug users seeking out these drugs, sometimes because they find out that the drugs are leading to more overdoses and figure that, therefore, they must be really potent.
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