The opioid epidemic has steadily risen in intensity for the past decade. But in the past few years, something has caused a nearly exponential spike the number of opioid overdose deaths. Pharmaceutical companies are making more opioids now than they ever had in the past, and doctors are prescribing, and in some cases, overprescribing them.
Drug cartels also have flooded the U.S. black market with heroin, increasing its availability. Today, heroin is the most easily obtainable illegal drug after marijuana. Together, these factors have caused the steady rise in opioid overdose and addiction, but why has it spiked in the past few years?
The answer seems to be, at least in part, because of a synthetic opioid called fentanyl. In 2016, synthetic opioids including fentanyl were involved in 50 percent of opioid-related overdoses. Studies have shown that fentanyl is the most common synthetic opioid on the market. Fentanyl is a powerful opioid, and most opioid users don’t seek it out. However, dealers often mix it into adulterated heroin to give the impression of high power and quality.
Fentanyl is cheaper and easier to make and ship than heroin, so mixing it into weak heroin can be lucrative. It allows dealers to stretch heroin supplies without drug users noticing, at least in theory. However, fentanyl is so powerful that when heroin users who believethey have the genuine article take their normal dose, fentanyl can cause a severe overdose.
Fentanyl is a synthetic opioid that’s used in both medical and recreational settings. As a medication, it’s used for its qualities as a fast-active painkiller and is commonly used in epidurals during labor. Because labor can be unpredictable in terms of its timeline, a painkiller that can work within 10 minutes is ideal. Fentanyl is unique when compared to other opioids like morphine because it has a high transdermal bioavailability, which means it can be absorbed into the bloodstream through the skin under the right circumstances.
While it’s unlikely that contact with the chemical powder would get into your bloodstream, transdermal patches have been developed that work effectively. In medicine, fentanyl is carefully managed and used in tiny doses. The drug is considerably more powerful than typically prescription and illicit opioids. It’s about 50 times stronger than heroin and 100 times stronger than morphine. Synthetic opioids can be made to be incredibly more powerful than natural derivatives of the opium poppy. This is typically done to improve efficacy and cut down on the price. A fentanyl analog called carfentanil is 10,000 times more powerful than heroin, and it’s used to treat elephants.
Fentanyl works in the central nervous system in a way that’s similar to other opioids. The body has opioid receptors in several places. These receptors are designed to bind with naturally occurring opioids in the body called endorphins, which are released to ease pain. Endorphins block pain from being transmitted by binding to receptors at the site of pain, in the spine, and in the brain. Opioids are significantly more potent than endorphins and can cause euphoria, pain relief, and sedation.
Fentanyl causes effects that are consistent with other opioids, but it’s rare for users to seek out fentanyl over more common drugs like heroin or opioid pain medications. However, fentanyl is often found in other drugs, and can even be pressed into pill form.
Overdose is the greatest threat you face if you encounter fentanyl unknowingly, but if you do take fentanyl in a small enough dose to cause a high without causing an overdose, it can be a powerful euphoric high, that can lead to addiction.
Addiction usually comes with a few warning signs, and like most psychoactive drugs, it can start with tolerance and dependence. Tolerance occurs when the body becomes used to an opioid and starts to counteract it to balance out brain chemistry. As tolerance grows, you may start to develop a dependence on the drug. If you stop using or cut back, you may experience intense cravings and unpleasant withdrawal symptoms.
Because the drug affects the pain detection system all over the body, withdrawal symptoms are also felt throughout the body, often mimicking flu symptoms, which include:
Addiction occurs when the euphoric and positive feelings from drug use affect the reward center of your brain. According to the American Psychiatric Association, addiction is characterized by compulsive drug use despite the consequences. They say, “They keep using alcohol or a drug even when they know it will cause problems.”
If you are worried that a friend or family member might be struggling with addiction, there are some behavioral signs you might be able to notice, including:
Fentanyl is among the most dangerous drugs that recreational drug users might typically encounter because it is so potent. A small amount of fentanyl can cause a person to experience a fatal overdose, and it can be easily mixed into heroin or other drugs without detection. For most people, 2 milligrams to 3 milligrams is enough to be lethal. That’s about the same weight as a single snowflake.
However, fentanyl’s power is also what makes it attractive to drug dealers. Small amounts of the can be shipped without detection and still return a sizable profit. For instance, instead of shipping a large crate of heroin, you could ship similarly priced and powdered fentanyl in an iPhone 7 case. Fentanyl is mixed into heroin supplies, which allows dealers to cut heroin with inert substances to stretch profits without losing potency.
During an overdose, the opioid will start to suppress the nervous system to the point of causing dangerous consequences. Most people who die in an opioid overdose suffer from respiratory depression or slowed breathing. This can cause brain damage, coma, unconsciousness, and death.
Withdrawal symptoms are not usually fatal although they can be extremely unpleasant. In some cases, flu-like symptoms can cause vomiting, diarrhea, and sweating, leading to dangerous dehydration.
Fentanyl addiction and substance abuse involving all opioids are treated with a continuum of care starting with medical detoxification. Opioid withdrawal may not always be life-threatening, but the uncomfortable symptoms and risk of dehydration are severe enough that going through a detox program is the best method to begin your recovery. During detox, you can be given medications to ease symptoms and avoid any dangerous complications. Detox is also ideal if you have any other urgent medical needs.
After detox, clinicians can help you find the next level of care that is appropriate for your needs. Addiction is complex, and it requires a complex solution. That’s why a therapist will help you create a personalized treatment plan that specifically addresses your needs.
Addiction treatment often involves behavioral therapies, group therapy, and family therapy. Cognitive behavioral therapy is one of the most common options, and it works by teaching you how to identify triggers, how to cope with stress positively, and how to develop relapse prevention strategies.
American Psychiatric Association. (2017, January). What Is Addiction? Retrieved from https://www.psychiatry.org/patients-families/addiction/what-is-addiction
Bond, A. (2018, March 08). Why fentanyl is deadlier than heroin, in a single photo. Retrieved from https://www.statnews.com/2016/09/29/why-fentanyl-is-deadlier-than-heroin/
Centers for Disease Control and Prevention. (2018, May 29). Synthetic Opioid Overdose Data. Retrieved from https://www.cdc.gov/drugoverdose/data/fentanyl.html
National Institute on Drug Abuse. (2018, August 09). Overdose Death Rates. Retrieved from https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates
Science Direct. (2018). Fentanyl. Retrieved from https://www.sciencedirect.com/topics/biochemistry-genetics-and-molecular-biology/fentanyl