If you had never heard about fentanyl before the results of Prince’s autopsy were revealed, you are not alone. The drug has been around for more than 30 years but has managed to fly below the radar of most everyday Americans. Unless you are suffering from excruciating pain after surgery or from advanced cancer, fentanyl has probably been completely invisible to you. With the news now popping up about the number of fentanyl-related overdose deaths, how worried should you be?

Journey to the U. S.

Fentanyl is currently a Schedule II synthetic opioid used to treat chronic pain.[1] But this drug did not get its start in this country. It was first synthesized by Dr. Paul Janssen in 1960 in Belgium.[2] He and his group of chemists were attempting to develop analgesics (pain relievers) that would easily migrate into the central nervous system (CNS). The initial batches of fentanyl, which were produced for intravenous uses, were 100 – 200 times more potent than morphine in the animal subjects tested. Initially, Dr. Janssen would not get U. S. Food and Drug Administration (FDA) approval for fentanyl because of its potency. After a merger with Johnson and Johnson and the agreement to only use fentanyl in combination with other drugs, it was introduced to the U. S. in 1968. In 1972, fentanyl was approved for standalone use.[3]

A Patch, a Pill, a Snort and a Squirt

Initially, fentanyl was introduced as an injectable under tradename Sublimaze® in 1968. Since this introduction, it has been modified and reformulated. Currently, pure fentanyl and numerous analogs, which are developed by slight maneuvering of the basic chemical structure, are available. One of the most deadly analogs is acetyl fentanyl, which has been connected to a number of overdoses deaths in the United States.[4]

Pharmaceutical versions include tablets, pills, lozenges, nasal sprays, skin patches and even lollipops.

A distinction should be made between pharmaceutical fentanyl and non-pharmaceutical fentanyl (NPF), which is illicitly-produced and often mixed with heroin and/or cocaine to heighten its effects. Forms of the pharmaceutical versions include tablets, pills, lozenges, nasal sprays, skin patches and even lollipops. They are prescribed for pains associated with cancer, when other opioid medicines have proven ineffective, HIV- associated neuropathy and as an analgesic during and after various surgical procedures, including heart.[5]

Some of the specific brands include:

• Actiq® – Transmucosal lozenge (Placed between the cheek and lower gum then sucked)
• Abstral® – Sublingual tablet (Dissolved on the floor of the mouth)
• Duragesic®- Transdermal patch (placed on a healthy, unbroken skin location)
• Fentora® – Buccal tablet (placed between the cheek and gums)
• Lazanda® – Nasal spray

The U. S. Drug Enforcement Administration (DEA) recently issued a warning to law enforcement officials about the handling procedures. The deadly effects of fentanyl can be easily absorbed through the skin or accidentally inhaled if the powder becomes airborne.[6]

NPF comes from many sources and can be just as deadly as pure fentanyl. On the street, it has been sold as fentanyl, an additive in street heroin or completely camouflaged as another drug.[7] The Centers for Disease Control and Prevention (CDC), working with other agencies, developed a definition for an NPF-related death. It is defined as one in which:

• Fentanyl caused or contributed to it
• No evidence of pharmaceutical fentanyl was presented
• Toxicology testing confirmed fentanyl in the body[8]

Even pharmaceutical fentanyl can be used for illicit purposes. When patches are not properly disposed, leftover fentanyl gel can be extracted.[9] Guidelines have been established for the correct procedures for fentanyl disposal.[10]

The Path across the U. S.

Fentanyl has taken a circuitous route across the world and the nation since its inception in Belgium over 50 years ago. Abuse of the drug began recreationally in the 1970s,[11] appearing on the streets under names such as Apache, China Girl, China White, Murder 8 and TNT, to name a few.[12] It was initially just stolen from pharmacies, but was eventually used to lace cocaine and heroin to increase profits for illicit drug dealers. According to the CDC, one gram of pure fentanyl can be broken down into 7,000 doses for street sales.[13] The DEA estimates that a kilogram of fentanyl powder can be bought for $3,300 by drug traffickers and sold at 300 times the amount.[14]

Throughout the 80s and 90s, the DEA occasionally discovered illicit fentanyl labs, but the turn of the century and millennium ushered in an explosion of the drug’s popularity.[15] From 2005 – 2007, the CDC reported over 1,000 fentanyl-related deaths.[16] After a spike in fentanyl seizures in 2007, it appeared that the drug had faded away, but it made a strong comeback in 2014, leading the DEA to issue a nationwide alert in March of 2015.[17] Seizures of fentanyl have spiked in New Jersey, Maryland, Ohio, Massachusetts, Pennsylvania, Virginia, Florida, New Hampshire and Indiana.[18]

While illicitly produced fentanyl is being brought into the U.S. primarily by Mexican-based drug cartels, they are purchased directly from China, according to DEA reports.14 The drug is so potent that it is prescribed in micrograms instead of milligrams. When a drug with this level of potency is cut into heroin and prescription opioids, the results are often deadly. From 2013 to 2014, there were more than 700 fentanyl overdose deaths in the U.S.18 While Prince’s tragedy may appear to be unique, rising statistics show that it is anything but.

Protect Your Family from Opioid Addiction

One of the biggest differences between an addiction to a prescription opioid and an illicit drug is that a person can develop an opioid addiction by following doctor’s orders. When a person is using prescription drugs for pain over a long period of time, eventually tolerance sets in and stronger drugs and higher doses are needed. Typically a person needs painkillers addiction treatment to stop. It appears this was the unfortunate case with Prince.

If you’ve been taking more and more painkillers to find relief, or you’ve noticed someone close to you taking more prescription meds than seems necessary, it may be time to seek treatment. A tragic overdose is always a possibility when increasingly taking powerful opioids.

Our opioid addiction experts at our drug rehab in Palm Beach are fully versed in the dangers of fentanyl and other opioids and will create a personalized addiction treatment for you or an important person in your life. One of the biggest mistakes people make when dealing with addiction is waiting too long before seeking help. Make sure you and your family don’t make the same mistake by contacting our professionals today at 561-220-3981.