By Dr. Edward A. Selby, Ph.D.
On the left, a lethal dose of heroin; on the right, a lethal dose of fentanyl. SOURCE: NEW HAMPSHIRE STATE POLICE FORENSIC LAB
Fentanyl is killing people, and most people don’t even know what the drug fentanyl is. In fact, in January 2021, in the United States, drug overdose deaths were reported for 94,498 individuals over the last 12 months. Many of these drug overdose deaths can be attributed to Fentanyl. In a study of 2019 overdose deaths, over 36,000 people died from fentanyl and the largest number of fentanyl deaths were seen in the western US (67.9% of overdose deaths) and northeastern US (43.8% of overdose deaths; Mattson et al., 2021). Given this incredible loss of life, public awareness of this dangerous drug is extremely important, and it’s vital for everyone to know what fentanyl is, even if substance use isn’t a personal issue. The rising prevalence of substance use in the United States is causing more people to come into contact with drugs (Glei & Preston, 2020), including fentanyl, and adolescents are also being exposed to fentanyl more frequently, resulting in severe medical outcomes such as hospital admissions in 35% of exposures (Allen et al., 2017). The COVID-19 pandemic has made drug overdose problems even worse, with overdose deaths rising over 29% between March 2020 and March 2021 (CDC, 2021). With increased public awareness of the dangerousness of fentanyl, and where people are most frequently exposed, we can work to reduce the number of lives lost to fentanyl and get people lifesaving treatments earlier.
What is fentanyl?
Put simply, fentanyl is a synthetic opioid drug in the same drug family as heroin, morphine, codeine, hydrocodone, oxycodone, and methadone. In its raw form, it’s a light, white powder. Fentanyl, along with the other drugs mentioned, is used primarily in the treatment of severe pain, such as post-operative surgical pain or pain arising from a severe injury or cancer. So, why is this single member of such a large drug family (opioids) responsible for so many deaths? Well, it all boils down to the potency of the drug, and fentanyl is incredibly potent. In fact, fentanyl is between 80-100 times more potent than morphine (DEA, 2021a). This means that just a small dose of fentanyl can result in overdose and potential death.
If fentanyl is so dangerous, why do people use it?
Fentanyl is a carefully controlled drug with multiple appropriate medical uses, such as transdermal patches (e.g., Duragesic, Abstral, Subsys brands). However, fentanyl is extremely addictive and the majority of US deaths from fentanyl use are not due to inappropriate medical usage, but rather illegal creation and distribution of fentanyl (DEA, 2021a). There is high demand in illegal markets for fentanyl, which when used for illicit recreational effects can cause a powerful high similar to other opioid drugs (e.g., heroin, morphine, hydrocodone). Because of the powerful euphoria that fentanyl can create, it is common for illegal drug dealers and distributors to mix fentanyl into heroin to increase the effects of the drug. In some cases, “cutting” another drug with fentanyl will work as intended, creating a powerful mixture of drugs. But in many other cases, if too much fentanyl is added to the mixture the drug composite can become dangerous or even fatal. There is a small margin of error, and unfortunately, illicit drug sellers typically do make the health of a consumer of their products a high priority.
Fentanyl has multiple additional “street names,” including: apace, China girl, China town, China white, dance fever, Goodfellas, great bear, He-Man, poison, and tango & cash (DEA, 2021a). Because of the high demand, illegal manufacture and distribution of fentanyl is big business. The bulk of illegally important fentanyl is imported from Mexico, China, and India, and in some cases, fentanyl or precursors to the drug are simply shipped or mailed into the United States (DEA, 2020). The illegal distribution of fentanyl-laced products is particularly worrisome given the increased potential for overdose, and as an example of this, the DEA reports that 42% of pills tested contained at least 2 mg of fentanyl, a dose considered potentially lethal (DEA, 2021b).
Dangers of fentanyl use in the home
It is also important to understand that because of the powerful effects fentanyl can have, it is being laced into more and more products, some of which might not typically be expected. This means that someone can be exposed to fentanyl when using heroin, cocaine, or even generic pills. This also means that even something simple like spilling a fentanyl-laced drug can cause hazards to others in the home and that even something as simple as a fentanyl-contaminated pin-prick or skin absorption of powder can lead to an accidental overdose, including fatal overdoses. Accidental exposure is particularly dangerous when youth are living in the house and especially with adolescents and young adults are using opioids. For example, children are facing increased exposure to fentanyl-laced candy and gummies (Fox, 2021), which could easily be fatal if a child found the candy or it was left out.
When it comes to substance overdose deaths it can be common to encounter dismissive attitudes toward those suffering from addiction, with some people suggesting that drug users harmed by fentanyl may deserve to be harmed by their drug use. But it is extremely important to consider that fentanyl can kill people on the first exposure, and exposure may be inadvertent (e.g., accidental ingestion, pediatric exposure, being given an unmarked pill for another drug without knowing it contained fentanyl or even accidental transdermal patch exposure). Therefore, knowledge about the signs of fentanyl exposure and overdose is necessary for any setting and may save lives even in unanticipated situations.
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