Since about 2013, the dramatic spike in the number of opioid overdose deaths has been mainly attributed to the presence of fentanyl in the nation’s drug supply. That trend is reflected in Massachusetts, where data from the Massachusetts Department of Public Health shows the percentage of opioid-related overdose deaths in which fentanyl was present steadily increased from 41.9% in 2014 to 93.2% in 2019 and 91.8% in 2020. Figures from 2021 are not yet available.
Fentanyl is not only found in illegally manufactured opioids, but increasingly is present in other white powder drugs sold on the streets including cocaine, methamphetamine and MDMA, as well as in counterfeit pills made to look like Xanax, Percocet, and other pharmaceuticals. Very often, people consuming drugs purchased on the streets are not aware the drug they are ingesting contains fentanyl, leading to unintentional overdoses.
Despite the death toll and heartache fentanyl is responsible for, there are many misconceptions about the drug. This column will address them.
What exactly is fentanyl?
Fentanyl is a synthetic opioid and has been used in clinical settings since 1968. It is also manufactured in unregulated or illegal drug settings around the globe.
How does fentanyl differ from heroin as well as other medically prescribed opioids?
Fentanyl is often described as 80-100 times stronger than morphine and about 50 times as potent as heroin. Fentanyl lasts a shorter amount of time in the body than heroin (two to four hours compared to four to eight hours), which leads people with dependence to use more frequently, creating a greater risk for overdose or infection.
Does it have any positive, medicinal use?
Fentanyl is similar to morphine in that it is effective in relieving severe, intractable chronic pain and end-stage cancer pain, and is used during surgery and for post-surgical pain management. It can be misused to achieve a euphoric effect, but even small amounts can be lethal, leading to overdose deaths.
Why is fentanyl added to common street drugs?
Because fentanyl is cheap to manufacture and highly potent, a small amount goes a long way. It has overtaken the heroin market and is found in counterfeit pills, tablets and capsules and sold as heroin and other drugs. In many cases, people overdose without knowing the drug they ingested contained fentanyl.
How is fentanyl taken into the body?
Non-pharmaceutical fentanyl comes in the form of a white, gray or tan powder and like heroin, can be injected, smoked, or snorted.
What is a fentanyl patch?
Because fentanyl cannot be absorbed directly through the skin, after years of research, a fentanyl patch was developed for transdermal delivery of the drug at extremely slow rates of absorption to be used to relieve severe pain in people who are expected to need pain medication around the clock for an extended time but for whom other medications don’t work or are not appropriate. These are available by prescription.
Is fentanyl dangerous to touch or inhale?
Fentanyl must be introduced into the bloodstream or a mucus membrane in order for someone to feel the effects, which means you cannot overdose simply by touching powdered fentanyl. Transdermal fentanyl patches, used primarily in medical settings, are specially formulated to be absorbed by the skin very slowly.
Does fentanyl pose a danger to first responders?
Experts believe that powered fentanyl poses very little risk to people who touch or inhale it with incidental encounters. There has been no definitive evidence that first responders have overdosed when exposed to fentanyl in the course of their work, nor have there been reports of overdoses from handling fentanyl in illicit settings.
However, the Centers for Disease Control recommends first responders use gloves when responding to scenes where fentanyl or other unknown substances are present as extra precaution.
What is fentanyl poisoning?
Signs of fentanyl poisoning or overdose are the same as other forms of opioid overdose symptoms. This includes the person being unresponsive to stimuli/pain; trouble breathing that might sound like snoring; slow, shallow breathing; cold, clammy skin; inability to be roused.
Is fentanyl addictive?
Yes, like other opioids, fentanyl is addictive and as tolerance increases, people who use it need to take higher amounts to feel the same effect, which increases the risk of overdose.
What are fentanyl test strips?
Fentanyl test strips identify the presence of fentanyl in drugs purchased on the streets. They can easily test injectable drugs, powders and pills so people can find out if fentanyl is present. This informs people about the drugs they are buying and using, allowing them to adopt strategies that reduce the risk of an overdose. Fentanyl test strips are considered part of a harm reduction approach to drug use. Fentanyl test strips do not measure the concentration/amount of fentanyl, only if it is present or not.
Is fentanyl found in marijuana?
Federal investigators have not been able to confirm anecdotal reports that fentanyl has been added to marijuana, although it is believed that marijuana could be accidentally cross-contaminated if someone regularly uses marijuana and also uses other drugs that contain fentanyl. However when cannabis is smoked, the heat applied by the flame would essentially deactivate fentanyl if it were present.
Is Narcan effective against fentanyl overdose?
Fentanyl does respond to naloxone intervention because fentanyl is an opioid. Naloxone should be used in the event of an overdose. If it appears someone overdosing is not responding to naloxone, it may be that the naloxone needs more time to take effect or the person needs more than one dose of naloxone to be revived. It could also mean that other drugs may be involved or naloxone was administered after the person had been without oxygen for too long.
For another take on misconceptions around fentanyl and the role stigma plays in helping people with addiction issues, check out this edition of John Oliver’s “Last Week Tonight”: www.youtube.com/watch?v=RMpCGD7b_H4.
Wendy Penner, DART coordinator for the Northampton Health Department, and Liz Whynot, director of harm reduction services at Tapestry Health, are members of the Hampshire HOPE opioid prevention coalition run out of the city of Northampton’s Health Department. Hampshire HOPE members contribute to this monthly column about local efforts addressing the opioid epidemic.