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Fentanyl  is a synthetic opioid that was originally developed as an analgesic – or painkiller – for surgery. It has a specific chemical structure with multiple areas that can be modified, often illicitly, to form related compounds with marked differences in potency.

For example, carfentanil, a fentanyl analog formed by substituting one chemical group for another, is 100 times more potent than its parent structure. Another analog, acetylfentanyl, is approximately three times less potent than fentanyl, but has still led to clusters of overdoses in several states.

Despite the number and diversity of its analogs, fentanyl itself continues to dominate the illicit opioid supply. Milligram per milligram, fentanyl is roughly 50 times more potent than heroin and 100 times more potent than morphine.

 

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Anesthesia

Intravenous fentanyl is often used for anesthesia and as an analgesic. To induce anesthesia, it is given with a sedative-hypnotic, like propofol or thiopental, and a muscle relaxant.To maintain anesthesia, inhaled anesthetics and additional fentanyl may be used.These are often given in 15–30 minute intervals throughout procedures such as endoscopy and surgeries and in emergency rooms.

For pain relief after surgery, use can decrease the amount of inhalational anesthetic needed for emergence from anesthesia. Balancing this medication and titrating the drug based on expected stimuli and the person’s responses can result in stable blood pressure and heart rate throughout a procedure and a faster emergence from anesthesia with minimal pain.

Regional anesthesia

Fentanyl is the most commonly used intrathecal opioid because its lipophilic profile allows a quick onset of action (5–10 min.) and intermediate duration of action (60–120 min.).Spinal administration of hyperbaric bupivacaine with fentanyl may be the optimal combination. The almost immediate onset of fentanyl reduces visceral discomfort and even nausea during the procedure.

Obstetrics

Fentanyl is sometimes given intrathecally as part of spinal anesthesia or epidurally for epidural anaesthesia and analgesia. Because of fentanyl’s high lipid solubility, its effects are more localized than morphine, and some clinicians prefer to use morphine to get a wider spread of analgesia. It is widely used in obstetrical anesthesia because of its short time to action peak (about 5 minutes), the rapid termination of its effect after a single dose, and the occurrence of relative cardiovascular stability.In obstetrics, the dose must be closely regulated in order to prevent large amounts of transfer from mother to fetus. At high doses, the drug may act on the fetus to cause postnatal respiratory distress. For this reason, shorter acting agents such as alfentanyl or remifentanil may be more suitable in the context of inducing general anaesthesia.Buy Fentanyl Online UK , Fentanyl For Sale England, Order Fentanyl Powder Scotland, Where to buy Fentanyl Powder Northern Ireland , Purchase Fentanyl Wales

 

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Pharmaceutical fentanyl’s adverse effects resemble those of other narcotic opioids, including euphoriaconfusionrespiratory depression (which, if extensive and untreated, may lead to arrest), drowsinessnausea, visual disturbances, dyskinesiahallucinationsdelirium, a subset of the latter known as “narcotic delirium,” analgesianarcotic ileusmuscle rigidityconstipationaddictionloss of consciousnesshypotensioncoma, and even death. Alcohol and other drugs (i.e., cocaine, heroin) can synergistically exacerbate fentanyl’s side effects. Naloxone (also known as NARCAN) can reverse the effects of an opioid overdose; however, because fentanyl is so potent, multiple doses might be necessary.

Fentanyl was first synthesized by Paul Janssen in 1959 and was approved for medical use in the United States in 1968. In 2015, 1,600 kilograms (3,500 pounds) were used in healthcare globally. As of 2017, fentanyl was the most widely used synthetic opioid in medicine;in 2019, it was the 278th most commonly prescribed medication in the United States, with more than a million prescriptions. It is on the World Health Organization’s List of Essential Medicines.

Fentanyl continues to fuel an epidemic of synthetic opioid drug overdose deaths in the United States. While prescription opioid deaths remained stable from 2011 to 2021, synthetic opioid deaths increased from 2,600 overdose deaths per year to 76,238 per year. Fentanyl constitutes the majority of all drug overdose deaths in the United States since it overtook heroin in 2018.The United States National Forensic Laboratory estimates fentanyl reports by federal, state, and local forensic laboratories increased from 4,697 reports in 2014 to 117,045 reports in 2020. Fentanyl is often mixed, cut, or ingested alongside other drugs, including cocaine and heroin.Fentanyl has been reported in pill form, including pills mimicking pharmaceutical drugs such as oxycodone.Mixing with other drugs or disguising as a pharmaceutical makes it difficult to determine the correct treatment in the case of an overdose, resulting in more deaths. Fentanyl’s ease of manufacture and high potency makes it easier to produce and smuggle, resulting in fentanyl replacing other abused narcotics and becoming more widely used.

 

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As an emergency physician, I give fentanyl as an analgesic, or painkiller, to relieve severe pain in an acute care setting. My colleagues and I choose fentanyl when patients need immediate pain relief or sedation, such as anesthesia for surgery.

But even in the controlled conditions of a hospital, there is still a risk that using fentanyl can reduce breathing rates to dangerously low levels, the main cause of opioid overdose deaths. For those taking fentanyl in nonmedical settings, there is no medical team available to monitor someone’s breathing rate in real time to ensure their safety.

One measure to prevent fentanyl overdose is distributing naloxone to bystanders. Naloxone can reverse an overdose as it occurs by blocking the effects of opioids.

Another measure is increasing the availability of opioid agonists like methadone and buprenorphine that reduce opioid withdrawal symptoms and cravings, helping people stay in treatment and decrease illicit drug use. Despite the lifesaving track records of these medications, their availability is limited by restrictions on where and how they can be used and inadequate numbers of prescribers.

Other strategies to prevent overdose deaths include lowering the entry barrier to addiction treatment, fentanyl test stripssupervised consumption sites and even prescription diamorphine (heroin).

Despite the evidence supporting these measures, however, local politics and funding priorities often limit whether communities are able to give them a try. Bold strategies are needed to interrupt the ever-increasing number of fentanyl-related deaths.

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Drug dealers have used fentanyl analogs as an adulterant in illicit drug supplies since 1979, with fentanyl-related overdoses clustered in individual cities.

The modern epidemic of fentanyl adulteration is far broader in its geographic distribution, production and number of deaths. Overdose deaths roughly quadrupled, going from 8,050 in 1999 to 33,091 in 2015. From May 2020 to April 2021, more than 100,000 Americans died from a drug overdose, with over 64 percent of these deaths due to synthetic opioids like fentanyl and its analogs.Buy Fentanyl Online UK , Fentanyl For Sale England, Order Fentanyl Powder Scotland, Where to buy Fentanyl Powder Northern Ireland , Purchase Fentanyl Wales

Illicitly manufactured fentanyl is internationally synthesized in China, Mexico and India, then exported to the United States as powder or pressed pills. Additionally, the emergence of the dark web, an encrypted and anonymous corner of the internet that’s a haven for criminal activity, has facilitated the sale of fentanyl and other opioids shipped through traditional delivery services, including the U.S. Postal Service.

Fentanyl is both sold alone and often used as an adulterant because its high potency allows dealers to traffic smaller quantities but maintain the drug effects buyers expect. Manufacturers may also add bulking agents, like flour or baking soda, to fentanyl to increase supply without adding costs. As a result, it is much more profitable to cut a kilogram of fentanyl compared to a kilogram of heroin.

Unfortunately, fentanyl’s high potency also means that even just a small amount can prove deadly. If the end user isn’t aware that the drug they bought has been adulterated, this could easily lead to an overdose.

 

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