Fentanyl is a very strong synthetic opioid, similar to morphine but much more dangerous. It’s medically prescribed for severe, disabling pain most commonly after surgery or to treat patients with chronic pain who don’t respond to other opioids. With fentanyl being up to 100 times more potent than morphine, there is a small margin between a therapeutic dose and a toxic one, thus making it very easy to overdose on.
How does it work?
Fentanyl, once ingested, attaches to and activates certain opioid receptors, which are located in areas of the brain that affect pain and emotion. Because of the interaction with these receptors, it leads to increased release of dopamine from cells in our brain’s reward center thus resulting in a well-known euphoria. However, the drug also slows down breathing, which due to fentanyl’s potency can easily lead to an overdose.
While the effects of fentanyl may be felt for only a few hours, traces of the drug remain in the system for much longer. Fentanyl consumption can be detected on a urine test 24-72 hours after last use and a blood test 5-48 hours depending on the amount used. However, interestingly enough it can be detected for up to 3 months using a hair test.
Misuse and how to recognize an overdose
Fentanyl, while it is consumed by some independently, it’s most commonly found mixed with other recreational drugs such as heroin or oxycodon either to make it cheaper for production or to make up for the low quality of the later.
Deaths involving other synthetic narcotics other than methadone (including fentanyl and fentanyl analogs) continued to rise over time with more than 31,335 overdose deaths reported in 2018.
Its high potency combined with common unawareness of the consumer regarding its presence in the recreational drug, has made it one of the most commonly listed opioids resulting in overdose and death. And, just in case you’re wondering, the lethal dose of fentanyl is only 2-3 milligrams compared with heroin’s 30 milligrams.
When someone overdoses on fentanyl their breathing will slow down or even stop thus significantly decreasing the amount of oxygen that reaches the brain. This condition is called hypoxia and can lead to coma and permanent brain damage, even death. Even accidental exposure to transdermal fentanyl patches (releases 25 micrograms of fentanyl / hour), especially in children has the potential of causing life-threatening harm.
Recognizing the symptoms of fentanyl overdose is crucial in saving a person’s life, as the symptoms can grow deadly quickly. Symptoms include:
Difficulty swallowing
Dizziness / Fainting
Respiratory arrest
Slurred speech
Confusion
Cardiac arrest
If you’re near someone showing these symptoms call emergency services immediately, turn them on their side so chocking doesn’t occur and if possible administer Narcan (Naloxone).
What is Naloxone and how to administer it?
Naloxone is a medication designed to rapidly reverse the effects of opioid overdose. It binds to opioid receptors and can reverse/ block the effects of other opioids thus quickly restoring normal respiration to a person whose breathing has slowed down/ stopped as a result of an overdose. There are 3 FDA-approved formulations of Naloxone: injectable, autoinjectable and nasal spray, but only the later 2 are recommended for non-professional use.
EVZIO (autoinjectable) is a prefilled auto-injection device that makes it easy for families or emergency personnel to inject Naloxone into the outer thigh (allows for the medication to be absorbed into the bloodstream quickly).
NARCAN (nasal spray) is a prefilled, needle-free device that requires no assembly and is sprayed into one nostril while the patient lies on their back. Both NARCAN nasal spray and EVZIO are packaged in containers containing two doses which allows for repeat dosing if necessary.
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