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Editor Daniel Callahan MSW, CAP
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What is Fentanyl

What is Fentanyl

As America’s opioid addiction continues to escalate, many people are hearing about different drugs they never encountered before. Opioid abuse impacts millions throughout the country and one of the most common drugs people are using now is called fentanyl.

What Is Fentanyl?

Fentanyl is an extremely powerful and dangerous opiate drug made in a lab. The drug derives from piperidine, an organic compound that is used throughout many pharmaceutical laboratories to synthesize and manufacture different types of prescription drugs.

Doctors prescribe fentanyl as a painkiller to people post-op or to patients who have developed a drug tolerance to regular opioids after years of taking them to manage chronic pain. Because of its potency, the drug is considered highly addictive and dangerous. Prescription fentanyl is 50 to 100 times stronger than morphine, one of the heaviest pain medications on the market.

The U.S. Department of Justice classifies fentanyl as a schedule II drug, meaning it has high addiction potential.

Non-pharmaceutical fentanyl, or NPF, is widely abused and mass-produced cheaply. Illegal versions of the drug are designed to be stronger and produce an even more intense high than the prescription form, but this modification also makes the drug even more deadly.

China is one of the leading suppliers of fentanyl to the United States. Underground labs and dealers have come up with illicit versions that are based off modified carfentanil, a veterinary form of fentanyl that can be used to tranquilize elephants.

A single kilogram of pure fentanyl can produce roughly 667,000 counterfeit pills according to the U.S. Drug Enforcement Administration.

Cheaper than heroin, illicit fentanyl gives defunct labs and drug manufacturers the opportunity to net millions of dollars in profit for next to nothing. The result for them is a life of wealth and fortune, but for their customers, fentanyl use leads to a life of eventual abuse and overdose.

Illegal fentanyl distributors are growing throughout the country. The Drug Enforcement Administration reports that there were nearly eight times as many fentanyl exhibits in the country in 2015 than 2006. Around the same time, the American opioid crisis reached its peak.

Deaths from the Opioid Epidemic

In 2016, 64,000 people died from a drug overdose, and fentanyl caused more deaths than heroin and prescription painkillers.

Every day in America, more than 130 people die from an opioid overdose. Drug abuse is no stranger to the United States, but the mass production of illicit opiates has created a problem so massive that the Department of Health and Human Services declared a national public health emergency.

In 2017, more than two dozen people visited a Georgia emergency room for a suspected overdose. All of them had bought counterfeit pills on the street. They thought it was Percocet, but in reality, each of the pills had been laced with modified illicit opioids, including U-47700. These synthetic opioids are filled with fentanyl analogs, potent drug formulas that can even evade drug screenings.

Over 70,000 people died from a drug overdose in 2017. The rate of death for a drug overdose in the U.S. has increased 9.6 percent from 2016. Specific drug-related deaths are not monitored, but it’s impossible to deny that the increase in illegal opioids correlates with the rising death rates.

Even more startling, opioid addiction encourages users to experiment with more drugs. Someone who begins to abuse a prescription medication will likely seek out pills on the street when they can no longer get their supply from a pharmacy. As a result, they become susceptible to laced pills and other drug abuse side effects such as STDs.

What Is Fentanyl Abuse?

Opioid addiction can start with a prescription. Doctors prescribe a painkiller, and people think that they’re doing the right thing. After all, why wouldn’t they trust a physician?

Unfortunately, even short-term use can lead to addiction.

The biggest issue with opiate abuse is the fact it triggers the brain’s natural reward system. Aside from relieving physical pain, users experience a flood of euphoria and “feel good” hormones called endorphins. When the relaxed, safe and happy feeling wears off, people may crave it again.

When you become addicted to opioids, things that normally bring pleasure stop feeling as great as they used to. Natural endorphins are designed to reward us and make things worthwhile, but the changes to the brain from opioid abuse make it difficult to feel pleasure from natural occurrences.

The brain convinces people that the endorphins from drug abuse are much better than natural ones. Activities like eating and exercising naturally produce endorphins that lift spirits and make people happier, but compared to the flood of hormones someone experiences when they’re high, real-life falls short.

Over time, a person develops opioid tolerance. Their brain’s opiate receptors require a greater dose to produce the same result. While one or two pills may have worked in the past, a person will soon require four or more. As time goes on, a person may require large doses to feel even a hint of what they used to. The desire to achieve the once mind-numbing high becomes so intense that someone can take a lethal amount of drugs, resulting in an accidental overdose.

Drugs like fentanyl entice people because they promise an intense high. While OxyContin and heroin used to be some of the most intense drugs out there, fentanyl promises something even greater. Of course, the reality is that the drug is also much more dangerous and can easily kill someone with a much smaller amount.

How Fentanyl Overdose Kills

The same opiate receptors in the brain that produce endorphins can end a person’s life. When the drug connects with the brain’s opiate receptors, it stops the brain from understanding important cues that keep the body alive, like the need to breathe. Blocked opiate receptors prevent the body from responding to a lack of oxygen or too much carbon dioxide.

People who snort or inject drugs can die much faster than those who swallow a pill. An overdose can happen in a matter of minutes. How can an onlooker help? It isn’t much you can do when an overdose hits suddenly, but one drug is available that can buy a person sometime before paramedics arrive.

Naloxone is an FDA-approved medication designed to reverse opioid overdose. When a person’s breathing has slowed as a result of an overdose, Naloxone can be injected or sprayed up the nose to restore a person’s respiration for 30 minutes. This won’t stop the overdose or prevent a person from dying altogether, but it can give someone precious time until first responders arrive.

You can get Narcan nasal spray or EVZIO injectables from a pharmacy, sometimes without even a prescription. Insurance may cover the cost of Narcan or EVZIO, so check with your health insurance provider before you buy. Keep in mind that this is not a means of preventing death. Overdose is life-threatening, and Naloxone can only delay breathing problems until medical personnel arrives.

What Are the Warning Signs of an Overdose?

Overdose from opioids can be progressive or fast depending on how the drug was taken. In some cases, only several minutes may pass before a person draws their last breath. It’s vital as both a user and a family member or friend of one to know the warning signs and seek help ASAP.

The most common symptoms include:

  • Restricted “pinpoint” pupils
  • Dizziness or fainting
  • Slow, shallow breathing
  • Cold, blue skin

In all cases of suspected overdose, you should call 911.

Identifying Addiction

The signs of a fentanyl addiction may be subtle, but there are some telltale warnings you can look for if you suspect a loved one is abusing drugs. Keep in mind that they may flat out deny a problem even if you provide examples and evidence. Shame keeps people from being honest with others and themselves, sometimes at the expense of their lives. Remind yourself that this isn’t something you can change overnight, but you can try your best to intervene thoughtfully and constructively.

Speaking with a rehab center could be a good first step. Many facilities have intervention specialists who provide concerned friends and family members with advice on how to bring up the subject of recovery with a loved one. Sometimes, you may actually stage a professional intervention and convince someone to get help with the guidance of a substance abuse counselor.

Some signs someone is addicted to opioids include:

  • Taking more than a prescribed dose or taking a drug because they like the way it makes them feel
  • Refilling a prescription even after an injury has healed or visiting new doctors to get a different prescription for “backup”
  • Taking medication as a preventative measure instead of a treatment, just in case their symptoms flare up
  • Uncharacteristic mood swings and irritability
  • Disappearing for periods of time with no account as to why
  • Borrowing medications from people or “losing” their own so that they have to get more
  • A sudden drop in work performance, school attendance or failure to meet other obligations
  • Withdrawal from social activities and hobbies
  • Signs of withdrawal without the drug such as sweating, muscle spasms, and a headache

How to Get Help

If you or someone you know struggles with drug addiction, help is available. The first thing to understand is that you shouldn’t quit without reaching out. Many people often keep their addiction hidden or avoid treatment for fear of judgment. They’re worried what people will think about them.

The truth is that addiction can happen to anyone. Angered loved ones often accuse an addict of ruining their own lives, and to a degree, this is true. They are the ones who made the choice to take drugs in the first place, but after a certain point, addiction surpasses decision.

Substance use disorder is a diagnosable disease, and it requires treatment just like any other psychological or medical condition. Inpatient rehab is one of the best ways to break an addiction. Medical staff can ensure that the painful and uncomfortable symptoms of withdrawal are managed during the detox process.

Rehab also ensures that triggers are avoidable. A side effect of withdrawal is intense cravings, and someone is more likely to accidentally overdose and become careless when they’re desperate for a hit. Rehab can provide someone with medication that diminishes the intensity of withdrawal symptoms. Methadone is a common choice, but the FDA also recently approved the first opioid withdrawal drug called LUCEMYRA.

While there is no “one-and-done” method of treatment, recovery is possible even after years of struggle. Reaching out now can help ensure a future that is free of substance abuse, fear and guilt. The freeing effects of recovery will help you or a loved one overcome the temporary high of an addiction.

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