Understanding Fentanyl: The Silent Epidemic

For decades, we have been in an opioid epidemic. With increasing opioid-related deaths and rises in developing addiction, significant concern has been raised around the impact these types of drugs have. The side effects of opioids can be particularly potent, coming with a range of difficult challenges for users as well as on the broader scale of public health. Yet, when we talk about opioid addiction treatment, we may focus on drugs like heroin and morphine. There are a range of other substances in the opioid family – such as fentanyl – that can be just as dangerous. But why are opioids so addictive? And what is it that makes fentanyl addiction particularly risky?

What is Fentanyl?

Opioids

Fentanyl is a synthetic opioid. The term ‘opioid’ refers to ‘a class of drugs that derive from, or mimic natural substances found in the opium poppy plant.’ These types of drugs are very strong painkillers and also have sedative qualities. Some opioids are legal and can be available over-prescription. Other opioids are illegal, meaning that they are manufactured illicitly. Opioid addiction symptoms are considered to be particularly difficult to deal with. Such an addiction is sometimes known as opioid use disorder (OUD).

Opioids can change the way that we perceive, respond to and manage pain signals. They do this by blocking pain messages that are sent to the brain. Whilst this type of treatment can be life-changing for many, opioids are also known for their addictive potential. When taken inappropriately, drugs such as fentanyl can catalyse a range of physical and mental health effects that significantly impact a user’s quality of life.

Fentanyl: Key facts

There are two types of fentanyl available on the drug market:

1. Pharmaceutical fentanyl
2. Illegally made fentanyl

Pharmaceutical Fentanyl

Both of these substances are created rather than found in nature. The difference between the two is medical professionals prescribe the pharmaceutical fentanyl. It is usually used to treat people with severe pain, especially in cases of:

• advanced cancer
• recovery after surgery
• recovery after major trauma

In these cases, fentanyl may be referred to as its brand name. Brand names for fentanyl include:

• Abstral
• Actiq
• Durogesic Dtrans
• PefFent
• Effentora
• Matrifen

Pharmaceutical fentanyl can come in different forms, such as patches, lozenges, dissolvable tablets and nasal sprays.

Illegally made Fentanyl

Whilst fentanyl is available via prescription, the CDC warns that ‘most recent cases of fentanyl-related overdose are linked to illegally made fentanyl’ or IMF. This type of fentanyl is produced illicitly and then distributed through illegal channels. It is used by individuals seeking pain relief but is also sought out for its heroin-adjacent properties. Studies into illicitly procured drugs have identified that many other substances are cut with fentanyl – this makes the drugs ‘cheaper, more powerful, more addictive, and more dangerous.’

IMF can be found in both liquid and powder forms. It has been found frequently in heroin, cocaine, meth and other opioid medicines. This is particularly risky as polydrug use increases the risk of fatality. Given fentanyl’s established overdose risk, this makes the potential for death following fentanyl use concerningly high.

The rise of Fentanyl

Opioids are thought to be ‘some of the strongest painkillers available.’ This makes fentanyl very dangerous and potentially fatal. In an article published in 2023, it was reported that ‘more Americans than ever are dying from fentanyl overdoses.’ Cultural commentators describe the current increase of fentanyl use in the US as ‘the fourth wave’ of the fentanyl crisis. A similar situation is happening in the UK.

Some key statistics on fentanyl:

• Fentanyl can be up to 50 times stronger than heroin
• Fentanyl can be up to 100 times stronger than morphine
• Synthetic opioids are involved in almost 70% of fatal overdoses

Why is Fentanyl so dangerous?

Opioids, in general, are known for being potent, carrying an increased risk of health complications and a high addiction potential. However, fentanyl is considered to be especially concerning in the wake of increased use over the past ten to fifteen years. Synthetic fentanyl is much cheaper to produce than other stimulants or opioids. This makes it an attractive substance for producers, distributors and users alike. However, this does increase risk, as it means that other opiate and stimulant substances are likely to be cut with fentanyl. Whilst fentanyl has a high overdose risk, it has also been linked with a range of difficult physical and mental health symptoms, such as:

• Nausea and vomiting
• Drowsiness
• Constipation
• Stomach pain
• Difficulty breathing
• Headaches
• Feeling weak or dizzy
• Respiratory depression

Less common side effects include:

• Diarrhoea
• Hyperhidrosis
• Seizures
• Involuntary muscle movements
• Difficulty passing urine
• Rashes and skin reactions
• Nosebleeds
• Confusion
• Difficulty maintaining body temperature
• Nightmares
• Decrease in white blood cell count
• Oedema
• Bowel problems

Signs of opioid addiction

As a strong opioid, fentanyl carries a high risk of addiction. An addiction to fentanyl could manifest as:

• Difficulty managing pain
• Generally feeling unwell
• Difficulty sleeping
• Change in appetite
• Weight loss
• Unstable mood
• Anxiety and paranoia
• Aches and pains
• Issues with homeostasis
• Sickness
• Struggling to pass urine
• Going to the toilet more regularly
• Become more susceptible to infection
• Increased use of fentanyl
• Concealing the use of fentanyl
• Seeking out other opioids or painkillers
• Seeking out other drugs from non-legal channels

The challenge of detection

When purchasing drugs illegally, it can be very difficult to know what the substances you buy truly contain. This is because drugs are regularly ‘cut’ in order to reduce and produce as strong a substance as possible. If a drug contains fentanyl, you won’t be able to tell just by looking at it – fentanyl is not identifiable by taste, sight, or smell. If you wish to test your drugs for fentanyl, the best way to do this is by using test strips. These can inform you if the drug you are using contains fentanyl. Conducting such a test can be a positive move towards harm reduction, decreasing the risk of developing addiction or fentanyl-related death.