Fentanyl – Past, Present, and Future

If you’ve been paying attention to current events, odds are that you’ve heard about fentanyl and its impact on our skyrocketing rates of drug overdoses. (A useful medication when legally manufactured and dispensed under physician supervision, fentanyl can become extremely lethal when it’s in the wrong hands. Let’s take a closer look at the substance that’s making headlines and shows no signs of slowing down.

An Innocent History

First synthesized in 1959, fentanyl citrate became known as a potent analgesic that’s almost 50 times stronger than heroin and 100 times stronger than morphine.[1] Legally manufactured and distributed in the U.S., fentanyl was quickly adopted in medical settings to relieve severe pain[2] and became the most often used opioid for intraoperative analgesia.[3]

Over the years, fentanyl has become available in many different forms, such as a transdermal patch for cancer patients. Other delivery devices were eventually developed, including fentanyl lollipops, injections, buccal tablets and sprays, sublingual tablets and sprays, and effervescent lozenges – just to name a few.[4]

Building a Bad Reputation

If it’s such a useful medication, why is fentanyl so dangerous? Because it’s so potent, it’s very easy to become addicted. Add that it’s simple and inexpensive to replicate, and you have a popular substance with which to cut street drugs, such as heroin and other opioids. Usually, people cutting street drugs with fentanyl don’t practice medicine or understand how addictive and lethal it can be. When you consider that it takes less than 0.7 ounces (or 2 mg) of fentanyl to kill someone, it’s easy to see how it has caused a more than 1000% increase in overdose deaths since 2015.

Today, the illegal use of fentanyl is widespread, and it’s crossing our borders from China and Mexico at unprecedented rates.[5] It’s hard to detect because it’s easily converted to create an endless number of “analogs” – or slight alterations to its chemical structure. Each analog mimics the effects of the original substance but may be much more powerful and deadly. Carfentanil, for example, is the strongest and is 5,000 times more potent than heroin (it only takes 0.2 grams to be lethal).[6]

Monica Frasier, a Substance Abuse Counselor at our Crossroads location in Ft. Worth, TX, says, “With illegal fentanyl, you don’t know what you’re taking. I have many clients on my caseload who have come to the clinic trying to escape this addiction for fear that they could be the next one on the news. The reality is, it only takes one small dose to be fatal, and you never know when your next dose is your last.”

So Where Do We Go from Here?

How do we stem overdoses of a drug that’s so hard to detect? When looking at today’s numbers, it’s easy to feel helpless against fentanyl – but our fight is not a lost cause. According to the CDC, research and technology have given us fentanyl testing strips, are inexpensive and typically give results within 5 minutes. The problem is that they sometimes give false negative results because they cannot detect more potent forms of fentanyl, like carfentanil.[7]

Because of its notoriety, there are lots of research projects dedicated to curbing fentanyl and its role in so many overdoses. One promising project is being conducted at federally funded Sandia National Laboratory and it involves inventing a device (a repurposed spectrometer) that’s able to recognize fentanyl’s common molecular structure.

So far, this research conducted by Matthew Moorman, a principal member of the technical staff at Sandia, is promising and has led to the detection of fragments of synthetic opioids in samples as small as less than a billionth of a gram. Sandia hopes to have a functional device within three years that law enforcement can use to detect analogs of fentanyl in the field – especially at border crossings or in mail-sorting stations. Members of the general public could also use this technology to avoid more overdoses by revealing trace amounts of fentanyl in street drugs before taking them.[8]

Even with such promising research, the chilling statistics and horror stories around fentanyl continue to leave their marks on our world. Some are calling for it to be declared a weapon of mass destruction.^[9] In fact, according to the U.S. Defense Department, fentanyl could be used as a chemical weapon, which isn’t that bizarre considering that it’s happened before. In 2002, Chechen terrorists seized more than 800 hostages at a Moscow theater. When negotiations failed, Russian security forces pumped aerosolized carfentanil ([TU2] into the theater, killing the terrorists and about 130 of the hostages. While it stopped a terrorist plot, the incident revealed that Russia had continued its research into fentanyl as a potential weapon after the U.S. agreed to suspend a similar program.[10]  

From the war on the streets to the actual battlefield, fentanyl has become enemy number one. It’s definitely costing us dearly – at least one person is lost every 8.57 minutes[11] – and it shows no signs of stopping any time soon.

As we better understand the dangers of fentanyl, we can work toward a future where fentanyl overdoses become a thing of the past. . Until street drugs include labels and ingredient lists, we’ll have to fight this drug with every weapon in our arsenal – staying wary that others may decide to exploit its negative attributes. It’s a battle worth fighting, and a battle we can and must win.

---