Difference between prescribed and illicit opioids
There are around 10 to 12 opioids used routinely in clinical settings today. Some opioids such as heroin have no medical purposes and can only be obtained from illicit sources like the streets. Other opioids such as fentanyl have legitimate medical uses but are also produced illicitly in unsanitary environments with no quality control. Fentanyl has received considerable national attention for being the No. 1 cause of opioid-related overdose deaths when obtained through illicit means. Illicit drugs are those produced outside of a licensed pharmaceutical environment.
Between 2020 to 2021, 80,000 Americans died of problems related to illicit fentanyl and similar illicit opioids. And the death toll continues to rise dramatically:
What Makes Fentanyl Unique
Fentanyl is a powerful painkiller. According to the Centers for Disease Control, it’s up to 100 times more potent than morphine.
Its strong potency means it can be used in operating rooms, to control pain after surgery and to alleviate pain for people with advanced cancer. But its effectiveness at relieving pain and increasing pleasure also have made it a popular street drug with dangerous risks of addiction, overdose and death.
As an opioid, fentanyl travels through your blood to attach to opioid receptors in brain cells. Once attached, fentanyl helps decrease feelings of pain. It remains one of the most commonly used opioids in controlled medical settings or advanced cancer pain. Fentanyl also can increase feelings of pleasure, often referred to as euphoria. Other effects can include drowsiness, nausea, confusion, constipation and addiction.
In addition to the euphoric feelings fentanyl can produce, those who are addicted to fentanyl can experience unpleasant withdrawal symptoms such as muscle pain, bone pain, diarrhea, vomiting, cold flashes and uncontrollable leg movements.
Whether prescribed or obtained illegally, there are serious risks to using fentanyl when it’s not dosed or used correctly — especially if you take too much or combine it with certain other medicines or alcohol. Fentanyl misuse can lead to unconsciousness, compromise respiratory function and lead to overdose resulting in death.
How is Fentanyl Used
Pharmaceutical fentanyl (Actiq, Fentora, Sublimaze) is a synthetic opioid — a lab-created compound — used under medical supervision. It can come in a variety of formats including:
- Nasal spray to treat cancer pain.
- Patch for the skin to address pain after surgery.
- Injection to relieve pain during and after surgery.
- Oral spray, tablet or lozenge to treat cancer pain.
Comparable to fentanyl, fentanyl analogs have similar chemical structure and effects. Common pharmaceutical industry fentanyl analogs used during surgery include sufentanil (Sufenta), alfentanil (Alfenta) and remifentanil (Ultiva). There are more than 30 nonpharmaceutical-grade fentanyl analogs circulating on the illicit drug market, many of which cannot be detected on standard urine drug screens.
Illicitly manufactured fentanyl is illegal and can be sold as powder, nasal spray or pills that look like other prescription opioids. Fentanyl can be known by street names such as Apache, China Girl, Dance Fever or Goodfellas.
Illegal fentanyl can be used in the same ways as prescribed fentanyl. But it also can be misused by snorting or smoking. Some people who misuse fentanyl remove the gel contents of a fentanyl patch and then inject or ingest the contents. Others might freeze patches and then place frozen pieces under the tongue.
Why is Fentanyl Deadly
While fentanyl is legally manufactured and distributed in the U.S., it can be stolen, obtained with fraudulent prescriptions or made in illegal labs. Illegal labs have no quality control. There is no standardized measurement of the amount of fentanyl or biproducts produced in each product. In addition, it is frequently contaminated with other dangerous compounds such as other drugs or talc. The Drug Enforcement Agency (DEA) states that 60% of all seized illicit fentanyl pills have enough fentanyl in 1 dose to kill an adult.
Many other drugs are now being laced with fentanyl to make them more addictive. This includes substances such as cocaine, methamphetamine and even cannabis. It is impossible to tell if a drug has fentanyl in it just by taste or smell. Specialized testing strips can be used to help detect the drug.
Harm Reduction Strategies
Harm reduction strategies are approaches aimed at reducing the negative consequences associated with opioid addiction. These strategies focus on keeping individuals safe and minimizing harm, even if they are not ready or able to stop using opioids completely. They often serve as critical access points for people who struggle with addiction and have few interactions with the community.
- Overdose prevention
Overdose prevention strategies aim to prevent fatal opioid overdoses. One important approach is the distribution of naloxone, a medication that can reverse the effects of an opioid overdose. Naloxone kits are often provided to individuals at risk of overdose, as well as their friends and family members. Fentanyl test strips can be used to help detect contamination of other substances and avoid deadly overdoses. - Medication for Opioid Use Disorder (MOUD)
MOUD involves the use of medications like methadone or buprenorphine to help manage opioid addiction. These medications can reduce cravings and withdrawal symptoms, allowing individuals to stabilize their lives and focus on recovery.
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