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The sudden rise of synthetic opioids like fentanyl has caused an epidemic of opioid overdose in the United States. In the last decade, fentanyl has become one of the most commonly misused opioids — often without individuals even knowing they are taking fentanyl. This incredibly potent substance can quickly lead to addiction and overdose.
Fentanyl is a powerful synthetic opioid. When people use fentanyl, they can experience several sedating effects that are common across the entire class of opioid drugs, such as:
But unlike opioids such as heroin and morphine, fentanyl is not derived from the opium poppy. Instead, it is created and manufactured entirely in chemical laboratories.
When compared to other opioids, fentanyl is an exponentially more potent substance. The Centers for Disease Control and Prevention report that fentanyl available in the US is up to 50 times stronger than heroin and 100 times stronger than morphine.
While pharmaceutical fentanyl has been used by physicians to treat severe pain since the 1960s, illicitly manufactured fentanyl has only become widely used as a recreational drug since 2006. While initially, fentanyl was laced into heroin to make a more potent opioid, it is now common for people to seek out fentanyl directly.
Like other opioids, fentanyl is a highly addictive substance that can quickly lead to dependence and substance use disorders. When people ingest opioids, either by smoking, snorting, swallowing, or injecting them, the drugs quickly enter the bloodstream and cross over into the brain.
Opioids produce their effects by latching onto opioid receptors, which are present throughout both the brain and body. When drugs latch onto these receptors, people experience the characteristic effects of an opioid high, such as euphoria and pain relief.
However, after repeated administration, the brain and body quickly become accustomed to these effects. People begin to need a greater quantity of opioids to achieve the desired effect. They also develop debilitating physical withdrawal symptoms if they suddenly stop using opioids.
These two effects are known as tolerance and dependence, and they play a key role in the development of addiction.
But several other factors play into addiction as well. When people use fentanyl or other opioids, a region of the brain known as the mesolimbic dopamine pathway begins to change. This brain region is responsible for reinforcing rewarding behaviors. When an individual activates this brain pathway, it pushes them to repeat the behavior.
In a healthy brain, this system motivates people to eat good food, exercise regularly, engage in social activities, and pursue achievements at work or school. But when a person begins using addictive substances, these rewards begin to pale in comparison to the rewards that drugs can bring.
Brain changes in this region make it extremely difficult for people to break free from addiction on their own. While the brain can recover from these changes, it often requires prolonged abstinence and the help of a team of addiction professionals.
Perhaps the most dangerous and well-known side effect of fentanyl is the risk of overdose. Due to fentanyl’s incredibly high potency, the risk of overdose is much higher than with other opioids.
This is further complicated by the fact that many people are unaware of whether they are actually using fentanyl, as it is often laced into drugs such as heroin or pressed into pills meant to resemble OxyContin.
Fentanyl overdose causes a person’s central nervous system to slow to dangerous, often deadly levels. The signs of fentanyl overdose include:
If left untreated, fentanyl overdose is often fatal. If you recognize someone experiencing a fentanyl overdose, call 911 immediately. If available, the medication naloxone can reverse an opioid overdose if administered in time.
Although fentanyl is a prescription drug, the vast majority of fentanyl being used on the streets comes from illicit sources. Due to the incredible potency of fentanyl, even small volumes of pure fentanyl can result in thousands or millions of doses. As such, fentanyl can be surreptitiously shipped from international drug manufacturers without authorities becoming aware.
According to the Drug Enforcement Administration, the vast majority of illicit fentanyl comes from China. Chemical manufacturers in China produce fentanyl directly or ship precursors for manufacturing fentanyl into the United States or Mexico. The majority of fentanyl coming from China is low volume and high potency, with some drug seizures reaching purities of around 90%.
These packages can weigh less than a kilogram but contain half a million lethal doses of fentanyl.
Mexico is another significant supplier of fentanyl in the United States. Unlike China, most of the fentanyl that is seized from Mexican suppliers is high volume and low potency, ready to be sold at the street level from the moment it crosses the border.
Mexican fentanyl producers have elaborate equipment to synthesize fentanyl, press it into pills meant to resemble prescription painkillers, or combine it with heroin to make it more potent.
Opioid overdose has spiked significantly since 2013 due largely to the widespread availability of fentanyl. According to information from the CDC, there were 106,000 drug overdose deaths in the United States in 2021. Of that number, 70,601 were attributed to synthetic opioids, such as fentanyl.
The rates of overdose death have continued to rise year after year, driven almost entirely by fentanyl. According to the National Safety Council, the rate of fentanyl-caused deaths increased by 26% in just one year between 2020 and 2021.
In comparison, the overdose rate of drugs such as prescription opioids, benzodiazepines, and heroin has held relatively steady. Overdose from psychostimulant drugs such as methamphetamine has increased by 36% between 2020 and 2021 — but with 32,537 psychostimulant overdose deaths in this period, stimulants are still only responsible for less than half the number of deaths that fentanyl causes.
The current estimate of 2021 deaths by synthetic opioids like fentanyl is estimated to exceed 70,000, roughly two-thirds of all drug overdose deaths in this period.
Overdose deaths are determined from reports via medical examiners, who can identify which substances were present at the time of death.
Yet estimating how many people use fentanyl is more difficult. Many people are unwilling to divulge their substance use to researchers, and many are unaware that they are using fentanyl in the first place.
Data from the Substance Abuse and Mental Health Services Administration’s National Survey on Drug Use and Health does provide some insight into how many people are using illicit opioids in general. In 2021:
While this includes drugs such as heroin, oxycodone, and morphine, the widespread contamination of fentanyl into these substances provides a picture of how common fentanyl use has become.
Perhaps unsurprisingly, the growing rate of fentanyl use has led to a reduction in overdose deaths involving heroin. While heroin overdoses rose dramatically from 2010 to 2016, they have dropped significantly since then, when fentanyl overdoses first began to peak. This suggests that fentanyl use has begun to overtake heroin use.
Recent studies have shown that fentanyl is becoming more prevalent, even if many individuals who use substances aren’t aware.
Recent research from NYU showed that 80% of people who inject drugs test positive for fentanyl — although only 18% were aware of the fact. While this study was restricted to New Yorkers, numerous state agencies have found similar trends of fentanyl appearing in all manner of different illicit substances.
So while many people may believe they are using drugs such as heroin or Xanax, they may actually be using fentanyl without knowing it. And while they may expect Xanax withdrawal symptoms, they may not be prepared for fentanyl withdrawal.
What is clear from the data is that fentanyl use in the United States will continue to grow, and overdose rates will likely continue to rise. Fentanyl is a high-value narcotic to major illicit drug manufacturers. Its high potency means it is easy to smuggle, creates a powerful drug for street use, and is relatively cheap to produce.
State governments and federal enforcement agencies have taken significant measures to curb the opioid overdose epidemic. The first is harm reduction, which aims to help those addicted to opioids like fentanyl. This is often accomplished by increasing the distribution of naloxone (also known by the brand name Narcan), which can often reverse the course of an overdose.
To increase awareness and further reduce potential harm, multiple states have begun freely distributing fentanyl test strips. These tests inform users whether fentanyl is present in a drug and has the potential to save thousands from accidental overdose.
To cut the problem off at the source, the DEA and several other government agencies are actively involved in stopping the supply of fentanyl from reaching the United States. In 2022, the DEA seized over 13,000 pounds of fentanyl powder — as well as 57.5 million fake prescription pills laced with fentanyl.
But one of the best ways to stem the tide of fentanyl misuse is to help people struggling with substance misuse achieve lasting and worthwhile recovery. Drug enforcement alone has not been enough to reduce the amount of fentanyl coming into the United States, and harsh punishments have not prevented people from using illicit substances.
However, people can recover from drug addiction if they reach out for professional help. Decades of scientific research have provided substance use treatment centers with sophisticated tools for helping people break free from substance use disorders and achieve lasting and meaningful recovery.
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