Fentanyl and other fentanyl-based compounds have accounted for over 67 thousand preventable deaths in 2021. This represents a 26% increase from the over 53 thousand deaths recorded in 2020. In conjunction with the deadly effects of fentanyl abuse, there has been a steady increase in reported cases of fentanyl use.

So it begs the question, why is fentanyl use on the rise? 

What is Fentanyl?

Fentanyl is a synthetic opioid compound that is used medically for the management of severe pain. Opioids are a range of powerful painkillers derived from the poppy plant Papaver Sominiferum. Notable drugs in the opioid class include morphine, codeine, and oxycodone, amongst others. 

Fentanyl was first developed in 1959 and introduced in the 1960s as an intravenous anesthetic. Fentanyl, similar to other commonly used opioid compounds, produces effects such as relaxation, euphoria, pain relief, and sedation. 

Common side effects of fentanyl abuse include confusion, drowsiness, dizziness, nausea, vomiting, urinary retention, pupillary constriction, and respiratory depression.

Why Is Fentanyl So Addictive?

Addiction is defined as a medical condition characterized by compulsive drug seeking and use irrespective of adverse psychological and physiological effects. Addiction often presents clinically with structural changes to the brain and can occur due to a variety of substances and drugs. 

There are various reasons why fentanyl is so addictive; these include:

Very High Potency: Fentanyl is incredibly potent and is reported to be 50 times as potent as heroin. This means that only a tiny amount can produce a strong effect. Because only a small amount has such a strong effect, drug users may switch to fentanyl use to get a more intense high. The intense high felt with each use invariably leads to fentanyl addiction. 

Mixing With Other Drugs: Illicitly produced fentanyl often finds its way into other street drugs, like heroin or cocaine, without people knowing it. This makes these drugs even riskier and more addictive. 

Taking one or more substances together either intentionally or unknowingly is known as polysubstance use. Research shows that people who engage in polysubstance use are more likely to develop an addiction. 

Fast Onset of Effects: Fentanyl acts quickly in the body, providing a rapid and intense high. This quick onset can appeal to those seeking immediate relief from emotional or physical pain. Clinical studies have shown that drugs with faster onset of effects can be more addictive.

In certain cases, fentanyl when used medically can also lead to addiction. This is due to the development of drug dependence while a patient is on fentanyl. Fentanyl is highly addictive and clinicians are urged to only administer fentanyl as required. Fentanyl use should also be tapered to prevent the development of uncomfortable withdrawal symptoms. 

Overview Of The Rise Of Fentanyl Use In The US

The rise of fentanyl use in the United States represents a troubling facet of the opioid epidemic. Fentanyl, a synthetic opioid, is 50 to 100 times more potent than morphine. Several vital factors characterize fentanyl’s journey from legitimate medical use to illicit substance abuse:

Pharmaceutical Origins: Fentanyl was first created in 1959 as a strong painkiller for treating severe medical conditions, like cancer-related pain or the recovery period after surgery.

Illegal Production: The crisis started when unlicensed facilities, mainly in China and Mexico, started making fentanyl and its analogs. These substances were smuggled into the US, contributing to increased illicit fentanyl availability. According to the DEA (Drug Enforcement Agency), increased trends in fentanyl-related deaths and overdoses were seen between 2011 through 2018. Illegally manufactured fentanyl is mostly available in either powder or liquid form.

Potency and Overdose Risk: Fentanyl’s potency poses a significant risk of overdose, with even minute amounts leading to respiratory depression and death. The potency and affordability of fentanyl are the main factors driving the rise of fentanyl-laced medications. 

Accessibility and Economical Production: Fentanyl’s artificial nature and the availability of precursor substances have made it economical to produce, enticing drug dealers eager to maximize profits. Drug dealers combine trace amounts of fentanyl with other narcotics to increase their potency and sales.

Challenges For Law Enforcement: Because fentanyl production is global and distributed widely, addressing its unlawful production and distribution has proven difficult. As of 2022/2023, there has been a continual rise in seizures of packages containing fentanyl at various borders around the United States. 

Public Health Response: Addressing the problem requires a comprehensive strategy, which includes harm reduction initiatives, enhanced naloxone availability, awareness-raising initiatives, and increased access to addiction treatment programs. 

Globally, this tendency is present, but it is more pronounced in areas where fentanyl or its precursors are more easily accessible, such as parts of the United States, Canada, and Mexico. These laced drugs are distributed more easily thanks to offline and online illegal drug markets.

The emergence and rise of fentanyl in the U.S. emphasizes the need for swift action to address the opioid epidemic. This emphasizes harm reduction, treatment, and prevention to combat the devastation that its misuse may cause.  

Why Fentanyl Costs So Little To Produce Compared To Other Drugs

As a fully synthetic opioid, fentanyl can be chemically synthesized using relatively inexpensive precursor chemicals. These precursors include 4-anilino- N-phenethylpiperidine (ANPP) and N-phenethyl-4-piperidone (NPP). Due to heightened potency only small quantities of these precursors are needed to produce a significant amount of the drug, reducing raw material costs.

Another way costs are cut is by producing illicit fentanyl in areas with less expensive labor and less stringent anti-drug laws. Due to its accessibility and strong strength, which has the potential for overdose, it is a common substance on the black market for illicit drugs, where it poses serious risks.

Fentanyl Abuse Treatment Options

Fentanyl abuse is a potentially life-threatening issue and requires prompt treatment. Here are various treatment options available for individuals living with fentanyl abuse:

Medical Detoxification: This is frequently the first stage of treating fentanyl misuse and should be carried out under a doctor’s supervision. People can safely stop using fentanyl with this method while controlling withdrawal symptoms.

Inpatient Rehabilitation: For people who abuse fentanyl severely, inpatient or residential treatment facilities offer a highly regulated and controlled environment. These programs include 24/7 support, medical oversight, and intensive rehabilitation. They are especially helpful for those with co-occurring mental health conditions.

Outpatient Therapy: Outpatient programs are more adaptable and enable people to continue living at home while attending therapy and counseling sessions. People with less severe addictions or those who have finished inpatient treatment but still want continuous care might consider this option.

Medication-Assisted Treatment (MAT): MAT uses drugs such as methadone, buprenorphine, or naltrexone to lessen cravings and withdrawal symptoms brought on by abusing fentanyl. Counseling and treatment are frequently paired with these drugs.

Individual and Group Therapy: Some therapeutic approaches, like cognitive-behavioral therapy (CBT) and contingency management, can successfully address the psychological aspects of addiction. Group therapy sessions offer community and peer support.

Relapse Prevention: People must recognize triggers, deal with cravings, and create suitable coping strategies. Aftercare programs and support groups like Narcotics Anonymous (NA) or SMART Recovery can offer continued support and accountability after formal treatment.

Holistic Strategies: To aid with their healing and general well-being, some people find value in supplementary therapies, including yoga, meditation, and art therapy.

Long-Term Recovery Planning: It’s crucial for preserving sobriety to create a personal relapse prevention plan and establish long-term recovery objectives.

Individualized treatment plans for fentanyl abuse should consider each patient’s unique needs and situation. For the greatest likelihood of recovery and long-term sobriety, seeking expert assistance and participating in a thorough treatment program is crucial.