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October 18, 2022

The Drug Enforcement Administration (DEA) has sent out an advisory to the public regarding the opioid crisis, specifically warning of the presence of brightly-colored fentanyl pills in general circulation.  The presence of highly addictive “rainbow fentanyl” is a trend which potentially targets young people. 

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I’ve known of fentanyl my entire medical career.  My professional experience with it involved use during general anesthesia on patients undergoing surgery and epidurals during labor.  It has also been used in combat casualties and cancer patients in the form of “lollipops” for pain relief and sedation.

First synthesized in 1960, it gained approval for medical use in 1968 and achieved widespread acceptance.  By 2017, fentanyl was the most frequently-used synthetic opioid in medicine.  Two years later, more than one million prescriptions for it were being written annually.  In 2021, fentanyl accounted for more than 71,000 opioid overdose deaths in the United States.  The vast majority of recent cases are linked to illicitly manufactured fentanyl originating, it’s thought, in Mexico.

The Department of Justice reports the seizure of more than 10.2 million fentanyl pills and approximately 980 pounds of fentanyl powder in the period from May 23 through Sept. 8, 2022

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WHY FENTANYL?

For a drug dealer, fentanyl has some attributes that compare it favorably to heroin: Fentanyl is more potent, has higher profit margins, and is easier to transport to the “market” in the form of pills, lozenges, injections, nasal sprays, eye drops, and skin patches.  It’s given unthreatening nicknames such as “dance fever,” “goodfellas,” and “jackpot.”  As it’s relatively cheap, it can be used to mix in with more expensive illegal drugs.

For the consumer, fentanyl acts like other opioids, but “on steroids.”  Once in the body, fentanyl attaches itself to nerve receptors that control pain response and emotions.  The drug provides strong pain relief and creates an intense euphoric high.  It does this by elevating levels of the chemical dopamine. The drug also takes effect faster than either morphine or heroin.

The duration of effect depends on the dosage taken, the method of intake, and other factors. In those who inject the drug, the “high” lasts 11-22 hours. If used as a patch, lozenge, or pill, it can last even longer.  As the body breaks down the drug, it leaves traces behind called metabolites.  Metabolites remain longer than the duration of fentanyl effects; as such, they may be detected in drug tests much longer than the high lasts.

FENTANYL DANGERS

Unfortunately, there are serious risks associated with the use of fentanyl.  You can expect sedation, confusion, drowsiness, dizziness, nausea and vomiting, urinary retention, pupillary constriction, and respiratory depression.  This highly addictive substance leads to serious physical dependence in addition to tolerance (the need for higher doses over time to get the same “high”).