What You Need to Know About Fentanyl Abuse in America

Fentanyl is one of the most potent and deadly opioids available. Learn more about why it is regularly being mixed into street drugs.

As the opioid epidemic unfolds in the United States, the abuse of the opioid fentanyl has increased as well. As one of the strongest opioids, fentanyl can be very dangerous. Its danger is only worsened by the fact that it is sometimes mixed with other drugs, so people might not even know they are taking it. If you or a loved one have been in contact with street drugs, it is very important to know about the risks of fentanyl.

What is Fentanyl?

Fentanyl is a synthetic opioid, meaning that it is made in a lab. It is up to 100 times more potent than morphine and 50 times more potent than heroin. When prescribed by a doctor, it is normally reserved for severe pain, like cancer-related pain.

How is Fentanyl Abused?

People obtain fentanyl without a prescription in two main ways:

• Diversion of a prescribed drug: Diversion occurs when a drug is used by someone for whom it was not prescribed. Sometimes people prescribed fentanyl may give or sell it to others. However, sometimes fentanyl is stolen from the person for whom it was prescribed.
• Illicitly manufactured fentanyl, or IMF: Since fentanyl is made in a lab, sometimes people will make it to sell. Because law enforcement confiscations of fentanyl rose by a factor of 7 from 2012 to 2014, experts suspect that most of the fentanyl sold on the street is IMF.

Fentanyl is also commonly used as an additive with other drugs like cocaine, heroin or even counterfeit medications. Therefore, the person taking those drugs may have no idea that they are taking fentanyl. Luckily, fentanyl test strips are available so people can test drugs before they take them. One study found that 63% of people who take street drugs discovered that their drugs contained some fentanyl.

Because so many people who use street drugs are exposed to fentanyl, data suggests that over time people start to prefer fentanyl over other opioids. Some people report a stronger high with fentanyl than heroin. Because fentanyl is so strong, people who get used to using it may be at higher risk of dependence and tolerance.

Fentanyl can be abused in several different ways. Ways people use fentanyl include:

• Fentanyl injection: Legally manufactured fentanyl for injection is often for hospital use only. However, some people will boil fentanyl patches to extract the drug and then inject the liquid.
• Transdermal fentanyl abuse: Legally manufactured fentanyl patches can be abused by scraping out the gel contents of the patch. The contents can then be injected or swallowed. Some people also freeze the patches, cut them up and place them in their mouth.
• Snorting or sniffing fentanyl: Sometimes IMF is snorted or sniffed for a quick high. Some people have overdosedon IMF, thinking they were snorting cocaine.
• Smoking fentanyl: Legally manufactured fentanyl patches are sometimes smoked for a rapid high.
• Oral fentanyl abuse: Fentanyl is legally manufactured in oral forms like lozenges and tablets. Further, IMF can come in oral dosage forms.
• Fentanyl on blotter paper: Some drug dealers have started putting IMF on blotter paper. The paper often has pictures on it is usually intended to be placed in the mouth. A unique risk of blotter paper is that the pictures may attract children.
• Cocktails and gray death: As fentanyl has become more common, it is being used in new ways. Starting in 2017, it began to be used in a cocktail with other opioids called Gray Death. This mixture has the appearance of concrete and can be smoked or snorted. Powdered Gray Death can also be airborne.

What Caused the Fentanyl Abuse Epidemic in America?

The fentanyl abuse epidemic is the most recent wave of the opioid epidemic in America. The first wave was prescription opioids. When doctors cracked down on prescription opioids, the second wave took place as people turned to heroin. The third wave, fentanyl abuse, started around 2013. It took place when drug dealers realized that fentanyl was much cheaper and more potent than heroin. Therefore, by selling fentanyl and cutting existing drugs with fentanyl, the drug dealers could make more money.

Fentanyl Abuse Facts and Statistics

In 2017, there were almost 3,000 confiscations of fentanyl by law enforcement, much of it originated from overseas. Those fentanyl confiscations often revealed that the fentanyl was already combined with other drugs like heroin. Further, there has been a rise in chemical cousins to fentanyl, like acetyl fentanyl, furanyl fentanyl and carfentanil. About 34% of the confiscations for drugs in the fentanyl family in 2017 were for these and other fentanyl-related drugs, as opposed to regular fentanyl.

Is China the Answer to America’s Fentanyl Abuse Epidemic?

Most IMF comes from China and Mexico. Although IMF from China tends to be seized in small quantities, as opposed to the bulk quantities seized from Mexico, it is much purer. China IMF tends to be more than 90% pure while Mexico IMF is often less than 10% pure. Further, data from 2016 suggests that more than half of the chemical precursors to fentanyl is made in China. The Chinese government has slowly begun to respond to world demand to stop IMF. In 2018, China said they would begin to crack down on sales of the chemical precursors to fentanyl that Chinese chemists were using to make IMF. However, experts were able to easily go undercover to China and circumvent these laws. Although the United States has stated they will begin to put additional pressure on China to stop IMF, it is unclear if this will work.

Editor – Thomas Christiansen

With over a decade of content experience, Tom produces and edits research articles, news and blog posts produced for Advanced Recovery Systems. Read more

Medically Reviewed By – Dr. Jessica Pyhtila, PharmD

Dr. Jessica Pyhtila is a Clinical Pharmacy Specialist based in Baltimore, Maryland with practice sites in inpatient palliative care and outpatient primary care at the Department of Veteran Affairs. Read more