Why fentanyl is contributing to the rise in overdose deaths
Fentanyl is a large contributor to the opioid crisis. Fentanyl-related deaths in Wyoming have been on the rise since 2015, with 106 overdose deaths in 2021.
The illicit use of fentanyl can be extremely addictive and dangerous. However, Melissa Hunter, the drug information director at the University of Wyoming School of Pharmacy, emphasized that when fentanyl is being used appropriately by a provider, the benefits outweigh the risk.
“When fentanyl is being used appropriately by a provider for pain, the risk of addiction is fairly low because they’re using it for its created purpose, which is pain relief,” explained Hunter. “When someone is using it for addictive purposes, they’re using significantly higher doses to get that high feeling.”
According to the Mayo Clinic, fentanyl is commonly used to relieve pain during and after surgeries and to help anesthesia work better. Hunter said in hospitals, fentanyl is used every day for acute pain.
“Typically fentanyl is prescribed in a hospital setting,” said Hunter. “It’s used for severe acute pain, and it’s usually injectable at that point. When someone has chronic severe pain, sometimes we’ll use it in the outpatient setting.”
In the outpatient setting, Hunter said it is typically dispensed as a patch that delivers the drug through the skin or it can occasionally be in the form of a lollipop for extreme acute pain. Hunter explained that these different forms of prescriptions affect how pain is managed.
“The patch takes about 12 hours to start having pain relief and then lasts for about three days, in perfect conditions,” said Hunter. “For the lollipops, it is much quicker because it’s absorbed through the tissue in the mouth and goes straight to the brain to give pain relief.”
Both of these forms of prescriptions also have different effects than when fentanyl is being abused or used illicitly. Hunter explained that when used in the medical field, fentanyl is prescribed in a dose that is significantly smaller than what is typically used when people are abusing fentanyl.
Fentanyl is a synthetic compound that is inexpensive for illicit manufacturers to create pounds of when the typical dose is in milligrams.
“A lethal amount can actually fit on the tip of a sharpened pencil,” explained Hunter. “Two milligrams can be a lethal dose and two milligrams is so small, it can sit on the tip of a sharpened pencil.”
This means drug busts often confiscate thousands of lethal doses of fentanyl. In Wyoming’s largest drug bust in 2020, one kilogram of fentanyl was confiscated in Casper. With a potentially lethal dose of only two milligrams, the amount seized contained 500,000 potentially lethal doses of fentanyl.
Illicit manufacturing of fentanyl has also led to an abundance of laced products on the market. According to the Drug Enforcement Administration (DEA), six of ten fake prescription pills contain a potentially lethal dose of fentanyl.
“It's being laced in everything. There’s been heroin, cocaine, fake oxycodone tablets, fake Xanax tablets, pretty much anything,” said Hunter.
Illicit products laced with fentanyl run the risk of people unknowingly consuming the drug, leading them to become addicted, or even overdose.
According to the Centers for Disease Control, fentanyl is up to 50 times stronger than heroin and 100 times stronger than morphine. Hunter said that when people are using fentanyl for addictive purposes, they are using the drug in higher doses, leading to a high that is not experienced inside the medical field.
“Fentanyl is so much more potent. It crosses the blood brain barrier way faster than morphine does, and even faster than heroin,” explained Hunter. “It binds to the receptors in the brain so much more tightly that it causes a bigger, faster high.”
In 2021, the DEA launched the One Pill Can Kill Public Awareness Campaign to educate the public about the dangers of fake pills. The DEA has listed fentanyl as the deadliest drug threat in America.
But there are ways to protect yourself and others from an overdose. Naloxone and Narcan can be used to rapidly reverse the effects of an opioid overdose, like fentanyl, by restoring normal breathing for 30 to 90 minutes before receiving medical attention.
“If anyone knows someone who is at risk for an overdose, it’s important that they have access to Narcan,” said Hunter. “Because Narcan can save lives.”