Fentanyl: From Helper to Killer

Fentanyl was never intended to be a killer. In the 1950s, pharmaceutical researchers were searching for a potent, fast-acting analgesic that would work better than morphine in post-surgical patients and people living with chronic pain. Within ten years, they succeeded in developing fentanyl, a fully synthetic opioid.

Fentanyl wasn’t the first entirely human-made pain reliever, but it was—and is— one of the strongest: It’s 100 times more potent than morphine. Fentanyl works directly on the central nervous system by binding to the receptors in the brain and spinal cord that regulate pain. It interrupts the way nerves send pain signals; people taking fentanyl don’t feel themselves hurting. These receptors also influence emotions, so the drug can cause feelings of euphoria.

But as fentanyl works, it depresses the central nervous system. There’s barely a margin for error. As little as two milligrams—the size of a few grains of sand—can have a fatal impact. If fentanyl slows the brain too much, the victim drifts into unconsciousness. The respiratory system forgets to signal the body to breathe. After one minute without oxygen, brain cells start to die. After three minutes, permanent brain damage becomes likely. At five minutes, death is imminent. The end comes without the victim realizing it. That danger is part of why fentanyl use is so carefully controlled in medical settings. In fact, hospitals dose fentanyl in micrograms. (A microgram is one thousandth of a milligram.)

Because fentanyl is made in a lab, it’s easy to produce and relatively inexpensive. Couple that with the feeling of happiness it gives and the addictive nature of opioids, and fentanyl quickly became the darling of the illegal drug trade. Worse, illegal drug makers discovered they could change fentanyl’s chemical composition to create new variants, called analogs. Carfentanil, one of these analogs, is 100 times more potent than fentanyl itself—making it 10,000 times more potent than morphine.

Fentanyl has no taste and no smell, and in powder form it looks like any other white powder. Illegal drug makers can mix illicit fentanyl into other drugs or even pass fentanyl off as an entirely different drug with no one being the wiser. When making counterfeit prescription pills, they use the same kinds of pill presses as legitimate pharmaceutical companies.  Not even experienced DEA agents or forensic chemists can reliably tell which pills or powders contain fentanyl by sight.

Illegal drug makers may use the same kind of pill presses as pharmaceutical companies for looks, but clandestine labs don’t bother with quality control. There’s no way to know how much fentanyl is in something they make or how strong it is. It might be enough for a high. It might be enough to kill—and frequently is.

Fentanyl’s extreme potency means one bad choice can be fatal. It’s tragic that fentanyl, intended as a medication to manage severe pain, has become a source of devastation for countless families and communities. Its misuse has transformed fentanyl from a life-improving treatment to a deadly force exploited for profit. No drugs bought on the street, via social media, or through illegal online pharmacies are safe. Fentanyl—legally manufactured, genuine fentanyl—only belongs in the hands of licensed doctors.