Why is fentanyl so deadly?

As a medication, fentanyl subdues and reduces pain. But its consumption has to be strictly monitored — when fentanyl is consumed as an illicit drug, it impairs a person's awareness, and can lead to slow breathing, comatosed states, and death in the worst cases.

More than 70,000 people died in 2021 alone as a result of fentanyl use in the USA. It is highly addictive.

When is fentanyl used in medicine?

Fentanyl is used in the care of cancer patients as they approach the end of their lives. It is also used to treat pain after serious surgical operations.

It is stronger and more effective than other opiate painkillers, like morphine, oxycodone (more commonly known by its product name, Oxycontin), and hydromorphone. Fentanyl is 50 times stronger than heroin, another common illicit opiate drug.

Since it affects the central nervous system, fentanyl is also used as an anesthetic before an operation. It puts patients into a deep sleep-like state, in which they relax and feel no pain. The dose of the drug depends on the severity and the duration of the operation. 

Because fentanyl can cause respiratory depression (slow or ineffective breathing and reduced oxygen supply in the body), the dose of the drug must be carefully monitored by doctors and other medical personnel. They are there to ensure that the patient's organs, like the heart and brain, receive enough oxygen.

How is fentanyl administered?

Fentanyl can be administered intravenously. This sends the drug straight into the bloodstream, where its effects are fast.

When people use fentanyl in an uncontrolled, unmonitored way, they often suffer an overdose, and in the worse case, death.

The drug is also sold as a powder. People addicted to fentanyl often snort it as powder. Some take it as pills, commonly produced from the powder in makeshift labs in Middle and Latin America.

Both forms of consumption can make it hard to get the dosage right, especially as even a small amount, just 2 milligrams, can be fatal.

Fentanyl plasters — otherwise known as transdermal fentanyl — are used to treat chronic pain over a sustained period of time.

Clinics, doctors' surgeries and chemists have been forced to ensure a proper disposal of fentanyl plasters, because people addicted to fentanyl have been known to search through trash cans, looking for used fentanyl plasters, as it's sometimes still possible to extract some of the drug from the plaster.

People addicted to fentanyl sometimes also smoke fentanyl and inhale the drug's fumes. Even then, it is possible to suffer an overdose and its subsequent effects.

Where does illicit fentanyl come from?

A lot of the substances needed to produce fentanyl come from China. From there, they are exported to Middle and Latin America, where they are cooked up into the drug and sold illegally, often in North America.  

The US Drug Enforcement Administration (DEA) said it had confiscated 50.6 million fentanyl pills and more than 4,500 kilograms of fentanyl powder in 2022. According to the DEA, that is the equivalent of 379 million potentially fatal doses of fentanyl — enough to kill the entire US population of 333 million people.

Fentanyl has been used illicitly since the 1970s. The illegal production of the drug grew rapidly in the 80s and 90s and took on ever bigger proportions in the 2000s. As the spread of the drug increases steadily, especially in the USA, so too does the number of people addicted to the drug and fentanyl-fatalities.

This article was originally published in German.