What is fentanyl?

History of Use

Fentanyl was first synthesized in a medical drug research laboratory in Belgium in the late 1950s. The original formulation had an analgesic potency of about eighty times that of morphine. Fentanyl was introduced into medical practice in the 1960s as an intravenous anesthetic. Subsequently, two other fentanyl analogs were developed for medical applications: alfentanil, an ultrashort-acting analgesic (of 5–10 minutes), and sufentanil, an exceptionally potent analgesic (5–10 times more potent than fentanyl) for use in heart surgery. Fentanyls are used now for anesthesia and analgesia. The most widely used formulation is a transdermal patch for relief of chronic pain.

Illicit use of fentanyl first occurred within the medical community in the mid-1970s. Among anesthesiologists, anesthetists, nurses, and other workers in anesthesiology settings, fentanyl and sufentanyl are the two agents most frequently abused. Potential abusers have ready access to these agents in liquid formulations for injection and can divert small quantities with relative ease. Transdermal patches cannot be readily adapted for abuse. The fentanyl lozenge has been diverted to illegal use. On the street, the lozenge is known as perc-a-pop.

More than one dozen analogs of fentanyl have been produced clandestinely for illegal use outside the medical setting. Since the mid-2000s, fentanyl abuse has emerged as a serious public health problem. Fentanyl-laced heroin or cocaine powders have become the drugs of choice for some addicts.

Effects and Potential Risks

The biological effects of fentanyl are indistinguishable from those of heroin, with the exception that illicit fentanyl analogs may be hundreds of times more potent. Short-term effects of fentanyl abuse include mood changes, euphoria, dysphoria, and hallucinations. Anxiety, confusion, and depression also may occur. High doses or long-term use may impair or interrupt breathing due to respiratory depression. Unconsciousness and even death can occur.

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